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Applying Strength and Conditioning Principles to a Functional High-Intensity Resistance Training Program for Older Adults

 

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Background 

My desire to become a physical therapist is rooted in my personal experiences as an athlete. Through my close relationships with an incredible sports medicine staff, my passion for exercise prescription, strength and conditioning, and performance grew and now serves as a driving force for my career in physical therapy. I believe it is imperative that these values and principles are effectively applied to all patients. However, throughout my educational and clinical journey, and my experience in PHYT736 PT for Older Adults, I have learned that this is often not the case, especially for our older adult patients.

As a future clinician in the outpatient orthopedic setting, this Capstone project has helped increase my confidence and skill in treating a population that will become a significant part of my case load. It is important that the therapeutic exercise I prescribe to these patients is supported by the latest evidence, adequately challenges the patients to improve functional outcomes, and is specific and individualized to each patient’s presentation.

Finally, I greatly appreciated my experience in Musculoskeletal II course, as I learned from Dr. Jennifer Cooke and served as a Teaching Assistant.  My experiences as a TA allowed me to present educational material and serve in a mentorship role. I hope to continue to serve in this manner and grow in my confidence to synthesize literature, find clinical application, and present information to fellow healthcare providers. This project has allowed for just that. I am thankful to serve as an educator once more and create a product for a program that has given so much to me over the past three years and I am hopeful that this product will benefit future students of this program.

 

Statement of Need/Purpose

Unfortunately, our profession often fails to appropriate load our older adult patients, resulting in exercise programs that are physiologically inadequate to create the changes in muscular strength that we seek, and our patients need.1 Whether this tendency to underload our older adult patients come from our biases surrounding older adults, hesitancy due to the myriad of potential comorbidities, or a failure objectively establish and monitor levels of strength and intensity, we are limiting the benefits of our training and failing to capitalize on the numerous health and functional benefits an individualized strength training program can have for older adults. Furthermore, high-intensity resistance training is not only safe, but often more effective, for older adults with underlying comorbidities and conditions.2–9

Additionally, most older adults don’t meet the CDC guidelines for physical activity and only 10-15% of older adults perform resistance training.10 It is critical to advocate for and effectively prescribe resistance training exercises for this population, due to the physiological benefits and numerous improvements in physiological, functional mobility, ADL performance, resistance to injuries and falls, and improvements in psychosocial well-being.11 Through the application of an appropriately loaded resistance training program, we can help our older adults maintain independence.11 There is a clear need for students to understand the importance of and feel confident in the application of strength and conditioning principles to promote high-intensity resistance training for older adults.

 

Evaluation Component

Following frequent revision of content, flow, organization, and delivery, I believe I have created a product that effectively synthesizes the current literature in a learner friendly and clinically relevant manner. I incorporated the suggestions and feedback of my committee members to improve the delivery of the material and identify gaps in my information. I prioritized clinical application and utilized pictures of therapeutic exercises for clarity and reinforcement of the concepts I discussed. I emphasized accurate referencing of information in a manner that allowed for easy access for the learner. Additionally, although this presentation did align with the PHYT736 PT for Older Adults schedule, I have prepared an evaluation form to be completed following its delivery. This form addresses the quality of the presentation effectiveness of my information delivery and will help mold the content and delivery of this material in the future and guide my future teaching experiences.

 

Products

Final products are linked below and were created to serve as adjunct to the PHYT736 PT For Older Adults Course.

 

Voicethread

 

Powerpoint (pdf)

 

Evaluation Component

 

 

Reflection

As I reflect on this experience, I cannot help but appreciate my increased confidence and passion for physical activity promotion and exercise prescription. Our profession is in such an incredible position to guide novice lifters, who have been told or believe that they are not meant to participate in resistance training, especially of high intensities. With our expertise in the neuromusculoskeletal system and desire to identify the numerous personal factors and barriers to health behavior change, I know we can provide holistic care and make significant changes for our patients and our community.

Additionally, this experience has helped me grow tremendously as a professional. I am confident that I can apply the numerous lessons that I gained while creating this educational material for my fellow clinicians and peers. I have improved greatly in the synthesis and application of literature, which has given me confidence to continue to grow as an evidence-based clinician and has inspired me to serve as an educator and mentor in the future.

 

Acknowledgements

I would like to thank Dr. Neisha Wetzel for her guidance and expertise throughout this experience. I cannot think of a better person to learn from. Neisha is passionate about serving the older adult population and she is certainly great at doing so.

To Dr. Luke Boyd and Dr. Chris Hope, thank you for your advice and support. I greatly appreciate the lessons that you both have provided me in the clinic and while serving on my committee. I am a better clinician because of you and will always be thankful for your mentorship. I look forward to serving in this manner for future students and young professionals.

Finally, thank you to my incredible UNC classmates and faculty of this program. I could not have made it through the last three years and the challenges of an unexpected online learning experience without all the support you provided.

 

  1.    American Physical Therapy Association | Choosing Wisely. Accessed March 3, 2022. https://www.choosingwisely.org/societies/american-physical-therapy-association/
  2.    Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res. 2018;33(2):211-220. doi:10.1002/jbmr.3284
  3.    Harding AT, Weeks BK, Lambert C, Watson SL, Weis LJ, Beck BR. Effects of supervised high-intensity resistance and impact training or machine-based isometric training on regional bone geometry and strength in middle-aged and older men with low bone mass: The LIFTMOR-M semi-randomised controlled trial. Bone. 2020;136:115362. doi:10.1016/j.bone.2020.115362
  4.    Kemmler W, Weineck M, Kohl M, et al. High intensity resistance exercise training to improve body composition and strength in older men with osteosarcopenia. results of the randomized controlled franconian osteopenia and sarcopenia trial (frost). Front Sports Act Living. 2020;2:4. doi:10.3389/fspor.2020.00004
  5.    Bray NW, Jones GJ, Rush KL, Jones CA, Jakobi JM. Practical Implications for Strength and Conditioning of Older Pre-Frail Females. J Frailty Aging. 2020;9(2):118-121. doi:10.14283/jfa.2020.15
  6.    Messier SP, Mihalko SL, Beavers DP, et al. Effect of High-Intensity Strength Training on Knee Pain and Knee Joint Compressive Forces Among Adults With Knee Osteoarthritis: The START Randomized Clinical Trial. JAMA. 2021;325(7):646-657. doi:10.1001/jama.2021.0411
  7.    Steib S, Schoene D, Pfeifer K. Dose-response relationship of resistance training in older adults: a meta-analysis. Med Sci Sports Exerc. 2010;42(5):902-914. doi:10.1249/MSS.0b013e3181c34465
  8.    Valenzuela T. Efficacy of progressive resistance training interventions in older adults in nursing homes: a systematic review. J Am Med Dir Assoc. 2012;13(5):418-428. doi:10.1016/j.jamda.2011.11.001
  9.    Izquierdo M, Merchant RA, Morley JE, et al. International exercise recommendations in older adults (ICFSR): expert consensus guidelines. J Nutr Health Aging. 2021;25(7):824-853. doi:10.1007/s12603-021-1665-8
  10.   Mayer F, Scharhag-Rosenberger F, Carlsohn A, Cassel M, Müller S, Scharhag J. The intensity and effects of strength training in the elderly. Dtsch Arztebl Int. 2011;108(21):359-364. doi:10.3238/arztebl.2011.0359
  11.   Fragala MS, Cadore EL, Dorgo S, et al. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res. 2019;33(8):2019-2052. doi:10.1519/JSC.0000000000003230

 

2 Responses to “Applying Strength and Conditioning Principles to a Functional High-Intensity Resistance Training Program for Older Adults”

  1. Ethan Pierson

    Chris, love this topic and agree with you that there is a wide gap often times between appropriate load and interventions delivered in older adult patients seeing physical therapists. I also think in general, we as PTs can do a much better job at incorporating strength and conditioning principles into exercise programing for all of our patients. Concepts such as periodization, progressive overloading, and the SAID principle are all areas that are vastly important for sound programming and need to become the standard of care in physical therapy practice. I think its great how you’ve incorporated these principles into the consideration of geriatric care, as these individuals can often intimidate clinicians away from progressive loading due to their long list of comorbidities, medications lists, and age related changes as you’ve mentioned. I think this is a great addition to the geriatrics course and am glad to have it as a resource to look back on with future patient care, nice job!

    Reply

  2. Mary Grace Knoll

    Chris,
    Great job! I like how not only clinically relevant this presentation is, but also how functional it is, particularly with older adults. All of the example exercises and their relation to functional activities of daily living making it a prime example of why these things should be implemented into the clinic. Additionally, it’s very important not to under-treat these patients. This is something I worry about when working in the clinic, making sure I adequately treat the patient to make real, functional gains, especially in this population when we are often fearful to pushing too hard, in turn under-treating. Great presentation and something I will be referencing back to with my future older adult populations in clinic.

    Reply

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