Toolkit for Prescribing Muscle Strength and Balance Interventions Flashcards
What are the 3 general steps of the process?
STEP 1
-ID signs of physiologic
overload
STEP 2
- ID evidence-based training
window for overload to occur
STEP 3
-Prescribe exercise and adjust modifiable
parameters to observe overload in training window
How do we identify signs of physiologic overload for therapeutic exercise?
-change in ROM
-use of compensatory strategies
-form failure
-change in speed of movement
What is the training window for physiologic strength?
8-12 reps
**form failure should be seen on 9th rep
ACSM FITT Guidlines for strength training for older adults
FREQUENCY
-2 or more days a week
INTENSITY
-moderate to vigorous; RPE 5/6 -7/8
- 50% 1 RM to 80% 1 RM
TIME
-8-10 exercises involving major muscle groups
- ** form failure on 9th rep
-change up muscle group each time you train
TYPE
-multi-joint; target agonist and antagonist
-single joint after multi-joint
Repetitions in reserve
ex: stop the patient at 10 reps, ask them how many more they can do
Ways to increase the difficulty of an exercise
Perform slow movement, add isometric hold to increase time under tension
Increase range of motion that person needs to move through
Increase resistance or place farther from the joint
Request person to hold a conversation or perform a cognitive task
Stand on a softer surface or decrease base of support
Decrease patient use of UE support
what increments of resistance should you use to increase challenge?
5 lbs for UE
10 lbs for LE
When is it appropriate to increase the challenge of specific exercise?
when the patient can successfully complete more than 8 reps or 80% of the task
Findings from study about effectively dosing balance intervention:
There is incomplete reporting of balance exercise intervention variables in RCTs of balance exercise interventions
How to identify failure during gait and balance training
one further level of assistance
unintentional decrease in speed
unintentional change in how the body is moving in space
What is high balance intensity?
ACSM: highest level of balance enhancing exercises that can be tolerated without inducing a fall or near fall
What is the BIS-T
looking for hesitancy, breathing changes, more than one attempt to get to starting position, postural sway, arm movement, rigidity, physical assistance required, appear unsteady?
-do you need assistance from someone to start the exercise?
-need more than one try to get into starting position or need to hold onto something to get into starting position
Training window for gait and balance training:
GOAL: less than or equal to 80% success
PROGRESS: ** progress to patient being successful 80% of the time or more
Parameter modifications for gait and balance training:
base of support
surface
static–> dynamic
anticipatory
reactive
sensory organization
Stepping exercise progressIon:
Stepping front to back–> stepping into tandem
vary speed
add a dual task (counting, naming items, holding a cup of water)
