Strength Training For Older Adults

Dr. Alexandra Germano, PT, DPT: Greg Glassman said it best and he is the founder of Crossfit. And he says that the needs of an Olympic athlete and our Grandparents differ by degree, not kind. One is looking for functional dominance, the Olympic athlete, and the other is looking for functional competence, which is our grandparents or older adults. There’s no reason that we cannot be performing the same exercises that we’re doing at Crossfit that are: functional, performed at high intensity, over broad and modal domain. You should be doing those same things with older adults.

Dr. Jimmy McKay, PT, DPT: Welcome to FOXcast Physical Therapy, a podcast for clinicians made by clinicians. It’s brought to you by FOX rehabilitation. Find out more at foxrehab.org.

Jimmy: Welcome to the show. My name is Jimmy McKay a physical therapist on FOXcast PT here with Alex Germano. Alex, welcome to the show. Now you’re in Northern Virginia. FOX is in 16 states, practicing PTs, OTs, SLPs and EPs. And you’re in Arlington Virginia?

Alex: Yeah, Arlington and I’m working in most of Alexandria at this point right now.

Jimmy: Love that. It’s where I went to PT school right down the street from you at Marymount University. It’s my old hood.

Alex: I pass it every day.

Jimmy: So we connected and I wanted to get you on the show because you have a little bit of a diverse background. Or at least you know you do something by day and then you have a lot of fun somewhere else with big sweaty people at night. Tell us a little about that.

Alex: Yeah. By day, physical therapist with FOX, by night I am a crossfit level two coach at Ballston Crossfit here in Arlington, and I have been doing crossfit for right around 9 years this month. And I have been coaching for over five years and it’s what led me to become a physical therapist and I didn’t know I was going to end up in the world of older adults. But I have and I see a lot of ability to apply Crossfit and their methodology and treatment of older adults.

Jimmy: Yeah I like when you put two or two things that shouldn’t necessarily be together and you kind of mush them. That’s my scientific term, mush them. Like I’m a radio DJ, a former radio DJ, and now physical therapist! Look at us we’re on a podcast.

Alex: Perfect.

Jimmy: All right. The topic of today’s show is really just adapting strength training to treating older adults right?

Alex: Yeah.

Jimmy: And so where do we start with that? Where Do you start to bring in that that Crossfit, strength and conditioning world into treating older adults? Because for a long time that’s not what you should do. You shouldn’t push those people too hard. But now we know that’s not the case.

Alex: Yeah it’s definitely coming out that moderate to higher intensity workouts are actually indicated in most of the older adult population. And I think Greg Glassman said it best and he is the founder of Crossfit, and he says that the needs of an Olympic athlete and our grandparents differ in degree not kind. So one is looking for functional dominance, the Olympic athlete, and the other is looking for functional competence, which is our grandparents or older adults. He said that perfectly. There’s no reason that we cannot be performing the same exercises that we’re doing in Crossfit that are functional, performed at high intensity, over broad and modal domains. We should be doing the same things with older adults. Yes we might have to modify and adjust but we can do the same things.

Jimmy: Yeah I love that line. The needs of an Olympic athlete and grandparents differ by degree, and not kind. We can even go further and say that it’s even more important for the older adults because that can separate them from a loss of function or a slippery slope into the health care system even further down the line if we don’t strengthen our older adults.

Alex: Yes, absolutely.

Jimmy: All right. So a generic definition of strength-training principles, what would you tell someone?

Alex: Were trying to manipulate the amount of repetition, sets, tempo and rest. Rest being the big one that people don’t think to manipulate, but we’re trying to do that to overload and improve muscle strength, endurance, size ect. So that’s kind of how I think of just a very generic strength training definition.

Jimmy: And a lot of times I think we can agree and we’ve talked about this on the show before. We don’t push those older adults hard enough. A lot of times we wanted to kind of take it easy on them. But this is science. This is muscle physiology 101. Reps, sets, tempo, rest, weight. Those things your body is going to respond to them whether you’re 6 years old or 96 years old.

Alex: Absolutely.

Jimmy: Where do you want to start? We’ll go with tempo first. How are you going to bring that into training with an older adult?

Alex: Yes. Use of tempo, something I do a lot on day one or two is start to create movements that are functional and like a sit to stand, or a hip hinge, and start to bring tempo into the eccentric part of the movement. This way. So for those beginners it’s a really nice way to facilitate increases in movement, like improvements in movement quality. So I can have them really feel through the movement of a hip hinge a nice slow pattern. They can feel the glute contraction, the pull on their hamstrings, and then coming back up you know nice solid core. Then you can take it to those more advanced patients that you have and use it to help overload the muscle in an eccentric way. And you know we know eccentric overloading can increase muscle mass, and if that’s your goal of making people stronger you should be using tempo’s and eccentric movements more frequently.

Jimmy: And just to make sure we don’t skip ahead – tempo. How would you basically describe that? I don’t want to I don’t want to skip over that.

Alex: Oh yeah. For example when I’m doing sit to stands with the patient, I’ll have them concentrically stand up quickly. Work on that power and speed. And then as they sit, count to five. So they have to sit through a count of five. Landing in the chair at the last second. They’ve got to really take it slowly through that movement. And this is something you can bring in. I mean there’s an eccentric movement about everything. So this is something you can do across many different exercises and muscle groups.

Jimmy: I love that using words like strength and power in training our older adults. I think those words aren’t used with people that we typically treat in geriatrics nearly enough.

Alex: I agree.

Jimmy: OK Where are we going to go next? So bringing in tempo is number one, what’s number two on your list?

Alex: I think a lot that’s lacking in the treatment of older adults is the intensity aspect and trying to keep intensity high. I know that we get stuck in a rut of that you know the seated 3 x 10 hip abduction exercises with a thera band, and then after 3 x 10, we’re doing like some adductor strengthening and then maybe some long arc quads and we’re really just not taking advantage of getting some aerobic training out of it, and like improving the patients ability to move for you know an extended period of time, and working many muscle groups at once. So I like to try workouts structures called-in the Crossfit world they’re called the EMOM’s-every minute on the minute. I like to use it where like minute one you’re going to do sit to stand. You’re just going to do as many as you can. And then when minute two hits you’re going to do a weighted walk, you’re going to take a dumbbell. You’re going walk across the room down and back as many times as you can in minute to minute three maybe some pushups at the counter and then minute four is a rest. And then if you do that three to four times there you have a 12 to 16 minute workout where they’ve been moving for most of it. But you’re incorporating rest which you know, we know older adults need a little bit, they might need some time to recover if they’ve not worked out in that capacity before. But this lets them dictate the amount that they can perform that EMOM style. So maybe initially they’re getting like five set to stand’s and then if you repeat this workout you know we like to look at outcomes and like repeating workouts, especially in Crossfit, and they do this again and they’re getting 8 reps on their sit to stand every minute. You have the ability to look and say that there was actually a change. They are getting better they are getting stronger. And so I just like to use these workouts to keep the pace really high in my sessions. There’s not a lot of a lot of sitting going on with me. Plenty of patience speak to that.

Jimmy: I love that every minute on a minute. I love incorporating that Crossfit style. And listen as a profession we like to call ourselves movement experts, and we’re supposed to be able to gauge and dose exercise appropriately. And just by monitoring it and just using our eyes and checking vitals, I think that that’s a great approach to do. And also it sounds more fun than just doing one exercise.

Alex: Definitely. And it’s just like if you can maximize the amount of different muscle groups you’re using you’re going to get such an aerobic benefit like muscle endurance response to that. Versus just sitting there doing the three sets of 10. You don’t get that adduction exercise. You want to overload muscles but this is just a different way to make it fun I think like you said.

Jimmy: Yeah. Alex I kind of feel like you and me looking to get rid of the three times ten. Right. Like that should be like a hashtag online. .

Alex: Yeah I don’t think 10 reps with a theraband is going to cut it for most people. Or like you know everyone. So we’ve got to we’ve got to start it.

Jimmy: Yeah love how it’s objective as well. You know you do the same exercise a few weeks in a row and now you see a change, you can quantify that -it’s an objective measurement that you can see over time. I love that.

Alex: You should be doing the same exercises you know week after week. Right we’re doing progressive resistance training, we want them to get better at sit to stands. We want them stronger. We should be doing them weekly in different variations and making them more challenging. And so this is a great way to do it week to week, and it’s not just like adding a little bit of weight to the sit to stands. And again monitoring progress over time.

Jimmy: Love it. So tempo was first. Fixed numbers of reps sets, try out those EMOM’s. How about number three, what’s third on your list?

Alex: Usually address this with patients on day 1 because I do think it’s important when talking about strength training, is protein intake. And not diving into the specifics like as a nutritionist would, but as a physical therapist it’s under our scope of practice to recommend that if we’re trying to increase your muscles size and performance make sure you’re eating enough protein as you age that doesn’t become as palatable anymore. Like no one wants to eat just chicken breasts. I’m not sure if you’ve seen any of your patients chowing down on chicken breast and broccoli. But I always see them in the morning they have like that you know half eaten piece of toast on the counter with jam, and they have an empty ensure bottle nearby. And if you’ve ever looked at those things they don’t have enough. They’re not providing the people with enough protein to really provide the nutrients they’re going to need to muscle strength.

Jimmy: Again Muscle Physiology 101, you know micro tears to make the muscle hypertrophy. You need that protein to form new muscle.

Alex: I’ve made the recommendation for patients to maybe try out just that that the ensure like clean whey protein or collagen protein, something to help up the amount that they’re getting in their day to day.

Jimmy: Love that. A physical therapist Alex Germano in Northern Virginia for FOX Rehab. Tempo, try out those EMOM’s, I can hear people out there thinking in their head right now what they’re going to do with an EMOM with a patient tomorrow. Right now I can hear it, and make sure that they’re fueling for optimal muscle growth with that protein intake. Alex appreciate you taking your time out to talk to us about how to incorporate some strength training principles into treatment of older adults.

Alex: Thank you. Appreciate your time.

Jimmy: Thanks for listening to FOXcast Physical Therapy, a clinically-excellent podcast. It’s brought to you by FOX Rehabilitation. Listen to other episodes or read articles and position papers at FOXRehab.Org.