New York Physical Therapy Ebook Continuing Education

Further information can be found in the “Resources” section of this course. Table 8 provides examples of resistance exercises. Table 8: Examples of Resistance Exercise • Pilates. • Yoga. • Free weights. • Tai chi. • Downhill walking. • Resistance bands. • Machine circuit workout. • Group resistance exercise classes. • Stairs. • Rowing. • Body weight resistance such as chair stands and wall push- ups. • Calisthenics that use body weight for resistance (such as push-ups, pull-ups, and planks). • Carrying heavy loads. Practitioners are familiar with assessing and treating general limitations in joint range of motion that occur with illness or injury. Although stretching may improve the global decrease in joint range of motion that occurs with aging (Ahmed et al., 2005), few studies have focused on the relationship between flexibility exercises and functional outcomes in older adults. Because of this lack of research, little consensus exists as to the amount and type of flexibility exercises best suited to healthy older adults (Chodzko-Zajko et al., 2009). The goal of a flexibility program for healthy older adults should be to improve the range of motion of most major joints (Stathokostas et al., 2012). Although some studies have demonstrated functional improvements in older adults after a general stretching program, • Heavy gardening. Note . From HHS (2018). Flexibility exercise benefits and prescription a recent systematic review concluded that there is a lack of evidence to recommend stretching routines for functional improvements outside of the rehabilitative context (Stathokostas et al., 2012). The American College of Sports Medicine currently recommends that flexibility exercises for older adults be performed at least two to three days a week for at least 10 minutes (Liguori & American College of Sports Medicine, 2020). The College also recommends a general stretching routine involving major muscle groups with a 10- to 30-second static stretch and three to four repetitions per stretch. It is preferable that stretching exercises follow aerobic or resistance exercise (Liguori & American College of Sports Medicine, 2020). However, given the dearth of evidence for stretching and functional outcomes, it is best to add stretching as an adjunct to resistance and aerobic exercise and not make it the main focus of a general exercise program for healthy older adults. In all cases, practitioners should use their general knowledge and expertise regarding joint structure and function when evaluating and prescribing flexibility exercises in older adults.

Older adults should be encouraged to find and participate in a mode of resistance exercise that is appealing and enjoyable. Downhill walking has been explored as a potential method of eccentric lower extremity resistance training (Drexel et al., 2008; Yang et al., 2010; Zeppetzauer et al., 2012). Downhill walking results in an eccentric contraction of many of the large muscle groups of the lower extremities for a prolonged period of time. Studies demonstrate that downhill walking results in improved lower extremity strength in those with Parkinson’s disease and decreased cholesterol, insulin resistance, and inflammation in middle-aged adults (Drexel et al., 2008; Zeppetzauer et al., 2012). Zeppetzauer et al. (2012) randomly assigned 45 sedentary adults to hike either uphill or downhill three to five times per week for eight weeks. The path that was used had a grade of approximately 19% for 2.9 kilometers. Although both the uphill and downhill groups improved their cholesterol, inflammation, and insulin resistance, the eccentric (downhill) group made significantly better increases in their glucose tolerance. The authors of this study concluded that eccentric exercise is a promising modality for those who are unable to tolerate more strenuous programs. While strength was not examined as an outcome in this study, Yang et al. (2010) also examined the use of downhill walking on lower extremity strength in those with Parkinson’s disease. Thirty-three individuals were randomly assigned to either a physical therapy (PT) group that engaged in stretching, balance training, and overground walking or to a group engaged in downhill treadmill walking. After only four weeks of exercise, those in the downhill treadmill walking group made significant gains in knee extensor strength, while those in the usual PT group did not. Although similar studies have not yet examined the effects of downhill walking on older adults, it is reasonable to assume that similar results may be found, given the previously demonstrated benefits of eccentric exercise in older adults. Tai chi is another mode of resistance training that may appeal to older adults. Traditionally, tai chi has been used more often as a balance or stress reduction program for older adults, but the benefits extend beyond balance. Tai chi is an eccentrically biased program with slow-flowing movements. When performed standing, the intensity of the activity can be varied by the depth of the squat that is performed during the movements. While tai chi may not be vigorous enough as a resistance training program to result in a gain in muscle mass, it has been shown to result in improved lower extremity strength in older adults, and its slow-flowing movements may be more appealing than traditional resistance exercise for some older adults (Barbat-Artigas et al., 2011; Shen et al., 2012). In a study of 62 postmenopausal women, Barbat-Artigas et al. (2011) found that a 12-week tai chi program performed three times per week resulted in improved muscle strength, chair stand time, and single- limb stance time, indicating improved lower extremity strength and balance. Finding a resistive exercise with which older adults feel comfortable and in which they are willing to participate may be challenging, but older adults should be encouraged to participate frequently in both aerobic and resistive exercise. The National Institute on Aging and the Growing Stronger program (a collaboration of the Centers for Disease Control and Prevention and Tufts University) provide additional recommendations for resistance training exercises.

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