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By Wayne Westcott, Ph.D., Mark Richards, M.S., P.T.,
Gary Reinl, and Donna Califano, P.T.A.
During the past decade, several studies have established that strength training is a safe and beneficial activity for adults of all ages (Fiatarone et al., 1990; Butts & Price, 1994; Campbell et al., 1994; Pratley et al., 1994; Westcott & Guy, 1996).
The basic studies showed that strength exercise is effective for increasing muscle strength and size in senior men (Frontera et al., 1988), senior women (Nelson et al., 1994), and even nursing home residents (Fiatarone et al., 1994). Other research, much of which was conducted with senior subjects, revealed that strength training reduced resting blood pressure (Harris & Holly, 1987), improved blood lipid profiles (Stone et al., 1982), increased gastrointestinal transit speed (Koffler et al., 1992), enhanced glucose utilization (Hurley, 1994), alleviated low back pain (Risch et al., 1993), increased bone mineral density (Menkes et al., 1993), eased arthritic discomfort (Tufts, 1994), relieved depression (Singh et al., 1997), and improved postcoronary performance (Stewart et al., 1988). None of these studies reported any training related injuries, and a large scale project with more than 1,100 participants reported that 95 percent of the adults and seniors continued to strength train after completing the program (Westcott & Guy, 1996).
Based partly on the success of these studies, we designed a strength training protocol for elderly nursing home residents who were essentially non-ambulatory. Our research objectives were to determine how a 5_station training program would affect the patients' body composition, muscle strength, joint flexibility, and functional ability.
Subjects
We started the study with 27 physician referred patients (18 women, 9 men) who resided at the John Knox Village Campus (which includes the Med Center, Assisted Living, and Independent Living facilities) in Orange City, Florida. Nineteen subjects (14 women, 5 men) completed the 14_week strength training program. Two residents passed away during the course of the study, four encountered illnesses that prevented them from training, and two discontinued the program for personal reasons. On average, the subjects were 88.5 years of age, 63.7 inches in height, and 130.0 pounds in weight. However, the men were considerably taller (66.9 inches to 62.6 inches) and heavier (164.7 pounds to 117.7 pounds) than the women.
METHODS
Testing Protocol
All of the subjects were assessed for body composition, muscle strength, joint flexibility, and functional ability before and after the 14 week training period. All body composition assessments were conducted by the same investigator using ultrasound (sonar) technology, with fat thickness readings taken at the mid-thigh and suprailiac sites on the right side of the body.
Subjects were tested for lower body muscle strength (quadriceps, hamstrings, gluteus maximus) by the 10 repetition maximum (10 RM) Nautilus leg press, and for upper body muscle strength (triceps, pectoralis major, anterior deltoids) by the ten repetition maximum (10 RM) Nautilus triceps press. All testing repetitions were performed in approximately six seconds, with two seconds for each lifting movement (concentric muscle action) and four seconds for each lowering movement (eccentric muscle action).
Joint flexibility was assessed with an electronic goniometer at the shoulder joint and the hip joint. Shoulder abduction was measured from the side position (arm vertical) to the highest point attained without torso movement. Hip flexion was measured from the seated position (thigh horizontal) to the highest point attained with knee bent. All flexibility assessments were taken on the right side of the body.
Our assessment of functional ability included each subject's Functional Independence Measurement (FIM) score (a standardized system for rating patient independence in performing daily living activities), mobility distance, and frequency of falls.
All of the data were analyzed for differences in pre-training and post-training values by means of paired t-tests. The level of statistical significance was set at p<0.05.
