Decoding EMOMs, AMRAPS, and 1 RM for Improved Patient Outcomes

By Alex Germano, PT, DPT
Physical Therapist

If you have experience in the fitness space or watch fitness influencers online, you may have heard of EMOMs, AMRAPs, or 1-RMs. You may have also thought to yourself, “What language are these people speaking?!”

As it turns out, they may be on to something. Let’s start with decoding these acronyms.

• EMOM: Every Minute on the Minute
• AMRAP: As Many Rounds As Possible
• 1 RM: One Repetition Maximum

EMOMs and AMRAPs are essentially a way to structure exercise. In the EMOM, a person performs an exercise on each minute. These are tools clinicians can use to program exercise in a more efficient and fun way.

EMOMs and AMRAPs are all about scaling up intensity and timing rest. Intensity is an important factor in designing exercise programming for older adults because higher intensities achieve more meaningful results. Higher intensity interval training is able to improve many health-related factors including hypertension, insulin sensitivity, cardiorespiratory fitness, neuromuscular performance.1,2 In comparison to lower intensity programs, high intensity can provide significant improvements to all-cause mortality with much less total time exercising needed.3 This will have profound implications in terms of exercise adherence. Patients will be more likely to follow programs that are shorter and more fun!

EMOMs are a vital skill for clinicians to program in order to better quantify and adjust resting time. Many times, when working with older adults, we can let rest periods extend too long, get caught up in conversation, or provide more rest than is actually needed. With the EMOM exercise structure, a patient is kept on a clock with a defined rest time. This way, the patient will remain appropriately challenged and won’t be resting unnecessarily. They also make for a more interesting exercise structure that can be more engaging than a typically 3×10 prescription of a singular activity. For example:

EMOM 16

• Minute 1: 10 marches
• Minute 2: 5 sit-to-stands
• Minute 3: walk fast 50 feet
• Minute 4: complete seated rest

In this example, the patient would be performing a 16-minute workout. During the first minute, the patient would complete 10 marches in place, during the second 5 sit to stands, and finally during the third complete a 50 foot walk as fast as possible. The last minute in this example would be a complete minute of seated rest. The patient would complete this sequence four times until 16 minutes had elapsed. During each interval, the patient would complete the described number of repetitions and then rest the remainder of the minute. This would give the patient a brief chance to rest between exercises. If the patient needed an increase in difficulty, the EMOM could be changed to:

EMOM 16

• Minute 1: marches
• Minute 2: sit-to-stands
• Minute 3: fast walking
• Minute 4: complete seated rest

In this example, the EMOM now has the patient completing each exercise for the entire minute interval for a maximum number of repetitions. This would cause the patient to eliminate resting between each exercise, greatly challenging a patient’s muscular and cardiovascular endurance. The patient would still have the opportunity for a complete seated rest during interval four.

For more information on scaling EMOMs to every patient, check out this free resource.

AMRAPs are quite similar to EMOM. Exercises performed in AMRAP fashion can very much mimic functional activities, like cooking a meal or performing laundry. They can be used to build up endurance for tasks that require multiple components. This means occupational therapists can leverage this type of exercise structure in order to build up a patient’s functional capacity.

For example, if a patient was having difficulty making a meal, a clinician could program an AMRAP with components mimicking the activity. In this example, you will see options for both physical and occupational therapists. An AMRAP looks like this:

AMRAP 16

• 5 sit-to-stands
• 10 marches
• 50’ fast walk

In this example, one round would consist of sit-to-stands, marches, and fast walking. The patient would work continuously in this example until 16 minutes had elapsed. The patient can rest as needed throughout the AMRAP but should be encouraged to move at a pace they can maintain through the 16 minutes.

Below is an example of how to increase a patient’s capacity for cooking a meal. In this example, you see more traditional strength and conditioning exercises on the left side and more functional related tasks on the right. This could mimic the difference in how a physical therapist or occupational therapist might program exercise for a similar goal.

AMRAP 20 

• 10’ weighted carry with 5# → Carrying items in the kitchen to cook with
• 10 deadlifts with 5# → Reaching for items on low shelves
• 10 overhead lift with 3# → Taking dishes out of a cabinet
• 10 side steps at counter → Navigating kitchen

One Repetition Maximum Testing

One repetition maximum (1-RM) refers to the maximum amount of weight a person can lift for any given exercise. For example, if a person has a 1-RM of 100 pounds for a squat, it indicates they are only capable of listing 100 pounds during a single squat repetition. 1-RMs are physically demanding and can be very exhausting! It is very important to understand this concept because the minimal overload necessary for muscular adaptation in older adults is 60% of a 1-RM.4 As clinicians, we need to be aware of what a patient’s estimated 1-RM is in order to appropriate dose strengthening protocols. This becomes important to understand and conceptualize when we meet a patient who cannot get out of a chair without their arms. In this scenario, this patient’s body weight is above their 1-RM. This leaves them in an extremely vulnerable position during their activities of daily living, needing to use all their strength for every stand that they do.

In clinical practice, it can be easier to perform maximum repetition testing with a predetermined weight versus a true 1-RM test. In this case, you may give a patient a five-pound weight and ask them to perform as many repetitions as possible. With these numbers, you can use an online calculator to determine a patient’s 1-RM. Armed with this information, you can appropriately dose your patients’ exercise programs.