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Strength Training Changes Lives of
90-Year Old Nursing Home Patients
Wayne L. Westcott, Ph.D.
The assisted living patients selected to participate in our strength training study
were typical of many nursing home residents. They were old, weak and relatively
immobile. As a general description, our new research participants were characterized
by a dropped head, rounded shoulders and a curved back. Most had low back pain, and
spent the majority of their time in a bed, chair or wheelchair.
Nonetheless, after talking with senior exercise advocate Gary Reinl, the administrators
and medical team at the John Knox Village Senior Living Center in Orange City, Florida
were convinced that these deliberated individuals had the potential to change their lives
for the better through a simple and sensible program of strength exercise. In fact,
they challenged us to implement a safe, efficient and effective strength training program
that would enable these older adults to feel better, function better, and ambulate
better. Basically, they were hoping that after 14 weeks of strength training these
special seniors would have less low back pain and spend fewer hours in their wheelchairs.
We accepted the challenge, and introduced a five-machine Nautilus program to the
physical therapists and elderly patients who would participate in this innovative research
experiment. All of the subjects were assessed for body composition, muscle strength,
joint flexibility and functional ability before and after the 14-week training period.
The participants completed two brief strength training sessions per week, working
one-on-one with a physical therapist. Each exercise was performed for one set of 8
to 12 repetitions to the point of moderate muscle fatigue. When 12 repetitions were
completed in good form (slow movement speed and full movement range), the weightload was
increased by about five percent. Although each strength exercise required less than
90 seconds of physical exertion, the training sessions typically took between 15 to 20
minutes depending upon the participant's physical ability to transfer on and off the
equipment. Table 1 presents the Nautilus exercises, target muscles and desired
outcomes of the strength training program.
The results of the assisted living patients strength training study surpassed
everyone's expectations. As presented in Table 2, the elderly exercisers achieved
significant improvements in body composition, muscle strength, joint flexibility and
functional ability over the 14-week training period. Specifically, they replaced
about four pounds of lean (muscle) weight, reduced about three pounds of fat weight,
increased their leg strength by more than 80 percent, increased their upper body strength
by almost 40 percent, enhanced their joint flexibility by 30 percent, and improved the
functional independence measure (FIM Score) by almost 15 percent.
Even more impressive than the objective outcomes of the strength training program were
the personal observations by the medical professionals and administrative directors.
Dr. Pradeep Mathur, John Knox Village Medical Director, reported that the exercise
participants exhibited better physical and mental fitness, more endurance, and less low
Gary Brcka, Assisted Living Administrator, cited examples of how the strength training
program helped patients. In one case, an 87-year-old woman with compression
fractures in her lower spine wore a back brace to reduce pressure and pain. After
completing the exercise program, she discontinued wearing the back brace claiming that she
no longer needed it.
Carol Sullivan, John Knox Village Director of Nursing, noted that with more muscle
strength some patients spent less time in wheelchairs, and one patient no longer needed to
use a wheelchair.
Donna Califano, PTA and On-Site Program Director, reported that the patients enjoyed
doing the strength exercises because they felt they were really working and seeing
progress as their weightloads increased.
Perhaps the most remarkable lifestyle change was experienced by Esther Duvall, an 84
year old assisted living patient who claimed to hurt all the time. After completing
the strength training program, her functional capacity and walking ability improved so
much that she actually left the nursing home and rejoined her husband in the independent
Fitness, Function and Finance
As the exercise participants increased their physical fitness, they concurrently
improved their functional abilities. That is, they were able to perform various
activities associated with daily living that they were unable to do before the strength
training program. These restored abilities included walking, washing, dressing,
brushing, combing and other activities characteristic of personal independence.
Of course, this is beneficial to both the participants and the providers. It is
estimated that every point increase in a patient's FIM Score reduces the cost of care by
50 cents a day. An 11-point FIM Score gain therefore represents a cost of care
reduction of $5.50 per day. Multiplying this by the 19 subjects in our study, we
have a daily cost of care reduction of about $105. On a yearly basis, this
represents almost $40,000, which is about 2.5 times the cost of the Nautilus machines.
Based on the results of our 14-week strength training study with frail nursing home
residents, we conclude that performing one set of 8 to 12 repetitions on five selected
Nautilus machines is a safe, efficient and effective means for enabling elderly exercisers
- Improved body composition
- Increased muscle strength
- Enhanced joint flexibility
- Increased functional ability
Our findings further indicate that senior living facilities that provide well-designed
and properly supervised strength training programs may expect:
- Increased patient independence
- Improved cooperation between patients and care givers
- Reduced health care costs
- Enhanced potential for attracting new residents and professional staff
Table 1. Nautilus machines, target muscles and desired outcomes of the strength
||Desired Outcome of the Training Program
|Able to hold head erect for enhanced breathing, swallowing, speaking,
seeing, and comfort.
|Low Back Machine
||Able to hold torso erect for better posture, physiological function,
ambulation, and comfort.
|Compound Row Machine
|Able to hold shoulders square for better posture, physiological function
|Triceps Press Machine
|Able to push against chair arms to assist legs in rising from and lowering
to wheelchairs or chairs.
|Leg Press Machine
|Able to lift body up from and down to wheelchairs or chairs. Able to walk
without losing balance or falling.
Table 2. Changes in body composition, muscle strength, joint
flexibility and functional ability for elderly exercisers following 14 weeks of strength
||+ 1.0 lbs
||- 2.2 %*
||- 2.9 lbs*
||+ 3.8 lbs*
||+ 47.2 lbs*
||+ 14.7 lbs*
||+ 9.4 deg*
||+ 15.3 deg*
||+ 11.0 pts*
* Statistically significant difference (p<0.05).
Wayne L. Westcott, Ph.D., C.S.C.S, is
Fitness Research Director at the South Shore YMCA in Quincy, MA. He is strength training
consultant for numerous national organizations, such as the American Council on Exercise,
the American Senior Fitness Association, and the National Youth Sports Safety Foundation,
and editorial advisor for many publications, including Prevention, Shape, and Club
He is also author of 20 fitness books
including the new releases, No More Cellulite, Building Strength and Stamina, Strength
Training Past 50, Strength Training for Seniors, Complete Conditioning for Golf, and
Strength and Power for Young Athletes.
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