The American Heart Association's fear that a one repetition maximum strength training program can be harmful to people with heart conditions and hypertension has been found to be completely untrue. Kelly and Pollack, in Hypertension and Circulation, showed a well designed 50-80% of a one repetition maximum strength training program actually decreased blood pressure _(1,2). Therefore, persons of all ages who have cardiovascular problems should not only consider strength training, but make that a routine part of his or her exercise program.

What is a one repetition maximum? It is the maximum amount of weight that can be lifted throughout the full range of motion a person is capable of doing one time. However, people are not to exercise at that amount; they are to exercise at 50-80% of that amount.

• For example, if I can lift 10 pounds one time throughout my full range of motion using my biceps, my one rep max for elbow flexion would be 10 lbs. 
• If I were to exercise at 50% of that, I would lift 5 lbs. between 8-30 times.
• If I were to exercise at 80% of that, I would lift 8 lbs. between 8-30 times.

The literature is very clear that if you can lift a weight more than 30 times you are not getting true strength training benefits. Frequently, people are lifting weights but the are too easy. Therefore, they are gaining endurance, but they won't be getting any increase in strength or change in muscle fiber types.

All therapists should be designing one repetition maximum strength programs using dynamometry to measure the person's isometric strength, calculating the one rep max, and then determining the percentage to exercise (based on the person's condition, i.e. frail or robust). GREAT Seminars has a one repetition maximum pad that calculates the one rep max based on the Odvar Holton diagram (please check our Publications list for the cost).

A one repetition maximum strength training and calculation is something that can be easily computed and reflected in one's notes in a concise and effective manner. The following is an example of a simple one page form that functions as your evaluation as well as a progress note and discharge form. 

_{1. Kelly. "Progressive Resistive Exercise and Resulting Blood Pressure" Hypertension, 2000.}

_{2. Pollack. "Resistance Exercise in Individuals With and Without Cardiovascular Disease." Hypertension, 2000.}