Exercise Programming for Older Adults

40 years old on 50 mile run

60 years old finishing 4300 mile ride

Important Considerations

The goal is to maintain the basic and advanced activities of daily living (ADL) for as long as possible to allow for independent functioning as long as possible.

The key is to accentuate the movements they CAN do rather than to dwell on what they can’t do.

Consider what activities they might enjoy doing – let them pick!

Demographics

Those age 65+ represent the fastest growing segment of the US population.

By the year 2030 the population of those over age 65 will have doubled (to over 63 million).

1 out of every 8 Americans is > 65 In US in 1998, there were:

34 m people over age 65 20 m older women 14 m older men Ratio of 10 women to 7 men BUT… As reach age 85, the ratio changes to 10:5

Demographics - Future

The dramatic growth of seniors is expected to continue.

The ranks of the oldest-old will swell five-fold to more than 19 million people in the year 2050.

Greater need for exercise programs and professionals to lead them.

Rate of Decline

Data collected from the Masters Track & Field Org and US Masters Swimming Congress found the average aging-related rate of decline was 0.5% per year for older exercisers (12.5% over 25 years).

In sedentary people, the rate of decline was 2% per year 50% over 25 years.

Those seniors who are only at 30% of their functional capacity are considered “frail”.

Those seniors who remain engaged in an exercise program will likely remain highly functional.

Leadership Tips

Motivating seniors

Understand chronic conditions

Accommodate programs to meet needs

Adjust FITT principle accordingly

Purchase resources to learn more

Incentives & Motivators

Ambiance should be inviting to elders

Consider music selection

Social opportunities

Intergenerational exercise programs

Awards

On-going fitness assessments

Safety & Guidelines

Obtain medical clearance First Aid & CPR certifications Before developing a program, get a

complete lists of client’s medications…know side effects

Knowledge of intensity levels: target training zone, rated perceived exertion, Talk

Group formations – circles and semis

Safety & Guidelines

Encourage immediate notification if feeling ill

Breathing techniques Clothing and shoes Include warm up and cool down

segments Include flexibility program Reducing fear and anxiety

When Does Old Age Begin?

Chronologically considered ~ 65 y.o.

50+ is often referred to as an older adult or senior.

Inactivity and sedentary lifestyle influence this number greatly.

Regard the aging process as one of function what is the older client capable of doing?

Activities of Daily Living (ADL)

Basic ADL:Dressing

Eating

Ambulating

Toileting

Hygiene

Advanced ADL:Shopping

Housework

Accounting

Food Prep

Transportation

Categories for Physical Functioning

Physically:Elite

Fit

Independent

Frail

Dependent

The Senior Fitness Test(Developed by Rikli & Jones, Scanned from Health Fitness Instructor’s Handbook,

Howley & Franks)

Effects of Aging on the MS Loss of muscle mass, strength and mobility

is associated with aging. Adults lose ~ ½ pound of muscle per year

during 30’s & 40’s As a rule, strength remains relatively intact

until ~ age 40-50. Muscle mass decreases ~ 10% between

ages 24-50. There is an accelerated decline of muscle

mass of ~ 30% between ages 50-60. Sedentary folks between 50-70 y.o.

experience strength declines of ~ 15% per decade.

Effects of Aging on the MS

Muscle mass is better maintained in the upper body vs. lower body.

Aging is also associated with a decline in testosterone and human growth hormone.

Some studies have shown increased atrophy in fast twitch type IIb fibers in those over 70.

Due to a loss of motor units and a regrouping of muscle fiber, there is an enlargement of the motor unit size, but less distinction between muscle fiber types.

Effects of Aging on the musculoskeletal system

Peak muscle strength in females occurs ~ age 20; males age 30.

Surveys conducting in the US indicate that 28% of older men and 66% of older women cannot lift objects weighing 10 lbs.

Strength Training for Older Adults

Benefits of Strength Training

Increased Strength

Increased Lean mass

Improved Mobility & Independence

Reduced Bone Loss

Prevent or Modify Chronic Disease

Fall Prevention

Improved Mood

Benefits – Increased Strength

Older adults gain strength at ~ same rate as younger adults

Strength increases as great as 40% have been seen with high-intensity strength training up to age 96.

Some studies have shown that in the 3-4 months following the start of a strength training program for the older client that as much as 3 decades of functional decline can be reversed.

Benefits – Increased Lean Mass

RMR decreases with aging ST increases lean mass increases basal

metabolic rate Muscle hypertrophy resulting from resistance

training has been documented in folks 90+ y.o. Study found that men in their 70’s who started

and continued strength training before age 50 had strength and muscle cross sectional areas similar to sedentary 28 y.o. (Yound & Skelton, 1994)

An increase in body fat with age is attributed more to a decrease in physical activity than an increase in caloric intake.

Benefits – Reduced Bone Loss

Increased bone density through strength training and weight bearing exercises.

Especially a concern of post-menopausal women.

The type of exercise DOES matter see next slides!

Types of Exercise(Dr. Ginger Schirmer, PH.D, RD, Med 2000 Inc., Version 7,

Women’s Health & Stress Management. 2001)

Stair Climbing Hiking Dancing Jogging Downhill Skiing

Aerobic Dancing Volleyball Basketball Gymnastics Strength Training

– can be high/low impact

Weight Bearing / High Impact

Types of Exercise(Dr. Ginger Schirmer, PH.D, RD, Med 2000 Inc., Version 7,

Women’s Health & Stress Management. 2001)

Non Wt Brg/Non-ImpactLap Swimming

Indoor Cycling

Stretching

Wt Brg/Low-ImpactWalkingCross-Country SkiingSki MachineStair Step MachineRowingWater AerobicsDeep Water WalkingLow Impact Aerobics

ACSM Exercise Guidelines for ST Programs for Seniors

Thorough health screening and medical exam needed.

Frequency of strength training 2 days/week

Rest Minimum of 48 hours between sessionsSeniors tend to have more soreness and may

need a longer recovery up to 3-4 days.

ACSM Exercise Guidelines for Strength Training Programs for

Seniors

Sets/Reps Start with 1 of 10-15 reps.Gradually increase to 2 or 3 sets

Intensity Start with 40-60% of 1 rep maxGradually increase to 70-80% of 1 rep max

Rated Perceived Exertion 12-13 (mild to moderate)

ACSM Exercise Guidelines for Strength Training Programs for

Seniors Include at least one exercise for all major

muscle groups. Which are? Focus upon functional, multi-joint

exercises. Examples are? For many clients, you many need to start

with single joint exercises / machine exercises perceived as easier by the client.

Progress them from machine to functional when they become accustomed to the exercise.

ACSM Exercise Guidelines for Strength Training Programs for

Seniors

Complete session within 30 minutes 1st 8 wks should use only minimal

resistance to allow for connective tissue adaptation.

1st few sessions should be supervised. Emphasize proper technique within a

painfree range of motion Encourage normal breathing pattern.

ACSM Exercise Guidelines for Strength Training Programs for

Seniors

Initial overload should be achieved by increasing the number of reps then the weight.

When returning from a layoff, use a resistance of 50% of the previous intensity.

Should be a year-round program.

ACSM Exercise Guidelines for Strength Training Programs for

Seniors

Avoid isometrics and other exercises that may increase blood pressure.

Work large muscle groups first and opposing muscle groups in succession.

Machines preferred over free weights initially.

Risk of Injury

Consider the learning curve.

Watch form and technique.

Use caution when performing any eccentric contractions due to the potential for increased muscle soreness and longer recovery period.

Consider any pre-existing conditions or illnesses the older client may have.

Consider medications effect during exercise session.

Strength Programming Guidelines

Be aware that the senior will tend to move and progress slower.

Design program to emphasize function.

Work only through the pain-free range of motion No Pain!

Program Structure

Should consist of exercise to improve the ability to:Stabilize the torso

Push

Pull

Grip

Get up & down

Move

Stabilizing The Torso

Activities: All activities of daily living involve the torso.

Muscles: Erector Spinae, Rectus Abdominus, Obliques.

Exercises: Stability BallSitting

Marching

Arm/Leg lifts

Catching drills

Pushing

Activities: Need to move furniture, kitchen activities, putting things away, shopping cart.

Muscles: Triceps, Pects, Anterior Deltoid Coracobrachialis, Serratus Anterior.

Exercises:Wall push upsFwd/overhead med ball pressSqueezing a balloonSeated chest pressShoulder pressPush up

Pulling

Activities: Need to rake leaves, open doors, laundry, groceries from trunk, picking up the cat!

Muscles: Lats, teres major, post. delt., biceps, traps, rhomboids.

Elastic tubing exercises:RowingVary AnglesSeated RowReverse Flys

Grip Strength & Dexterity

Activities: Need to open lids, use tools, writing, eating, sewing, buttoning, etc.

Muscles: Forearm and intrinsic muscles of the hand.

Exercises: Towel rolls, ball squeezes, rubber band exercises, dexterity drills, progressively tighter jar lids (series).

Getting Up & Down

Activities: Needed to climb stairs, getting in/out of chair/car, toileting.

Muscles: Quads, gluts, hams, torso. Functional Exercises:

Ball Squats, chair squatsLungesStep ups

Traditional Gym Exercises:Leg pressHack squatSmith Machine SquatAbduction/Adduction exercises

Avoid:Leg extension due to shear forces

Improve Mobility

Walking is the most popular and is highly functional.

Strength Training will improve the client’s ability to walk.

Take note of the muscles around the ankle – note strength and flexibility.

Treadmill walking with a slight incline can help to improve strength & endurance in the leg muscles. Also improves speed and balance.

Consider age appropriate obstacle courses. Low step ups holding on or carrying

something. Do forward, backward, laterally.

In A Nutshell

Strength training benefits for seniors is well documented.

Should be a long-term part of client’s life.

Remind seniors that strength training will improve their cardio program as well.

Greatly increases the client’s quality of life and adds “life to their years.”