Why & how to recommend strength training in primary care

Transcription

1 Why & how to recommend strength training in primary care Eric LaMotte, R3 11/12/2015 UWMC Primary Care Conference Pat, 73F s/p b/l knee replacement Lock Haven, PA

2 Disclosures I have no financial conflicts of interest. I do have (non-expert) opinions that I will share with you.

3 Agenda Current practices & guidelines Benefits & barriers Training & adaptation theory Beginner programs & modifications Contraindications & caution Myths & misinformation

4 Agenda Current practices & guidelines Benefits & barriers Training & adaptation theory Beginner programs & modifications Contraindications & caution Myths & misinformation

5 Percent Participating Exercise habits of UW IM interviewees so far this year (Unpublished data) Running Men Women Strength training

6

7 The Guidelines

8 Resistance exercise: Category : Entire body 2-3 d/wk A At mod-vig intensity 6-12 reps for novices 1-12 reps after 6 mo w/ focus on 1-6 reps 1-3 sets Increase weight by 2-10% increments. Emphasis on multiple-joint exercises for novices through advanced. A B A A

9 2009 Recommends resistance exercise training for arthritis, cancer, COPD, CKD, CHF, CAD, depression, disability, HTN, obesity, osteoporosis, PVD, stroke, DM2. Supervision needed in dementia. 2010

10 Agenda Current practices & guidelines Benefits & barriers Training & adaptation theory Beginner programs & modifications Contraindications & caution Myths & misinformation

11 Benefits Strength Bone density/health Joint health Basal metabolic rate Mobility Independence Confidence Barriers Not sure it s safe, especially with prior injuries Doesn t help me meet my fitness goals (endurance, cardiovascular protection). Don t know how Especially for women: The weight room is a hypermasculine space Don t want to get too bulky

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13 Willie Murphy, 77 y.o. powerlifting grandmother Joe Stockinger, 82 y.o. Canadian athlete We re not all talking about the same resistance exercise. National Council on Aging Stock photo Go4Life (NIA/NIH) Stock photo

14 Agenda Current practices & guidelines Benefits & barriers Training & adaptation theory Beginner programs & modifications Contraindications & caution Myths & misinformation

15 Training Exercise Physical Activity

16 Why strength training works: the Progressive Overload Principle

17 Novices gain strength quickly from simple programming

18 Training parameters should reflect training goals. If someone s goal is to improve strength and bone density, how many reps should they be doing?

19 There are many subcultures among those who exercise. Everyone has their biases. The typical medical bias is to tell people to train like bodybuilders, but this often fails to reflect patients goals. Why the discrepancy? Ignorance of basic training principles Fear of heavy weights

20 Agenda Current practices & guidelines Benefits & barriers Training & adaptation theory Beginner programs & modifications Contraindications & caution Myths & misinformation

21 Squat Deadlift Bench Press Overhead Press

22 BEGINNER PROGRAMS Set x Reps(per set): Starting Strength Stronglifts Greyskull LP 3x5 (1x5 for deadlift) 5x5 (1x5 for deadlift) Starting Strength Stronglifts 5x5 Greyskull LP Linear progression: Yes Yes Yes 2x5,then 1x5+ Days per week Workouts(Alternate A day and B day) Squat A B A B A B Squat Squat Squat BP OP BP OP BP OP Squat DL DL Clean DL Rows Powerlifting: Squat Bench Press Deadlift Olympic weightlifting: Clean & jerk Overhead Press Snatch Other: Barbell rows

23 Older trainees Require adequate time for recovery (train 2 d/wk, not 3) Are volume-sensitive and intensity-dependent. Consider sets of 3 instead of sets of 5, especially for women. Little old ladies make good progress on 3s. Can omit the Olympic lifts because they are high impact. May benefit from a medication review beta blockers etc. Frail older trainees (think Gus) Probably will require exercise substitutions: Bodyweight squats to increasing depths until at parallel. Lat pull down instead of overhead press Benefit from close supervision

24 Books Jonathan Sullivan s Book (Forthcoming, 2016) Local coaches Francis Howard (Francis@urbancrossfit.com Fran Mason (fran@crossfit206.com Todd Olsen (training@toddolyolsen.com) Andrew Jackson and Emily Stanford (Michael@fulcrumtraininghall.com)

25 Agenda Current practices & guidelines Benefits & barriers Training & adaptation theory Beginner programs & modifications Contraindications & caution Myths & misinformation

26 What the guidelines say

27 Contraindications: expert opinion Absolute: Vascular lesions (aneurysm, dissection) Decreased safety under a load (epilepsy, recurrent malignant tachyarrhythmias) Relative: Kyphosis, syncope, drug interactions (AV nodal blockade, beta blockers, hypoglycemic agents) Not a contraindication: HTN, CKD/ESRD, neuromuscular disease, Parkinson s, stable CHF.

28 Agenda Current practices & guidelines Benefits & barriers Training & adaptation theory Beginner programs & modifications Contraindications & caution Myths & misinformation

29 Misinformation is everywhere The least we can do is not spread it ourselves

30 Myths Don t hold your breath (aka use the Valsalva maneuver) because it is dangerous. Use light weights for lots of reps Good Advice You should definitely Valsalva, and also please sign this liability waiver. Start at a low weight, and gradually increase by a small amount every time. Machines are safer Machines and barbells are both safe and effective. Squatting (at full depth) will hurt your knees Squatting (at full depth) will improve the health of your knees

31 Key Learning Points Recommend strength training to your patients. Strength is vital to successful aging. It is time to re-examine our perception of strength training as being ancillary to other forms of exercise. Adaptations are specific to the training stimulus, and short sets are most beneficial for strength and bone density. People get stronger when they recover from lifting weights, so eating and sleeping are important. Start at a light weight and gradually increase the weight on the bar, not the number of reps, sets, or training frequency.

32 References ACSM Position Stands, Egan B and Zierath JR. Exercise Metabolism and the Molecular Regulation of Skeletal Muscle Adaptation Rippetoe,M. Starting Strength: Basic Barbell Training, 3 rd Ed The Aasgaard Company. Rippetoe, M and Baker, A. Practical Programming for Strength Training, 3 rd Ed The Aasgaard Company. Sundell J, Resistance Training is an Effective Tool against Metabolic and Frailty Syndromes 2011, Advances in Preventive Medicine. You can copy my Epic smartphrase for strength training: ELSTRENGTHTRAINING