Muscular Strength & Endurance Testing & Rx: Clinical Scenarios

top 10 chronic conditions for adults 65+ + what others can you think of

*lot of CV

*80% of at least 1 chronic condition; 68% of 2 or more

-Neuro control issues: ex: Parkinson’s; could use stationary machines

-Autoimmune diseases: RT impact on immune system, but prob worse w/ aerobic

-Cancer: bone mineral density, osteoperosis

Cardiovascular Disease

-RT is effective; but don’t do 1RM or isometric (valsulva/high pressure; so do 5-10RM to assess)

-Coronary artery disease, heart failure, hypertension, hypercholestermia, valve disease (atherosclerosis)

Is strength assessment and training safe or appropriate?

-CAD and Heart Failure: used to say don’t push; now know RT increases P but decreases HR, so really effective bc CA get lots of blood; little risk if done right (higher reps and low volume)

*CA: off aortic valve, higher HR=more systole and less filling of CA → heart attack (fill cusps when relaxes/dystole)

-Hypertension: RT helps control or lower BP

-Hypercholesteremia: no great data for RT, know RT increases muscle mass=increase metabolic activity; aerobic better to lower LDL

-Heart Valve Disease: RT distorts valves quicker, so not good

Pulmonary Disease

-COPD, asthma, CF, Pneumothorax

*maybe 1RM, yes, maybe, definitely not

Is strength assessment and training safe or appropriate?

-yes they can

-could test w/ spirometry

-Respiratory muscle training

• Mean Inspiratory and Expiratory Pressure: activate accessory muscle and more diaphragm; suck in or blow out as much as can

  • Acapale Devise: sets resistance(also incentive spirometer where ball goes up)

*valsulva could crease spontaneous pneumothorax (small risk)

Hypertension/Valve Disease

*HT could be bc of valve disease?

-long-debated topic

-upper body RT: no benefit BP; lower body RT: mild decrease BP

Hypertension

-Peripheral Heart Training: similar to high intensity; alternate UB and LB exercises so confused body and make it good at fine tuning VD/VC; use relatively large muscle groups

Valve Disease

-make sure it’s resolved before do RT

Diabetes

-Type I and Type II

-RT benefits in Type II: all increase glucose sensitivity and insulin control

-Ask: is there kidney disease present? peripheral neuropathy (lack of sensation)?

-Aerobic all good, but RT increases muscle mass so better glucose control

Children and RT: American Academy of Pediatrics

-big debate!

*prepubertal: can do weights but be careful

*rare will get a ton of muscle hypertrophy

*higher muscle mass=higher overall performance

*rare; if inappropriate

*understand more now, but not necessarily stronger; more accessible diets

*Mike: but what gain?

What did Michael teach you?

-FMS

-1,3,5, and 10 RM

-Sit-up, push-up, YMCA bench test

Non-Traditional Strength Assessments: List

-Manual Muscle testing

-Handheld dynamometry

-30 second Sit to Stand

Manual Muscle Testing

-push against patient

-Benefits: clinical populations, an option

-Limitations: very subjective, different ratings between practitioners; lot of athletes=5

Hand Held Dynamometry

-Quantify (get #’s) manual muscle testing (go hand in hand; get more data)

-F in lb

-like a bathroom scale; hand held; hold against wall/stationary structure; can do many movements; do 6 sec effort; can also do balance

-can see peak and fatigue curve; tracking lines while dong could add some neuromuscular trainging

-can Rx off of/give an exercise Rx based off results

30 Second Sit to Stand

-age groups (for people are age=26/27)

-when can’t do it is when you get the greatest info (ex: if poor LB strength; older person might not be able to even get out of the chair)

who absolute should NOT do RT?

-post stroke

-risk of an annarhrism (=bubbling vessel, could bleed out; in eye, BV, etc.; pressure sensitive)

-aortic stenosis/any sever valve disease

-phenumothorax/sever lung disease

-injury prohibits a safe form

-HD: severe heart failure

-cancer: can do, but don’t decrease BMD

-osteoporosis/penia: be careful; if in spine don’t do back squats, etc.