Strength

Strength training forms an important part of the foundational exercise cancer rehabilitation program. You may use functional strength testing, such as a repeated chair stand test or testing of a person’s repetition maximum so you can set their starting intensity. 

Additional strength tests can be found here

The 5-times sit to stand is a common test of lower limb functional strength used in cancer rehabilitation. To perform this test, you will need a stopwatch and 46cm tall chair (or chair of constant height). Only one test is required. 

Procedure 

  1. Place chair against a wall
  2. Have patient cross arms over chest 
  3. Have patient practice one stand
  4. Instruct patient to ‘Stand up and sit down as quickly as possible 5 times, keeping your arms folded across your chest’ 
  5. Stop timing when the patient fully stands on the 5th time 

Other functional strength tests such as the 30 second chair stand and grip strength test can be found here.

Tests of repetition maximum (RM) are safe for people with cancer without bony metastases. You may choose to do a 1 RM or multiple RM/ estimated 1RM test. If you choose to do an estimated 1RM test, you can calculate your starting intensity using the Byrziki equation: 

1RM = Weight ÷ ( 1.0278 – ( 0.0278 × Number of repetitions ) 

To perform RM testing, you will need a pin loaded weights machine. Chest press and leg press are commonly used in RM testing but you can perform this test for any muscle group 

Procedure: 

  1. Familiarise patient with equipment 
  2. Complete a warmup set of submaximal repetitions of the movement you want to determine the RM 
  3. Determine the 1 RM (or multiple RM) within four trials with rest periods of at least 2 minutes between trials 
  • Select initial weight within person’s percieved capacity (e.g.50-70% 1RM, RPE 3-4) 
  • Progressively increase weight 5-10% for upper or 10-20% for lower body exercise until a second repetition (or selected number of repetitions) cannot be completed (10 RPE).  
  • You may ask the patient how hard the weight is being lifted on a scale from 0 (light as a feather) to 10 (heavy as a ton of bricks) after each trial to help determine the weight progression 

(adapted from ACSM Guidelines for Exercise Testing and Prescription 10th Ed.)

 

Source: PRESTO Trial, funded by MRFF

An advantage of the 1RM test is that it is quicker than an estimated 1 RM and there is no need for calculations. However, the 1RM may not be appropriate where patients are very deconditioned, unfamiliar with gym equipment or have other musculoskeletal problems preventing safe completion. 

Safety! 

RM testing should be avoided at the affected sites where patients have bony metastases or known or suspected osteoporosis. (e.g. avoid leg press for people with pelvic or femur metastases). Other sites without lesions can be tested (e.g. 1RM chest press for people with only lower limb metastases).  

Check your individual site protocols whether medical clearance is required for testing.  

Example 1RM Testing form 

1RM calculator

Example calculation of estimated 1RM

Your patient completes a maximum of 7 repetitions of 60 kilograms on the leg press during a multiple RM test.  

  1. Estimated 1RM = 60 ÷ ( 1.0278 – ( 0.0278 × 7 ) 

  = 72 kg 

  1. According to the ACSM guidelines, you want to set your starting intensity to 60% of 1RM to reduce fatigue 

Starting intensity = 0.6 x 72kg = 43kg 

  1. Therefore, your starting dose for this patient will be: 

 2 sets x 12 repetitions of 43kg