Exercise Prescription and Rehabilitation Considerations for Older Adults: Summary 75
PRINCIPLES OF EXERCISE PRESCRIPTION
• Going from normal speed to fast or slow speed of the movement • Moving from a stable surface to a more unstable or variable surface • Begin with eyes open and more to practicing with eyes closed • Begin with working over the Base of Support (BOS) and progression to working outside the BOS
Overload To achieve the highest level of function the appropriate intensity of exercise has to be prescribed. LEARNING TIP!
The muscle tissue must be exposed to a stimulus of at least 60% of the muscle’s maximum force-generating capacity if the force of that muscle is going to be improved.
EXERCISE PRESCRIPTION
Speed & Power • Power = time rate of force development • Loss of speed and power is correlated with frailty, falls, and slow gait speed: ○ Slow gait speed predicts loss of ADL ability and future institutionalization • Speed is a key component to safety and should be assessed in older adults: ○ Activities such as crossing the street, getting to the bathroom in time, walking with pedestrian traffic all require speed • Speed training is part of specificity of exercises and should be considered with all functional activities Muscle Contractions • Concentric • Eccentric: ○ Incorporating Overload Principle: Perform the exercises/tasks slower • Isometric • During gait activities the trunk muscles often act as stabilizers so training should include exercises that mimic this: – isometric exercises • The gait cycle is 60% eccentric muscle contractions so muscle groups that are utilized during gait need to have eccentric training Motor Learning At minimum, 6 weeks is needed for true muscle strengthening. Some individuals will show functional performance improvement immediately and this is due to motor learning. Motor learning improvements occur through repetition and practice. If tasks are practiced using random practice – performing different tasks in variable orders and variable environments – then an older adult’s ability to use that muscle/muscle group in any situation improves. If the goal is to increase strength of the knee extensors so that the older adult has improvement with tasks such as sit to stand, stand to sit, squatting, and going up and down stairs, then random and repetitive practice is necessary.
The greater the stimulus, the greater the improvement with all types of exercise. With older adults who are severely deconditioned or even frail, a stimulus below 60% may be necessary initially but it will not produce significant change. Overload can also be assessed using the Borg Scale of Perceived Exertion, other perceived exertion scales. Scales can all be used to determine overload in the cardiovascular and muscular systems for all individuals regardless of age. Specificity Exercises that are prescribed must match the type of muscle contraction and the speed of muscle contraction that is needed for the functional movement desired. Functional strengthening needs to be considered with all older adults. • Functional strengthening = strengthening of a movement rather than a muscle or muscle group Functional activities are multiplanar, asymmetrical, have rotation components, and require balance and speed. Exercises that are being performed with the goal of improving function need to meet these same requirements. If a patient is walking as part of their rehabilitation, this may not be enough to improve their Functional activities are complex neuromuscular events that involve many systems: muscular, proprioception, cutaneous sensation, vestibular and visual systems. • Functional training = overloading the movement or activity desired so that the whole neuromuscular system is challenged The patient is challenged to use multiple joints in many axes of motion. Progression of functional exercise programs can be done by: • Moving from simple movements to more complex ones walking performance. Functional Training
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