Resisted Exercise Initiative (RExI)

Original Editor - Shaimaa Eldib Top Contributors - Shaimaa Eldib, Kim Jackson, Oyemi Sillo and Aminat Abolade

This article is currently under review and may not be up to date. Please come back soon to see the finished work!

Introduction

RExI is an abbreviation for the PT Knowledge Broker facilitated project started in April 2019: Resisted Exercise Initiative (RExI) – Use of resisted exercise by physiotherapists for elderly patients in British Colombia (BC) Hospitals.

The current volume and level of acuity of elderly patients in acute care settings challenges physical therapists to address all needs. One related aspect of practice that is receiving increasing attention is the optimal prescription of resistance exercise in these settings.

Goal: To support best practice in use of resisted exercise by physical therapists for elderly patients in BC Hospitals.

Objectives:

1. To determine existing practice.
2. To identify opportunities to support enhanced practice.
3. To undertake knowledge translation (KT) strategies to target barriers to enhance using of resisted exercise.
4. To evaluate effect of introduction of the KT strategies.

This project will:

• Describe current practice to confirm whether there is ‘a gap’ between current actual and desired evidence-based practice for PTs in BC.
• Determine the barriers to desired evidence-based practice from the perspective of the front-line public-practice PT.
• Map the barriers identified to categories identified by KT/implementation/behaviour change science.
• Using KT/implementation/behaviour change science and resources to identify targeted KT strategies to address the barriers.
• Develop/undertake, disseminate & support implementation of the targeted strategies.
• Re-evaluate practice post-implementation of the strategies.

Resistance Exercise Tool Kit

Definition&Benefits

Resistance Exercise;

Defined as movement using body weight or external resistance that improves muscular strength ,power , endurance and it may positively impact mobility ,function and independence.

Benefits of resistance exercise ;

• Improving muscle strength and tone.
• Maintaining flexibility and balance .
• Weight management and increased muscle to fat ratio.
• May help in prevent or reduce cognitive decline in older people.
• Greater stamina ( people will not tire easily due to improved body strength ).
• Prevention or control of chronic conditions ...eg (back pain, heart disease , arthritis , obesity &depression ).
• Pain management .
• Improved posture and decrease risk of injury.
• Decrease risk of osteoporosis by helping in increasing bone density.
• Improve sense of wellbeing , boost confidence and self-esteem.

A statement from National Strength and Conditioning Association highlighted the benefits of resistance exercise to older people ( Fragala et al .2019).

Aproberly designed resistance training programme can help in :

1. Counteracting the age related changes in human skeletal muscle.
2. Enhance the muscular strength ,power and neuromuscular functioning of senior citizens.
3. Improve older adults resistance to injuries and catastrophic events like : falls.
4. Improve mobility , physical functioning , performance of daily activities (ADL) and preserve independence.
5. Help in promoting psychosocial well-being of older adults.

Also Fragala et al .2019 recommended the resisted exercise training programme should be matched appropriately to the individuals'abilities and goals.

Considerations & Flags

Before prescribing resistance exercise , liaise with patient's physician your treatment plan and discuss the signs and symptoms to monitor :

Also, the American College of Sports Medicine (ACSM) screening guidelines flow chart could help to determine if REX is appropriate for resistance exercise https://www.acsm.org/docs/

Flags &Contraindications
Cardiac Conditions....eg ( unstable coronary heart disease, heart failure, acute myocarditis, endocarditis or pericarditis ) HR (Uncontrolled arrhythmia) BP ( uncontrolled hypertension >180/110mm HG. Aortic dissection or any risk factor to aortic dissection. Blood flow .....eg aortic stenosis.

Patient Considerations	Hematological Consideration	Physical Activity History	Cardiovascular Considerations	Musculoskeletal Considerations	Other Considerations	Equipment Consideration
Pain Strength Function Ability to learn Comorbidities and medications Oxygen Saturation and requirements Needs Supervision Fatigue Management Mobility Assessment	Hemoglobine (hgb) (monitor patients with levels less than 70g/L) Blood Pressure HR Oxygen Saturation SPO2. Platelets	Physical Activity vital signs (PAVS)* Rapid Assessment of Physical Activity * Physical Activity Screening for Elderly *	Risks of coronary Artery Disease Uncontrolled hypertension People with implanted pacemakers and defibrillators	Musculoskeletal Limitation Joint Pain and Instability (from arthritis or any other causes)	Diabetes at any age	Lines Aids ( eye wear , hearing aids & gait aids )

Exercise Physiology Foundation

1-Muscle strength & life course

Muscle strength decrease through adult years and life course . There is a strong link between decreased muscle strength and falls,immobility and mortality .

Loss in strength can be moderated by maximizing muscle in early adulthood , maintaining strength in middle age and minimizing loss in older age. This can be achieved through resistance exercise training . *(diagram)

Hospitalized older adults may experience some problems from immobility like: Muscle atrophy , Sarcopenia , cachexia.....eg

1- Muscle Atrophy

Types of muscle atrophy

• Disuse or physiologic Atrophy.
• Neurogenic Atrophy.
• Myogenic Atrophy.

2- Sarcopenia

Is defined as a progressive and generalized skeletal muscle disorder associated with an increased likelihood of adverse outcomes like falls, fractures, physical disability and mortality. Sarcopenia is considered a muscle disease ( muscle failure ) with the following 3 criteria :

1. Low muscle strength.
2. Low muscle quantity and quality.
3. Low physical performance.

• Probable sarcopenia is identified by criteria 1.
• Diagnosis is confirmed by additional documentation of criteria 2.

• sarcopenia is considered severe if 1,2 &3 criteria are met.

3- Cachexia

Cachexia is a complex metabolic syndrome associated with underlying illness and characterized

by loss of muscle with or without loss of fat mass. The prominent clinical feature of cachexia is weight

loss in adults (corrected for fluid retention) or growth failure in children (excluding endocrine

disorders). Anorexia, inflammation, insulin resistance, and increased muscle protein breakdown are

frequently associated with cachexia. Cachexia is distinct from starvation, age-related loss of muscle

mass, primary depression, malabsorption, and hyperthyroidism and is associated with increased

morbidity.Sarcopenia is one of the factors that may cause cachexia.

2-Regeneration Of Injured Skeletal Muscle

If the patient has sustained an injury to skeletal muscle, the following information regarding types of muscle injuries and phases of muscle healing may be helpful in planning the progression of resisted exercise.

File:Muscle regeneration.png

File:Muscle regeneration phase .png