Powering Up
Monday July 19, 2010
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Michael Puthoff, PT, PhD, GCS, assistant professor in the physical therapy department at St. Ambrose University in Davenport, Iowa, was working on his dissertation when he saw a 68-year-old patient who was noticeably deconditioned after suffering from pancreatitis. After six weeks in the hospital, the woman struggled with walking up three steps to enter her home. She labored to stand up from a seated position.
Puthoff’s dissertation explored the relationship between muscle power and function in older adults, and he was optimistic that this patient would benefit from an exercise program focused on power training. Rather than asking this woman to perform exercises at her own pace, power training meant he would have her build up to doing them rapidly. The concept of high-velocity exercise had been used to train athletes, but it was newer territory for rehabilitating older adults.
Although the exercises Puthoff suggested seem simple — standing on tiptoes, tossing a medicine ball, using a leg press machine — researchers and practicing PTs are finding that the addition of velocity to the equation is having a profound impact on the quality of life for older patients.
“By using power training, I see good results with function and we can keep older adults independent longer,” Puthoff says. “That improves their confidence.”
Power Training Defined
The concept of power training is linked to the well-known physics formula that power equals force multiplied by velocity. Traditional strength training exercises require people to perform a certain number of repetitions at a particular weight, or force. This kind of exercise builds power, but the level of power increases when the same exercises are performed at a higher velocity.
Building muscle power to perform tasks quickly is vital for older adults, Puthoff says. Life activities such as climbing stairs, crossing the street, getting out of a chair or catching oneself when falling require high-velocity muscle action.
“With power training, you are not only making muscles stronger, but you are also improving neurological control of the muscle,” Puthoff says. “You are teaching the muscle to respond more quickly. If someone is losing their balance, for example, the brain is trained to recruit that muscle quickly to recover.”
The exercise still must be performed smoothly with proper posture and muscle control. If the patient is using weight machines, then the contraction portion of the exercise must be done quickly, but the release should be done slowly.
Power training exercises may include functional activities such as standing or walking up a flight of stairs. When using weight machines, it is light to moderate loading for one to three sets of three to six repetitions per set, according to the American College of Sports Medicine. Puthoff spends the first week or two ensuring that the patient has proper form, and then asks the patient to increase the speed of the task over time.
“You don’t do power training the first session,” Puthoff cautions. “First you want to do the activity at a slow speed with good form and posture.”
In the case of the 68-year-old woman, Puthoff saw a dramatic change after two months of power training. She could climb stairs herself, walk more quickly and get out of a chair without using her arms.
Power Training Research
Jonathan Bean, MD, MS, MPH, assistant professor in the department of physical medicine and rehabilitation at Harvard Medical School and medical director of the Spaulding Cambridge Outpatient Center in Massachusetts, was so intrigued by the idea of power training for older adults that he has conducted studies to document the benefits. In a study published in the September 2009 issue of the Journal of Gerontology, Bean and his colleagues explored the differences between two participant groups. One group of older adults was asked to perform functional exercises at an increased velocity while wearing a weighted vest. The other group was asked to perform exercises with barbells or ankle weights at regular speed.
Bean and his colleagues found that both groups had improvements in strength, but the power training group had a significant improvement in muscle power. “There is a segment of the population for whom speed of movement is important,” Bean says. “There are some people, for example, who have certain impairments that may put them at greater risk for decline by incidents like falling. Lower muscle power can be a fall risk. What we showed was that power training is effective among these people who have low power or are slow in their movement.”
Mark Richards, PT, MS, CEEAA, vice president of clinical education at Accelerated Care Plus in Reno, Nev., agrees. He is part of a team that developed a new certification through the American Physical Therapy Association Section on Geriatrics that incorporates power training into a course for PTs who want to become exercise specialists for the geriatric population.
“We felt it was important to include power training in the course because some, but not all, research studies have shown that power training may have a greater impact on function than strength training in aging adults,” he says.
At the same time, Richards points out that PTs should not eliminate strength training practices, but do them in combination with power training. Traditional strength training — higher levels of resistance at slower speeds — is highly effective at stimulating muscle fiber hypertrophy, while power training is better suited for stimulating the recruitment of fast-twitch muscle fibers, Richards explains.
Jill Heitzman, PT, DPT, GCS, CWS, FACCWS, CEEAA, a clinical coordinator at East Alabama Medical Center’s RehabWorks, started to reconsider her strategies with older adults when she began reading research articles about the importance of power training.
“I realized I wasn’t challenging my older patients enough,” she says. “People are fearful of pushing their aging adults, but I knew that if we increased their muscle power, they could be more functional at home.”
As she started using the new concept, she saw noticeable changes in her patients. “Many of them were getting rid of assistive devices or going from a walker to a cane,” she says. “Some started to do more walking in the community or had an easier time getting in and out of the car.”
At times, patients may initially express fear that this type of training will cause pain, but Heitzman is careful to help them slowly try a new exercise until they feel comfortable. “It can be challenging and rewarding for patients, and I enjoy it when they can plan a trip they thought they could never take and do the things they love,” she says. •
Heather Stringer is a freelance writer.
Puthoff’s dissertation explored the relationship between muscle power and function in older adults, and he was optimistic that this patient would benefit from an exercise program focused on power training. Rather than asking this woman to perform exercises at her own pace, power training meant he would have her build up to doing them rapidly. The concept of high-velocity exercise had been used to train athletes, but it was newer territory for rehabilitating older adults.
Although the exercises Puthoff suggested seem simple — standing on tiptoes, tossing a medicine ball, using a leg press machine — researchers and practicing PTs are finding that the addition of velocity to the equation is having a profound impact on the quality of life for older patients.
“By using power training, I see good results with function and we can keep older adults independent longer,” Puthoff says. “That improves their confidence.”
Power Training Defined
The concept of power training is linked to the well-known physics formula that power equals force multiplied by velocity. Traditional strength training exercises require people to perform a certain number of repetitions at a particular weight, or force. This kind of exercise builds power, but the level of power increases when the same exercises are performed at a higher velocity.
Building muscle power to perform tasks quickly is vital for older adults, Puthoff says. Life activities such as climbing stairs, crossing the street, getting out of a chair or catching oneself when falling require high-velocity muscle action.
“With power training, you are not only making muscles stronger, but you are also improving neurological control of the muscle,” Puthoff says. “You are teaching the muscle to respond more quickly. If someone is losing their balance, for example, the brain is trained to recruit that muscle quickly to recover.”
The exercise still must be performed smoothly with proper posture and muscle control. If the patient is using weight machines, then the contraction portion of the exercise must be done quickly, but the release should be done slowly.
Power training exercises may include functional activities such as standing or walking up a flight of stairs. When using weight machines, it is light to moderate loading for one to three sets of three to six repetitions per set, according to the American College of Sports Medicine. Puthoff spends the first week or two ensuring that the patient has proper form, and then asks the patient to increase the speed of the task over time.
“You don’t do power training the first session,” Puthoff cautions. “First you want to do the activity at a slow speed with good form and posture.”
In the case of the 68-year-old woman, Puthoff saw a dramatic change after two months of power training. She could climb stairs herself, walk more quickly and get out of a chair without using her arms.
Power Training Research
Jonathan Bean, MD, MS, MPH, assistant professor in the department of physical medicine and rehabilitation at Harvard Medical School and medical director of the Spaulding Cambridge Outpatient Center in Massachusetts, was so intrigued by the idea of power training for older adults that he has conducted studies to document the benefits. In a study published in the September 2009 issue of the Journal of Gerontology, Bean and his colleagues explored the differences between two participant groups. One group of older adults was asked to perform functional exercises at an increased velocity while wearing a weighted vest. The other group was asked to perform exercises with barbells or ankle weights at regular speed.
Bean and his colleagues found that both groups had improvements in strength, but the power training group had a significant improvement in muscle power. “There is a segment of the population for whom speed of movement is important,” Bean says. “There are some people, for example, who have certain impairments that may put them at greater risk for decline by incidents like falling. Lower muscle power can be a fall risk. What we showed was that power training is effective among these people who have low power or are slow in their movement.”
Mark Richards, PT, MS, CEEAA, vice president of clinical education at Accelerated Care Plus in Reno, Nev., agrees. He is part of a team that developed a new certification through the American Physical Therapy Association Section on Geriatrics that incorporates power training into a course for PTs who want to become exercise specialists for the geriatric population.
“We felt it was important to include power training in the course because some, but not all, research studies have shown that power training may have a greater impact on function than strength training in aging adults,” he says.
At the same time, Richards points out that PTs should not eliminate strength training practices, but do them in combination with power training. Traditional strength training — higher levels of resistance at slower speeds — is highly effective at stimulating muscle fiber hypertrophy, while power training is better suited for stimulating the recruitment of fast-twitch muscle fibers, Richards explains.
Jill Heitzman, PT, DPT, GCS, CWS, FACCWS, CEEAA, a clinical coordinator at East Alabama Medical Center’s RehabWorks, started to reconsider her strategies with older adults when she began reading research articles about the importance of power training.
“I realized I wasn’t challenging my older patients enough,” she says. “People are fearful of pushing their aging adults, but I knew that if we increased their muscle power, they could be more functional at home.”
As she started using the new concept, she saw noticeable changes in her patients. “Many of them were getting rid of assistive devices or going from a walker to a cane,” she says. “Some started to do more walking in the community or had an easier time getting in and out of the car.”
At times, patients may initially express fear that this type of training will cause pain, but Heitzman is careful to help them slowly try a new exercise until they feel comfortable. “It can be challenging and rewarding for patients, and I enjoy it when they can plan a trip they thought they could never take and do the things they love,” she says. •
Heather Stringer is a freelance writer.
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Monday July 19, 2010