Strength Training for Elderly | A Guide to Build Muscle and Power

Incorporating Strength Training into our routine is a great way to build up our physical strength. Strength Training or resistance training is an important part of any fitness regime. It is the ability to perform a given set of exercises, with ease and comfort. These exercises are a combination of repetition and load.  As an individual gets stronger, the repetition and load for an exercise can be increased. While recommending strength training your physiotherapist has to take care of the proper dosage. In older adults, it is difficult to properly dose strength training as there is a loss in muscle strength and power, which can lead to decreased function and increased fall risk. This article will discuss why proper dosage is important and how to properly dose strength training exercises in older adults.

In older adults, it is difficult to properly dose strength training to avoid any injury. Older adults exert considerably more effort to perform daily tasks. For example, to rise from a chair, a young individual works at 42% relative effort while an older adult works at 80% relative effort. We can increase that capacity through strength training and other forms of exercise so that older adults can function easily and comfortably.

Many older adults have pathologies like osteoporosis, arthritis, decreased tissue elasticity, and decreased recovery capacity. But still, older adults can safely perform and benefit from strength training.  Even though there is a risk of causing adverse cardiac events in older adults. The physiotherapist designs programs specifically for complex patients so that these patients can exercise at a relatively high intensity, simultaneously monitoring their vital signs and symptoms.

To improve strength, we need to give training in the intensity range of 60-85% 1RM, with higher intensities resulting in greater strength gains. An intensity of 60% represents the minimum to get stronger, while the 70-85% range is optimal for strength adaptations.

1RM stands for one repetition maximum. It is the maximum amount of weight an individual can lift for a single repetition. In the same way, 2RM is the maximum amount of weight an individual can lift for two repetitions, 3RM is the maximum weight an individual can lift for three repetitions, and so on.

To test % 1RM, this can become time-consuming when performing various exercises, e.g., assessing % 1RM for a leg press, bench press, lunge, lat pull down, etc. Simultaneously, strength also fluctuates based on a variety of factors.  Also, with rapid gain in the first weeks of training clients will get stronger over time, so the usually % 1RM will not always match the individual's abilities for a given session. Therefore, a target rep range can be used instead and RPE to achieve that intensity.

RPE stands for Rate of Perceived Exertion, which is the measure of exercise intensity, a scale designed for cardiovascular exercise. It gives an estimate of the actual heart rate during activity. To use it, multiply the RPE by 10 to get an estimated heart rate. For example, if RPE is 12, then 12 x 10 = 120 beats per minute.

The use of the OMNI Resistance Exercise Scale has been validated for use in older adults. This scale is explained and shown to older adults. During strength training aim should be to work in the range of 6-15 repetitions, loads that can be performed for 6 reps are approximately 85% 1RM, and loads that can be lifted for 15 reps are approximately 60% 1RM. Starting an individual with higher rep sets of 15 and over several weeks work down to lower rep sets of 6, if appropriate and tolerated.

Use RPE to make sure an individual is working in that 60-85% 1RM range. To assess RPE, ask the patient to rate their exertion level at the set’s end.

An individual should not be pushed till absolute muscle failure. The patient should work up to an RPE of 6-8 ("somewhat hard" to "hard") within that 6-15 rep range, to ensure that enough load is applied to make the patient stronger.

Some patients may start with greater than 15 reps and intensities of less than 6 RPE and that is ok if tolerated. Later. they should be progressed into the 6-15 rep range with RPEs of 6-8 to reach the 60-85% 1RM intensity that is optimal for strengthening.

If an individual performs a given repetition and load combination for several weeks and the RPE increases or stays the same, this could mean that the client is not getting stronger by that exercise. In this case, it might be time to change the strength training program.

To assess the progress an individual over time should be able to perform more reps with heavier loads, and with a similar level of RPE.

High-intensity exercises are often considered important for young athletes, while older adults are given gentle exercises. But at the same time, we need to sufficiently recommend strength training exercises to our older adults so that they can function and live better.

 

Top 8 Tips to Manage Arthritis Pain During Winters

Winter is a season of discontent for people suffering from Arthritis. This is because of the fall in barometric pressure (pressure within the atmosphere of the earth), which can cause joints to expand, resulting in pain and inflammation. During winter low temperatures may increase the thickness of the synovial fluid (joint's shock absorber), which makes joints stiffer and more sensitive to pain. Winter season can also affect our DNA by simultaneously decreasing the genes in our body that suppress inflammation. Here in this blog are some tips to ease joint pain, and maintain bone health during the winter.

 

Effects of Cold Weather on Arthritis

Winter season has a significant impact on our health, especially for those who are suffering from arthritis.  There is a lot of damage done to the cartilage and bone cells.  As the temperature drops, bones usually become stiff and inflexible, which can increase discomfort or Pain in the joints, leading to depression and anxiety making life troublesome.

More pain is felt during low temperatures, this is because cold temperatures reduce blood flow around the body, and reduced blood flow can increase nerve pain. A drop in air pressure can negatively impact nerve pain, thus aches and pains are experienced more.

During winter most people go out less, don't exercise much, or see other people so frequently. These lifestyle factors can have an impact on mood – and depression makes the pain worse. Depression usually leads to reduced activity and our joints end up getting less and less mobile. The activity decreases as temperatures drop. It becomes hard for an individual to exercise and keep active in winter. Most arthritic patients suffer a flare-up of symptoms because they are not active in the cold season, which stiffens their joints and causes pain to worsen during movement.

 

Tips to Cope with Arthritis in Cold Weather

 

Physiotherapy:

The physiotherapist can develop a program that can help improve mobility and functionality. And an individual gets acquainted with the kinds of exercises and electrical modalities like TENS, Ultrasound, Thermotherapy, Laser therapy, Wax therapy, etc that can make a huge difference in joint pain.

 

Exercises

Mobility is crucial for people living with arthritis. To maintain strength and flexibility muscle fibers in our body need to flex and contract. When the weather turns low people tend to move less and reduced mobility results in an increase in pain and stiffness in arthritic joints, which makes exercise challenging to begin with. An individual with arthritis with no other severe health conditions is advised to do at least 150 minutes of moderate-intensity aerobic activity a week and two weekly sessions of strength training. Little light exercise, stretching, and walking are considered to be enough for people with arthritis. Even regular massages on affected joints are also recommended as they increase the blood flow and this keeps the joints warm.

 

Keep warm

Heat therapy is very effective for stiff joints. It increases blood flow to help flush out pain-producing chemicals and stimulates receptors in the skin that improve pain tolerance. Warmth also relaxes muscles, reduces stiffness, and decreases spasms. Heat therapy can be applied by heating pads, taking a warm shower or soaking in a tub, electric blankets, and single-use hand and feet warmers can slip into pockets, gloves, or shoes.

 

Vitamin D

Vitamin D reduces pain in arthritis sufferers. During winters Vitamin D levels drop due to the reduced light, so it may be worth considering a supplement if Vit D levels are low

 

Dress Warmly

Keep aching hands, knees, and legs warm with gloves, tights or leggings, and boots. Add extra layers of clothing, when going out in winter. More layers of clothing, trap the body heat than wearing thicker clothes. When buying outerwear, choose clothes that can be worn with ease and should protect from bad weather. But these clothes should not hinder movement and even affect balance

 

Stay Hydrated

Dehydration can increase pain sensitivity. Water flushes toxins out of the body, which can help fight inflammation. Also, water helps keep the joints well-lubricated.

 

Wear compression Gloves

Accessories like gloves, scarves, hats, and boots are important, as the majority of the heat is lost from the body's extremities. A pair of thermal compression gloves help improve the symptoms of arthritis. They vary in style and technology, provide compression to reduce swelling as well as emit or help trap heat to provide a warming sensation. Most styles are fingerless, so they are not suitable for outdoors. Even mittens can also be used as fingers generate more heat when they're not separated from each other by fabric, as they are with gloves.

 

Assistive aids

During winter select footwear that provides stability and traction. Before going out, muscles should be warm and relaxed, which can make it easier to keep balance. For more stability, consider a cane, walker, or even trekking poles to help maintain balance.

 

Weight Loss

Weight loss and Exercising go hand in hand to relieve pain and symptoms associated with arthritis. Weight loss reduces the amount of weight the joints have to deal with. Being overweight places a lot of pressure on the knees and hip joints, which increases the risk of impairment.

Different type of arthritis requires different methods to treat, whereas the above methods may work in all.

 

World Mental Health Day 2022 | Healthy Mind Leads to a Healthy Body

Every year World Mental Health Day is observed on 10th October. Nowadays mental health disorders are becoming more common. Mental disorders like depression, anxiety, and stress not only affect your mental health but also your physical strength. Poor mental health can have a major impact on physical health, as it directly affects heart health, and increases the risk of stroke, and other conditions. Negative psychological factors and mental health disorders can negatively impact Cardiovascular health. Depression, stress, and anxiety are rising faster than ever. Mental health and strength play a huge role in the ability to compete and succeed in any physical activity or performance. Only when a person is mentally strong his /her body will also be physically strong. This blog discusses how good mental health leads to good physical health or vice versa.

 

As the brain and body are connected, good mental health can lead to good physical health.

Positive psychological attributes are associated with a lower risk of cardiovascular disease and lower mortality rate but negative psychological health conditions such as depression, pessimism, anger, chronic stress, anxiety, and pessimism are associated with potentially harmful biological responses such as increased blood pressure, heartbeat irregularities, reduced blood flow to heart, inflammation, and digestive complaints.

 

Depression:

Depression is the most common mental disorder; it doesn't just impact mood and motivation. but also, directly affects the immune system by suppressing the T- cells' response to viruses and bacteria, making the person prone to sickness.  A weak immune system can also lead to a jump in the severity of allergies or asthma. Stress triggers an immune response within the brain, and this inflammatory response may cause depression.

 

Mental illness and Fatigue:

Depression, anxiety, and other mood disorders cause persistent feelings of exhaustion and tiredness.  Exhaustion is the inability to keep up with a pace of 60 revolutions per minute for 5 or more seconds.

Persistent tiredness can easily lead to a decrease in physical health. When someone is depressed, they are less likely to engage in exercise. Fatigue from mental illness can also interfere with hygiene, thus increasing vulnerability to disease.

 

Stress:

Repeated stress, causes the brain to release cytokines. Cytokines are a type of protein associated with inflammation, and the release of cytokines leads to damage in the medial prefrontal cortex, a part of the brain that plays a critical role in depression. As a result of the immune system's response to stress, depression symptoms are triggered.

A strong immune system leads to strong physical health, but stress increases the chances of depression which may further weaken the immune system, resulting in a discouraging cycle.

 

Anger and Anxiety:

Angry and anxiety are bad for heart health. Intense anger episodes can act as a trigger for a heart attack. Tense body language and clenched fists or teeth increase a person's risk of heart attack 8.5 times higher.                                                                                                                  

Anxiety increases the risk of heart attack by 9.5-fold in the following two hours. Anger and anxiety involved in impulse control disorders can negatively affect the heart.

One of the most inexpensive and beneficial ways of boosting your mental health is exercising. Regular exercise can have an impact on the symptoms of mental disorders. An increase in activity levels such as 3 exercise sessions a week reduces the risk of depression by around 20 percent. Exercising is very effective, produces immediate benefits, and has no side effects if done appropriately. So, it is important to train the mind in addition to training the body. And exercise is one of the most natural and reliable ways to improve mental health. Routine workout or physical activity has numerous physical health benefits, such as stronger muscles, bones, heart, and lungs. And has a significant impact on your mental health too.

 

Physiotherapy and Fitness | Improve Your Athletic Performance by Carbohydrate Loading

Carbohydrates are the main source of fuel that our body requires while exercising. During Exercise, our body utilizes carbohydrates and fats to produce energy. Higher-intensity exercises need more carbohydrates and thus require carbohydrate loading. Carbohydrate loading is a strategy, used by competitive athletes to improve physical performance. It involves adjusting the diet and activity levels to boost the amount of carbs in our body. If an athlete is exercising at a steady pace and intensity, carbohydrate loading will increase the output by 20%. This means that if an athlete is running 20 miles without exhaustion, carbohydrate loading will increase the output by 4 miles without any exhaustion. Carb loading reduces fatigue by 2-3% for activities longer than 90 minutes, which is a considerable amount in relation to competitive sports.  An individual must ensure not to make mistakes by overconsumption of calories that can hinder performance. Thus, it is advisable to consult a physiotherapist to ensure improvement in endurance by helping the athletes keep up their best pace for a longer time. This blog will discuss the guidelines for carb loading, and tips to do it effectively.

 

CARBOHYDRATE LOADING

Carb loading aims to increase the amount of carbohydrates stored in the muscles used during tough races, training sessions, and other events. It regulates an enzyme (glycogen synthase) that creates muscle fuel (glycogen) and causes the muscles to store higher levels of glycogen. Glycogen is the fuel that helps to generate energy during long-distance events to help maximize performance.

An athlete who is involved in moderate to high intensity for 90 minutes or more like long-distance swimming, marathons, cycling, etc, can benefit from carbohydrate loading.

To achieve this an athlete needs to taper off the training volume 1-4 days before the event and simultaneously increase the amounts of carbohydrate consumption in the days leading up to the game or an event.

 

GUIDELINES FOR CARB- LOADING

These guidelines should be followed to avoid some mistakes while Carb loading:

• Rest should be taken and work should be reduced before an event.
• As carb loading increases the weight by 2 kg, therefore some athletes might be worried about this weight gain and thus, they don't do carb loading correctly.
• Carb-loading does not give an excuse to eat high-fat foods, an athlete should eat enough carbohydrates and low-fat food.
• Avoid eating too much high-fiber food as it can lead to stomach upset. Cut out fiber and use carbohydrate food like sports drinks, jam, soft drinks, honey, tinned fruit, jelly, and sugar, as these help in prolonging energy levels and maintain sufficient levels of glycogen to allow performance to continue at a high level.

 

CARBOHYDRATE LOADING STRATEGY

The body needs a lot of fuel to keep going over a long period, events between 60-90 minutes or lower do not need carb loading, but the body needs an extra amount of fuel for longer events, to stave off fatigue and perform at a high level for an extended period. 

Most people have enough energy stored to fuel 90-120 minutes of exercise, but for more than this, it is advisable to take supplements to help maintain blood glucose levels and prevent fatigue. 

 

CARBOHYDRATE PLAN

A Carbohydrate loading plan goes hand-in-hand with an exercise plan, as the exercise training is adjusted with the carb intake.  The aim is to maximize the body's carbohydrate stores, which will be of most benefit for events longer than 2 hours.

An athlete needs to fill up on carbohydrates. An athlete should consume 8-10kg per kg of body weight per day or 60% of the daily calorie intake from carbohydrates. This equates to approx. 1500kcal and 1800kcal of carbohydrates per day for the average woman and man. An athlete weighing 70kg should consume 700g of carbohydrates daily. These figures are based on the fact that each carbohydrate gram equals four calories.  Therefore, for a 70 kg runner during the carbo-loading 2800kcal carbohydrates per day would be recommended.

Also, increase the carbohydrate intake progressively over 5 or 6 smaller meals during the day rather than heavily overindulging with 3 meals only.

Examples of high carbohydrates include wholegrain bread, brown rice, cereals, pasta, and potatoes

• 3 days before the event, the amount of exercise should be reduced. Athletes must go on 3 days of complete rest and must fill up on a lot of carbohydrates during this time to fill up the glycogen stores.
• 3-5 hours before the event, the athlete should aim to top up the carbohydrate stores in the liver. A breakfast meal packed with the right nutrients, e.g., cereals, porridge, bread and jam, honey, or bananas.
• 30-60 minutes before the event consume the final top-up in the form of a gummy bar and energy gel.
• For events longer than 2.5h consume 80-120g carbohydrates per hour. This needs to be done in training as the gut needs to adapt and be trained to handle high amounts of carbohydrates while exercising.
• After the event, provide the body with both protein and carbohydrates to recover and also replenish the carbohydrate stores.
• Carbohydrate loading intake will depend on the kind of sport an individual plays and the kind of training the athlete receives for it.

An athlete can feel indigestion, bloated, and constipation because the intestines are filled up with carbs. To hold so many carbohydrates and glycogen in the body, water is required. So, feeling heavier than usual is normal.

World Heart Day | Maintaining Your Heart Health by Physiotherapy

29th September 2022 is celebrated as World Heart day. This day is observed to cater and manage the needs of the increasing number of patients who have undergone cardiac surgery. Cardiac rehabilitation is a treatment process that is found to be effective for patients suffering from a heart attack, coronary artery disease, heart failure, angina, or heart surgery. Cardiac Rehab is a complex intervention that includes Physical activity, Exercise training, and Cardiovascular risk management to improve the well-being and functional capacity of patients with heart disease. The treatment involves various healthcare professionals including healthcare providers, nurses, and rehabilitation specialists. A physiotherapist is one healthcare professional who works with the patient during cardiac rehab and designs an exercise program for the patient. These exercise programs are personalized according to the patient's needs. In this blog, we will guide you through what are the potential benefits and goals at each stage that you can aim for, as you move through the recovery phase of your cardiac condition.

CARDIAC REHABILITATION USUALLY PROGRESSES THROUGH THESE 4 PHASES:

Phase I starts when the patient is still in the hospital. Rehabilitation exercises and regimens are recommended and supervised by the experts at the hospital.

Phase II is when the patient is discharged from the hospital, cardiac rehabilitation usually involves outpatient care.

Phase III starts when the patients are prescribed to continue the cardiac rehab exercises and regimens on their own at home.

Phase IV starts when the patient continues to follow the guidance on exercise and lifestyle. The patient proceeds independently with the current exercise training. He/she should receive regular check-ups to make sure that he/she is effectively managing the heart condition and thus avoiding any flare-ups.

Phase I or clinical cardiac rehab:

Patients with acute heart conditions, such as those recovering from a heart attack or heart surgery, may be referred to a cardiac rehab team while still in the hospital. Phase I cardiac rehab starts in the hospital, and the physiotherapist helps to recover basic functional mobility. The patient is taught to learn techniques to monitor the activity. This phase likely lasts between 2 and 5 days, depending on the patient's physical condition. The physiotherapist designs and carefully monitors the progress and limits the exercise program to get the patient back on his/her feet again. This initially involves just sitting up in bed, standing, and testing the range of motion, before moving to short walks around the hospital wing.

 

Phase II or outpatient cardiac rehab:

Once the patient leaves the hospital, he/she can engage in phase 2 cardiac rehabilitation in an outpatient physiotherapy clinic.  Though the patient must still be having difficulty with functional mobility.  The physiotherapist will closely work with the patient to ensure a smooth transition into outpatient rehab. The patient is monitored through lifestyle changes and as he/she begins to progress with the exercise regime.

 

Phase III Post-cardiac rehab:

Phase III cardiac rehabilitation is the next step in the physiotherapy rehab program. Phase III cardiac rehab involves more intensive exercises and activities while simultaneously monitoring vital signs, such as blood pressure and heart rate, which should remain stable while workloads are increased to ensure a safe transition into phase III cardiac rehabilitation.

 

Physiotherapy Evaluation

The physiotherapist conducts the initial evaluation of phase 3 cardiac rehab, by asking the patient to perform various tests and measures to assess the functional ability.  During the initial evaluation in phase 3 cardiac rehab, the physiotherapist may also choose to perform a specific outcome measure to provide an objective measure of functional mobility. Outcomes measures are also used during phase 3 cardiac rehab including the timed up-and-go test and the 6-minute walk test.

During phase III of cardiac rehab, the physiotherapist aims to help the patient become more independent and informed. The patient learns how to self-monitor his heart rate and exertion levels during exercise.

Phase 3 cardiac rehabilitation mostly involves exercises. The physiotherapist prescribes specific exercises to improve the overall tolerance and endurance level for the activity. The exercises include working on a stationary bike, treadmill walking, flexibility, and upper and lower body strength exercises. Before starting phase III, the physiotherapist should ensure that the patient is fully capable of monitoring his/her exercise and activity intensity. These techniques may include checking the heart rate, using the Borg scale, or using a heart rate monitor to assess exercise intensity while working out. The therapist also teaches the patient simple talk test to monitor their activity level.

As the patient progresses through phase 3 cardiac rehab, the physiotherapist will prescribe more independent exercises and activities. Usually, the patient spends 3 to 4 weeks participating in phase 3 cardiac rehabilitation This is done to prepare the patient for phase 4 cardiac rehabilitation, independent exercise, and lifestyle modifications. The physiotherapist will ensure that the progress is safe through the program with the ultimate goal to move on to independent exercises in phase 4 cardiac rehabilitation.

 

Phase IV or Maintenance:

After the completion of the previous three stages of cardiac rehabilitation, the patient is well aware of the heart condition and how best to manage it. Independent exercise and conditioning are essential to maintain optimal health and prevent the possibility of future cardiac problems. While phase IV is an independent maintenance phase, the physiotherapist helps to make changes in the ongoing exercise routine to help achieve physical fitness and wellness. Phase 4 essentially continues for the rest of their life.

By working closely with the concerned physiotherapist and participating fully in the four phases of cardiac rehabilitation, the patient can increase the chances of returning to optimal health quickly and safely.