The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


Preparing for a fall: The role of muscular strength & muscular endurance

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Monday, Aug 08, 2011

When discussing the topic of falls and older adults, the topic of osteoporosis frequently arises. Osteoporosis is often considered a silent disease until after a fracture, that might be the result of a fall.1 It is defined as a skeletal disorder that is characterized by compromised bone strength (often low bone mass) causing an increased risk of fracture. “Normally, the inside of a bone looks like a honeycomb.”2 Think of a tightly knit honeycomb and how hard it would be to smash it or fracture it. It is very strong. But in situations of osteoporosis, “the spaces in the honeycomb get larger and the bone’s hard outer shell gets thinner.”The honeycomb represents the density of your bone and the less dense it is, the easier it is for a fracture to occur--just like the wide-holed honeycomb would likely be easier to smash, break or fracture.

“In 2005, an estimated 2.1 million fractures were attributed to osteoporosis, resulting in health care costs of approximately $17 billion. By 2025, fracture rates are expected to rise to 3 million, and the corresponding increase in health care costs is expected to reach $25 billion.”1

Last week, we discussed the “Best Way to Prevent Falls” through the role of power exercises. But power exercises are only one component of muscular fitness. Remember muscular fitness includes muscular strength, muscular endurance, and power. All of which can be improved through resistance training.

Are power exercises the only component of muscular fitness that individuals should focus on in relation to falls?

Of course, as discussed last week, a certain level of muscular strength and muscular endurance is needed to perform power exercises. But there is also significant news in reference to the staggering statistics above and the prevention of osteoporosis and the consequences that can occur if a fall occurs.

Research has shown that exercise that promotes muscular strength and mass also effectively increases bone mass and bone strength. But to increase the strength and mass of bones, the bones must be put under stressed, or used. Thus, ACSM's position stand published in Medicine and Science in Sports and Exercise reported that muscular strengthening exercises may serve as “valuable measures to prevent, slow – or even reverse – the loss of bone mass in people with osteoporosis.”3

How do you train for muscular strength and muscular endurance with an older individual? Recommendations from research have shown that for older, very deconditioned, or frail individuals starting a resistance training program, they should begin with lower resistance between 40%-50% of a 1 repetition max or weight that is considered very light to light intensity. Repetitions for these individuals should be higher and in the range of 10-20 repetitions per set.

As little as 1 set can elicit improvements in muscular strength and size, especially for novice lifters. As older individuals begin progressing, then they can increase towards the general recommendations for muscular fitness. General recommendations would include 2-4 sets of resistance exercises per muscle group. Rest is suggested between 2-3 minutes for increased strength and size. Intensity should be between 60%-80%, with beginners starting closer to 60%-70% and progressing. This intensity range should allow the completion of 8-12 repetitions per set. Research referenced in ACSM's position stand showed that training two to three times per week produces optimal gains in muscle function and size.

Conclusions Through power exercises falls can hopefully be prevented. But when they do occur, there is hope that as a result of muscular strengthening exercises, bone density has remained high and fractures do not occur. So continue performing strengthening exercises and begin implementing power to your (or your client's) workout to prevent falls.

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1Iversen, Maura D., Vora, Ruchita R., Servi, Amber, Solomon, Daniel. (2011). Factors Affecting Adherence to Osteoporosis Medications: A Focus Group Approach Examining Viewpoints of Patients and Providers. Journal of Geriatric Physical Therapy. 34(2), 72–81. 2Simmons, S. (2011). Osteoporosis. Nursing Journal. 41(1), 35. 3American College of Sports Medicine. (2011). Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise. Medicine and Science in Sports and Exercise. 43(7), 1334-1359.