October 2017

Out on a limb: Strength of purpose

By Jordana Bieze Foster, Editor

Everyone has days when we just go through the motions—at our jobs, in social situations, at the gym—and tell ourselves it isn’t a big deal. But as clinicians you know that when patients just go through the motions of complying with prescribed treatments, their outcomes are almost certainly going to suffer. And new research suggests that can literally be a matter of life and death.

Multiple national healthcare organizations now recommend that older adults participate in strength training at least twice a week, and research suggests the benefits of complying with those recommendations include an extended life expectancy (see “Get stronger, live longer: But few older adults meet US guidelines,” April 2016, page 13).

The problem with these types of guidelines, however, is their lack of specificity. For some people, a 30-minute session of strength training might involve pushing their muscles to the limit; for others, that same 30-minute session might involve more sitting and socializing than actual strengthening.

It makes sense intuitively, of course, that strengthening exercises are more likely to have the desired effects on mortality in the results-oriented group of individuals than in those who put in minimal effort. And, as we report in this issue of LER, a new study supports this concept: Researchers from the University of Mississippi found individuals’ self-reported compliance with national strength training guidelines was not associated with cancer-specific mortality, but lower extremity strength was (see “Strength drives survival: But benefits of training appear complex,” page 13).

In other words, the mortality-related benefits of strength training require more than just showing up and going through the motions.

The mortality-related benefits of strength training require more than showing up and going through the motions. You can help.

Experts say lower extremity clinicians can help improve the effectiveness of their patients’ strength training endeavors by offering specific advice about training approaches that are most likely to actually increase strength, and by monitoring patients’ strength over time to see if significant increases are being achieved.

This, obviously, is a lot more work for clinicians than simply telling patients about the national guidelines and asking them to self-report their level of compliance. For many clinicians, it’s already difficult to find enough time to give each patient the care he or she needs without adding to the workload. Those who do have the time may not have the appropriate equipment for monitoring lower extremity strength during patient visits.

But, knowing patients left to their own devices are likely to fall short of the strength levels needed to improve outcomes, I hope most clinicians will try to find ways to give those patients more constructive guidance. Maybe that means having them bring copies of their resistance training worksheets from the gym every time they have a clinic visit. It’s not the same as measuring strength directly, but it could still make a meaningful difference.

National guidelines serve a valuable purpose. But it’s becoming more apparent that such guidelines are unlikely to translate to improved outcomes unless both patient and practitioner are committed to doing more than just going through the motions.

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