Therapeutic resistance training: proposal for an algorithm-based approach

Background Ageing, immobilization, sepsis or cachexia reduce muscle mass and function. The age-related loss, i.e. sarcopenia, contributes to frailty and results in a loss of mobility and autonomy in aging and disease. Affected individuals are often socially isolated, have a greater risk of metabolic disorders and psychosomatic problems. As a result, quality of life and life expectancy are affected. Immobilization and lack of adequate stimuli to the skeletal muscle seem to play a central part in these problems. To overcome them, resistance training (i.e., weightlifting) is an effective intervention. Statement of the problem Despite the efficacy of resistance training for increasing muscle mass and function, this treatment is underused in clinical practice. We argue that this is due to a lack of a generally applicable methodology. Methods and framework To address this and related problems, we have formed the Network of Expertise for Immobilization-induced Muscle Disorders (KNIMS) to develop a potential algorithm for treating sarcopenia and other immobilization-related muscle disorders. An important aspect of the proposed method is that it is defined as a formal algorithm that consists of two stages. Stage A aims to recover bed-ridden patients’ ability to stand by applying vibration-tilt table technology. Stage B aims at rehabilitating compromised gait, using a combination of squats, lunges and single leg raises. It is anticipated that this algorithm-based approach will enhance the ability for standardization and documentation, whilst reducing resource efforts at the same time, which will be equally useful to clinical practice and to clinical research.