Geriatric Strength Geriatric Strength TrainingTraining

Chad Hensel, PT, DPT MHS, Chad Hensel, PT, DPT MHS, CSCSCSCS

Who are the geriatric?Who are the geriatric?

•• A minority group that we will all become A minority group that we will all become members of members of

•• Most commonly grouped as those age 65 Most commonly grouped as those age 65 and overand over

•• Growth rate exceeds that of the general Growth rate exceeds that of the general population; by 2040, 1 in 5population; by 2040, 1 in 5

•• Current life expectancy is 83 years in USCurrent life expectancy is 83 years in US

•• Over 85 category is the fastest growing Over 85 category is the fastest growing demographic according to the U.S. demographic according to the U.S. Census BureauCensus Bureau

•• Chronological age may not necessarily Chronological age may not necessarily correspond to psychological or correspond to psychological or physiological agephysiological age

•• Medicare B caps, exemptionsMedicare B caps, exemptions

Run! The Baby Boomers are Run! The Baby Boomers are coming!coming!

•• Identifies the generation born between Identifies the generation born between 1946 and the early 1960s1946 and the early 1960s

•• Single largest generation in US historySingle largest generation in US history•• Will be eligible for traditional Medicare in Will be eligible for traditional Medicare in

20112011

Aging TheoriesAging Theories

•• There is no single accepted theory as to There is no single accepted theory as to the cause of aging the cause of aging

•• Hayflick theoryHayflick theory•• Free radical theoryFree radical theory•• Endocrine theoryEndocrine theory•• Combination?Combination?

Effects of Aging: SensesEffects of Aging: Senses

•• HOHHOH•• Visual changesVisual changes•• Loss of sense of smellLoss of sense of smell•• Loss of tasteLoss of taste

Exercise and DiabetesExercise and DiabetesSpecial ConsiderationsSpecial Considerations

Type I and Type IIType I and Type II

•• Type IType I•• Insulin dependentInsulin dependent•• Onset: <30Onset: <30•• Does not respond to Does not respond to

diet alonediet alone•• Often not obese at DxOften not obese at Dx

•• Type IIType II•• NonNon--insulin insulin

dependentdependent•• Onset: >30; rapidly Onset: >30; rapidly

rising in younger pop.rising in younger pop.•• Diet can affect Diet can affect

disease early ondisease early on•• Commonly obese at Commonly obese at

DxDx

Benefits significant to DMBenefits significant to DM

•• Increased insulin sensitivityIncreased insulin sensitivity•• Improved glucose metabolismImproved glucose metabolism•• Increased thermic effect of foodIncreased thermic effect of food

Patient RecommendationsPatient Recommendations

•• Exercise with a partnerExercise with a partner–– supportsupport•• Keep a daily logKeep a daily log•• Plan ahead for sessionsPlan ahead for sessions•• Wear a diabetic ID braceletWear a diabetic ID bracelet•• Wear good shoesWear good shoes•• Practice good hygienePractice good hygiene•• Monitor caloric intake/expendituresMonitor caloric intake/expenditures

Exercise and ArthritisExercise and ArthritisSpecial ConsiderationsSpecial Considerations

TypeType

•• There are several varieties of arthritisThere are several varieties of arthritis•• More commonly seen in TherapyMore commonly seen in Therapy––

Osteoarthritis and Rheumatoid ArthritisOsteoarthritis and Rheumatoid Arthritis•• While the two diseases are quite different, While the two diseases are quite different,

exercise goals are similarexercise goals are similar

Goals for the Arthritis PatientGoals for the Arthritis Patient

•• Preserve or restore range of motion Preserve or restore range of motion around affected jointsaround affected joints

•• Increase muscle strength and endurance Increase muscle strength and endurance to enhance joint stabilityto enhance joint stability

•• Increase aerobic conditioningIncrease aerobic conditioning

Muscle Strengthening GoalMuscle Strengthening Goal

•• Utilize both isometric and isotonic Utilize both isometric and isotonic resistanceresistance

•• Isometric to be used during times of acute Isometric to be used during times of acute exacerbations exacerbations

•• ACSM recommends building up to 2ACSM recommends building up to 2--3 3 times a week of resistance trainingtimes a week of resistance training

•• High rep, high resistance, and/or high High rep, high resistance, and/or high impact are not advisedimpact are not advised

Aerobic Exercise GoalAerobic Exercise Goal

•• Should not be performed during acute Should not be performed during acute flaresflares

•• Low impactLow impact——i.e. swimming, water i.e. swimming, water aerobics, walking, cycling, rowingaerobics, walking, cycling, rowing

•• Start with 10 to 15 minutes every other Start with 10 to 15 minutes every other dayday

•• Gradually increase to 30 to 45 minutes at Gradually increase to 30 to 45 minutes at moderate intensitymoderate intensity

ComplicationsComplications

•• Common complications to be aware of:Common complications to be aware of:–– OA: spinal stenosis, spondylosisOA: spinal stenosis, spondylosis–– RA: cervical spine subluxation, foot pain and RA: cervical spine subluxation, foot pain and

instability, loss of hand grip strengthinstability, loss of hand grip strength

Considerations in Ther Ex PlanningConsiderations in Ther Ex Planning

•• What type of arthritis does the patient have?What type of arthritis does the patient have?•• What sx are experienced and what limitations What sx are experienced and what limitations

does the patient have?does the patient have?•• What meds are used and what are their side What meds are used and what are their side

effects?effects?•• What specific joints are most painful? What specific joints are most painful? •• Ask yourself: can this patient participate in a Ask yourself: can this patient participate in a

regular exercise regiment?regular exercise regiment?

ResearchResearch

•• Exercise has not been shown to increase Exercise has not been shown to increase the disease processthe disease process

•• Several ongoing studies are examining Several ongoing studies are examining whether exercise, and specifically whether exercise, and specifically resistance training, can reverse the resistance training, can reverse the damage from the diseasedamage from the disease

Questions?Questions?

Physiology of Strength Physiology of Strength TrainingTraining

Factors which affect gaining of Factors which affect gaining of strength and muscle massstrength and muscle mass

1.1. GeneticsGenetics1.1. Size of muscle fibersSize of muscle fibers2.2. Type of muscle fibersType of muscle fibers3.3. Ability to train without muscle sorenessAbility to train without muscle soreness4.4. Anatomic lever arrangement of muscle to Anatomic lever arrangement of muscle to

bonebone1.1. Longer the lever, greater force potentialLonger the lever, greater force potential

Muscle FibersMuscle Fibers

•• See attachedSee attached

DOMS: Delayed Onset Muscle DOMS: Delayed Onset Muscle SorenessSoreness

•• Confirmed: Eccentric greater than Confirmed: Eccentric greater than concentricconcentric

•• Theories:Theories:–– Spasm hypothesisSpasm hypothesis–– Tear theoryTear theory–– microtears in individual muscle microtears in individual muscle

fibersfibers–– Excess metabolite theoryExcess metabolite theory–– resistance leading resistance leading

to excess staying in muscleto excess staying in muscleedemaedemamuscle muscle irritationirritationnerve ending irritationnerve ending irritation

–– Connective tissue damageConnective tissue damage

•• Environmental FactorsEnvironmental Factors•• Nutritional statusNutritional status

–– Adequate nutritional intake (total calories)Adequate nutritional intake (total calories)–– Adequate protein intake Adequate protein intake –– Adequate fluid intakeAdequate fluid intake

•• Nervous System ActivationNervous System Activation–– Increased CNS activationIncreased CNS activation–– Improved synchronization of motor unitsImproved synchronization of motor units–– Lowering of neural inhibitory reflexesLowering of neural inhibitory reflexes

Physical Factors which Physical Factors which influence strength levelsinfluence strength levels

•• Adaptations in the contractile mechanismsAdaptations in the contractile mechanisms•• Muscle hypertrophyMuscle hypertrophy•• Muscle hyperplasiaMuscle hyperplasia•• Thickens and strengthens connective Thickens and strengthens connective

tissuetissue•• Increase in bone mineral contentIncrease in bone mineral content•• Improves structural integrity of tendons Improves structural integrity of tendons

and ligamentsand ligaments

Performance CapacityPerformance Capacity

•• Performance capacity is the end result of Performance capacity is the end result of the blending of many physiologic, the blending of many physiologic, biochemical, neurologic, and biochemical, neurologic, and biomechanical support systems and is biomechanical support systems and is NOT determined by any single factor.NOT determined by any single factor.

Physiological AdaptationsPhysiological Adaptations……

•• Cardiac hypertrophy Cardiac hypertrophy •• Improved HDL levelsImproved HDL levels•• Reduction of stress levelsReduction of stress levels•• Improved physical appearanceImproved physical appearance•• Enhanced energy levelsEnhanced energy levels•• Improved elation in personalityImproved elation in personality

STRENGTH TRAINING:STRENGTH TRAINING:Concepts and Advanced Concepts and Advanced

TechniquesTechniques

The BasicsThe Basics

•• There are six components of the strength There are six components of the strength training program:training program:

1.1. Training TimeTraining Time2.2. Training FrequencyTraining Frequency3.3. Training VolumeTraining Volume4.4. Training IntensityTraining Intensity5.5. Type of ExerciseType of Exercise6.6. Quality of ExerciseQuality of Exercise–– speed, breaks, etcspeed, breaks, etc

Training TimeTraining Time

•• Length of individual sessionsLength of individual sessions•• Length of training time in a weekLength of training time in a week•• Rest intervals are removedRest intervals are removed•• Ideal varies from 30Ideal varies from 30--90 minutes depending 90 minutes depending

on intensityon intensity

Training FrequencyTraining Frequency

•• # of training sessions per given week# of training sessions per given week•• Athletes: 3Athletes: 3--15/week15/week•• Recreational Athletes: 2Recreational Athletes: 2--6/week6/week•• Elite: > 15 /weekElite: > 15 /week

Quality of ExerciseQuality of Exercise

•• Proper formProper form•• Concentric phase, 2 countConcentric phase, 2 count•• Eccentric phase 4 countEccentric phase 4 count

Sets: How many?Sets: How many?

•• Research shows that one set is sufficient Research shows that one set is sufficient to improve strengthto improve strength

•• For motor learning and neurogenic effects, For motor learning and neurogenic effects, greater number of sets may be usefulgreater number of sets may be useful

•• 1212--20 sets per muscle group/one time per 20 sets per muscle group/one time per weekweek

RepsReps

•• 33--6 : mass building; highest strength gains6 : mass building; highest strength gains•• 66--12: some mass building, some 12: some mass building, some

endurance gains, neurogenic endurance gains, neurogenic improvementsimprovements

•• Greater than 12 reps will work on Greater than 12 reps will work on endurance training and will not serve to endurance training and will not serve to enhance strength levels significantlyenhance strength levels significantly

Rest BreaksRest Breaks

•• Shorter= enhanced cardio effects; less Shorter= enhanced cardio effects; less than 1 minutethan 1 minute

•• Moderate= improved strength gains 1Moderate= improved strength gains 1-- 8minutes8minutes

•• After 8 minutes, a warm up set must be After 8 minutes, a warm up set must be performed to prepare the muscle for performed to prepare the muscle for activation againactivation again

•• 48 hour minimum breaks between 48 hour minimum breaks between sessionssessions

**Overload**Overload•• SupersettingSupersetting•• Forced RepsForced Reps•• Giant SetsGiant Sets•• Rest PauseRest Pause•• Mid Range PauseMid Range Pause

OverloadOverload

•• New and progressively higher training New and progressively higher training demands enable the athlete to develop demands enable the athlete to develop both physical and mental functions to both physical and mental functions to increase performance capacityincrease performance capacity

SupersettingSupersetting

•• Combining two different exercises for the Combining two different exercises for the same muscle group into one continuous same muscle group into one continuous set. Most effective if the first exercise is set. Most effective if the first exercise is linear followed by an angular exercise. linear followed by an angular exercise. Example: bench press, followed by Example: bench press, followed by butterfly machinebutterfly machine

Forced RepetitionsForced Repetitions

•• To have a training partner assist you lift To have a training partner assist you lift the weight for a few extra repetitions once the weight for a few extra repetitions once you have reached muscular fatigue.you have reached muscular fatigue.

Giant SetsGiant Sets

•• Supersetting three different exercises into Supersetting three different exercises into a single a single ““giantgiant”” set. Example: Crunches set. Example: Crunches supersetted with crossover crunches supersetted with crossover crunches supersetted with reverse crunches.supersetted with reverse crunches.

RestRest--Pause TrainingPause Training•• Designed to maximize load without heavy Designed to maximize load without heavy

weightsweights•• Benefits of hypertrophy as well as endurance Benefits of hypertrophy as well as endurance

trainingtraining•• 33--5 mini5 mini--sets in each set, with pauses in sets in each set, with pauses in

between each minibetween each mini-- that holdthat hold•• EX: reps/restEX: reps/rest–– 10/15, 8/15, 610/15, 8/15, 6--8/158/15–– pause is pause is

held in an isometric contractionheld in an isometric contraction•• Rest at least two minutes after each long setRest at least two minutes after each long set

M id Range PauseM id Range Pause

•• Going with the principle of the restGoing with the principle of the rest--pause pause trainingtraining

•• Client pauses in different points through Client pauses in different points through the range to maximize muscle tension in the range to maximize muscle tension in an isometric manneran isometric manner

•• Benefits: Increased muscle metabolism Benefits: Increased muscle metabolism and increased stimulus for muscle growthand increased stimulus for muscle growth

•• Costs: Increased muscle fatigueCosts: Increased muscle fatigue

Chair DipsChair Dips

Chair DipsChair Dips

Shoulder RaiseShoulder Raise

Shoulder RaiseShoulder Raise

Side RaiseSide Raise

Side RaiseSide Raise

Seated Row/ Overhead Tricep Seated Row/ Overhead Tricep PressPress

Alt DB CurlsAlt DB Curls

DB Trunk RotationDB Trunk Rotation

BOSUBOSU——Balance ThrowBalance Throw

BOSUBOSU---- High ThrowHigh Throw

Swiss Ball CirclesSwiss Ball Circles

Swiss Ball MarchingSwiss Ball Marching

PulloversPullovers

Bolster MarchingBolster Marching

Incline Bench Incline Bench ““TT””

ShrugsShrugs

Abduction with ERAbduction with ER

Forearm CurlsForearm Curls

Hamstring Curls/ Hip Hamstring Curls/ Hip AbdAbd

Side BendsSide Bends

Seated March/ Heel RaisesSeated March/ Heel Raises