RPE, RIR, and Judging Failure

Is your training week built on evidence, or on habit? In part one of a five-part series, Dr. Altamash Raja and Dr. Darsh Shah unpack the American College of Sports Medicine's 2026 resistance training position stand: what didn't consistently matter (training to failure, machines versus free weights, complex periodization) and what did, depending on the goal. They lay out four training qualities, three questions to ask before writing a program, and a realistic week for people who already train, plus a fallback for when life interferes.

TOPICS COVERED

• What the 2026 ACSM position stand found on failure training, equipment choice, and periodization, and the goal-specific variables that do matter
• RPE versus reps in reserve (RIR), and why "close to failure" is harder to judge than it sounds
• The four qualities: aerobic fitness, strength, power, and mobility and stability, with everyday examples
• Three questions before writing a program: what to improve, what you can repeat, and how you'll know it's working
• A sample 45–60 minute training week, Darsh's HYROX prep, and what group classes like Pilates and F45 leave out
• How Dr. Raja adapts his own training around surgery and joint limitations, allostatic load, and the two-week planning assignment

RESOURCES & LINKS MENTIONED

Studies

• Currier et al., ACSM Position Stand: Resistance Training Prescription for Muscle Function, Hypertrophy, and Physical Performance in Healthy Adults, Medicine & Science in Sports & Exercise (2026). Strength: at least 80% of 1RM, 2+ sessions a week. Size: about 10+ sets per muscle per week. Power: 30–70% of 1RM moved fast (https://pubmed.ncbi.nlm.nih.gov/41843416/)
• Oja et al., sport type and mortality in 80,306 British adults, British Journal of Sports Medicine (2017). Observational; racquet sports linked to 47% lower all-cause mortality (https://pubmed.ncbi.nlm.nih.gov/27895075/)
• Lee et al., leisure-time physical activity intensity and mortality, Circulation (2022). Covered in the cardio episode (https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.058162)

Concepts & tools

• CDC adult guidelines: 150 min moderate or 75 min vigorous aerobic activity a week, plus strength training 2+ days (https://www.cdc.gov/physical-activity-basics/guidelines/adults.html)
• Rating of perceived exertion and the Borg 6–20 scale (https://en.wikipedia.org/wiki/Rating_of_perceived_exertion) · Sports periodization (https://en.wikipedia.org/wiki/Sports_periodization)
• SAID principle (https://en.wikipedia.org/wiki/SAID_principle) · Allostatic load (https://en.wikipedia.org/wiki/Allostatic_load)
• VO2 max (https://en.wikipedia.org/wiki/VO2_max) · HYROX (https://hyrox.com)

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The Show

• Website: medicineredefined.com (https://medicineredefined.com)
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Dr. Altamash Raja

• Instagram: @draltraja (https://instagram.com/draltraja)
• LinkedIn: Altamash Raja (https://www.linkedin.com/in/altamash-raja-do-rmsk-cscs)
• Refining Health & Performance (https://refininghealthrx.com)

Dr. Darsh Shah

• Instagram: @doctor.darsh (https://www.instagram.com/doctor.darsh/)
• LinkedIn: doctordarsh (https://www.linkedin.com/in/doctordarsh/)

Ready to stop guessing and start performing? Dr. Raja is now seeing patients through his telemedicine practice — limited founding member spots available at refininghealthrx.com (https://refininghealthrx.com).