[Physio Explained] Muscle power, not strength, the key to falls prevention with Dr Mariana Wingood
Sep 4, 2024
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Dr. Mariana Wingood, a geriatric-focused researcher and program director, shares insights on the crucial distinction between muscle power and muscle strength in preventing falls among older adults. She highlights that muscle power, rather than strength, is a better predictor of falls, with practical assessments like the 5x sit to stand test proving essential. Mariana discusses the importance of incorporating power training into rehabilitation and balance programs, advocating for strategies that can enhance muscle power effectively, thereby reducing fall risk.
Muscle power is a crucial predictor of fall risk in older adults, surpassing traditional assessments of muscle strength alone.
Effective fall prevention strategies should incorporate power training through high-velocity resistance exercises that enhance muscle power performance.
Deep dives
The Significance of Muscle Power in Fall Prevention
Muscle power plays a critical role in preventing falls among older adults, overshadowing the traditional emphasis on muscle strength. Research reveals that as people age, fast-twitch muscle fibers, which contribute to muscle power, deteriorate more rapidly than endurance fibers. The inability to generate quick, powerful responses can increase fall risk, highlighting the need for targeted interventions that assess and enhance muscle power. Specifically, studies show that those who are non-fallers can perform movements like the five-time sit-to-stand test significantly faster than those who fall, indicating that power output is a more reliable predictor of fall risk than mere strength.
Effective Assessments for Measuring Muscle Power
Clinicians can utilize specific assessments to evaluate muscle power in older adults effectively. The five-time sit-to-stand test is a popular and accessible measure that includes a cutoff time of approximately 12 seconds, indicating satisfactory power output. Additionally, the four-step stair climb power test offers another practical method to assess power by timing how quickly individuals can ascend stairs. Both tests not only identify muscle power levels but also aid in implementing more sensitive measures based on power output, providing valuable insights into the patient's risk of falls and progression over time.
Training Approaches to Enhance Muscle Power
Incorporating power training into rehabilitation programs for older adults can significantly improve their fall prevention capabilities. Evidence suggests implementing high-velocity resistance training that focuses on rapid contractions can enhance muscle power. Suitable exercises include variations of lunges, step-ups, and the previously mentioned sit-to-stand activities, ensuring patients engage in both concentric and controlled eccentric movements. Clinicians should aim for a regimen that applies appropriate resistance while promoting the speed necessary for effective movement, encouraging adaptation and reinforcing the development of crucial power skills.
In this episode with Mariana, we discuss a recent article looking at the difference between muscle power and muscle strength in predicting falls in older adults. This paper found the 5x sit to stand as a measure of power was a better predictor of falls compared to manual muscle testing or strength testing using a dynamometer. We discuss:
The implications of this paper for our patients
The difference and the relationship between muscle power and muscle strength
Best tests to use to assess power output in your patients
How you can use strength exercises to improve power in patients of all ages with and without equipment
Importance of power and strength for balance training in this population
Dr Mariana Wingood is a clinician, a program director of a CEU company that provides courses related to Geriatrics, and has a PhD on physical activity prescription among physical therapists.
Reference to article: Simpkins C, Yang F (2022) Muscle power is more important than strength in preventing falls in community-dwelling older adults. J Biomech, 134, 111018.
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Our host is @James_Armstrong_Physio
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