As a conference speaker, I have met many fitness professionals who tell me they don’t work with older adult populations because the work is not fun, intense, easy, nor does it include opportunities to get a workout. I realize this may sound negative and antagonistic, but these fitness professionals are right - these objections are true unless there is an understanding of what it takes to work with this ever-growing population.
As an industry veteran, who has worked extensively with older adults, I can say with authority that this is the demographic where today’s fitness professional can make an impact in improving people’s lives. It is true that it’s not a physically demanding population to work with, nor does it afford the opportunity to move along with the participants in an intense manner- much like a conventional group exercise class. This population requires a very “on” personality with a lot of enthusiasm and interpersonal engagement. Often there are some deep, both happy and sad, stories that align with the people you will meet in these classes and the need for the fitness instructor to create socialization and a sense of happiness is very real, which can be hard work. Working with this population also requires additional knowledge in the form of continuing education in order to ensure safe classes and effective exercise selection for the purpose of fall prevention. These factors create a need for the opportunity to lead fitness classes or sessions, much like general population, but with a different emphasis. This article will attempt to guide the fitness professional successfully into this population to help them find that these people are fun and worthy to work with, offering rewarding experiences and opportunities for professional growth, development of a deeper sense of empathy and an expansion of fitness education and knowledge.
The following will offer options and program design suggestions that can be used in assisted living facilities, parks & recreations, residential facilities, YMCA’s, and other locations where active adults converge to engage in exercise, socialize, and improve their physical function. Let’s examine the sub-classes of aging adults and their particular fitness needs during these stages of life. We will also explore exercise selection recommendations to help to guide fitness professionals with ideas for movement selection for the primary purpose of fall prevention and socialization. Based on this, I will offer a two-chair group training solution incorporating balance, agility, power, socialization and range of motion options.
Sub-Classes of Aging Adults
According to AARP, sub-classes of aging populations can be identified in terms of age categories. NOTE: I realize that many people in their fifties, sixties and beyond are extremely fit, capable of much and can do many of the same fitness-related activities that a healthy 30 or 40-year old can. However, I am presenting information about the average American and not recreational athletes who have identified with and are already on the path to better health and wellness through fitness. Additionally, almost all populations can benefit from cardiovascular program design. The purpose of this article is to address functional movement primarily for these classes of aging adults, with an emphasis on the oldest old – 82 years and older.
- Middle-Aged can be defined as those who are 50-59 years old. These individuals are able to perform most activities with little to no need for options or modifications, but may be seeing or beginning to live with some limitations. The primary goals for this population are closed-chain activities, functional movement with an emphasis on power to preserve fast-twitch muscle fiber and strength, balance and agility for continued pattern coordination and pain-free functional movement.
- Seniors are classified as those 60-69 years old, seeing or living with limitations. They don’t necessarily need extreme caution, but may have more difficulty moving from floor-based to standing positions, or struggle with other agility, coordination or power-based movement. They may benefit from a combination of chair-based and standing exercises for movement balance training. Agility, coordination, strength development and preservation, range of motion, reactive training, and pattern development should be included in program design. Partner exercises are ideal for this population as it facilitates for socialization.
- Older, active adults are between 70-81 years old. This group may need significant modifications and would benefit from primarily chair-based classes with intervals of standing for lower body power development, and balance training. There should also be a strong emphasis on socialization as well as a combination of both simple and more complex movement patterns.
- The Oldest Old are 82 years and older. This group may require significant modifications with an emphasis on chair-based movement, but fitness professionals should include the option to stand when appropriate. Some participants will not stand at any point during the class or session, but may be present simply for the exposure to the social opportunity. In my years of experience, I have had many participants come to these classes and just sit and watch. This is perfectly OK. The emphasis should be on socialization, with opportunities to practice balance and memory using less confusing exercises. Also encourage range of motion, deep breathing and relaxation techniques.
Movement Selection for Fall Prevention
The primary goal of movement selection for all of these populations is ultimately fall prevention. In 2013, over 2.5 million adults over the age of 65 years had a non-fatal fall, resulting in injuries, fractures and hospitalizations (1). Falls are a very serious problem in the United States and they often have a complex set of causes that can be a challenge to figure out. Although it sounds intuitive, placing a member of one of these sub-groups onto a balance trainer simply for the purpose of improving balance may not be the best idea because just having balance is not the only method to avoiding falls. Consider all of the following factors as components of a fall prevention plan (2):
Creating More Confidence to Decrease Fear of Falling
Many older adults are fearful of exercise because they are afraid of falling, which sets up a vicious cycle. They are fearful, so they restrict their activities. Muscles get weaker and activities are restricted so they are more likely to fall. In addition, individuals with any gait impairment fall “less well” because they are less able to brace themselves when they do lose their balance. Fitness professionals can instill confidence through movement selection, and using chairs in the exercise sessions can be very powerful in instilling this confidence.
Increased Energy and Vitality
Exercise naturally increases energy levels and the sense of vitality, which is a feeling of being strong, active and having energy.
Improved Physical Function
In generally healthy adults, exercise has been demonstrated to improve physical function in aging adults, as long as exercise selection is specific to improving function and fall prevention.
Joint Range Of Motion
Having the ability to move through uninhibited and pain-free ranges of motion can be practiced specifically in a chair-based fitness program safely, and offers participants confidence which serves to build self-efficacy (3).
Stretching and flexibility lend themselves to greater ranges of motion as well as increased muscular strength, endurance and comfort. Tight muscles can obstruct joint ranges of motion, so including flexibility and if appropriate, self-massage techniques can be very helpful with this population in promoting muscular balance.
This population undergoes significant stress-related situations including life changing events, changes in medication, illness, loneliness, isolation and loss. These are frequently a part of daily living. Relaxation includes mental imagery, deep breathing, meditation and recovery between exercise sessions. Exercise sessions and classes that are fun and enjoyable that include opportunities for socialization can make a big difference in stress reduction too.
Many older adults take medications including those for pain management. In particular, rheumatoid conditions can cause issues with gait as well as produce pain when moving through active ranges of motion.
Chair-based exercise classes have been shown to have a beneficial effect at maintaining or promoting independence and mobility in older adults. The range of improvements demonstrated in chair-based fitness research include the following:
- Exercise compliance, especially amongst the oldest old and those with low baseline levels of fitness and function.
- Stability in the spine by providing a fixed base.
- Particularly important in those with kyphosis or lordosis
- Greater range of motion by providing support.
- Minimized load-bearing and reduced balance issues in those with poor mobility and arthritis.
- Increased confidence in those unable to perform free-standing exercises.
The following movements should be integrated into a chair-based fitness class or session:
Ankle Range Of Motion
Practicing activities where plantar and dorsiflexion occur for the ability to push off during walking and to create more powerful movement through the ground up, into the muscles of the lower body. Individuals who shuffle when they walk frequently have restricted ankle ROM and also have a much higher incidence of falling, compared to those who move the ankle joint with more freedom. Fitness professionals need to encourage activities that include ankle ROM activities and discourage the shuffle of feet when walking. This can be done during chair-based exercises sessions frequently.
Improved Gait, Multi Directional Movements
This may include practicing the movement of sagittal pane motion including walking or side-to-side stepping. Fitness professionals should teach participants to move their arms by their sides; lifting the knees to hip height and flexing the ankle joint. Standing behind the two-chairs can be very helpful with this drill, as would moving in the frontal plane side to side as in a step touch pattern. Participants can hold onto the back of the chairs to maintain their balance and increase their confidence when practicing these drills and movements.
Power Development for Explosive Movement
Muscle power has to do with how quickly and efficiently participants can move, and is connected to activities of daily living and physical function. Use the Sit to Stand exercise to help with explosive power like getting off a chair or a toilet seat. This drill includes moving from a seated position to a standing one, using one of the two chairs. Try timing participants to see how many Sit to Stands they can do in 30-seconds. Focus on the success rather than the lack of ability to complete very many. They will improve in this skill over time. Tempo squats can also be performed behind the chairs, which offers additional power and strength training, as well as a confidence boost for those who are intimidated by performing an unassisted squat. Limit range of motion if the movements are not pain free in the knees or hips.
Strength Training for Increased Muscle Mass
Atrophy and sarcopenia are health-related issues for this population. Sarcopenia is a term referencing the decline in lean muscle mass associated with aging, literally translated to mean a wasting away of muscle. Atrophy is a decrease in muscle size as the actin and myosin filaments decrease in size due to non-use. According to Harvard Heath, less muscle means greater weakness and less mobility, both of which may increase the risk of falls and fractures. People with sarcopenia have 2.3 times the risk of experiencing a non-fatal injury as a result of a fall. These two issues combined can prove disastrous with respect to the ability for an aging adult to maintain personal independence and daily, functional movement. Strength exercises may be incorporated into this two-chair routine by adding resistance tubing or dumb bells. Although the loads may not be great enough for strictly strength gains, there is significant benefit to be had though muscular endurance training.
Scapular Depression and Retraction for Improved Posture
Teaching aging adults to depress and retract their scapula after years of living with elevation and protraction can be difficult to coach. This associated with spinal misalignments (kyphosis or Dowagers hump) may not be realistic to address with an expectation to reverse the situation in a fitness class setting. However, progress can be made with respect to improved scapular positioning and increase core stability. Focus on skills and drills in which scapular placement is highlighted. This will likely help with functional movement of the shoulders, arms and spinal alignment and can lend itself to core stability.
Two-Chair Fitness Classes
Ideally each participant will require two chairs each; a 2:1 ratio. The best chairs are banquet style chairs – those seen in hotel banquet facilities. Often these can be purchased from hotels looking to replace their old chairs, so it may be worthwhile to inquire at a local hotel. These chairs are frequently padded, without arms with a sturdy back. These are ideal for chair-based classes as they are both sturdy and comfortable and at the right height. Place these chairs side by side, with enough space in between the chairs to move the body into and out of the space. This can be adjusted as the class progresses. I usually use this space when performing standing balance exercises, yoga postures or modified lunges. Begin sitting in one chair, focusing on posture and foot position. Feet should be parallel to another, side by side, about hip width apart.
The Warm Up
The easiest way to lead this class is to start at the top (the head and neck) and work your way down to the ankles and feet. Begin with gentle breathing exercises and then move into easy stretches and range of motion activities for the neck and shoulders. Use a gentle, soothing voice to encourage confidence and relaxation. Begin to incorporate shoulder rolling and easy arm swinging, always controlling movements. Move into the elbows, wrists and hands. One should transition into the spine with flexion and extension type movements from a seated position. If appropriate, begin to incorporate rotation. Move next into the hips and knees, beginning with easy knee lifts and marching movements from a seated position. Begin to incorporate hip hinging and lateral reaching. These activities, if performed at a quick enough pace, will increase blood flow, body temperature and joint lubrication. However, encourage the participants to work at a comfortable pace and level. These activities should take eight-10 minutes.
Sit to Standing Exercises
Assure the participants that they can chose to stay seated during this section of the class. Begin to include Sit to Stand activities and other movements where standing is highlighted. Move the participants to the back of the chairs and begin to perform squats, modified lateral lunges, high knee lifts between the chairs and side-to-side movements behind them. Yoga based movements including a modified Warrior Series works well here. Use your imagination, but always offer options where the participants can use the backs of the chairs for balance. Encourage taking a break or having a seat if the exercises begin to become too much for them. Try not spend too much time standing, as those individuals who may not chose to stand will be seated and waiting for you to allow them to re-enter the class through participation. This section may take 10-15 minutes.
Move back to the chairs and begin to focus on static stretches using the chairs for assisted stretches. Prop one leg up on a chair while having the participants stay seated on another while facing the chair. This allows for assisted ranges or motion. Return back to the focused breathing exercises and gentle stretches for the neck and shoulders. Finally move participants into guided meditation and deep breathing exercises. This section should take 10-15 minutes.
Music Selection and Socialization
Be sure participants can hear you over music and select music that will encourage relaxation, but is not too low key that is decreases the energy levels. In between transitions into and out of the chairs, encourage water breaks and allow for a few minutes of social time. Fitness professionals may even decide to incorporate introductions, name games or other simple activities to integrate opportunities for engagement with the members of the class as well as the fitness leader.
Activity is a critical piece to ensure optimal functionality and overall health in the senior population. Trainers must take into consideration both the physical and psychological factors when working with this population. Due to these factors, the environment in which seniors train in can play an important role to ensure their exercise program matches their physical capabilities as well as their comfort level psychologically. Implementing a chair-based program with this population can create a safe and inviting environment for these individuals to enhance physical activity engagement, resulting in improved health and functionality.
Centers for Disease Control and Prevention. (2014). Older Adult Falls: Get the Facts. Retrieved from: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html.
Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. (2011). Summary of the Updated American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons. Journal of the American Geriatrics Society, 59,148–157. doi:10.1111/j.1532-5415.2010.03234.
Dawe, D., & Moore-Orr, R. (1995). Low-intensity, range of motion exercise: Invaluable nursing care for elderly patients. Journal of Advanced Nursing. 21,675-81.
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