Regarding the 1 RM discussion…The APTA course to become a “Certified Exercise Expert for Aging Adults” recommends the following guidelines
using the Borg RPE terms
1. Have your patient perform (2) reps of the desired exercise with a weight you think will be appropriate.
2. Have the patient stop and ask him “Is that exercise fairly easy, somewhat hard, or hard?”. For 60-80% of 1 RM, the answer should be “Somewhat Hard”. This subjective RPE has been correlated to 60-80% 1RM. If it’s fairly easy, it’s 30-60% 1 RM, which is what we want to use with our frail/medically more fragile patients. At this level of intensity, he should be able to perform 12-25 reps with good form and no more.
3. Again, checking form continuously. “Somewhat hard” would be 12-14 on the Borg 20 point scale.
I have used this method with all of my patients with whom I’m trying to establish 60-80% of 1 RM. Yes, some of them reach that with only 2#, some with manual resistance, some with 8#. I’ve seen really good results with this and it’s very easy to teach your patient how to self-progress the weight used for carryover to exercising after d/c.
As an aside, I HIGHLY recommend this course. It is taught by 3 of the APTA leaders in Geriatric PT and 100% Evidence Based. I took it back in 2010 and it changed the way I treat.
Good luck!