21.2.2018

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Functional years –can we extend them?

Gerd Laxåback Research Coordinator/Physiotherapist

Health Sciences Unit, Kokkola University Consortium Chydenius,

University of Jyväskylä, FINLAND

Today, we are physically active 10% of what we were 100 years agoIn Finland we exercise on average less than 10 minutes per dayWe should exercise at least 30 minutes a day

Activity before/now

Functional years

Independent living = Lowers cost

Independent living = Quality of life

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The Most Common Risk Factors for Falls in Older People

(American Geriatrics Society et al. 2001)

• Muscle weakness• History of previous falls• Gait disorders• Balance disorders• Use of assistive device• Vision deficit• Arthritis• Problems with activities of

daily living (ADL)• Depression• Cognitive impairment• Age 80 and above

Muscle mass and aging

Janssen et al. JAP 89:81-88, 2000

Sarcopenia

A 90 year old should be put in a gym and not in a bed!

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Hypertrophy

Pre-training Post-training

MRI assessed MSCA of the upper arm of subject number #30 showing a striking 34% increase.

Kraemer, Nindl, Ratamess, et. al. MSSE 2004

Muscle hypertrophyWhen doing strength exercise there will become microscopic lesions in the muscle cells called catabolism(Karolinska institutet 2017 - “High-doses of anti-inflammatory drugs compromise muscle strength and hypertrophic adaptations to resistance training in young adults”)

Anabolism, or muscle cell correction begins shortly after the catabolism

Anabolism continues 2-48 hours after muscle strength training = Recovery of the heavy exercise session takes about 48 hours

Muscle cells adapt to the increased workload = hypertrophy!

Muscle mass growth is noticeable after six weeks of muscle strength training

Repetitions and hypertrophy

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Welmed - Assessment process

Welmed report-RAIsoft

Threshold values are age and/or gender dependent limits of the measured variables; the goal is to get values over the lower thresholds, and below the upper thresholds

The goal for a test person is to get all the test results within these threshold limits = green color

When a result is outside the threshold limit = red color

The WELMED physios plan the goals and exercises based on the results

Comparison of pre- and post test

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Measuring muscular strength

Measuring isometric maximum strength on HUR equipment using Performance recorder;

Fix the Performance Recorder onto the leg extension/curl or to the leg abduction/adduction machine

Isometric strength of knee extension is measured with the knee in 60 deg. joint angle (the PR is always fixed with the knee at the same angle)

Hold the meter with both hands

A maximum of three trials are recorded

Welmed strength limits

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Preventing falls and injury

Strength and balance training for elderly can

reduce the risk

of both non-injurious and injurious falls by

15-50%

(Carter et al 2001, Robertson et al 2001, Gillespie et al 2003, Chang et al 2004, National Institute for Clinical Excellence 2004, Li et al 2005)

RM = Repetition Max =Highest resistance one can do

15, 10 or 8 repetition with!

Progressive strength training – 3 months – increases muscle strength approx. 20%

2 x 15RM2 weeks

2 x 10RM6 weeks

2-3 x 8RM6 weeks

Rut 95 yrs.

Aktivoi strength training

0

5

10

15

20

25

30

35

Daalia 67 år Daalia 74 år Karleby stad, förebyggandehembesök 80 år

Förbätt

rin

g

%

Benstyrka

Hö knäböjning Hö knästräckning Vä knäböjning Vä knästräckning

Home exercise 67 yrs . N = 36Home exercise 74 yrs . N = 27Gym tra ining 80 yrs . N = 37Emelie = gym tra ining 90 yrs . N = 11

Emelie

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Best equipment for senior gym

1. Legextension/curl

4. Legabduction/adduction

2. Abdomen/Back

5. Bodyextension

3. Leg press

6. Optimalromb

7. Dipp/Shrug

8. Chest press

To extend functional years

Exercise is a true form of medicine, but it's not good enough to just look at a client and say, "You need to do more exercise.“ That's no better than handing someone a bottle of pil ls and saying, “Here, take a few," with no other explanation.

Instead you give them a progressive strength exercise plan tailored to make their medication work better and they will become stronger.

This has proved to be very effective in improving their balance and the functional capacity.

There is a need to shift the focus from corrective to pro-active measures!