Research Summary

Academy Title:avers2009
Research Article: White Paper: Strength training for the older adult.
One of the most common clinical mistakes is to arbitrarily assign resistance training levels to older adults, often choosing very low intensities. These low loads are often insufficient to increase muscle strength. Drs. Dale Avers and Marybeth Brown of the American Physical Therapy Association’s Section on Geriatrics published a whitepaper in the Journal of Geriatric Physical Therapy on strength training for older adults.

Both the Section on Geriatrics and the American College of Sports Medicine recommend strength training at 60% of 1 repetition maximum (RM) as the minimal intensity for strength gains. 1RM is the maximal amount of resistance an individual can move for only one repetition. Unfortunately, it’s often difficult to determine 1RM capabilities in older adults. Even using a multiple RM equation to estimate 1RM may not be accurate, since they haven’t been validated in older adults. However, using Thera-Band® resistance to quantify a multiple RM level has been validated in older adults (Manor et al.)

Using a “rating of perceived exertion” or RPE scale has been advocated to better estimate resistance exercise intensity. There are 2 popular RPE scales: the Borg scale and Omni scale. Several studies on older adults using elastic resistance have used Borg’s RPE scale to dose intensity, and both the Borg and Omni scales have been validated using Thera-Band resistance bands (Andersen et al. 2010; Colado & Triplett 2009). The RPE scale can be used to help determine the appropriate resistance by suggesting to patients that they “use a resistance at a level of 5-7 RPE that allows you to complete the exercise in 10 to 15 repetitions.”

In their whitepaper, Drs. Avers and Brown recommend the following dosage for older adult strength training programs:
• Intensity: at least 60% 1RM, corresponding with at least 11 on Borg’s RPE scale, or 3 on the Omni scale
• Sets: 1 set per exercise
• Reps per set: depends on intensity exercise prescription (eg, 10 repetitions for a 10RM prescription)
• Frequency: 2-3 times per week for the same muscle; every day if varying muscles groups (such as in-patient therapy)

The paper also suggests a well-rounded exercise program for acute care physical therapists to provide care for inpatients receiving PT 5 days per week.

Drs. Avers and Brown recommend using Thera-Band exercises at home to gain and maintain strength gains after discharge from physical therapy. They also suggested that baseline assessment of strength is important to determine the appropriate resistance exercise intensity; furthermore, they concluded, “Strengthening without rationale or adequate stimulus is tantamount to malpractice.”

The Thera-Band Academy offers free customized exercise program print outs for home exercise programs. When using Thera-Band resistance bands with older adults, use RPE and multiple RM to determine the appropriate intensity levels for optimal strengthening outcomes.

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