““Resistive Exercise Testing in Resistive Exercise Testing in Cardiopulmonary Rehabilitation Cardiopulmonary Rehabilitation

Special Populations and the Special Populations and the Elderly”Elderly”

NCCRA Annual SymposiumNCCRA Annual SymposiumMarch 5-6, 2015March 5-6, 2015

• This presentation will This presentation will onlyonly focus on muscular focus on muscular strength and endurance testingstrength and endurance testing

• There are also There are also multiplemultiple tests for balance, tests for balance, gait, agility and flexibility that are in use gait, agility and flexibility that are in use today for various patient populations today for various patient populations

• Cardiopulmonary testing protocols are well-Cardiopulmonary testing protocols are well-

established and are also necessary for each established and are also necessary for each type of patient population type of patient population

• Cardiac (MI, CABG, Valvular, Stent, CHF, Transplant)Cardiac (MI, CABG, Valvular, Stent, CHF, Transplant)

• Cardiovascular (PAD, Stroke, HTN, TIA)Cardiovascular (PAD, Stroke, HTN, TIA)

• Metabolic (Diabetes, Obesity, Hyperlipidemia, Renal)Metabolic (Diabetes, Obesity, Hyperlipidemia, Renal)

• Geriatric (Frail, Elderly, Higher Risk Older Populations)Geriatric (Frail, Elderly, Higher Risk Older Populations)

• Immunologic (Cancer, AIDS, Fibromyalgia, CFS)Immunologic (Cancer, AIDS, Fibromyalgia, CFS)

• Neuromuscular (MS, ALS, Cerebral Palsy, Parkinson’s)Neuromuscular (MS, ALS, Cerebral Palsy, Parkinson’s)

• Musculoskeletal (Osteoporosis, Arthritis, Low back Musculoskeletal (Osteoporosis, Arthritis, Low back pain)pain)

WHICH SPECIAL POPULATIONS DO WE TREAT WHICH SPECIAL POPULATIONS DO WE TREAT IN CARDIOPULMONARY REHABILITATION?IN CARDIOPULMONARY REHABILITATION?

Chronic muscle deconditioning Chronic muscle deconditioning

leads to:leads to:

• energy expenditureenergy expenditure

• basal metabolic ratebasal metabolic rate

• muscular strengthmuscular strength

• activity levelactivity level

• fallsfalls

• disabilitydisability

• injuriesinjuries

• sedentary living sedentary living

NO ONE TEST IS SUITABLE NO ONE TEST IS SUITABLE ALL TYPES OF PATIENTS!ALL TYPES OF PATIENTS!

WhyWhy do we Need to Perform do we Need to Perform Strength Testing for Our Strength Testing for Our Rehabilitation Patients?Rehabilitation Patients?

• MustMust have pre- & post-rehab strength measurements have pre- & post-rehab strength measurements for strength improvement outcomes documentationfor strength improvement outcomes documentation

• Need to test after 3, 6, 12, 18 and 24 months (or Need to test after 3, 6, 12, 18 and 24 months (or whatever outcome follow-up intervals you prefer)whatever outcome follow-up intervals you prefer)

• For For AACVPR Program Certification AACVPR Program Certification and and AACVPR AACVPR Cardiopulmonary Rehab Outcomes RegistriesCardiopulmonary Rehab Outcomes Registries

• To let the patient know how they stand up compared To let the patient know how they stand up compared to those in their age and gender groups strength-wise to those in their age and gender groups strength-wise

• To let the patient know how much they are improving To let the patient know how much they are improving (or regressing) throughout their rehabilitation program(or regressing) throughout their rehabilitation program

• To help determine the patient’s ability to perform To help determine the patient’s ability to perform basic ADL’s (walking, dressing, picking things up, basic ADL’s (walking, dressing, picking things up, housework, squatting)housework, squatting)

• To measure individual success in resistive exercises To measure individual success in resistive exercises with validated normswith validated norms

• To boost confidence and self-efficacyTo boost confidence and self-efficacy

• To help assess posture and balance issues and to To help assess posture and balance issues and to prescribe posture and balance exercisesprescribe posture and balance exercises

• To assess and determine the To assess and determine the individual needs individual needs of the of the patient with respect to their unique overall muscular patient with respect to their unique overall muscular weaknessesweaknesses

WHY IS RESISTIVE EXERCISE WHY IS RESISTIVE EXERCISE TESTING UNDERUTILIZED?TESTING UNDERUTILIZED?

Few (if any) evidenced-based guidelines and Few (if any) evidenced-based guidelines and

lack of researchlack of research

Fear of the patient becoming injuredFear of the patient becoming injured

Lack of testing protocols and knowledge of Lack of testing protocols and knowledge of

existing protocolsexisting protocols

Each special population has their own unique Each special population has their own unique

and specific characteristicsand specific characteristics

Time factor—do you perform different tests for Time factor—do you perform different tests for

different patients for their individualized ITP?different patients for their individualized ITP?

HOW DO YOU SELECT THE HOW DO YOU SELECT THE PROPER RESISTIVE TESTING PROPER RESISTIVE TESTING

PROTOCOL FOR YOUR PATIENTS PROTOCOL FOR YOUR PATIENTS WITH VARYING TYPES OF WITH VARYING TYPES OF

DISEASES?DISEASES?

• The CEP should look for established The CEP should look for established protocols with normative data in the protocols with normative data in the literature.literature.

• The test need not necessarily be designed The test need not necessarily be designed specifically for that type of patient.specifically for that type of patient.

•There is a There is a significant lack significant lack of testing of testing research for special populations in the research for special populations in the literature—thus, the CEP must often use literature—thus, the CEP must often use their own best judgment on which test to use their own best judgment on which test to use for which type of patient.for which type of patient.

A good place to start is the A good place to start is the “Senior “Senior Fitness Test Manual, 2Fitness Test Manual, 2ndnd edition” edition” (Rikli & Jones, 2013, Human Kinetics)(Rikli & Jones, 2013, Human Kinetics)

How do we Measure Resistive How do we Measure Resistive Exercise Testing Outcomes?Exercise Testing Outcomes?

1.1. Properly screen the patient! Properly screen the patient!

2.2. Test with the appropriate testing modality.Test with the appropriate testing modality.

3.3. Record entry strength testing measurements.Record entry strength testing measurements.

3.3. Test again at 12-16 weeks (or whatever follow-Test again at 12-16 weeks (or whatever follow- up interval your institution utilizes) and up interval your institution utilizes) and throughout program participation.throughout program participation.

5.5.Subtract the entry test value from the post-test Subtract the entry test value from the post-test value and divide by the post-test value for the value and divide by the post-test value for the % improvement.% improvement.

Sample ITP Recording FormSample ITP Recording FormPatient:Patient:

Elvira, MODElvira, MOD(Age: 64) (Age: 64)

EntryEntry(1-10-15)(1-10-15)

12-12-WeekWeek(4-10-15)(4-10-15)

% % ChangeChange

24-24-WeekWeek(7-10-15)(7-10-15)

% % Change Change (From (From Entry)Entry)

50% 50% NormativeNormative Data For Data For

Age GroupAge Group

6MW Test 864 ft. 1222 ft. +41% 1684 +95% 1238 ft.

1 RM Leg Press

75 lb. 105 lb. +40% 130 lb. +73% 115 lb.

30-second Arm Curl

Test

10 25 +150% 30 +200% 25

8-foot Up and Go Test

10 s 8 s +20% 7.2 s +28% 5 s

Handgrip Test

15 kg 31 kg +107% 40 kg +167% 40 kg

• MajorMajor orthopedic limitationsorthopedic limitations

• Hip or knee replacement? Hip or knee replacement?

• Breathing distress or Breathing distress or ““poor airpoor air”” days days• SaOSaO2 2 < 90% < 90%

• Acute episodes of joint inflammatory orAcute episodes of joint inflammatory or degenerative disease (e.g., gout, bursitis)degenerative disease (e.g., gout, bursitis)

• Acute systemic illness (e.g., mono, flu) Acute systemic illness (e.g., mono, flu)

• Uncontrolled metabolic disease (e.g., Uncontrolled metabolic disease (e.g., BP) BP)

• Symptomatic patientSymptomatic patient

• Pulmonary HTN Pulmonary HTN ??

ACUTE HEART RATE, BLOOD PRESSURE, ACUTE HEART RATE, BLOOD PRESSURE, & VO& VO22 RESPONSES DEPEND UPON: RESPONSES DEPEND UPON:

• Muscle mass used (e.g., legs vs. arms)Muscle mass used (e.g., legs vs. arms)

• Number of repetitionsNumber of repetitions

• Amount of weight lifted (e.g., body vs. arms)Amount of weight lifted (e.g., body vs. arms)

• Rest duration between trials Rest duration between trials

• Valsalva influenceValsalva influence

• Total volume of work performedTotal volume of work performed

• Pulmonary/cardiac/cancer medicationsPulmonary/cardiac/cancer medications

• Upper vs. lower body resistive testingUpper vs. lower body resistive testing

• Physical condition of the patientPhysical condition of the patient

SAFETY ISSUESSAFETY ISSUES

SAFETY ISSUESSAFETY ISSUES

• 1-RM testing is 1-RM testing is OKOK in properly screened patients in properly screened patients if performed by properly certified clinical exercise staff! if performed by properly certified clinical exercise staff!

• If the patient complains of mild muscle sorenessIf the patient complains of mild muscle soreness 12-24 hours after resistive testing, this is 12-24 hours after resistive testing, this is normalnormal..

• If the patient complains of chronic (> 1 week) muscle If the patient complains of chronic (> 1 week) muscle soreness after resistive testing, this is not normal.soreness after resistive testing, this is not normal.

• Demonstrate the test yourself first.Demonstrate the test yourself first.

• Report any significant injuries or complications to Report any significant injuries or complications to the supervising physician and the patient’s physician.the supervising physician and the patient’s physician.

ADMINISTERING THE ADMINISTERING THE TESTSTESTS

• Have the patient perform at least 5-8 minutes of Have the patient perform at least 5-8 minutes of warm-up and stretching activities (typical rehab warm-up and stretching activities (typical rehab warm-up activities)warm-up activities)

• OKOK to test the patient after group warm-up to test the patient after group warm-up

• Typically no additional physiologic monitoring Typically no additional physiologic monitoring needed (telemetry ECG or SAOneeded (telemetry ECG or SAO22 OK) OK)

• Include dynamic stretching that exercises Include dynamic stretching that exercises the muscle groups being testedthe muscle groups being tested

•Prior to the test tell the patient to “Do the best Prior to the test tell the patient to “Do the best they can, but not to the point of overexertion or they can, but not to the point of overexertion or beyond what they think is safe for them” beyond what they think is safe for them”

• Stop testing immediately if the patient is using Stop testing immediately if the patient is using improper technique or formimproper technique or form

• Stop testing if any clinically abnormal signs or Stop testing if any clinically abnormal signs or symptomssymptoms

• For those with visual or auditory limitation, make For those with visual or auditory limitation, make the appropriate testing adjustments (e.g., have the appropriate testing adjustments (e.g., have cleared area, ask if you can help, large cones)cleared area, ask if you can help, large cones)

• Demonstrate the testing protocolDemonstrate the testing protocol

•For those with chronic pain, if For those with chronic pain, if > 5> 5 on a 0-10 scale on a 0-10 scale best to delay testing until the pain level is best to delay testing until the pain level is lowerlower

COMMON TESTS OF COMMON TESTS OF MUSCULAR STRENGTH MUSCULAR STRENGTH

AND ENDURANCEAND ENDURANCE

MACHINE WEIGHT TESTINGMACHINE WEIGHT TESTING • Demonstrate proper position of the seat and other attachments on the machine weights.

• Demonstrate proper pin placement in the weight stack.

• Demonstrate proper placement of additional weight on the weight stack.

• Reinforce proper breathing techniques and posture on the machine (i.e., exhale with the muscle contraction, pursed-lip breathing).

20142014 ACSM GETP PULMONARY ACSM GETP PULMONARY RESISTIVE TESTING GUIDELINESRESISTIVE TESTING GUIDELINES

• 1 RM1 RM:: The maximal amount lifted once, but not The maximal amount lifted once, but not twice, with proper technique (no straining, twice, with proper technique (no straining, full extension)full extension)

• Modified 1 RMModified 1 RM:: Progressively increase weight Progressively increase weight to determine the maximal amount lifted to determine the maximal amount lifted twice, but not 3 times, with proper techniquetwice, but not 3 times, with proper technique

• 4-, 6-, and 8-RM4-, 6-, and 8-RM:: Determine the maximal Determine the maximal amount of weight that can be lifted 4-8 timesamount of weight that can be lifted 4-8 times with proper technique and prescribe a % with proper technique and prescribe a %

RM Resistive Testing TechniquesRM Resistive Testing Techniques

SAFETY OF 1-RM TESTINGSAFETY OF 1-RM TESTING

Shaw et al. 1995, JCR Shaw et al. 1995, JCR (Healthy Older Adults)(Healthy Older Adults)

• 40 men / 43 women (60-72 yrs.)40 men / 43 women (60-72 yrs.)

• Divided into 3 groups by lifting experienceDivided into 3 groups by lifting experience

• Light warm-up of 9 min; tests on 5 machinesLight warm-up of 9 min; tests on 5 machines

• Many c/o muscle soreness (none by day 7)Many c/o muscle soreness (none by day 7)

• 2 older subjects in the inexperienced group 2 older subjects in the inexperienced group had injuries to the back and ribs had injuries to the back and ribs

ConclusionConclusion:: With proper prep, 1 RM testing With proper prep, 1 RM testing safe in older, apparently healthy subjects. safe in older, apparently healthy subjects. Use caution with older, inexperienced patients.Use caution with older, inexperienced patients.

SAFETY OF 1 RM TESTINGSAFETY OF 1 RM TESTING

Pollock et al. 1991, MSSE Pollock et al. 1991, MSSE (Healthy Older Adults)(Healthy Older Adults)

• Older men (70-79 yrs.)Older men (70-79 yrs.)

• 11 of 57 incurred injuries during 1 RM testing11 of 57 incurred injuries during 1 RM testing

• 5 injuries knee, 5 shoulder, 1 back (19%)5 injuries knee, 5 shoulder, 1 back (19%)

• 4 of 5 knee related to prior knee problems4 of 5 knee related to prior knee problems

• 6 other injuries unrelated to previous problems6 other injuries unrelated to previous problems

ConclusionConclusion:: 1 RM testing likely 1 RM testing likely inappropriate inappropriate for older men and women with joint problems for older men and women with joint problems specific to the muscle being tested.specific to the muscle being tested.

SAFETY OF 1 RM TESTINGSAFETY OF 1 RM TESTING

Kaelin et al. 1999, JCR Kaelin et al. 1999, JCR (Pulmonary Patients)(Pulmonary Patients)

• 9 men / 11 women (43-75 yrs.)9 men / 11 women (43-75 yrs.)

• 1 RM testing with gradual increase of weight1 RM testing with gradual increase of weight

• Light warm-up of 5-10 reps at 40-60% 1 RMLight warm-up of 5-10 reps at 40-60% 1 RM

• HR, BP, SOB, O2HR, BP, SOB, O2satsat, muscle soreness (1-4) monit., muscle soreness (1-4) monit.

• No sig. difference in muscle soreness afterNo sig. difference in muscle soreness after 1 week; no cardiopulmonary complications1 week; no cardiopulmonary complications

ConclusionConclusion:: No altered ADLs, muscle soreness, or No altered ADLs, muscle soreness, or muscle injury in patients with moderate to severe muscle injury in patients with moderate to severe COPDCOPD

EXAMPLE OF 1 RM BENCH TESTINGEXAMPLE OF 1 RM BENCH TESTINGPROTOCOL FOR OLDER MEN/WOMEN*PROTOCOL FOR OLDER MEN/WOMEN*

• Patient warms up in the group warm-upPatient warms up in the group warm-up

• Patient lays supine on the bench in the 5-Patient lays supine on the bench in the 5- point contact positionpoint contact position

• Bar is grasped in closed, pronated grip Bar is grasped in closed, pronated grip slightly wider than shoulder widthslightly wider than shoulder width

• Spotter is close to the patient’s head, holding barSpotter is close to the patient’s head, holding bar

• Patient performs a few reps with a light Patient performs a few reps with a light weight with the barweight with the bar

EXAMPLE OF 1 RM BENCH TESTINGEXAMPLE OF 1 RM BENCH TESTINGPROTOCOL FOR OLDER MEN/WOMEN*PROTOCOL FOR OLDER MEN/WOMEN*

• Determine the 1 RM (or multiple RM) within 4 Determine the 1 RM (or multiple RM) within 4 trials with rest periods of 3-5 min. between trialstrials with rest periods of 3-5 min. between trials

• Select an initial weight that is within the patient’s Select an initial weight that is within the patient’s perceived capacity (~ perceived capacity (~ 50%50% to to 70% 70% of capacity)of capacity)

• Progressively Progressively the weight by the weight by 2.52.5 to to 2020 kg until kg until the patient cannot complete the repetitionthe patient cannot complete the repetition

• All reps should be performed at the same speed All reps should be performed at the same speed of movement and ROMof movement and ROM

•The final weight lifted is the absolute 1-RM or The final weight lifted is the absolute 1-RM or multiple RM multiple RM *ACSM HRFM (2014), p. 83*ACSM HRFM (2014), p. 83

SENIOR FITNESS TEST SENIOR FITNESS TEST (SFT)*(SFT)*

CHAIR STAND CHAIR STAND (# of stands)(# of stands)

ARM CURL ARM CURL (# of reps)(# of reps)

6-MINUTE WALK 6-MINUTE WALK (# of yards)(# of yards)

2-MINUTE STEP TEST 2-MINUTE STEP TEST (# of steps)(# of steps)

CHAIR SIT-AND-REACH CHAIR SIT-AND-REACH (inches +/-)(inches +/-)

BACK SCRATCH BACK SCRATCH (inches +/-)(inches +/-)

8-FOOT UP AND GO 8-FOOT UP AND GO (seconds)(seconds)

*Rikli R, Jones J. (2013) Senior Fitness Test Manual*Rikli R, Jones J. (2013) Senior Fitness Test Manual

Champaign, IL: Human Kinetics.Champaign, IL: Human Kinetics.

Jones, CJ and R RikliJones, CJ and R Rikli Jones, CJ and R RikliJones, CJ and R Rikli

11Signorile et. al., Signorile et. al., J Aging Phys Act J Aging Phys Act 2007;15:56-74.2007;15:56-74.22Su Zhan et. al., Su Zhan et. al., JCRJCR 2006;26:180-187. 2006;26:180-187.33Kaminsky LA. Kaminsky LA. ACSM’s Health Related Physical Fitness ACSM’s Health Related Physical Fitness Assessment Manual, 4Assessment Manual, 4thth edition edition. Philadelphia: Wolters . Philadelphia: Wolters Kluwer/LWW, 2014, pp. 80-81.Kluwer/LWW, 2014, pp. 80-81.

Age Below Average Average Above Average60-64 < 87 87 to 115 > 11565-69 < 87 86 to 116 > 11670-74 < 80 80 to 110 > 11075-79 < 73 73 to 109 > 10980-84 < 71 71 to 103 > 10385-89 < 59 59 to 91 > 9190-94 < 52 52 to 86 > 86

MEN’S SCORES*

Age Below Average Average Above Average60-64 < 75 75 to 107 > 10765-69 < 73 73 to 107 > 10770-74 < 68 68 to 101 > 10175-79 < 68 68 to 100 > 10080-84 < 60 60 to 91 > 9185-89 < 55 55 to 85 > 8590-94 < 44 44 to 72 > 72

WOMENS SCORES*

*Jones & Rikli, 2002

The 8 Foot “Up-and-Go” TestThe 8 Foot “Up-and-Go” Test

– Indicates the level of the participant's Indicates the level of the participant's motor agility motor agility and and dynamic balancedynamic balance

– Also a measure of muscular endurance Also a measure of muscular endurance of the leg musclesof the leg muscles

– Associated with the lifestyle tasks of Associated with the lifestyle tasks of maneuvering in a crowd, getting on or maneuvering in a crowd, getting on or off a train/bus or moving around the off a train/bus or moving around the househouse

The 8 Foot “Up-and-Go” TestThe 8 Foot “Up-and-Go” Test

Required EquipmentRequired Equipment– Chair with a straight back (17” or 43 cm)Chair with a straight back (17” or 43 cm)

– Chair legs should be placed against wall to Chair legs should be placed against wall to stop the chair from sliding backwards stop the chair from sliding backwards

– Cone placed so the rear of the marker is Cone placed so the rear of the marker is 2.44 2.44 meters (8 feet) meters (8 feet) from the front of the chairfrom the front of the chair

– Stopwatch and tape measureStopwatch and tape measure

Age Below average Average Above Average60-64 > 5.6 5.6 to 3.8 < 3.865-69 > 5.7 5.7 to 4.3 < 4.370-74 > 6.0 6.0 to 4.2 < 4.275-79 > 7.2 7.2 to 4.6 < 4.680-84 > 7.6 7.6 to 5.2 < 5.285-89 > 8.9 8.9 to 5.3 < 5.390-94 > 10.0 10.0 to 6.2 < 6.2

MEN’S NORMS (seconds)*

Age Below average Average Above Average60-64 > 6.0 6.0 to 4.4 < 4.465-69 > 6.4 6.4 to 4.8 < 4.870-74 > 7.1 7.1 to 4.9 < 4.975-79 > 7.4 7.4 to 5.2 < 5.280-84 > 8.7 8.7 to 5.7 < 5.785-89 > 9.6 9.6 to 6.2 < 6.290-94 > 11.5 11.5 to 7.3 < 7.3

WOMEN’S NORMS (seconds)*

*Jones & Rikli, 2002

Parkinson’s DiseaseParkinson’s Disease

““The 8-foot up and go test appears to be The 8-foot up and go test appears to be a useful test which helps identify the a useful test which helps identify the impact that PD has on the QOL of impact that PD has on the QOL of suffers.”*suffers.”*

*Haaxma C, Bloem B, Borm G, & Horstink M (2008). Comparison of *Haaxma C, Bloem B, Borm G, & Horstink M (2008). Comparison of a timed motor test battery to the Unified Parkinson’s Disease a timed motor test battery to the Unified Parkinson’s Disease Rating Scale-III in Parkinson’s disease. Rating Scale-III in Parkinson’s disease. Movement DisordersMovement Disorders, , 23(12), 1707–1717.23(12), 1707–1717.

The 6-Minute Pegboard and Ring TestThe 6-Minute Pegboard and Ring Test

– The patient moves as many rings as The patient moves as many rings as possible in possible in 6 minutes 6 minutes on to a pegboardon to a pegboard

– Each ring weighs 50 g or 0.5 ounceEach ring weighs 50 g or 0.5 ounce

– This test has been shown to be a reliable This test has been shown to be a reliable and valid method to assess unsupported and valid method to assess unsupported arm exercise endurance in patients with arm exercise endurance in patients with COPDCOPD11 and to be a predictive test to and to be a predictive test to help maintain and improve upper body help maintain and improve upper body ADL’s in pulmonary rehab patientsADL’s in pulmonary rehab patients22

FOR MORE INFO ON THIS TESTFOR MORE INFO ON THIS TEST

1.1.Zhan S, Cerny F, Gibbons W, Mador J, Wu YW. Zhan S, Cerny F, Gibbons W, Mador J, Wu YW. Development of an Unsupported Arm Exercise Test in Development of an Unsupported Arm Exercise Test in Patients With Chronic Obstructive Pulmonary Disease. Patients With Chronic Obstructive Pulmonary Disease. Journal of Cardiopulmonary RehabilitationJournal of Cardiopulmonary Rehabilitation. . 2006;26(3):180-2006;26(3):180-187. 187.

1.1.Takeda et. al. The 6-minute pegboard and ring test is Takeda et. al. The 6-minute pegboard and ring test is correlated with upper extremity activity of daily living in correlated with upper extremity activity of daily living in chronic obstructive pulmonary disease. chronic obstructive pulmonary disease. International International Journal of COPD.Journal of COPD. 2013;8:347-351.2013;8:347-351.

Signorile Gallon Jug Shelf Test*Signorile Gallon Jug Shelf Test*

Fill five (5) one gallon jugs with water.Fill five (5) one gallon jugs with water.

Set bottom and top shelves of a bookcase level with top Set bottom and top shelves of a bookcase level with top of patella and tip of the acromion process respectivelyof patella and tip of the acromion process respectively

Time (in seconds) Time (in seconds) how long it takes to pick all five how long it takes to pick all five jugs (one at a time) with one arm (dominant arm) up jugs (one at a time) with one arm (dominant arm) up from the bottom shelf and place them each on the top from the bottom shelf and place them each on the top shelfshelf

This is a measure of This is a measure of powerpower and and strengthstrength

*Signorile JF. *Signorile JF. ACSM’s Certified News. 2014:ACSM’s Certified News. 2014:24(2):9-14. 24(2):9-14.

Signorile Gallon Jug Shelf TestSignorile Gallon Jug Shelf TestEquipment NeededEquipment Needed

Five (5) one gallon jugs filled with water.Five (5) one gallon jugs filled with water.

Bookshelf (84” H x 42” W x 12” D)Bookshelf (84” H x 42” W x 12” D)

StopwatchStopwatch

Signorile Gallon Jug Shelf TestSignorile Gallon Jug Shelf TestEquipment NeededEquipment Needed

QUESTION:QUESTION: Where would I find such a bookcase with Where would I find such a bookcase with adjustable shelves?adjustable shelves?

ANSWER: ANSWER: Have a patient with carpentry skills make a Have a patient with carpentry skills make a bookcase with shelving that is adjustable with “fine bookcase with shelving that is adjustable with “fine tuning.”tuning.”

REWARD: REWARD: Give the patient 1-2 free months of Give the patient 1-2 free months of maintenance exercise in your program for building this maintenance exercise in your program for building this bookcase!bookcase!

Signorile Gallon Jug Shelf TestSignorile Gallon Jug Shelf TestSet-upSet-up

Align the lower shelf with the participant’s Align the lower shelf with the participant’s patella.patella.

Align the upper shelf with the top of the Align the upper shelf with the top of the patient’s shoulder (acromion process).patient’s shoulder (acromion process).

Place the 5 one-gallon jugs on the bottom Place the 5 one-gallon jugs on the bottom shelf.shelf.

Provide detailed instructions prior to testing.Provide detailed instructions prior to testing.

Demonstrate the test protocol.Demonstrate the test protocol.

Signorile Gallon Jug Shelf TestSignorile Gallon Jug Shelf TestTest ProcedureTest Procedure

Patient sits comfortably in front of bookcase.Patient sits comfortably in front of bookcase.

Instruct the patient to keep back straight, head up, Instruct the patient to keep back straight, head up, not lean forward, use legs as primary source of not lean forward, use legs as primary source of power for lift, and abort if any feelings of discomfort.power for lift, and abort if any feelings of discomfort.

Provide a test trial and evaluate/correct form.Provide a test trial and evaluate/correct form.

Remind patient to move 1 jug at a time, not alternate Remind patient to move 1 jug at a time, not alternate hands, and begin test standing up.hands, and begin test standing up.

Begin trial with Begin trial with “Ready” “Ready” followed by followed by “Go!“Go!””

Stop test when 5Stop test when 5thth jug placed on the top shelf. jug placed on the top shelf.

Signorile Gallon Jug Shelf TestSignorile Gallon Jug Shelf TestTest BenefitsTest Benefits

Measure of upper/lower body powerMeasure of upper/lower body power

Measure of upper/lower body strengthMeasure of upper/lower body strength

Measure of upper/lower body dynamic ROMMeasure of upper/lower body dynamic ROM

Measure of ability to lift and place objects on shelvesMeasure of ability to lift and place objects on shelves

Safe Safe

Inexpensive Inexpensive

Easily administeredEasily administered

Probably a better assessment of ADL’s than the Probably a better assessment of ADL’s than the other tests presentedother tests presented

Men’s Percentile Ranks by AgeMen’s Percentile Ranks by Age

% 60-64 65-69 70-74 75-79 80-84 85-89 90-94

5th 12.6 (s) 10.9 13.2 14.5 14.8 18.6 18.6

25th 8.3 9 10.2 10.3 11.6 14.8 14.8

50th 7.7 7.9 8.9 9.2 9.8 12.7 12.7

75th 6.8 7.4 8.1 8.7 8.2 10.2 10.2

95th 5.9 5.2 6.7 7.5 7.3 9.4 9.4

Scoring: Signorile, 2011. Bending the Aging Curve—The Complete Exercise Guide for Older Adults.Human Kinetics

Age Groups (Years)

Women’s Percentile Ranks by AgeWomen’s Percentile Ranks by Age

% 60-64 65-69 70-74 75-79 80-84 85-89 90-94

5th 13.2 (s) 11.5 13.5 15.2 15.6 18.7 18.7

25th 10.8 9.8 10.8 11.8 12.5 14.0 14.0

50th 8.9 9.1 9.6 10.1 11.0 12.7 12.7

75th 8.1 8.3 8.7 8.9 9.8 11.4 11.4

95th 7.1 7.5 7.7 8.0 8.7 9.3 9.3

Scoring: Signorile, 2011. Bending the Aging Curve—The Complete Exercise Guide for Older Adults.Human Kinetics

Age Groups (Years)

Maintaining Maintaining muscular strength and endurance muscular strength and endurance is is criticalcritical for longevity, daily functioning and for longevity, daily functioning and QOL for all patients QOL for all patients in cardiopulmonary or cancer rehab.in cardiopulmonary or cancer rehab.

While musculoskeletal testing may not be a While musculoskeletal testing may not be a “billable” “billable” procedure, we should all be doing this for “best practices” procedure, we should all be doing this for “best practices” and optimal patient assessment and feedback, as well as and optimal patient assessment and feedback, as well as patient outcomes.patient outcomes.

Muscular strength and endurance testing should become a Muscular strength and endurance testing should become a significant component of the patient’s ITP, regardless of significant component of the patient’s ITP, regardless of what type of chronic disease(s) that may be present.what type of chronic disease(s) that may be present.