Improving strength in seniors

As discussed in chapters 2 and 3, maintaining an adequate amount of lower- and upper-body strength is necessary for executing a variety of common tasks associated with physical independence such as climbing stairs, walking distances, getting out of a chair or the bathtub, standing up from the floor, lifting and lowering objects, and reducing risk for falls. Reminding participants about the health-related benefits of strength training is also important—such as reducing risk of obesity, bone loss, low-back pain, osteoarthritis, cardiovascular disease, and diabetes. In the SFT, lower-body strength is assessed using a 30-second chair stand; upper-body strength is measured using the arm curl. Any form of exercise that stresses a person's muscles, including many common types of housework and yardwork activities, will help maintain strength. However, if your client scored low on either or both of the 30-second chair stand and arm curl test items and wishes to increase his strength, a particular regimen of progressive resistance exercises will need to be followed.

Briefly, strength is increased by gradually increasing the resistance placed on a muscle (i.e., by applying what is called the overload principle). Overloading a muscle means making it do more than it is accustomed to doing. This can be accomplished using free weights (similar to the dumbbells used to test arm strength in the SFT), elastic exercise bands, Velcro strap-on weights, exercise machines that are designed for specific muscle groups, or a person's own body weight and gravity. A suitable resistance for stimulating strength depends on the participant's health and fitness status. Generally, according to national recommendations previously mentioned, a beginner should start out with a load of 50 percent of one-repetition maximum (1RM), gradually increasing to approximately 70 to 80 percent of 1RM. A load of 70 to 80 percent of 1RM should cause the lifter to reach fatigue within 8 to 12 repetitions, with fatigue meaning the muscles cannot perform another repetition using proper form. Using a leg press as an example, lower-body strength can be increased by selecting a resistance (load) that can be pressed at least 8 times, but no more than 12 times, before the muscle is too fatigued to continue. Then, as muscle strength improves (as it becomes possible to press the selected weight more than 12 times before fatigue), the resistance should be increased, thus causing the muscle to again be overloaded (i.e., to do more than it was accustomed to). This process is repeated throughout the strength development program—as strength improves to the point where the new resistance can be performed more than 12 times without fatigue, it is again replaced with a heavier
resistance.

When recommending strengthening exercises that do not use traditional weight machines, such as the standing squat, which uses body weight and position as a form of resistance, the aforementioned guidelines do not directly apply. Although the goal is to complete 8 to 12 repetitions to fatigue, some participants will at first be able to complete only 1 or 2 repetitions. If this is the case, gradually increase the repetitions (not the resistance) until participants are able to complete the exercise between 8 and 12 times. Also, when performing nonequipment exercises (e.g., calisthenics), increasing the load (resistance) is achieved by increasing the challenge, such as changing body position, gripping up on (shortening) a resistance band, using a thicker resistance band, or adding dumbbells. Refer to the sections To Increase the Challenge throughout the chapter for more exercise examples.

Strength training guidelines for older adults recommend performing at least one set of 8 to 12 repetitions, to the point of fatigue, for each of the major muscle groups twice a week. Important muscle groups for older adults are those needed for lower-body functioning (hip extensors, knee extensors, and ankle plantar flexors and dorsiflexors), for upper-body functioning (biceps, triceps, shoulders, and back extensors), and for trunk and core stability (abdominals and lower back). Strengthening exercises can also be performed more than two times a week, with at least 48 hours between sessions.

Strength Conditioning Guidelines

• Always include a short warm-up (including dynamic flexibility exercises) before doing strength exercises to raise body temperature and get more blood to the extremities.
• Progress slowly, and cautiously increase both the range of motion and the amount of weight for people with chronic conditions or who are frail or less fit.
• The goal is to perform at least one set of 8 to 12 repetitions, to the point of fatigue, for each of the major muscle groups twice a week.
• Rest time between exercises depends on exercise type and resistance level. Participants should rest for 1 to 2 minutes after most exercises and 2 to 3 minutes after multiple-joint exercises using heavy
  resistance.
• Place exercises using larger muscle groups (e.g., leg press, bench press, seated row, standing squat, chest press, and wall push-up) at the beginning of the workout; place single-joint and isolated muscle actions (e.g., triceps extensions, biceps curls, knee extensions, and leg curls)toward the end of the session.
• Both concentric (shortening) and eccentric (lengthening) muscle actions are recommended.
• Increase weight (progression) by about 2 to 10 percent when the desired number of repetitions is met (larger muscle groups generally can handle a greater increase in load).
• If using a resistance band, switch to another band that provides more resistance after the participant can do 8 to 12 repetitions.
• Exercises should be conducted through the full range of motion.
• Remind participants to breathe throughout the movement (generally exhale during the exertion phase and inhale during the release phase).

Strength Conditioning Precautions

• Participants should talk with their doctors if they are unsure about doing a particular exercise, especially if they have had joint surgeries.
• Use only resistance levels that allow the participant to keep proper body alignment and form during the exercise.
• For the less conditioned and people with chronic pain disorders, stretch the same muscle group after each resistance exercise.
• Remind participants to avoid hyperextending or locking the joints.
• Remind participants to avoid jerking or thrusting the weight.
• Participants should always stay within their pain-free range.
• Allow 48 hours between moderate- to high-intensity workouts.

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