Modern Healthcare Management of the Older Adult

What is 1 Rep Max Living?

One rep max living is when demands of life are near or exceeding one’s maximum physical capacity. One-repetition max is a weight lifting term to describe the max amount of weight a person can lift for one repetition. Another way to think about one-repetition maximum is the max amount of force a person can generate in one maximum contraction. Many older adults perform day-to-day activities close to this level.

A study of adults with a mean age of 74 years, showed that on average: ascending stairs was performed at 78% maximum capacity, descending stairs at 88% maximum capacity and sit-to-stands at 80% of maximum capacity. In addition to a decline in maximum capacity to perform day-to-day activities, older adults tend to have a decline in their ability to recover from more physically straining activities. Over time, the demands of an activity can be physically greater than one’s physical function.

How can we identify 1 Rep Max Living?

The best way to identify one rep max living is to monitor day-to-day activities for increasing difficulty. Once this is identified, a physical examination will determine how close one is operating at maximum potential.

 Below is a list of ways we identify one-rep max living for common everyday activities:

• • Walking: 
    • Gait (walking) speed: Walking speed has been shown to correlate with patients’ functional abilities and balance confidence. It has the potential to predict future mortality, hospitalizations, and falls.
    • Timed Up and Go: In this test, patients rise from a chair, walk 3 meters, turn around, walk back to the chair and sit down. The test is timed and the results are an accurate predictor for falls. 
  • Grip Strength: Grip strength is correlated with one’s ability to open jars, carry groceries and turn door knobs. It is also a predictor of older adults maintaining independence. 
  • Balance: We take patients through a series of tests that determine one’s risk of falling. Falls have been correlated to injuries which can lead to fractures, hospitalization, and loss of independence. 

• Standing from a chair:

• • 30-Second Chair Stand Test: We measure how many times patients can sit to stand from a chair within a 30-second period. This test is a great way to objectively measure leg strength and endurance. 

Other limiting activities that our patients often report include playing with grandchildren, gardening, household, yard work and traveling. We will break down movements patients feel limited with to prescribe a guided program that will improve strength with impaired movements. 

Physical Therapy treatments include:

• Strengthening through large movements that mimic the limited activity 
• Manual therapy to address any joint or muscle restrictions limiting full range of motion 
• Balance exercises to reduce one’s risk for falls

References:

1. Celis-Morales, Carlos A, et al. “Associations of Grip Strength with Cardiovascular, Respiratory, and Cancer Outcomes and All Cause Mortality: Prospective Cohort Study of Half a Million UK Biobank Participants.” BMJ, 2018, https://doi.org/10.1136/bmj.k1651. 
2. Chun, Sohyun, et al. “The Timed up and Go Test and the Ageing Heart: Findings from a National Health Screening of 1,084,875 Community-Dwelling Older Adults.” European Journal of Preventive Cardiology, Vol. 28, No. 2, 2019, pp. 213–219., https://doi.org/10.1177/2047487319882118. 
3. Fritz, Stacy, and Michelle Lusardi. “White Paper: ‘Walking Speed: The Sixth Vital Sign.’” Journal of Geriatric Physical Therapy, Vol. 32, No. 2, 2009, pp. 2–5, https://doi.org/10.1519/00139143-200932020-00002. 
4. Hortobagyi, T., et al. “Old Adults Perform Activities of Daily Living near Their Maximal Capabilities.” The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol. 58, No. 5, 2003, https://doi.org/10.1093/gerona/58.5.m453
5. Jones, C. Jessie, et al. “A 30-S Chair-Stand Test as a Measure of Lower Body Strength in Community-Residing Older Adults.” Research Quarterly for Exercise and Sport, Vol. 70, No. 2, 1999, pp. 113–119., https://doi.org/10.1080/02701367.1999.10608028. 
6. Mcleod, Jonathan C., et al. “Resistance Exercise Training as a Primary Countermeasure to Age-Related Chronic Disease.” Frontiers in Physiology, Vol. 10, 2019, https://doi.org/10.3389/fphys.2019.00645

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