A large part of what we do as physical therapists is design programs to fit the individual needs of a patient. I am very sure a lot of thought is put into the design of the program to be implemented to improve the function of the older adult we are treating. I am also willing to bet that 75% or more of the time some type of strengthening exercise is included in the individualized program. I assume this because muscle weakness is a normal part of the aging process. The rate of strength loss occurs at about 1-5% annually after the age of 30 (Lindel, 1997).
I wonder... how much thought is put into the strengthening exercises? How do physical therapists determine the intensity of the strengthening activity? Do physical therapists rely on the results of manual muscle testing? If the patient has a strength grade greater than fair, how does a physical therapist determine the workload for strengthening? What do physical therapists think when a muscle grade of 5/5 is found during muscle testing? Does a 5/5 muscle grade really mean the patient will perform "within functional limits?" Did you know that the leg strength required to rise from a chair without using the upper extremities is about 40-47% of a person's body weight (Eriksrud & Bohannon, 2003)?
If you have a habit of strapping on a 2# ankle cuff weight on an older patient and then asking for however many repetitions of a knee extension movement pattern, ask yourself why? Before you begin any strengthening activity, really try to perform a baseline assessment. If your older patients are not performing exercises at 60% or higher of a 1 repetition maximum, ask your self why. This is the intensity required to improve strength and function. Sure, there are definite times when you don't want the patient even near the 60% or higher intensity level - like when they are learning the movement pattern (i.e. learning to control the movement, the speed of the movement, and the direction of the movement). It probably doesn't take more than a couple of sessions for the control and correct movement patterns to happen. Once the pattern is performed correctly and safely, it is time to increase the resistance of the activity.
Dale Avers, PT and Marybeth Brown, PT collaborated and wrote a White Paper on Strength Training for the Older Adult.
Are you demonstrating ageism? Do you believe older adults are frail and will not respond to strengthening activities? Do you fear they will injure themselves if exercising at 60% of 1 repetition maximum?
photo by KayVee.INC via Flickr
~Selena
