How do I build leg strength in a geriatric client with limited mobility?
I have a 74 year old male client who is awaiting a knee replacement (the other knee has already been replaced). He has had numerous surgeries (quadruple bypass, brain stem, removal of fluid from his knee, etc.) and is a real trooper. He cannot stand for very long so I have been doing most of my workouts with him in a chair. He would like to build more leg strength so he can stop using his walker and use a cane but it is very difficult to work his lower body with strength building exercises. Any suggestions on what I should be doing to (1) build his leg strength up and (2) keep him from getting frustrated until he gets his knee surgery?
You have to think specificity. If he wants to get better at walking, you have to start doing more exercises standing. Find a safe environment where there is no risk of falling. Standing up from a chair ever which way is probably an exercise for him. See how many times he can do it. This will also give you something quantifiable. Have him do mini squats. Sit down to rest in between as necessary but then stand again.
He is in a challenging situation, and there is currently only so much you can do. After the surgery, he will be initially under the care of a physical therapist, and you should hook in there as quickly as possible so that you can assist him seamlessly after he has been cleared for exercise.
I wish you and him good luck.
A ball against a chair leg can be a great hamstring workout waiting to happen- just have him put his heel on the ball & try to "pop" it. This can be done with fast "pulses" or for a longer hold (great way to measure a starting point & progress). Also don't be afraid to think outside the box- try "chair walks" by "walking" the glutes forward & backward (from the back of the seat to the front & vice versa) & use the chair to assist with balance during standing exercises. Keep encouraging him & if he's still frustrated try to help him channel it into his exercises. Remind him that he's making progress & not to worry about what can't be helped- to just work around it.
Sounds like you're on the right track. Karin has a good point that to get better at walking, he'll have to walk! I like the idea of water workouts as well since there's very little impact & lots of potential resistance but didn't know if you have pool access? Make sure he's medically cleared for everything you do with him. Feel free to contact me if you want more ideas!
I would recommend doing some basic chair squats, just as he would if he were getting up and down out of his chair. He could use the walker to assist if he has and at some point be able to use his own body weight without any assistance. As he gets stronger you can easily add resistance with a light dumbbell, if he were ever to need to challenge the exercise. Glute Bridge is another exercise that can be beneficial, as long as he can get up and down from the ground. This will help strengthen the core muscles and help build power within the hips, a very basic exercise with lots of benefits.
Have him sit up at the end of the bed in between exercises and do gentle shoulder circles or light bicep curls as he will need upper body strength as well.
Clear any new exercises with his doc
All of the above answers sound great, but I would suggest adding some cardio to the routine as well. Part of his problem with standing for long periods of time may be that he doesn't have the stamina. I usually start my older clients out on a recumbant bike or a Nu-Step for 5-10 minutes and progress them from there based on how well they are doing. This will also help build his knee strength. He may have already been riding a stationary bike after his first knee replacement so maybe that would be a good place to start. If you have access to his doctor or physical therapist it would likely be very beneficial to ask for their input.
I think that Judy did a great job of keeping the client's needs in mind here. Were this my client and I had the resources available to me, He would without a doubt start his training out in a pool setting using proper floatation assistance. I think there are only benefits here. Less load on the joint during motion being my primary concern. With this client not being able to stand up for an extended period of time, you have to train functionality and stability in that joint as much as you can. That limits the strength building part of this client's plan quite a bit. A step at a time is the only way to go, especially with much older clients, having worked with a few of them, myself.
I think the pool would also be a fun addition to the training. I've never known someone not to have a fun time in the water! It's a great change from the "land-lubber" existence that we have most of the time. =)
maybe start by assessing his R.O.M. without pain with motions like assisted squats(utilizing hands to stabilize & guide his motion). Testing his neg & pos motion ability here SLOWLY...
I have also utilized isometric contractions n the past 4 clients with very limited R.O.M. in the lower body, thera bands offer moderate/adequate resistance.
If available, I like the idea of working n water also. What will b big I think is to have both of your confidence levels up. U can feed off each other, especially if he is willing 2 put n a good effort.
SAFELY is the key word here. When we take on clients w/medical complications we are @ as much risk as they. If u have his trust, work him, if he does well w/basics offer him a challenge like assited sitting & standing from & to seated position(1/4 motions) but stress to him the importance of HIP GUIDED MOTION(move hips 1st) & knee & toe alignment, then tempo(always SLOW).
Weight bearing will help in small doses as well, to help with bone density as well as muscle strength.
Stay with machines that mimic body movements and move the client along one plane of motion.
I hope that this helps.
1. Why not work him lying on a bed or table (or floor if he can get there)? I think most people consider this "post op" or "rehab" but a lot can be gained. The following exercises can be done perhaps without pain? Lying straight leg lifts, bridges, ball rolls/heel slides, abductor, adductor ball squeezes, hip extension, prone leg curl with band resistance, pilates ring work, clamshell, and lots of core work too! Often when folks are in chairs they aren't aware of their core especially if they're worried about leg pain. This will go far helping his rehab. Good leg can help then progress to single leg if tolerable and ankle weights.
2. IMO: If someone feels pain standing, squatting might produce more lower body imbalance. I'd stick to partial squats with him holding on to something (standing) and work upper body in chair.
Difficult exercises first.
3. Calf raises too.
4. Bike with upper body (schwinn) so he can help himself too.