Studying physical function and disability in the older population from a scientific and academic perspective coupled with training a diverse mix of clients for the past 20 years has given me many insights and \u201caha\u201d moments regarding this issue of functional training. It is impossible to address all of the nuances of this subject in one topic so I simply want to make three primary points related to functional training:<\/p>\n
#1 \u2013 Functional training is an outcome\u2026not a method<\/strong><\/h4>\n![\"functional-training1\"](\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2016\/03\/functional-training1-300x292.jpg\")
<\/p>\n
The proof is in the pudding they say and the proof of whether an exercise program is functional or not is determined by whether or not the client\u2019s physical function improves. An example I often use is the basic bicep curl. Most functional training paradigms would argue that this is not a functional exercise. But is that always true? What about an 80 year old who struggles to lift their groceries because they have lost so much muscle strength in their arms as they have gotten older and have been inactive? What about the 20 year old who just spent six weeks in a cast after breaking their arm? In both these cases even the lowly bicep curl will improve the person\u2019s ability to perform daily tasks because muscle strength is the limiting factor. For these individuals and in these situations the bicep curl is indeed a functional exercise.<\/p>\n
Once bicep strength reaches a certain level however (called the \u201cthreshold effect\u201d) then further improvements in muscle strength will most likely not yield any more improvements in functional ability (unless the requirements of the task change). Simply ask the question \u201cWill improving bicep muscle strength improve the ability to perform a particular task?\u201d For most healthy, able-bodied adults the answer would probably be no because their bicep strength is adequate for the job at hand.<\/p>\n
But answering this question appropriately requires that we have a full understanding of physical function. While strength is certainly a component of function it is only one component. Traditional exercise programs have over-emphasized the role that muscle strength plays in function for most client types \u2013 including sports performance. Many trainers would argue that you can never be too strong. I would, in some ways, disagree. Once a client has enough strength to do the things required of them then further strength gains will not likely result in any further functional gains. Continuing to focus on muscle strength at this point would take unnecessary time and energy away from focusing on many other aspects of function that need to be improved.<\/p>\n
![\"funcational-training2\"](\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2016\/03\/funcational-training2.jpg\")
What are the components of physical function that need to be addressed? This is the basic model of functional ability that we use in the Functional Aging Training Model that is at the core of the Functional Aging Specialist Certification. Understanding the role of each of these domains \u2013 musculoskeletal, neuromuscular, balance, mobility, cognitive\/emotional and cardiorespiratory \u2013 is helpful to understand how complex physical function truly is.<\/p>\n
Of course each of these domains can be even further divided into more specific components than what is presented here. The point being that there are many physiological systems that are required (oftentimes many we take for granted) in order to perform activities properly.<\/p>\n
#2 \u2013 Functional training will NOT be the same for every person<\/strong><\/h4>\nFunction is person and context-dependent. What is more \u201cfunctional\u201d for one person may be less \u201cfunctional\u201d for another based on their individual capabilities and the tasks that are required of them. Refer back to the previous example of the bicep curl.<\/p>\n
I find it helpful to remember the NLW approach. The goal of functional training should be to help a person do the things they Need to do, Like to do and Want to do easier, better and with less discomfort. In fact, this is the mission of the FAI certified Functional Aging Specialist<\/strong>. So the first task should be to determine what those things are. Needs can be classified as ADL\u2019s (Activities of Daily Living) and include tasks such as bathing, dressing and shopping. Likes can be classified as the activities that give them pleasure \u2013 golfing, gardening, hiking, working, etc. Wants are those activities to which they aspire. These include that which they can no longer do (and want to do again) or things they have never been able to do. Before we can start to create a \u201cfunctional\u201d exercise program we need to understand what it is that the client needs, likes and wants to do.<\/p>\nThe second task should be to determine which areas of function are deficient so those can be addressed (and prioritized) in their training. This is especially true for older adults who vary widely in both their functional abilities AND the components (or domains) of function that have become deficient. The aging process does not affect everyone the same way and is contingent upon many factors such as genetics, chronic disease conditions and lifestyle (nutrition, physical activity, etc.). Treating older adults as one group, and therefore training them all the same, is one of the biggest mistakes a trainer can make.<\/strong><\/p>\nObviously the only way to determine areas of deficiency is to assess them. How are you to know if a person is lacking in a specific area of balance control, such as vestibular function, and therefore needs vestibular training without assessing it? The same is true of all of the functional domains.<\/p>\n
As an individual progresses and areas of deficit improve then the training methods will change according to the components that still need to be addressed. So what is most \u201cfunctional\u201d for the client right now may not be what is most \u201cfunctional\u201d for them later.<\/strong> The program will need to adapt as the client progresses.<\/p>\n#3 \u2013 The Evidence Should Drive Our Training Choices<\/strong><\/h4>\n![\"functional-training3\"](\"https:\/\/medfitnetwork.org\/public\/wp-content\/uploads\/2016\/03\/functional-training3-300x262.jpg\")
It seems that too often trainers make training decisions without fully understanding the connection between the exercise movements, techniques and equipment they use and the functional outcome they seek. We all need to do a better job at following the scientific evidence about what works and what doesn\u2019t instead of what we think works or what we think should work.<\/p>\n
The scientific evidence on power training for older adults is a great example. Building muscle strength through traditional slow-velocity strength training typically improves function to a moderate degree. However, muscle power is more highly correlated to function than muscle strength and power training (high-velocity strength training) improves function to a greater degree than traditional strength training. Several recent systematic reviews over the past several years attest to this. However, my experience tells me that you will find very few trainers using this with their older clients.<\/p>\n
Conversely, (and in my personal opinion) the use of unstable surfaces is one of the most misunderstood, abused and over-utilized techniques in the industry that has very little scientific support. In fact, there is concern that some of the uses of unstable surfaces are actually \u201cdysfunctional\u201d \u2013 by that I mean that their usage creates altered neuromechanics and muscle activation patterns that can inhibit effective and efficient movement patterns while on a stable surface (see example below). It is also probably the primary reason functional training gets such a bad rap by traditional exercise purists. Trainers promote all sorts of \u201ccreative\u201d exercise movements while standing on an inflated domed surface in the name of functional training. Oftentimes I wonder if fitness professionals ask themselves \u201cCan we?\u201d more than they ask themselves \u201cShould we?\u201d. Just because we can doesn\u2019t always mean we should.<\/strong><\/p>\nNote: The scientific research cannot always keep up with current trends in training methodology and equipment but we must do our best to stay true to the evidence that is available.<\/em><\/p>\nDon\u2019t Throw the Baby Out With the Bath Water<\/strong><\/h4>\nIn general I would agree that integrated strengthening movements are going to help most people improve their functional abilities more than isolated strengthening movements. A rowing pattern is a good example of this. Sitting on a seated row machine with a chest pad will definitely help maximize upper back strength. The support of the machine allows the user to focus all of their force into the rowing movement. However, there really isn\u2019t much else that is worked. In contrast, a standing one arm cable row will not maximize upper back strength because the limiting factor will no longer be the upper back muscles but rather will come from somewhere else in the kinetic chain. In addition to working the upper back muscles though many other muscle groups are engaged isometrically including the low back extensors, abdominals, glutes, quads, hamstrings and calves. In addition, this will create a transverse and sagittal plane force that the trunk and lower body musculature must handle which is much more akin to real-life movement patterns. Following the principle of specificity then it is much more likely that the one arm row is going to yield functional improvements compared to the seated row.<\/p>\n
However, I see this concept taken way too far many times (as mentioned earlier). Will performing the one arm cable row while standing on one leg on a highly unstable surface increase the \u201cfunctionality\u201d of this movement pattern? I think not. Yes it becomes more difficult to do but what does it accomplish? The vast majority of us spend 95% of our time (or more) on a stable surface called the floor. Therefore, we must train ourselves how to appropriately handle ground reaction forces, create stability in a stable environment (statically and dynamically) and respond to perturbations while on a stable surface (which follows the principle of specificity). It has been said that the instability fires up the proprioceptors but our proprioceptors get fired up on a stable surface too when external forces (like the cable) or perturbations are applied to the body. Plus unstable surfaces decrease force production capabilities because more energy must be diverted to co-contraction and there is not a stable base to apply force to in order to counteract a large force at the top of the body (the cable). And if the argument is that the unstable surface improves balance then you are only partially correct. Balance is a complex, multi-dimensional concept that can be broken down into many parts (center of gravity control, multisensory, etc.). Unstable surface training can play a role in effective balance training but ONLY for very specific components of balance.<\/p>\n
Let\u2019s not make the mistake of assuming a movement is more \u201cfunctional\u201d simply because it is more difficult to do. At the same time let\u2019s not make the opposite, but equally dangerous mistake, of not seeing the functional value of many traditional, basic movements. Since function is person and context-dependent and since functional training is not going to look the same for every person <\/strong>then the truth of functional training lies somewhere in between the two perspectives.<\/p>\n
\nCody Sipe, PhD, has an extensive background in the fitness industry with 20 years of experience as a personal trainer, fitness instructor, program director, exercise physiologist and club owner. He is currently an Associate Professor and Director of Clinical Research in the physical therapy program at Harding University. He is the co-founder and vice president of the Functional Aging Institute<\/a> (FAI).<\/em><\/p>\nThis article was reprinted with permission from the FAI blog.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"There are many perspectives on functional training and frankly a lot of confusion in the fitness industry about what it is and what it isn\u2019t. The \u201canti-functional\u201d training faction would argue that the functional training movement is a fraud and that all exercise done properly is functional. <\/p>\n","protected":false},"author":116,"featured_media":3398,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[134,198,193],"class_list":["post-15250","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-all-mfn","tag-fitness","tag-fitness-professionals","tag-healthy-aging"],"jetpack_publicize_connections":[],"_links":{"self":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts\/15250","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/users\/116"}],"replies":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/comments?post=15250"}],"version-history":[{"count":0,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts\/15250\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/media\/3398"}],"wp:attachment":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/media?parent=15250"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/categories?post=15250"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/tags?post=15250"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
<\/p>\nWhat are the components of physical function that need to be addressed? This is the basic model of functional ability that we use in the Functional Aging Training Model that is at the core of the Functional Aging Specialist Certification. Understanding the role of each of these domains \u2013 musculoskeletal, neuromuscular, balance, mobility, cognitive\/emotional and cardiorespiratory \u2013 is helpful to understand how complex physical function truly is.<\/p>\nFunction is person and context-dependent. What is more \u201cfunctional\u201d for one person may be less \u201cfunctional\u201d for another based on their individual capabilities and the tasks that are required of them. Refer back to the previous example of the bicep curl.<\/p>\n
I find it helpful to remember the NLW approach. The goal of functional training should be to help a person do the things they Need to do, Like to do and Want to do easier, better and with less discomfort. In fact, this is the mission of the FAI certified Functional Aging Specialist<\/strong>. So the first task should be to determine what those things are. Needs can be classified as ADL\u2019s (Activities of Daily Living) and include tasks such as bathing, dressing and shopping. Likes can be classified as the activities that give them pleasure \u2013 golfing, gardening, hiking, working, etc. Wants are those activities to which they aspire. These include that which they can no longer do (and want to do again) or things they have never been able to do. Before we can start to create a \u201cfunctional\u201d exercise program we need to understand what it is that the client needs, likes and wants to do.<\/p>\n The second task should be to determine which areas of function are deficient so those can be addressed (and prioritized) in their training. This is especially true for older adults who vary widely in both their functional abilities AND the components (or domains) of function that have become deficient. The aging process does not affect everyone the same way and is contingent upon many factors such as genetics, chronic disease conditions and lifestyle (nutrition, physical activity, etc.). Treating older adults as one group, and therefore training them all the same, is one of the biggest mistakes a trainer can make.<\/strong><\/p>\n Obviously the only way to determine areas of deficiency is to assess them. How are you to know if a person is lacking in a specific area of balance control, such as vestibular function, and therefore needs vestibular training without assessing it? The same is true of all of the functional domains.<\/p>\n As an individual progresses and areas of deficit improve then the training methods will change according to the components that still need to be addressed. So what is most \u201cfunctional\u201d for the client right now may not be what is most \u201cfunctional\u201d for them later.<\/strong> The program will need to adapt as the client progresses.<\/p>\n The scientific evidence on power training for older adults is a great example. Building muscle strength through traditional slow-velocity strength training typically improves function to a moderate degree. However, muscle power is more highly correlated to function than muscle strength and power training (high-velocity strength training) improves function to a greater degree than traditional strength training. Several recent systematic reviews over the past several years attest to this. However, my experience tells me that you will find very few trainers using this with their older clients.<\/p>\n Conversely, (and in my personal opinion) the use of unstable surfaces is one of the most misunderstood, abused and over-utilized techniques in the industry that has very little scientific support. In fact, there is concern that some of the uses of unstable surfaces are actually \u201cdysfunctional\u201d \u2013 by that I mean that their usage creates altered neuromechanics and muscle activation patterns that can inhibit effective and efficient movement patterns while on a stable surface (see example below). It is also probably the primary reason functional training gets such a bad rap by traditional exercise purists. Trainers promote all sorts of \u201ccreative\u201d exercise movements while standing on an inflated domed surface in the name of functional training. Oftentimes I wonder if fitness professionals ask themselves \u201cCan we?\u201d more than they ask themselves \u201cShould we?\u201d. Just because we can doesn\u2019t always mean we should.<\/strong><\/p>\n Note: The scientific research cannot always keep up with current trends in training methodology and equipment but we must do our best to stay true to the evidence that is available.<\/em><\/p>\n In general I would agree that integrated strengthening movements are going to help most people improve their functional abilities more than isolated strengthening movements. A rowing pattern is a good example of this. Sitting on a seated row machine with a chest pad will definitely help maximize upper back strength. The support of the machine allows the user to focus all of their force into the rowing movement. However, there really isn\u2019t much else that is worked. In contrast, a standing one arm cable row will not maximize upper back strength because the limiting factor will no longer be the upper back muscles but rather will come from somewhere else in the kinetic chain. In addition to working the upper back muscles though many other muscle groups are engaged isometrically including the low back extensors, abdominals, glutes, quads, hamstrings and calves. In addition, this will create a transverse and sagittal plane force that the trunk and lower body musculature must handle which is much more akin to real-life movement patterns. Following the principle of specificity then it is much more likely that the one arm row is going to yield functional improvements compared to the seated row.<\/p>\n However, I see this concept taken way too far many times (as mentioned earlier). Will performing the one arm cable row while standing on one leg on a highly unstable surface increase the \u201cfunctionality\u201d of this movement pattern? I think not. Yes it becomes more difficult to do but what does it accomplish? The vast majority of us spend 95% of our time (or more) on a stable surface called the floor. Therefore, we must train ourselves how to appropriately handle ground reaction forces, create stability in a stable environment (statically and dynamically) and respond to perturbations while on a stable surface (which follows the principle of specificity). It has been said that the instability fires up the proprioceptors but our proprioceptors get fired up on a stable surface too when external forces (like the cable) or perturbations are applied to the body. Plus unstable surfaces decrease force production capabilities because more energy must be diverted to co-contraction and there is not a stable base to apply force to in order to counteract a large force at the top of the body (the cable). And if the argument is that the unstable surface improves balance then you are only partially correct. Balance is a complex, multi-dimensional concept that can be broken down into many parts (center of gravity control, multisensory, etc.). Unstable surface training can play a role in effective balance training but ONLY for very specific components of balance.<\/p>\n Let\u2019s not make the mistake of assuming a movement is more \u201cfunctional\u201d simply because it is more difficult to do. At the same time let\u2019s not make the opposite, but equally dangerous mistake, of not seeing the functional value of many traditional, basic movements. Since function is person and context-dependent and since functional training is not going to look the same for every person <\/strong>then the truth of functional training lies somewhere in between the two perspectives.<\/p>\n Cody Sipe, PhD, has an extensive background in the fitness industry with 20 years of experience as a personal trainer, fitness instructor, program director, exercise physiologist and club owner. He is currently an Associate Professor and Director of Clinical Research in the physical therapy program at Harding University. He is the co-founder and vice president of the Functional Aging Institute<\/a> (FAI).<\/em><\/p>\n This article was reprinted with permission from the FAI blog.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" There are many perspectives on functional training and frankly a lot of confusion in the fitness industry about what it is and what it isn\u2019t. The \u201canti-functional\u201d training faction would argue that the functional training movement is a fraud and that all exercise done properly is functional. <\/p>\n","protected":false},"author":116,"featured_media":3398,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[134,198,193],"class_list":["post-15250","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-all-mfn","tag-fitness","tag-fitness-professionals","tag-healthy-aging"],"jetpack_publicize_connections":[],"_links":{"self":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts\/15250","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/users\/116"}],"replies":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/comments?post=15250"}],"version-history":[{"count":0,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/posts\/15250\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/media\/3398"}],"wp:attachment":[{"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/media?parent=15250"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/categories?post=15250"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medfitnetwork.org\/public\/wp-json\/wp\/v2\/tags?post=15250"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}#3 \u2013 The Evidence Should Drive Our Training Choices<\/strong><\/h4>\n
It seems that too often trainers make training decisions without fully understanding the connection between the exercise movements, techniques and equipment they use and the functional outcome they seek. We all need to do a better job at following the scientific evidence about what works and what doesn\u2019t instead of what we think works or what we think should work.<\/p>\nDon\u2019t Throw the Baby Out With the Bath Water<\/strong><\/h4>\n
\n