Most new trainers will answer the question “What kind of clients do you hope to train?” with an exuberant “Athletes!” or “People I can really push!” Our culture puts a high value on the vibrancy and beauty of youth, which can result in a certain level of disdain and uneasiness regarding the senior population. A health professional’s bias and unease could prevent an older client from fully benefiting from — or even starting — a well-developed exercise program.
This article will serve as a basic guide for training seniors. Why is this important for you to know? In the coming decades, the elderly population in America will reach nearly one in five residents (Clark, 2004), and we see similar population projections in other developed countries around the world, so your senior client base will likely grow accordingly. There is huge opportunity for you to tap into that market if you know how to effectively communicate with older clients and address their specific needs with appropriate programming.
By the age of 75, 33% of men and 50% of women will be doing absolutely NO physical activity (Hughes, 2005), so when you have clients in this demographic who want to train, let them know how extraordinary they are for being active and help them get moving!
Start your elderly clients with a once-a-week training session and transition their program to meet their needs and their physical capabilities. Sessions of only 20 minutes twice per week can make a big difference in an elderly client’s health, and with an increase in physical endurance you and your client may be able to train up to three times per week. As always, keep physical limitations and energy levels in mind when designing and implementing a new program.
Implementing Strength and Cardio
The general public may hold the belief that strength training is useless after a certain age, but research indicates otherwise. For example, a study published in the Journal of Gerontology discusses the strength gain results of 58 men and women aged 71 to 100 years (Singh, 2002). These individuals resided in senior citizen or nursing homes and were led through an 8-week moderate intensity strength program involving an upper body dumbbell strength plan or an upper body stretching control condition. The subjects increased muscle strength by more than 50%. If that doesn’t make you want to take a bundle of dumbbells to your nearest nursing home, this article is a lost cause!
Ease into the strength training program with your client by starting with lower weights and performing only one set of each exercise. Some beginning exercises include wall push-ups and lifestyle-reflecting exercises such as sitting in a chair and getting back up again. This is also a great time to use those giant space-killing dinosaurs also known as MACHINES! The controlled movement of machines will allow a client to become more body aware and confident, but please do NOT limit your client to just seated exercises during the session! You can safely adjust repetition range between 8 and 20, depending on the client's goals and stage of training. Be conservative in early training stages and during phases of low energy — which are sure to come even in healthy older individuals — by keeping the rep range between 8 and 12. As endurance builds, perform up to 3 sets. Allow generous rest times and always keep track of your client’s breathing and pulse.
When it comes to cardio and your aging client, play it safe and use careful analysis when choosing activities. A variety of exercises will both safeguard your client and improve cardiovascular health. Consider aquatic classes or swimming, treadmills with handrails, and recumbent or stationary bicycles. Start with short bouts of cardio totaling 8 to 10 minutes. All exercise — both strength and cardio — should be kept within a moderate intensity as outlined in the “Guidelines” portion of this article.
Introducing Balance Exercises
Can you imagine having to live with the fear of falling every time you walked into a grocery store, off of a curb or into a bathtub? This is the daily reality for many baby boomers who struggle with decreased balance and function. According to Dr. Christian Thompson (n.d.), over 33% of older adults fall each year. As a personal trainer, you have the tools to give these individuals the independence they deserve in their day-to-day activities. However, before guiding senior clients through a balance exercise regimen, be sure you fully understand their limitations. Oftentimes, beginning with one set of a conservative balance exercise in a safe environment will give an idea of a client's ability level. Make the exercise relevant to activities of daily life. For example, have your client perform a single-leg balance while reaching for a waist-high object. To train balance in an elderly client it may be helpful to teach them to stand with both feet on a cushioned Airex pad and then progress to one-foot balance for 10 to 30 seconds. Remember that aging clients may have unexpected balance difficulties due to fatigue, medication, and other factors so it is important to always be prepared to assist and protect them from injury during exercise.
Understanding Your Client's Lifestyle
Knowing whether your client lives alone, with family at home, in a nursing home, or in an assisted living center is significant when designing a workout program. According to Renae McCloud, owner of McCloud Fitness in Seattle, WA, exercises should be based on basic and fundamental movements that reflect each client's lifestyle. Again, a primary goal should always be to keep the client as independent as possible. Typical movements include, but are not limited to, activities of daily life such as squatting, lunging, pushing, pulling, as well as rotation. Learning about your client’s hobbies and ambitions also provides necessary considerations for program design.
Have you ever eavesdropped on a trainer in a session who seems to have an endless and dominant role in conversation, all the while their client is hammering out reps? Now picture the same scenario, but with an elderly client. I hope you cringed a little. Listening to your elderly client (or any client, for that matter) will give you vital information about their physical situation that may otherwise be overlooked.
Consider this story: A trainer was working with an elderly female client who had repeatedly complained of back pain. The trainer listened, took these complaints to heart, and discussed them with the woman’s family. The family insisted that the pain was imagined and asked the trainer to continue with the program and ignore future complaints. The trainer chose instead to listen to the client and insisted that the family take her to a doctor. Through a series of tests it was discovered that the client had a fractured vertebrae and severe osteoporosis.
If you feel like an exercise is too risky for your aging client, regress! Remember to always LISTEN to your client and LISTEN to your training instincts.
The milestones your aging client may overcome during your workout are likely going to be more ambiguous than some other populations. Keep your eyes open to the smallest successes and celebrate big! It is just as challenging — if not more challenging — for your older clients to get to the gym than it is for the rest of your clients. Acknowledge their efforts of attendance and persistence. I trained a client in her late 80s who took a taxi twice a week from her nursing home to the gym and never missed a session. For one appointment when the taxi did not show up at the nursing home, the 89-year-old woman walked from her nursing home to the gym. If only all of our clients had that level of commitment…
According to the National Academy of Sports Medicine, initial workouts with healthy older adults should last between 20 and 45 minutes and should be progressed as gradually as possible (Clark, 2004). During the workout be hyperaware of your client’s pulse keeping the intensity levels at a moderate intensity of approximately 60% of their maximal strength. According to a study published in the Journal of Physiology, “exercise intensity of at least 60% of maximal strength may be required to stimulate myofibrillar protein synthesis” as studied in healthy older individuals (Moore & Burd, 2009). Encourage your client to perform cardio of 8 to 10 minute bouts building up to 30 to 60 minutes per day. Each individual you train should go through a movement assessment. The aging population could have difficulty with some traditional forms of assessments such as the overhead squat. You can ease this process by watching their movement patterns during everyday activities such as sitting in a chair and rising back up again.
While contraindications exist for the over 85% of older adults with at least one chronic condition, this article only addresses the training necessities for healthy older adults. Consult each client’s primary physician and seek out specialty training certifications for clients that require more specialized assistance. Keep a record of the medication your client is taking and research possible side effects that could affect the workout.
Always observe your client for signs and symptoms of chronic disease. Some conditions such as heart disease may go undetected in the elderly. Symptoms may include shortness of breath, dizziness, chest pain, and swelling of the limbs or abdomen, among other symptoms (Mayo Clinic Staff, 2011).
For elderly clients with orthopedic challenges, getting up and down from an exercise floor mat may be uncomfortable or impossible. In this situation, use a sturdy massage table for floor exercises. This will allow them to participate in important core exercises without compromising their health or comfort.
Clients struggling with arthritis should have their rep range modified to 8 to 10 reps to avoid further inflammation of the joints. Avoid exercises that could reduce integral blood flow in arthritic clients such as isometric exercises or gripping exercises.
Elderly clients with heart maladies should also avoid isometric exercises. When training an elderly client with a heart condition who has been approved by their physician to exercise, be sure to avoid extreme temperatures as it can interfere with circulation and breathing. In addition, be sure the client is well-hydrated and is eased back into exercise after missing any regular appointments.
Elderly clients with diabetes should follow the same guidelines as for heart conditions with the added use of caution protecting the feet. Keeping the feet properly cushioned and dry while performing low-impact, moderate exercise with light weight and high reps is recommended (American Diabetes Association, 2011).
Finally, be cautious with your elderly clients when foam rolling as it is contraindicated with some chronic disease. Most important, make sure you are up to date on your CPR/AED training.
Sample Exercise Program for a Healthy Beginner Senior Client
||Recumbent bike/Treadmill walk
|Gentle stretching of major muscles
||If available, do these manually on a massage table or in a controlled environment.
||5 repetitions per leg
||Assess and continue.
|Stand unassisted on Airex pad
||10 to 30 seconds
||Progress to single-leg balance.
||8 to 10 repetitions
||Progress to 2 sets.
|Standing tubing row
||8 to 10 repetitions
||Be sure to stand with client to protect from balance difficulties.
|Seated lateral raise
||8 to 10 repetitions
||Progress from machine to bench to stability ball with light weight.
|Standing dumbbell curl
||8 to 10 repetitions
||Progress to standing on Airex pad.
||8 to 10 repetitions
||Assist and teach your client to recruit the right muscles when sitting and standing in a chair. Practice for everyday life!
|Assisted stretching and Stick work
||Using The Stick will help relieve tightness in an older beginner client who may have difficulty assuming traditional stretching positions.
- American Diabetes Association. (2011). Diabetes Mellitus and Exercise. Retrieved 2011, from Diabetes Care: http://care.diabetesjournals.org/content/25/suppl_1/s64.full.
- Clark, M. A. (2004). Optimum Performance Training for the Health and Fitness Professional. Calabasas: National Academy of Sports Medicine.
- Hughes, S. L. (2005, February 8). Characteristics of Physical Activity Programs for Older Adults: Results of a Multisite Survey. Retrieved January 24, 2011, from Oxford Journals The Gerontologist: http://gerontologist.oxfordjournals.org/content/45/5/667.full
- Mayo Clinic Staff. (2011, January 12). Heart Disease Symptoms. Retrieved January 24, 2011, from Mayo Clinic: http://www.mayoclinic.com/health/heart-disease/DS01120/DSECTION=symptoms.
- Moore, D.R. & Burd, N.A. (2009). Exercise intensity matters for both young and old muscles. The Journal of Physiology: 511-512.
- Thompson, C. P. (n.d.). Exercise for Older Adults. Retrieved January 24, 2011, from PTA Global: http://www.ptaglobal.com/ClientBin/PresentationMaterial/pdf/21042.pdf.
- Singh, M. (2002, May). Exercise comes of age: rationale and recommendations for a geriatric exercise prescription. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 57(5): M260-1.