Strength Training for You and Your Patients-Make Yourself Stronger Than Your Excuses!
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AOASM with ACOFP Sunday October 18, 2020 1 Strength Training for you and your patients-Make yourself stronger than your excuses! Vincent Disabella DO FAOASM 2 Faculty Disclosure It is the policy of the ACOFP Program Committee OMED organizers that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. All faculty in a position to control content for this session have indicated they have no relevant financial relationships to disclose. The content of this material/presentation in this CME activity will not include discussion of unapproved or investigational uses of products or devices. 3 Strength Training ! Strength training: Strength training involves the performance of physical exercises which are designed to improve strength and endurance. – Contrary to popular belief it does not only mean weight lifting. – Can be done by ANYONE and can be done ANYWHERE! – Has many more benefits than just building strength. – Strength training does not promote overall fitness but is a key component of fitness. – Myth: Cardio is better than Strength Training. 4 Terms to understand and help with the dialogue ! Concentric contraction: the act of shortening a muscle. – Used to do positive work or accelerate a body part. – The flex ! Eccentric contraction: the presence of a resistive force that elongates the muscle. – Used to do negative work or decelerate a body part. – The negative. ! Isometric contraction: the contraction of a muscle which neither creates shortening or elongation of the muscle. 5 Terms to understand and help with the dialogue ! Open chain exercises: the limb being exercised is free to move. – Examples: a biceps curl, leg extension, row. ! Closed chain exercises: the limb being exercises is fixed. – Examples: squat, push-up. ! Flexibility: the elongation of a muscle throughout a joints range of motion. ! Joint Mobility: the degree of movement an articulation can achieve before being inhibited by the surrounding soft tissue. ! Dynamic Warm-up: the slow deliberate movement of a muscle or group of muscles to increase blood flow to body part(s) to be trained. 6 Benefits of Strength Training ! Reverses the age related muscle loss know as sarcopenia. – Numerous studies have shown that regular strength training (2-3x per week) can cause gains in lean body mass even into the 10th decade of life. ! Increase in Basal Metabolic Rate – BMR comprises 60-70% of the caloric expenditure in sedentary people. ! Building more muscle therefore increases BMR ! Strength Training causes micro damage to the muscle fiber which are then repaired by the bodies healing processes which increases energy expenditure. ! This lasts for up to 72 hours where recovery from aerobic activity takes 24 hours. 7 ! Decreased body fat including visceral fat. – 2014 Harvard study published in Obesity showed that strength training is more effective at reducing body fat than aerobic exercise. – This is most likely due to increased BMR, increased insulin sensitivity and increased sympathetic activity. ! Better glucose control and decrease type 2 diabetes. – It is known that strength training decreases visceral body fat which is known to contribute to insulin resistance. – It is a fact that muscle utilizes more glucose than fat tissue. 8 ! Better physical function – Multiple studies on weight training show better balance, faster walking times, better daily activity function which prevents injuries and maintains independence in the elderly. ! Better Cardiovascular Health – Strength training increases HDL, decreases triglycerides and lowers blood pressure. – Decreases total cholesterol and LDL. – Study published in Lancet in 2015 postulates that grip strength is a better indicator for cardiac health than blood pressure. 9 ! Increased Bone Mineral Density – Every time a muscle contracts it causes stress on the bone which causes the bone to adapt. – Numerous studies show and increase in BMD of 1-3% per year of strength training which helps reverse the 1% loss yearly in post menopausal women. ! This benefit is lost with termination of strength training. ! Increased Flexibility and Joint Mobility – A 2017 study in the North American Journal of Sports Physical Therapy suggests that eccentric training may increase hamstring flexibility more than static stretching. 10 ! Improved mental health and body image. – Decrease in anxiety, depression and fatigue – Increased sense of accomplishment, less pain with activity and higher self-esteem. – These effects have been shown to be accomplished with low to moderate weights. – Group strength training enhances a sense of community. – Increased cognitive ability in elderly ! Even a greater effect when combined with aerobic activity. 11 Modes of Strength Training ! Body weight – Calisthenics: push-ups, pull-ups, squats, dips, toe raises – Can be done anywhere by anyone. – There are multiple adaptations to every movement. – Need little or no equipment. – Can be augmented with elastic bands or weighted attachments. – Can be much more advanced and done in many ways. – Great for older patients or people intimidated by gym atmosphere. “The only reason not to strength train is lack of a heartbeat’ -Statement I made when Team Physician at the University of Delaware. 12 ! Weight Lifting – Normally thought to be barbells, dumbbells, kettlebells. – Machines made specifically for specific exercises ! Some machines are select drive weight machines ! Some use hydraulic resistance. ! Some are loaded with weight plates. – Can be done in many settings but equipment is needed ! Home gyms have become very popular over the years, especially the last year. ! Globogyms come in all sizes and colors. – Proper instruction with intention to form and proper weight choice is important. 13 ! Odd Object Lifting – Has become very popular over the past decade or two. – Can consist of any objects from tires, ropes, sleds, rucks, medicine balls, sandbags. – Can be a creative way to help patients strength train who do not have access to gym equipment or can not afford gym memberships. ! Be creative: sandbags, buckets of sand, logs, children. ! Use household objects for elderly, it takes away the intimidation factor of a gym and makes training available on a small budget. ! Remember to make it accessible so that it can be done. 14 Meat and Potatoes: Different types of Strength Training. ! Circuit Training – Whole body training in one workout. – Consists of multiple exercises to target the entire body done in succession. – Usually done in a class or can be individual – Can use machines, free weights and aerobic equipment. – Often done with a time component to add aerobic conditioning. – Circuits can be varied to keep body stimulated and add variety. 15 ! Bodybuilding – More concerned about aesthetic appearance than overall health. – Body parts are isolated in each workout with specific body parts done in specific workouts ! Training days are split in multiple ways such as Back-Biceps, Chest-Triceps, Back, Legs. ! Can be separated into Push, Pull and Leg workouts ! Must be supplemented with aerobic activity . ! Often split into periods or cycles: building cycle, cutting cycle and maintenance. ! Typical Gym Rats ! Can have some unhealthy habits when taken to extreme. 16 ! Power Lifting – Concerned with building strength in three lifts for competition. – Bench Press, Squat and Deadlift – Do accessory exercises to develop these three lifts. – Safety can be an issue due to always chasing a higher weight lifted. ! Olympic Lifting – Concerned with building strength in two explosive lifts. – Clean and Jerk, Snatch – Technically difficult lifts which take a great deal of skill and neuro recruitment. – Can be used in training for sports. 17 ! Boot Camp, Body Pump, Orange Theory etc.… – Done in a group setting with intense circuit type training. – Have different ways of recording progress – In my mind make exercise exciting and fun for people who otherwise don’t enjoy it. ! P90X, Insanity etc.… – Home versions of boot camp type workouts done from video guidance. – Very high intensity which can lead to injuries if people are not ready to go to that level – No instructor to correct improper form or intensity. 18 ! HIIT: High Intensity Interval Training – High intensity training with heart rate up to 80% MPHR with built in recover or rest periods. – Can limit the amount of time in workouts and get the same stimulus as longer less intense workouts. – Can be done with both strength training and aerobic activity. – Due to the intensity injuries can occur when form gets sloppy. – Can use tabata type workouts, EMOMs, training on/off intervals. 19 ! Crossfit – Training methodology using multiple types of training: functional fitness – Combines powerlifting, Olympic lifting, gymnastics, kettlebell, bodyweight and odd object lifting along with aerobic training to build fitness and strength. – Utilizes HIIT type activities along with endurance and strength training to increase overall fitness. – Has its own little language: AMRAP, EMOM, METCON. – Can be adaptable to anyone at any level of fitness-works for a metabolic effect “Your needs and the Olympic athlete differ by degree not kind.