1 / 35

Geriatric Strength Training What are we weighting for?

Geriatric Strength Training What are we weighting for?. Michael L. Tuggy, MD Swedish Family Medicine. When I get the urge to exercise, I just lay down and it goes away. . . -- W.C. Fields. Illustrative Case.

Sophia
Download Presentation

Geriatric Strength Training What are we weighting for?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Geriatric Strength Training What are we weighting for? Michael L. Tuggy, MD Swedish Family Medicine

  2. When I get the urge to exercise, I just lay down and it goes away. . . -- W.C. Fields

  3. Illustrative Case • 91 y.o. WF living alone at home, presents with history “dizziness” and of multiple falls and recent left chest contusion. • P.E.: localized tender left 9th rib, mid-axillary line • Dx: Rib fracture • Plan: now what do you next?

  4. Scope of the Problem of the “Frail Elderly” • 10-20% of patient over 72 and 40% of nursing home patients are unable ambulate unassisted. • Increase numbers of osteoporetic patients as population ages. • Decades of sedentary lifestyles leading to significant weakness and atrophic changes.

  5. Exercise in the Elderly • 92 % of patients over 65 do not exercise vigorously • 66 % are sedentary • 66 % of women over age 74 cannot lift more than 4.5 kg overhead one time.

  6. Risks Associated with Frailty • Falls and their sequelae - a leading cause of morbidity and death in older women • Social isolation - depression • Inability of self-care- malnutrition.

  7. Big Bob’s Ballbearing Bananas Rollerskates & Floor Wax Inc

  8. Attitudes toward Strength Training You want me to do what? • Elderly feel its too late to start • Doubtful of benefit • Physicians often unaware of benefits

  9. What happens when we age to: • Cardiac output? • VO2Max? • Muscular strength? • Reflexes?

  10. Cardiac output • Myth: decrease in cardiac output is a normal process of aging • Reality: • Decreases in cardiac and pulmonary function are due to disease processes, not age. Cardiac output is maintained with changes in stroke volume.

  11. Strength and the Aging Process • Myths: Exercise capacity • Aging decreases VO2 Max due to decreased cardiac output. • Reality • Disuse atrophy leads to decrease muscle mass and strength • The less the mass, the lower the VO2 Max . • In healthy geriatric patients, VO2 Max can be maintained or improved 10-30% in < 3 mo.

  12. Strength and the Aging Process (Con’t) • Myth: as you age, you inevitably loose strength • Reality • Muscle mass can be significantly increased with strength training from 20-130% depending on the protocol • Long term atrophic changes can be radically reversed.

  13. Reflexes and Balance • Myth: as we age, our reflexes slow and loose their adaptive capability • Reality: • Balance can be substantially improved with training

  14. Principles of Strength Training • Very high intensity with less than 10 repetitions. 80% 1 Rep. Max. 2- 3 sets of reps. • Eccentric work induces most rapid growth • Should achieve fatigue at 10-12 repetitions. • Weight should be increased as capacity increases. • Every other day schedule. • Combine with stretching to avoid tendon strain.

  15. Methods of Strength Training • Isometric - fixed muscle length applied to load • moderate improvement in strength • Isotonic - shortening muscle length with work load applied • Eccentric - lengthening muscle with work load applied. • maximal strength increase

  16. Physiologic Effects of Strength Training • Muscular changes • enlarges white fibers • enhanced anaerobic metabolism • Cardiovascular effects • increased vascular flow to muscle groups • transient hypertension • Hormonal effects - Growth hormone stimulation (18-fold), improved glucose metabolism and glycogen stores

  17. Swedish Family Medicine Study Biceps Triceps Gastroc Quad

  18. Swedish Family Medicine Study (Cont.)

  19. Recent Studies on Geriatric Strength Training • FISCIT Studies - on going nationwide. Preliminary results: high intensity training is most beneficial for elderly. • Nichols (1993) - (80% of 1RM ) 20 -65% increase in strength in most muscle groups in 6 months • Ettinger (1997) - improved arthritis pain and functional tests with strength training.

  20. Recent Studies on Geriatric Strength Training, (Cont.) • Judge (1994) - (Isokinetic 60-75%) - 20% increase in 3 weeks. (? Enough weight) • Fiatorone (1990) - (80 % 1RM) - ten 90 y.o. males for 8 wks. - 136 % increase in strength of quadriceps group. Gait speed from 13 cm/sec to 20 cm/sec. • Strength persisted beyond 4 weeks post cessation of exercise

  21. Who should strength train? • Very few contraindications- • Severe CAD • Advanced valvular heart disease • In large studies, lower morbidity in exercising populations More than 90% of your patients are free to strength train.

  22. Physiologic Effects of Endurance Training • Muscular changes • expansion of red fibers • improved aerobic metabolism, O2 transport. • Cardiovascular effects • increased stroke volume, decrease baseline HR • responsive autonomic system • Hormonal effects • improved glucose metabolism - extended duration to replenish glycogen stores.

  23. Risks of Strength vs. Endurance Training • Strength - increase risk of stroke and vasospasm (theoretical) • Not seen in large cohort studies (FISCIT) • aggravation of DJD (not common -opposite shown to occur) • Endurance - increased risk of arrhythmia or vasospasm (even post-exercise). (documented) • Overuse injuries more common

  24. The Ideal Exercise Program • Warm up - stretches • focused on hip, knee, back, neck • Aerobic exercises • walking, swimming • based on tolerance • Strength training • focused muscle groups • replicate functional activities

  25. “Functional” Strength Training • Series of exercises that replicate movements that are commonly performed. • Added intensity by use of gravity, dumbells (5-10#), types of movements • Measure number of reps, amount of reach, duration of exercise, etc.

  26. Increasing intensity Principles of Functional Exercises • Static Balance - 3 planes • Dynamic balance - 3 planes • Lunges • Steps • Jumps • Hops Low High

  27. Muscle groups for focused training • Upper extremity flexors and extensors • Shoulder girdle • Abdominal flexors and lumbar extensors • Thigh - quadriceps group • Calf- Gastrocnemius/soleus groups

  28. “Equipment-less” Exercises • Milk jug or dumbbells- adjust weight by fluid volume • Biceps curls • Shoulder girdle - butterfly exercise • Push -ups (if needed modify initially- torso raises only), overhead lifts • Abdominal crunches or sit-ups • Sit to stand exercises, two-leg squats or one-leg squats or lunges • Toe raises - one leg.

  29. Modifications • Retro-patellar pain: isometrics quad sets or leg extensions with foot deviated externally • Low back pain/DJD: half-sit ups or isometric pull for 10 sec. holds • DJD of knees: multiple range isometrics with 10 -15 sec holds.

  30. “Yeah, Clem, I hurt. But y’ know, it’s a good kind of hurt.”

  31. So what will my patients gain? • Improved self-image/esteem • Greater confidence in ability to function outside of home • Large increase in strength of multiple muscle groups • Greater independence in ADL’s - extension of independent living for years.

  32. 60 Active 40 Training effect VO2 Sedentary 20 Independence Level 20 40 60 80 Age VO2 Max and Independence Adapted from Shephard, RJ - 1993

  33. Food For Thought Based on what we know, when should we start strength training? Target: Men and women in their 40’s - primary prevention of frailty.

  34. Summary • Strength training - high intensity, brief duration. • Can be performed at home, 3 times a week • Rapid initial strength gains • Translation into gains in independent living, and self-esteem.

  35. Hey Doc,It’s Back!!

More Related