Power Training and Explosive Movements for Improved Bone Density in Older Adults

Dr. Jeff Musgrave // #GeriOnICE // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Jeff Musgrave discusses research supporting the effects of high-velocity resistance training on older adults, including benefits for bone mineral density, the effects of detraining, and different ways to implement power training with patients. 

Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog.

If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

EPISODE TRANSCRIPTION

INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today’s episode, I want to talk to you about VersaLifts. Today’s episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today’s show notes to get your VersaLifts today. JEFF MUSGRAVE Welcome crew to the PT on Ice Daily Show. My name is Dr. Jeff Musgrave, Doctor of Physical Therapy. Super excited to be here with you. Hopefully you have been enjoying the holidays however you enjoy to celebrate over the last few days. Super excited to bring to you really interesting systematic review looking at high velocity resistance training for adults 50 plus. So what we're going to be covering today is you know what are the primary results, what can we learn about dosage when implementing this intervention for adults 50 plus and then we're gonna spend actually quite a bit of time talking about clinical considerations for this type of information and talking a little bit about just the body of research that already exists. So let's get into it team. This systematic review included 25 randomized controlled trials. We had 12 original studies. We had 13 follow-up studies. What they did is they were applying high-velocity resistance training to older adults. People 55 plus and they define this as having a slow eccentric phase with a explosive concentric phase. So in general, we would just reference this as power training, right? Kind of like a broad jump where you're going to slowly load the movement and then you're going to explode. then the other piece of this is having additional resistance with this. So traditionally this is basically just power training. Power training could include jump training, it could be Olympic style lifts like snatches or cleans with dumbbells, barbells, whatever implement you want, kettlebells, any of those type of implements.

EFFECTS OF HIGH-VELOCITY RESISTANCE TRAINING ON BONE MINERAL DENSITY So What they did is after they included their studies that met their criteria, they dug in and they had to have pre and post DEXA scans to figure out what their bone mineral density was at the beginning and then also at the end. They also had to have a six-month follow-up One of the studies actually had a 16-year follow-up, which is pretty wild. Being able to get a randomized control trial with a year follow-up is pretty great, but 16 years was pretty wild. So they looked at bone mineral density at the femur, the femoral neck, the lumbar spine, and also the distal radius. Only two of the studies looked at the distal radius to see if there were any changes in bone mineral density. The rest of the studies did not look at that area. Unfortunately, those two studies showed no change. So we'd need to dig into those studies more specifically to look at the loading strategies for those to really try to figure out what happened there because we know Basically, in general, our body's gonna respond to all the load. So if we get proper loading, due to Wolf's Law, we know those osteocytes are gonna start producing osteoblasts, and then we're gonna lay down fresh bone if we get proper loading. So no changes in the distal radius with using high-velocity resistance training. They did, however, find statistically significant results looking at the total femur on the DEXA scan, the femoral neck, as well as the lumbar spine. So there were statistically significant findings there using high velocity resistance training, AKA power training. So that was pretty cool. So we know that that is a modality that would be beneficial. The dosage, if we're moving on from what were the results, so it was beneficial, then the results were the results in the dosage were that twice a week is kind of the minimal dosage to see change in the skeletal system. So at least twice a week is what we should be looking for for dosage. Unfortunately there was so much heterogeneity in our different interventions that they weren't able to conclude a specific loading percentage. We do know just in general when it comes to power training that our percentages are going to be lower than resistance training because we're adding the component of speed. So if we're going to slowly get into that eccentric position to then explode into concentric, it can't be at the same percentages that we use at resistance training. So we know as a blanket statement that it's lower load than resistance training traditionally is. But what that is, there was not any formal consensus found from the systematic review. But they did find that two times a week is the optimal frequency that we're looking for if we're trying to change the skeletal system. they did find because their minimal follow-up was at six months, that if there was no training across that six-month period, that the gains that were created were also lost.

THE EFFECTS OF DETRAINING So we want to keep that in mind that detraining, just like for the musculoskeletal system, the skeletal system as well, if you don't maintain those results, you're not going to be able to keep them. A really easy way to think about this is fitness is forever. It's just like brushing our teeth. We don't go to the dentist and say, well, you know, you've done a good job the last 50 years, so you know what, let's just take off the last 40 years. You don't really need to brush your teeth anymore. No, the results are not gonna be sustained and the same thing goes for our skeletal system. So once we get those results, we wanna make sure that we're getting people to be loading their bones at least twice a week. And this to be a thing that it's like, it's gotta be scalable across a continuum, across a lifespan for people, or it's not gonna necessarily be beneficial. We can give them a little bump, but that just makes it so much more important. that we're selling fitness from day one. What are you gonna do once care ends? If you wanna maintain these results, we know we can give you results. We know we can get you there, but you're gonna need to continue this training, kind of indefinitely. So finding fun forms of exercise that's gonna include high-velocity resistance training to help maintain bone density is helpful. Now, where we're gonna spend the bulk of our time is on clinical considerations. So I talked about there being high heterogeneity in our interventions. So the interventions included dumbbells, they included machines, resistance training. I found this very interesting. There was actually a masters football team that was included in this study, which I think is super cool. There were also some Olympic lifts that were being completed. in this study as well. Now, probably the most disappointing part of this study for me was this quote, which I'm gonna read to you. It may be unlikely that older adults are willing to engage in Olympic style lifting or soccer and that performing explosive concentric with slower eccentric movements using machines or free weight style equipment may be more feasible, safe and result in better adherence for the population. Now that was researcher opinion. And I can understand if you've got someone that is super sick, super frail, super deconditioned, it may not be feasible to get them out playing football or playing soccer. But when we're thinking about our active 50, 60, 70, 80 year olds, I mean, we've got people pole vaulting in their 80s. These things are not out of reach for older adults. For them to be doing Olympic style lifting, explosive type movements, Just anecdotally at Stronger Life, we do tons of agility, power, jump training with people all the way up into their 80s with no injuries. So a little disappointed in that statement. I can understand clinical practice, maybe we're talking, you were in the ICU, you're in acute care, you're like, okay, yeah, we're not probably gonna be playing soccer in my sessions.

"THE NEEDS OF AN OLYMPIC ATHLETE AND OUR GRANDPARENTS DIFFER BY DEGREE, NOT KIND" But when we're thinking about long-term, we're thinking about strategies for for people that are over 50 like these are not out of reach we can absolutely be doing olympic style lifts and it reminds me of the quote from coach greg glassman who created crossfitted the needs of the of athletes and our grandparents are the same. They differ by degree, not kind. We need these types of interventions for our older adults to help with their bone density. And I would argue that power training, Olympic-style lifting, some of these more explosive-style activities are actually way more fun. I mean, let's think about pickleball, for example. Pickleball has tons of power training incorporated in it. And I would say, although it is becoming more popular in younger populations, I would say 50 plus probably has a market cornered on those style of movements. So the big takeaway there is don't count out power training for our older adults, Olympic style lifting. where they're moving quickly. Now another interesting discussion in there while we're talking about power training is that there were specific adaptations that were special to some of these cutting and power agility type movements that they described as odd stressors. So when we're thinking about the bone, if the load is only in one direction, we're only going to get adaptations, by and large, in that direction. When we start thinking about loading the bone from different angles with different cutting and different movements, then we can get adaptations in different directions, which, by and large, is going to help make our bones more resilient, less likely to fracture if they've encountered load in multiple directions and odd type stressors.

POWER TRAINING VS. RESISTANCE TRAINING Now the study was, this systematic review was not strong enough to say high resistance interval training, or sorry, high intensity, high velocity resistance training is superior to high load resistance training. So we can't say power training's better than resistance training. We can't say that those odd type stressors with agility type movements are superior either. So basically this is all modality we should have. It was strong enough results that if you're not doing power based movements, agility, jump style training, Olympic style lifting, you should get that included into your clinical practice for older adults that are trying to improve their bone density. It is clear that it should be part of the approach. Now I will say if you're looking at the overall results, the two different, levels of quality here. We've got a systematic review, which way trumps the randomized control trials I'm about to reference. But if you look at this multi-modal approach, because the systematic review really did not have just high-velocity resistance training, there was strength training, there was balance, there was functional training. There were all these different modalities. It wasn't just high velocity resistance training included in the study. So it was really a mixed modal approach, but a common thread was that high-velocity resistance training was included. Now, some former studies of a lower level of evidence, if we're looking at the Lift-More or the Lift-More-M trials, those are both free access to the public, you can Google those very easily, use this mixed modal approach, but it had a much more specific dialed-in approach to loading. So there was high resistance training, 80% plus of a one rep max included and power training included. That mixed modal approach with a higher percentage of resistance seemed to be very beneficial when we're looking at the Lift-More and Lift-More-M trials. I would say that's one thing that's different from the systematic review is the criteria did not include a minimum threshold of resistance. Now those are my caveats from reading this and kind of thinking about the body of research.

SUMMARY So if we're gonna boil this down, we're gonna ask, does high velocity resistance training help build better bones? We would simply say yes. Dosage that we need, two times a week. We know that there's a detraining effect if people stop this training for more than six months. So fitness is forever. We need those training methods, those modalities to continue. Considerations for clinical practice. Can we hang our hat on just high velocity resistance training? No. This was not strong enough to rule out just heavy resistance training. The body of research is larger there for making changes in bone mineral density just in general. It should probably include some power training like Olympic style lifting or agility training as well. That's also going to be beneficial. No clear winner on the type of modality, whether we're going to use dumbbells, kettlebells, barbells, resistance bands. All of those things are on the table, which is actually great because we don't always have those same exercise modalities. So it seems to be more important to hit those thresholds for power training, to hit those thresholds for resistance training, but maybe it's not so important that we just have X equipment in our clinic or at our disposal, which is actually great news. Team, I hope you enjoyed this review. I will have the the DOI listed if you want to look at this article more in depth on your own as well as the ones for the Lift More and Lift More M trials. If you found this interesting and you're interested in coming to see us on the road, I tell you what, live is a great place if you are new to loading bones or maybe you want some new Method styles to load your bones for your older adults. We have a whole impact training lab Lots of resistance training labs where we can help you dial in the dosage for the person in front of you From the ICU all the way up to fitness and masters Athletes, which is wonderful in our older adult live course. The next ones are going to be in Santa Rosa, California That'll be January as well as you can catch us in Marysville, Ohio on the 13th and 14th of January, then we're going to have Clearwater, Florida just a week or so after. If you're looking to continue your journey towards getting your MMOA cert, if you want to catch us in the L1, Previously Essential Foundations, that will kick off on January 10th. In the L2 course, which prior was called Advanced Concepts, is gonna be kicking off on January 11th. I hope you have or are still enjoying your holidays. Love to get your thoughts, comments on this super interesting systematic review. And that is it for now, team. Catch you later.

OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you’re interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you’re there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.