Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 203

Resistance training programmes should be performed 2 to 3 times per week, starting with 1–2 sets and progressing to 2–3 sets of 8–12 repetitions. There has been clear evidence since 1990 that high‐intensity resistance training is feasible and optimally effective for clinical outcomes even in very frail elders. There is no need to wait months to introduce high‐intensity training, which can be achieved by measuring the strength (1 RM) of a muscle group and then using weights equivalent to 50, 60, 70, and then 80% of the 1 RM over the first four days of training. After that, perceived exertion scales can be used to increase the load as tolerated on each subsequent day of training. Perceived exertion can be rated subjectively by the patient and/or objectively by the trainer/caregiver when needed. This method has been used successfully in nursing home residents up to 101 years of age, as well as in older hip fracture patients within 12 weeks of surgery.⁷⁴ Frailty is not a contraindication to robust exercise; it is, by contrast, one of the most important reasons to prescribe it.

To optimise the functional capacity of frail individuals, resistance training programmes should also include exercises in which daily activities are simulated, such as the sit‐to‐stand exercise. Explosive resistance training (power training) should also be performed if tolerated, especially in the lower limbs, and this type of training can be prescribed at intensities ranging from 20 to 80% of the 1 RM.^6,100 However, using a high percentage of loading (80%) results in optimal adaptations of strength, endurance, and power with a single‐exercise paradigm. The concentric (i.e., shortening) phase must be performed as quickly as possible in this type of training. However, special care should be taken with the execution of the exercises to avoid musculoskeletal injuries and screen for rotator cuff and meniscus tears, especially before starting the explosive resistance training in those with osteoarthritis pain. This is the major barrier to power training in older adults but does not preclude traditional slow‐velocity, high‐intensity resistance training.