By the year 2030, the number of Americans over the age of 65 is projected to be over 71 million, meaning nearly one in five Americans will be considered elderly (U.S. Census Bureau, 2004). Estimations for Canada, Japan, Mexico and the U.K. are found to be closer to one in four (International Counsel of Active Aging, n.d.). As the world’s population grows older, it faces challenging issues including mortality, longevity, insecurity and quality of life. Evidence strongly supports an increase in physical activity — some studies suggest as little as 27 minutes two times per week — as a practical way for older adults to improve health, offset depression, enhance overall well-being, and reduce risk of chronic conditions.
Numerous studies report that regular physical activity is the strongest overriding positive determinant of health status for seniors. Positive outcomes include: reduced risk of falls; reductions in hypertension, BMI, blood glucose, and serum cholesterol; enhanced ability to manage stress; improved mental health (including depression); greater feelings of self-efficacy; reduced aging-related muscle atrophy and declines in strength; extended life; prevention/mitigation of colon cancer, arthritis and diabetes; and improved coordination and flexibility.
A Population Ripe for Fitness Programming
Offering a comprehensive older adult fitness program in your wellness facility can set you apart from your competition, attract a demographic that you would not traditionally see, and drive new business to your facility and staff. However, the most profound benefits go far beyond business growth and profits.
On a macroeconomic level, older adult programming lowers health care costs and mitigates the economic impact of an unhealthy culture. This is an important consideration because, ultimately, increased health care costs affect everyone.
From a microeconomic perspective, older adult programming offers exposure to an otherwise often “unseen” population. It gives a community heart, character, and socialization. This not only keeps the community and its businesses thriving, but it also creates comradery and a social structure that offsets isolation and depression.
Katon et al. (2003) found that depressed seniors incurred approximately 50 percent higher health care costs. This study demonstrated an increase by as much as US$1700 in total costs per person annually. Blumenthal et al. (2007) showed that exercise increases remission rates in 40 percent to 45 percent of participants with major depression and was as effective as Zoloft in treating major depression in adults age 40 and over. Glass et al. (2006) published longitudinal data on social engagements and depression in seniors, and reported that those with the least social engagement had the highest depression scores and vice versa.
Research clearly demonstrates that physical activity is one of the best opportunities to increase longevity, reduce disability, and improve the quality of life in older persons. It is somewhat unclear from the research which factor has a stronger impact on seniors’ quality of life: exercise or social engagement. It is clear, however, that both favorably affect senior health, particularly seniors who struggle with depression.
These findings support the need for comprehensive programming that offsets not only the physical degeneration we find with aging, but also the potential emotional and social degeneration.
Many fitness agencies geared toward the needs of older adults indicate that older adults have more free time, more disposable income, a desire to maintain their independence, and can work out during quieter times when facility traffic is slow. While this may be true for certain categories of older adults, this is not necessarily gospel. Making assumptions and generalizations regarding the aging population is a mistake that can be hazardous to a potentially successful program.
For example, it is important to be sensitive to older adults who may not appreciate being referred to as a “senior” or “senior citizen.” More recently terms like “active older adult” or “mature adult” have been used to define and describe what was once referred to as a “senior.” In addition, we are finding that categorizing a population by age is not a fair one-size-fits-all representation of fitness levels, since many "seniors" are, in fact, quite fit.
Changes that come with aging can be subtle, but progressive. Often a small, yet crucial, decline in functional ability goes unnoticed. Activities that were once easily done may now present significant challenges. For example, maneuvering on icy sidewalks, climbing up or down stairs, reaching high places, getting in and out of a bathtub, and attending to personal hygiene needs may become more difficult. As these changes develop, a type of vulnerability sets in and can cause day-to-day tasks to feel risky and instill fear. Programming should be created specifically to offset aging and degeneration while improving quality of life and increasing independence.
A solid fitness program for older adults should focus on improving stability and balance, strength, range of motion, and aerobic capacity. It is important to also pay attention to breathing and relaxation because of the prevalence of anxiety, depression, hypertension, and decreased lung capacity. The extremely elderly population or populations with various symptoms of aging and degeneration will require a lot more time, attention, and specific program designs. It will be important to be patient and empathetic with this demographic, as losing independence and faculties is very difficult.
Comprehensive program design is critical and the risks should never outweigh the benefits for any exercise. Contraindications should be noted and a thorough health history form should be completed and accessible to anyone working with these members. A medical clearance form may be required for many participants. Safe, slow progression with consistency and predictability will be the most successful types of workouts and will ensure satisfied return customers.
A reputable mature adult health and fitness program will offer a variety of well-rounded individual and group options. Personal training, small group training, group fitness classes like gentle yoga, dance, strength training, and fall prevention, plus educational seminars and social activities are key to building a successful program.
Hiring and Training the Right Staff
Many fitness professionals are ill-prepared and either unaware of or simply disinterested in working with the aging population. Therefore, fitness facilities must seek out confident, well-trained, certified fitness professionals with experience and a desire to impact and instruct older adults. Candidates may be seasoned personal trainers, group fitness instructors, or even older adults who have an interest to be a leader or role model amongst their peers.
While there is currently no specific senior fitness “certification” available, professionals have instant access to continuing education courses offered both live and online and through a variety of different fitness education bodies. A few examples include: NASM, ACE, AFFA, YogaFit for Seniors, and Zumba Gold (Zumba for the older population). You can find ongoing, comprehensive and collaborative information regarding demographics, current research and current international trends from the International Council on Active Aging.
Walking in the Older Client’s Shoes
In addition to general education on working with older individuals, wellness facilities should also offer "sensitivity" training to staff on a regular basis. Every club member requires collaborative service from the entire staff — the sales team, the front desk employees, the janitorial staff, the fitness team and even the kids’ club staff. A good wellness facility understands the benefits of creating a service-oriented approach and a sense of community with its members. Investing in developing empathetic or sensitive employees will help create connections, awareness and a sense of heightened acuity for working with or around older adults. When members see familiar, helpful faces and have a sense of belonging, retention improves. The return on this kind of retention translates directly into gross revenue. After all, retaining members is always more cost effective than recruiting new ones.
One of the drills I use to train fitness professionals to work with older adults is a simulation exercise. Participants begin by placing popcorn in their shoes and then trying to jog; this simulates the aging effects of losing fatty deposits in your feet, or the pain a diabetic may feel when walking. In addition, participants wrap duct tape around their bare feet, put their shoes back on and walk around to experience simulated peripheral neuropathy.
Next they each put on fitted medical gloved and wrap a band aid around each knuckle on all five fingers; this simulates limited dexterity and limited range of motions as well as arthritis. I ask them to place cotton balls in their ears to mimic limited hearing and use 3D movie glasses with a thin layer of Vaseline on them to simulate limited vision, cataracts, or limited peripheral vision.
Once everyone is prepared, each participant is asked to perform the following tasks:
- Read a section out loud from a page in a phone book (the local yellow pages) or something in 8- or 10-point fonts.
- "Quickly” fill out a fitness contract that is printed in 12-point font.
- Open a pill bottle with a few M&M's in it and take out just one M&M candy. This is an obvious example of the difficulties presented with skills as simple as taking a pill out of a bottle.
Typically, once participants are finished with this simulation exercise they are far more sensitive to issues of aging and are far kinder and more patient with this population. This kind of sensitivity is paramount for a well-equipped, caring and compassionate staff who can meet the diverse needs of an aging, changing, and sometimes vulnerable population.
In the two decades I have worked with older adults at numerous fitness facilities and for several companies, I have found the most successful older adult fitness programs are ones that offer age appropriate resources, staff support, social events, consistency, care and cutting edge programming performed by well-informed fitness professionals in a holistic manner. In addition, the facilities that seem to facilitate enormous success are the ones that are willing to invest more, step outside the box, and think about bigger issues than just the bottom line.
- Blumenthal., J.A., et al. (2007). Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Medicine, 69(7): 587-596.
- Glass, T. A., C.F. De Leon, et al. (2006). "Social engagement and depressive symptoms in late life: longitudinal findings." Journal of Aging and Health 18(4): 604-28.
- International Counsel of Active Aging.
- Katon, et al. (2003). Increased medical cost of a population based sample of depressed elderly patients. Archives of General Psychiatry, 60(9): 897-903.
- U.S. Census Bureau (2004). U.S. Population Projections.