Engage.. Ignite.. Empower..©

Developed by: Fabio Comana, MA., MS. NASM CPT, CES & PES; NSCA CSCS; ACSM EP-C; ACE CPT & HC; CISSN

Good to Great: Training Baby Boomer Client

Building Blocks for the Active Aging

Who are Baby Boomers … ?

Born between 1946-1964 (early 50’s to early 70’s)

What do they Seek (Physically) What do they Seek (Other)

Respect and Acceptance: •  Still productive, experienced and

willing to work harder (committing time and resources).

•  Although more resistant to change or learn new skills, they can.

•  Treated equally. Value choice and freedom.

Functional independence: •  Live like they were 40 – preserve health and

function. Overall health and wellness: •  Reduce risks of morbidity / mortality. •  Enhance overall quality of life – dimensions.

What Does this Mean?

Greater propensity for disease + accelerated changes within physiological systems that includes:

Physical Changes Musculoskeletal

Cardiopulmonary Cognitive

Emotional

Balance/Gait

Nutritional

General Health Concerns …

You NEED to conduct a more robust Health Risks Assessment (HRA) – risk v. pro (especially if program contains moderate-to-vigorous intensity activity)

Health Risk Assessment

PAR-Q (valid to 69 years)

ACSM / AHA Screening tool for CAD + Musculoskeletal Screening Offices in BBK, KL, India,

Singapore, Manilla, China.

Cognitive Changes •  Decreased mental efficiency and memory decline = #1 cognitive complaint in

older adults

By mid-late 20’s = 1% loss of hippocampus mass / year (learning, memory)

10% of adults > age 65 have some form of cognitive impairment.

50 % of adults > age 80 have some form of cognitive impairment.

Age

Cog

nitiv

e Pe

rfor

man

ce

Cognitive Decline with Age

20 40 60 80 100

Generally attributed to:

Physiological losses within cells, tissues, organs and systems. Disease (e.g. Alzheimer’s). Lack of use (repetition or practice) Lack of physical activity. Depression and medications.

Some Changes …

Postural Control Strategies •  Maintaining postural balance relies on 3 distinct / sequential processes

utilized consciously or subconsciously: o  Located at ankle, knee (step) and hip. o  Strategies function along a continuum depending upon the magnitude

and speed of the balance disturbance.

Some Changes …

Balance and Movement Changes

Central nervous system is key to successful balance: •  3 peripheral sensory systems provide information regarding position in space

relative to gravity and environment: o  Visual (75% of sensory input), vestibular and somatosensory. o  All suffer losses with aging.

Some Changes …

Balance Changes

Psychological Fear of Falling

Physiological Losses + Reduced

Mobility

Heightened Fear of Falling

Fall Risk Factors Muscle weakness

Lower extremity, physical inactivity, frailty

Gait and balance deficits.

Sensory. Vision, vestibular, touch, feel and cognitive deficits

Arthritis. Side effects of medications. Prior history of falls. Environmental hazards. Medications

American Academy of Orthopedic Surgeons: •  Over 30% of adults > 65 experience falls ≥ 1 time / year. •  Over 50% of adults > 75 experience falls ≥ 1 time / year. •  Falling = NOT part of aging process – attributed to multiple risk factors.

Some Changes …

Balance Changes

Types of Falls Percentage Slipping, tripping or stumbling 57.0% Loss of balance, dizziness, fainting, seizure 26.7% Other (collision, pushing, shoving; jumping, etc.,) 16.3%

Location of Falls Inside the house 49.9% Outside the house (but in close proximity - yard, etc.) 23.7% Street, highway, or parking lot (away from home) 6.3% Residential institution, health care facility, or public building 10.1%

Other (playground; park or recreation area, etc.) 10.0%

Programming

What language do you use? •  Exercise v. movement training or ability training? •  Diet v. eating patterns or eating habits?

Be more than just a trainer – don’t limit your programs to just activity. •  Cognitive training – mental games (digital or analog – Elevate) •  Social and Recreational activities.

New Experiences •  Learn something new – a new

skill, using non-dominant hand, new tasks, new trips, new tastes or new smells.

Mental Exercises

Participate in frequent digital or analog games, tasks and challenges to stimulate neurogenesis and synaptogenesis.

Digital Analog

Computer / Smartphone applications: •  Luminosity •  Elevate •  Sudoku •  Crosswords

Traditional Games: •  Scrabble,

Scategories, Risk

Non-Traditional Games: •  Backward Digit

Span, Word Spell (backwards).

•  Sequenced Information (names)

•  Brain Tasking (mental/physical)

Cross-lateral Patterns

Mental Activities …

•  Connectivity between left and right hemispheres.

•  High 5’s and 10’s with leg movement (balance training).

Brain under Tasking Stress: •  Do each activity until instructed to change to another activity

Drill #1 Drill #2 Clap your hands

Count out loud to 10 Tap the back of your head with your right hand

Cluck like a chicken Do arm circles with your left arm

Count backwards from 10 Wave hands above your head

Moo like a cow Snap your fingers

Recite the alphabet backwards Stomp your feet

Ask participants – 3rd / 4th task?

Mental Activities …

Assessments

Stop – pause! Who do the assessments really serve? •  Can they be disguised?

Other Population-specific Assessments •  Functional Reach Test •  Multidirectional Reach Test (MDRT) •  Modified Clinical Test for Sensory

Interaction in Balance (M-CTSIB) •  Berg Balance Test •  Fullerton Advance Balance Test •  Fullerton Functional Fitness Tests

(Senior Fit Tests) – 7 functional assessments..

•  Tinetti Balance and Gait Evaluation •  AAHPERD Functional Fitness Tests

Timed Up-and-Go Test (Rickli & Jones)

Consider Key Assessments •  Rhomberg Balance Test •  Sharpened Rhomberg Balance Test •  Any relevant balance screen (e.g.,

stepping, navigating obstacles) •  Postural Observation •  Sit-to-stand Movement Screen •  Overhead Reach Movement Screen •  Get-up-and-Go Test

Programming …

References: •  Katzmarzyk, P.T., et al., (2009). Sitting time and mortality from all causes, cardiovascular disease and cancer. Medicine and Science in

Sports and Exercise, 41(5): 998-1005. •  Levine, J.A. (2009). Move a little, lose a lot. Three Rivers Press, Pittsburgh, PA. •  Ekelund U, et al. (2015). Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men

and women: The European Prospective Investigation into cancer and nutrition study. American Journal of Clinical Nutrition, 2015: as doi: 10:3945/ajen.114.100065.

What does research tell us? •  Study: 17,013 individuals over a 12-year period.

o  In all individuals – strong correlation between sitting and mortality risk.

o  Physical activity does not cancel all ill effects of being sedentary: §  Reduced HDL levels = increased CVD risk. §  Decreased muscle LPL activity = elevated blood TG = increased CVD. §  Increased insulin resistance.

•  Study: Non-exercisers (low BMI v. high BMI) o  Low BMI group averaged ~150 min more movement per day.

§  Averaged 352 kcal more per day = 36.7 lbs. per year.

•  Study: 334,000 adults over 12 year period.

o  100 kcal per day (e.g., brisk 20-min walk) reduced mortality by 16-30%.

Programming …

Unloaded (bw) Loaded Explode (movement) (strength) (strength x speed)

Overload

Multi-Directional

Specificity Sagittal – Frontal –

Transverse

Linear

Foundational Training

Functional Training Ability –

Performance

Fundamental Preparation Corrective exercise

Isolated muscle training Self-efficacy

Specialized Movement

Generalized Movement

Programming Model

Programming …

Why isolated muscle training? Why self-efficacy? Internal barriers and social norms.

Within the Upper Extremity Mobility

•  Promote lumbar stability 1st !! •  Then target thoracic spine mobility next!!

o  Why is this so important? o  Think balance and perspective of their world. o  What does thoracic extension provide?

Never compromise lumbar stability !! – demonstration

Programming …

Balance Training

You manipulate variables to challenge postural control (stability). •  1st – reeducate neural pathways or reinforce core engagement.

Programming …

Variables Duration

Line of gravity Points of contact

Base of support Sensory alteration Sensory removal

Center of mass Additional unstable surfaces

External perturbances

Seated Exercises •  Supported v. unsupported •  Stable v. unstable

Standing •  Supported v. unsupported •  Stable v. unstable

Systematically introduce / progress variables

•  Positional Isometrics: 2-4 reps x 5-10 seconds to start.

Considerations: •  Vestibular issues = dizziness / loss of balance in transverse plane / head

rotations (e.g., in-step marching).

•  Caution (sagittal plane – loss of peripheral vision).

Static and Dynamic Balance

Hip-width Stance Neutral stance Narrow Stance

Staggered Stance Split-stand Stance

Tandem (heel-to-toe)

Single-leg Stance

Programming …

Weight Transference

In-step Marching

Stepping: •  ½ step •  Full step

Step ups; Stepping to Single-

leg end ROM Gait-

specific

Obstacles – walking variations (e.g., alternating width, tandem, high-knee, crossovers).

Dynamic, Standing:

Static, Standing:

Option One: Talk-Test:

•  Level 1-4: Caloric quality (fat), but little caloric quantity (kcal) •  Level 5-6½: Caloric quality (fat) + good caloric quantity (kcal) = optimal •  Level 7-10: Little caloric quality (fat), good caloric quantity (kcal), but higher risks.

Programming …

Option Two: Simple Cardio Solution

Consider ignoring HR monitoring – may be uncomfortable and inaccurately measured:

Volume-Intensity-Progression (VIP) Model

Total Training Volume x RPE frequency x duration (volume) x RPE (intensity)

•  Simple and easy. •  Requires no HR monitoring.

Programming …

Steps to using VIP Model: Example: Joe’s goal – improve his cardiorespiratory health and commits to 3x/week for ~ 20 minutes @ 5-out-of-10 effort + 10% weekly progression.

1.  Training Volume: Frequency x duration = 3 x 20 minutes = 60 minutes. 2.  Training Intensity: RPE of 5 3.  Training Model: V x I = 60 min x 5 = 300 points.

Frequency Duration Intensity Total Time 3 Sessions x 20 x 5 … 300

Variations 4 Sessions ü x 15 x 5 … 300

2 Sessions 1 Session

x 22 ü x 16 ü

x 5 x 5

… 220 … 80

2 Sessions 1 session

x 19 x 15

x 5.5 ü x 6 ü

… 209 … 90

10% weekly progression: •  Week 1 = 300 points (x 10%); week 2 = 330 points (x 10%); week 3 = 365 points.

Programming …

Considerations: •  Although load (intensity) is the most adaptable variable, what about frequency

v. duration (i.e., 1x30-min bout v. 4x7½-min) – training each fitness parameter frequently?

•  Outcomes = comparable if not better adaptions, but improved psycho-emotional impact of bouts (i.e., experiences).

Variable Modality Training (VMT)

Warm-up Conditioning Phase – cardio and/or resistance Cool-down Traditional:

5-10 min 5-10 min 45 min

1 2 Integrated: 3 4 5 6 7

Series of mini or micro-bouts (each can be uniquely different or repeat at fixed or odd intervals. 5-10 min

Programming …

Microsession 1 Microsession 2 Microsession 3 Microsession 4 Microsession 5 Microsession 6 Microsession 7 Microsession 8 Microsession 9

Inte

nsity

Warm-up / balance

Skill Drills – light agility

SS cardio

UE Endurance

Core stabilization

Power-reaction drills

SS Cardio

LE Strength

Cooldown / Flexibility

Programming …

Goals: Smaller, more manageable exercise bouts + greater transitions from (anaerobic) to type I (aerobic). •  Enables and facilitates appropriate anaerobic recoveries. •  Active recovery modalities include:

o  Light cardio o  Stabilization / mobilization exercises. o  Balance and postural control.

Avoid excessive body-position changes (i.e., lying-to-standing): •  Hypotensive responses •  Difficulty in movement

For individuals > 50 years of age (after 12 weeks of training)

Exercise (Resistance) Guidelines for Older Adults – FITT-VPP ACSM (2014)

Frequency (F): •  Target major muscle groups ≥ 2 days / week

Intensity (I): Light •  40-50% 1RM for older adults beginning a

program or for more frail individuals. •  3-5 out-of-10 effort (0-10 Scale)

Intensity (I): Moderate •  60-70% of 1 RM (one repetition max) •  7-8 out-of-10 RPE effort (0-10 Scale)

Type (T): •  Progressive weight-training program or weight-bearing calisthenics. •  8-10 exercises involving major muscle groups. •  ≥ 1 set x 10-15 repetitions each exercise (2-3 sets optimal for muscle hypertrophy /

strength).

Strength Gains

1x 2x 3x Training Frequency / week

Programming …

Why are we not training them like us, but like china dolls??

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Name: Fabio Comana, MA., MS.

Credentials: NASM CPT, CES & PES; ACE CPT & HC; NSCA CSCS; ACSM EP-C; CISSN.

Email: comana.fabio@gmail.com

Thank You..!! For Your Commitment to Excellence

Questions .. ??