From Tissue to System: What Constitutes an Appropriate Response to Loading?

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Optimal loading involves the prescription of an exercise stimulus that promotes positive tissue adaptation, restoring function in patients undergoing rehabilitation and improving performance in healthy athletes. Implicit in optimal loading is the need to monitor the response to load, but what constitutes a normal response to loading? And does it differ among tissues (e.g., muscle, tendon, bone, cartilage) and systems? In this paper, we discuss the "normal" tissue response to loading schema and demonstrate the complex interaction among training intensity, volume, and frequency, as well as the impact of these training variables on the recovery of specific tissues and systems. Although the response to training stress follows a predictable time course, the recovery of individual tissues to training load (defined herein as the readiness to receive a similar training stimulus without deleterious local and/or systemic effects) varies markedly, with as little as 30min (e.g., cartilage reformation after walking and running) or 72h or longer (e.g., eccentric exercise-induced muscle damage) required between loading sessions of similar magnitude. Hyperhydrated and reactive tendons that have undergone high stretch-shorten cycle activity benefit from a 48-h refractory period before receiving a similar training dose. In contrast, bone cells desensitize quickly to repetitive loading, with almost all mechanosensitivity lost after as few as 20 loading cycles. To optimize loading, an additional dose (≤ 60 loading cycles) of bone-centric exercise (e.g., plyometrics) can be performed following a 4-8h refractory period. Low-stress (i.e., predominantly aerobic) activity can be repeated following a short (≤ 24h) refractory period, while greater recovery is needed (≥ 72h) between repeated doses of high stress (i.e., predominantly anaerobic) activity. The response of specific tissues and systems to training load is complex; at any time, it is possible that practitioners may be optimally loading one tissue or system while suboptimally loading another. The consideration of recovery timeframes of different tissues and systems allows practitioners to determine the "normal" response to load. Importantly, we encourage practitioners to interpret training within an athlete monitoring framework that considers external and internal load, athlete-reported responses, and objective markers, to contextualize load-response data.