The cause and effect of strong legs delivering safe and independent mobility is not a well-understood phenomenon. The best way to explain why this isn’t common practice thinking is best broken down by profession.
Physical therapist:
More than half of the curriculum in physical therapy school centers around leg strength, but it is difficult to apply in the real world where function is the main objective. Also, reimbursement for exercise has been reduced dramatically over the past 25 years. In nursing homes under Medicare, exercise time with a client is dictated by a diagnosis.
According to research substantial strength gains take over 3 months. This is not a typical duration of physical therapy – it is normally 2 to 6 weeks.
It is difficult to fight the “system.” Research shows us that leg strengthening is most effective/beneficial when completed with the patient lying down. However, it is easier and more efficient to do in a sitting position. Unfortunately, sitting exercises have become the “norm” because of time constraints and simplicity.
Physical Therapists are focused on the environments in which they work. When a patient is discharged from a nursing home, the physical therapist may not think about what might happen 2-6 months later. They would hope for success because of a job well done, unfortunately many will never find out if/when declines occur with their patients.
Few physical therapists get the advantage of working with clients long term so they have never observed the advantages of pushing leg strength.
Physicians/nurses:
1. Physicians and nurses do not receive the same education on exercise, especially with older adults. Likely, not enough education has been completed in general about the benefits of physical therapy let alone the benefits of leg strength for older adults.
2. “Keep Walking” is a common response given to everyone when it comes to staying healthy. Unfortunately, this is just not enough for most older adults. EVERYONE loses leg strength starting at age 30 unless they are actively building it. A certain amount of leg strength is required for a person to be safe and independent with their walking. If that strength is not present – WALKIING WILL NOT BUILD STRENGTH! Leg strength can only be improved with resistance exercises that are specific to the functional muscles associated with mobility.
Social Workers:
1. Social workers are great for resources and planning. They are usually the ones that need to explain to families when Medicare is exhausted. They are advocates for the client, but they are working in the same system as the physical therapist.
2. Education is also limited in their education regarding leg strength.