Functional Strength Training for Older Adults

Functional Strength Training for Older Adults

Developed by: Jonathan Samuelson, CSCS

Thanks for visiting my DPT Capstone Site

Overview 

When considering potential capstone ideas, I seemed to bounce around somewhat, knowing that I wanted the topic to be exercise-related, but getting different advice on potential subjects matters. When I finally settled on a topic, I realized that my choice was a capstone project that genuinely incorporated my interests and research from my cumulative experience at UNC.

My first exposure into research was during Evidence Based Practice I, when I put together an evidence table on the effects of resistance exercise on bone mineral density and bone loss. In EBP 2 I researched the PICO question: In the geriatric population with lower extremity strength impairments, is closed kinetic chain (CKC) strength training more effective than open kinetic chain (OKC) strength training for improving gait velocity? Upon completion of my critically appraised topic (CAT), my findings indicated that although CKC training did not conclusively lead to greater improvement in gait speed than OKC exercise, there was more evidence citing better function overall from CKC exercise.  I also drew upon research from my health and wellness proposal on sarcopenia, in justifying the performance of multi-joint exercises for increased ADL performance, as well as providing information on exercise parameters.  From these three previous research experiences I developed an idea to create a SIMPLE, yet practical exercise brochure on functional strength training for older adults, and do an interactive demonstration for them at a local senior center.

This information is important because many elderly people have trouble not only with walking but also with ADL performance.  Getting in/out of bed, off a toilet and in/out of a car proves to be a daily challenge. Additionally, sufficient gait speed is needed for social activity participation such as retrieving a phone, getting to the bathroom and crossing the street safely. These are challenges I witnessed personally during the last years of my father’s life. Safe ADL performance is important to maintain independence and quality of life (QOL).

I have been an exercise enthusiast since I was young.  But while I was consistent with exercise, I dreaded long work out sessions. My feeling was that long work outs were extremely difficult to maintain over the long term, as life transitions took hold. My hope with this project was to provide older adults with some simple, yet effective exercises that they can perform at home while engaging in other activities such as watching television, waiting for dinner, or between household chores. This project is consistent with my past professional experience as a fitness trainer and future professional goal of helping older adults maintain their independence and QOL, so that they can enjoy leisure activities and live independently.

 

Project Development 

While I had already done the bulk of the research, I needed to organize it in a way that was easily accessible.  My first evidence table (Effects of exercise on function-Samuelson) summarizes the research I found concerning the effects of exercise on function.  Although, I had discussed with Carol Giuliani the number of exercises that would be appropriate to present at a live demonstration, I thought it was important to do some additional research on which ones would be most practical and effective.  Though, there was not much research available, I put together a second short evidence table (Exercise Quantity-Samuelson).

Latonya Brown, the Wellness Coordinator for the Orange County Department on Aging, helped me set up a presentation at the Central Orange Senior Center in Hillsborough. The presentation consisted of some evidence citing the efficacy of functional exercise activities, instruction on performing these exercises, and the opportunity to actually perform them using proper exercise parameters. Weight-bearing exercises such as sit-to-stand and steps-ups were incorporated, as were two upper extremity multi-joint exercises using pushing and pulling motions.  These exercises are appropriate to perform in the home utilizing nothing but bodyweight and a thera-band, which is ideal as there is no financial outlay involved.  At the end of the session there was a question/answer period.

I also provided written information with a short summary on why functional exercises are important for gait activities and ADL performance along with exercise illustrations. This information will be incorporated into a pamphlet. This is a link to the brochure that I provided to participants during the workshop (Functional Exercise Brochure-Samuelson).  Feel free to use and revise the brochure as you see fit.

I performed a review of presentation guidelines/health literacy assessment to make sure my written materials and verbal presentation were at an appropriate level for the audience. My assessment can be found here(Health Literacy-Samuelson).

Evaluation 

My personal learning objectives were as follows:

-Effective communication with an older adult audience.

-Develop an effective exercise presentation to facilitate ADL performance that is appropriate for older adults.

-Construct written materials that are simple to understand and will communicate the rationale for functional exercises.

Presentation goals consisted of the following:

-Participants will understand the importance of function exercises for performing ADLs     independently and safely.

-Participants will learn basic movement patterns that are used in ADL performance.

-Participants will learn basic exercises to do independently and safely.

-Participants will become familiar with basic contraindications to continuing exercise.

I provided attendees with a short survey to evaluate the presentation. Additionally, I monitored exercise performance during the presentation to assess the effectiveness of exercise demonstration and verbal instruction. At the end of the workshop I left time for a Q&A period. This link provides a compilation of the results and comments of the written surveys (Evaluation form-Samuelson).

I feel that I met my educational and presentation goals overall.

 

Reflection 

I found making the brochure to be fun yet challenging.  While selecting the exercises was somewhat simple for me as I was focused on basic movement patterns that are used every day, it was challenging to produce simple visual images of the exercises that break down the movements for adults who may have little experience with exercise. Additionally, the wording and layout of the brochure had to be simple to read yet thorough so that safety was addressed. Another challenge was ensuring that I was prepared to make modifications during the presentation to adapt to the different functional abilities of the workshop participants.  I stood up and walked around so that people were able to ask questions individually. I felt that the presentation went smoothly and people were patient as I helped individuals with specific exercise modifications.

Acknowledgements

I would like to thank my committee members: Dr. Carol Giuliani, PhD (Carol was also my project advisor) and Latonya Brown MHSA, CIRS-A for their constructive comments, advice and their efforts in gathering an audience for my presentation.  I would also like to thank Mary Beth Osborne and my academic advisor Vicki Mercer for providing some advice in fine tuning a topic. Finally, I would like to thank my daughter, Carli Samuelson for assisting me in the layout of both the flyer and functional strength training brochure as well as helping to assess the literacy level of the materials.

 

References

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Chou, C., Hwang, C., & Wu, Y. (2012). Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis. Archives of Physical Medicine and Rehabilitation, 93(2), 237-244.

Eyigor, S., Karapolat, H., & Durmaz, B. (2007). Effects of a group-based exercise program on the physical performance, muscle strength and quality of life in older women. Archives of Gerontology and Geriatrics, 45(3), 259-271.

Henry, K. D., Rosemond, C., & Eckert, L. B. (1999). Effect of number of home exercises on compliance and performance in adults over 65 years of age. Physical Therapy, 79(3), 270-277.

Krebs, D. E., Scarborough, D. M., & McGibbon, C. A. (2007). Functional vs. strength training in disabled elderly outpatients. American Journal of Physical Medicine & Rehabilitation, 86(2), 93-103.

Liu, C., & Latham, N. K. (2009). Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev, 3(3)

Olivetti, L., Schurr, K., Sherrington, C., Wallbank, G., Pamphlett, P., Kwan, M. M., & Herbert, R. D. (2007). A novel weight-bearing strengthening program during rehabilitation of older people is feasible and improves standing up more than a non-weight-bearing strengthening program: A randomised trial. Australian Journal of Physiotherapy, 53(3), 147-153.

Rastall, M., Brooks, B., Klarneta, M., Moylan, N., McCloud, W., & Tracey, S. (1999). An investigation into younger and older adults’ memory for physiotherapy exercises. Physiotherapy, 85(3), 122-128.

Rosendahl, E., Lindelöf, N., Littbrand, H., Yifter-Lindgren, E., Lundin-Olsson, L., Håglin, L., . . . Nyberg, L. (2006). High-intensity functional exercise program and proteinenriched energy supplement for older persons dependent in activities of daily living: A randomised controlled trial. Australian Journal of Physiotherapy, 52(2), 105-113.

Sherrington, C., Lord, S. R., & Herbert, R. D. (2004). A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Archives of Physical Medicine and Rehabilitation, 85(5), 710-716.

Valenzuela, T. (2012). Efficacy of progressive resistance training interventions in older adults in nursing homes: A systematic review. Journal of the American Medical Directors Association, 13(5), 418-428.

Venturelli, M., Lanza, M., Muti, E., & Schena, F. (2010). Positive effects of physical training in activity of daily living–dependent older adults. Experimental Aging Research, 36(2), 190-205.