New York Physical Therapy Ebook Continuing Education

FITT for resistance exercise recommendations As it relates to optimizing strength and muscle mass, the FITT principle of resistance exercise prescription can be viewed in Table 7. For resistance exercise, a moderate to high level of intensity refers not to the overall work of the exercise but to the work of the specific muscle group that is being used. If 0 is no movement and 10 is a maximal effort to move a muscle group, then moderate intensity is 5 to 6, and high intensity is 7 to 8. This means that intensity will be exercise specific and should be evaluated with each exercise and each muscle group. Adults who are new to resistance exercise may require education and demonstration to understand this concept. Initially, working larger groups of muscles, such as the knee flexors and extensors, may lead to large changes in breathing and heart rate due to the large amount of muscle mass activated. With resistance exercise, older adults should be taught to focus not on the total body effort for heart rate and breathing but instead on the specific muscle group being worked. Using resistance training to work large muscle groups, such as knee extensors, will increase the heart rate and breathing. This increase in heart rate and breathing may not be as evident when exercising smaller muscle groups such as elbow flexors. Although performing bicep curls may not increase heart rate or breathing in the same way as leg extensions might, older adults should nonetheless work at a moderate to high level of intensity for the biceps. They should feel fatigue in their muscle at the completion of the

exercise. In fact, if they are working at a high intensity for 10 to 15 repetitions, they should feel fatigue from approximately the eighth repetition to the last repetition of the set. Individuals working at a lower intensity but with higher repetitions will tire later in the set. As with all resistance exercise, individuals should be reminded not to rush, compromise form due to fatigue, or hold their breath. Good posture during all exercises should be emphasized. As fitness and strength improve, older adults should be encouraged to increase the frequency, duration, and weight used for each exercise because greater amounts of activity provide additional health benefits (Liguori & American College of Sports Medicine, 2020). It is generally agreed that once an adult can easily complete 15 repetitions, the weight for that exercise should be increased. When initially starting a resistance exercise program, it may be necessary to progress the patient’s weights every two to four weeks. Because initial changes may occur quickly, at a minimum, weight should be reassessed every four to six weeks. As with aerobic exercise, older adults should be encouraged to participate in high-intensity resistance exercise (Liguori & American College of Sports Medicine, 2020). For older adults who have never exercised before or who are not familiar with resistance exercise, resistance exercise should be done under the supervision of an individual familiar with exercise prescription for older adults.

Table 7: Resistance Exercise Recommendations FITT Recommendations F requency

• For experienced individuals: Frequency is secondary to training volume, so frequency is based on personal preference. • For novices: 2–3 days a week; at least 2 days a week strength training for each major muscle group and at least 2–3 days targeting balance. • Resistance training programs for older adults should follow the principles of individualization, periodization, and progression.

I ntensity

• For experienced individuals: Variable depending on personal fitness goals. • For novices: For weight resistance, do one weight repetition maximum test: ○ 60% to 87% of repetition maximum. ○ 8–12 repetitions.

T ime

• 20–30 minutes for 8–10 exercises. • When time is not a factor, >2 minute rest interval may allow for the ability to do greater amounts of work, which may lead to greater gains in muscular fitness. • A properly designed resistance training program with appropriate instructions on technique and proper spotting is safe for healthy older adults. • Work toward 2–3 sets of multijoint exercises that affect more than one muscle group; targeting agonist and antagonist muscle groups is recommended for all adults. • Single-joint exercises and core exercises. • A variety of exercise equipment and body weight can be used to perform these exercises. • Do varied, multicomponent physical activity that emphasizes functional balance and strength training on 3 or more days a week. • Include power exercises performed at higher velocities in concentric movements with moderate intensities.

T ype

Note : From Fragala et al. (2019); Liguori & American College of Sports Medicine (2020); WHO (2020). Developing an eccentrically biased program may require some creativity because most traditional resistance training exercises are concentrically biased. The key principle with eccentric exercise is to safely overload the muscle for maximal gains. Most research examining the benefits of eccentric exercise has used modified bikes on which the pedals are driven by attached motors—equipment that is not readily available in most clinic or home settings. However, eccentric exercise can still be

in an eccentric contraction of the left hip and knee extensors. This exercise could then be repeated on the other leg. As with all resistance exercise, individuals should be reminded to move slowly and complete a full range of motion; if proper form cannot be maintained due to fatigue, the exercise should be stopped. Similar exercises could be employed for the upper extremities. All eccentric exercise programs should provide an initial ramping period of two to three weeks, during which time weight is slowly increased to avoid excessive muscle damage and muscle soreness. While eccentric exercise may provide a good model for older adults with limited physical fitness, some older adults may find that traditional weight training with free weights or weight machines is unappealing or intimidating.

performed in a traditional clinic or gym setting in the absence of specialized equipment. For example, when working on the leg press, an individual could be taught to straighten both knees, performing a traditional concentric knee and hip extension, then remove the right leg and slowly bend the left leg, resulting

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Book Code: PTNY1024 Physical-Therapy

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