As physiotherapists, I think the vast majority of us enter into the profession due to a strong desire to help people. That was certainly the case for me. In fact, the main reason why I decided to go into physiotherapy rather than medicine was the allure of human connection – to have more time with my patients, a greater opportunity to connect with them, to educate and empower them, and to help restore function and performance in multiple facets of life. I couldn’t imagine a better job.
Fast forward several years, and I found myself working in a busy private orthopaedic clinic. I still loved my job and embraced the privilege of working with my patients every day. But there were days when at the end of my shift, I would reflect back and wonder if there was more that I could do.
Specifically, I observed that a lot of my older patients were having difficulty maintaining their strength and function as the years went by. In some cases, they felt afraid or reluctant to get active and unsure of what to do, particularly those who had diagnoses such as osteoarthritis, osteoporosis, joint replacements, metabolic syndrome or other chronic diseases. Additionally, there was a lack of safe, appropriate and effective exercise programming for older adults in our community. As a result, these older adults would often remain or become more sedentary. Unfortunately, as we can imagine, this only accelerates the decline over time. Bone density and muscle mass drop, strength and mobility deteriorate, balance suffers, fall risk climbs, and a multitude of psychosocial factors can be negatively impacted. Sadly, this is often just chalked up to “aging”, as if there is nothing we can do. Fortunately, that is far from the truth.
Strength Training as a Solution
Recent years have brought about some practice-changing research which has demonstrated that high intensity strength training is both safe and extremely effective in older adults, including osteoporotic patients. For instance, the 2017 LIFTMOR trial demonstrated that in osteoporotic patients, bone responds very well to progressive strength training (back squat, deadlift and overhead press) and impact loading (jumping chin-ups with drop landings). Additionally, they recorded improvements in functional performance and even thoracic kyphosis. Groups around the world are also demonstrating successful models of delivering just this type of intervention. Some examples include The Bone Clinic in Australia, Stave Off in Ontario, Greysteel Strength and Conditioning in Detroit, and a growing number of Masters programs in CrossFit gyms across North America.
The Longevity Program
The desire to do more for my patients led me to develop a program called Longevity, which was launched in CrossFit Leduc in the Fall of 2016. Held twice per week, this hour-long group training session for adults over 50, is coached by myself and the head coach and owner of CrossFit Leduc, Brad Bendfeld. We begin with a group warm-up, then work on resistance training and, finally, a WOD (“workout of the day”), which typically involves some interval training. Participants undergo an intake assessment prior to entry to the program, and all workouts are modified as needed to be safe and appropriate for each individual, while still delivering a challenge.
Our participants laugh, smile and encourage each other as both a sheen of sweat and a sense of accomplishment appear. I see that, in most cases, the decline in their function is not only slowed, but reversed. They are getting stronger, fitter, moving better than they have in years and they are having so much fun doing it. But there is more to it than getting stronger and building denser bones. We all want that, but what really makes me happy is when I hear a patient say that she can now play with her grandkids because getting on and off of the floor isn’t so hard anymore, she can now pick up her grandchild, go up the stairs much more easily, and so on.
We have a number of participants in their 70s, some with joint replacements, many with osteoarthritis and osteoporosis, and they are all making gains. We have participants who are now deadlifting 200lb with impeccable form and blowing their own expectations out of the water. The goal is not to deadlift 200lb – although those who can are incredibly proud of their progress to achieve that! The goal is to maximize function and to build resilience, with the overarching goal of maximizing and preserving quality of life. Isn’t that what physiotherapists strive to do? It certainly is what drew me to the field many years ago.
A New Career Path
What started out as a solution to fill a need in our community, ended up changing my career path. In falling in love with Longevity, I decided to leave my position as Clinical Lead at that busy private clinic. I now continue to program and coach Longevity on an ongoing basis but, additionally, I opened RX Physiotherapy, my own practice within CrossFit Leduc. In this setting, a new model of care has become a reality, one where strength training is integrated into treatment in a capacity that is not typically seen in traditional clinics, and where the lines between rehabilitation, preventative care, and physical performance are appropriately blurred.
In our field, I feel there is so much potential to continue to do more for our patients in this capacity. Let’s strive to deliver care that goes beyond traditional confines. Let’s explore partnerships with those in the strength and conditioning world – we can be tremendous allies, rather than competitors, and we have so much to learn from one another. Let’s challenge our beliefs regarding exercise and rehabilitation in the older adult and embrace appropriate loading in this population. Honestly, I cannot convey how rewarding this can be.
Watson, SL, Weeks, BK, Weis, LJ, Harding, AT, Horan, SA, Beck, BR. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research (2017) 1–10.