Senior Fitness

Average life expectancy has gone up and is expected to continue to increase. By 2010, 40% of the population of the US is expected to over 65 years old.

Aging is an inevitable biological process that gradually changes the body structure and function. There are two components of aging, biological and psychological aging. They are not synchronized and may occur at different rates in different people. Both are dictated by chronological age. A regular exercise program can reverse some of the effects of biological age and possibly the psychological age, thereby, increasing longevity. Physical inactivity can increase both age components.

The American College of Sports Medicine (ACSM) stresses the importance of strength training for older people. ACSM recommends that seniors begin an exercise program with strength training before they start an aerobic training program.

The purpose of this section is to increase the Fitness Instructor's understanding of the physiological and as well as the psychological changes that occur during the aging process. This will allow the instructor to develop an effective and safe fitness program specifically for the senior population. Senior classification varies according to who you ask. Generally, seniors are considered to be those that are 55 and older.

As in every population group, senior levels of fitness vary. However, with seniors there is a thin line between fitness training and rehabilitation. Unless you are a licensed exercise physiologist, you should not attempt to rehabilitate clients or exercise the frail. The senior candidate must have a doctor's physical exam and a doctor's clearance issued for him or her to participate in an exercise program and to what degree with any limitations noted. As a personal trainer you are responsible for the well-being of your clients. Don't take chances with their lives.

The client may be willing to endure pain in the expectation that it will be required to get in shape again. Careful observation should be made of the senior client to ensure that they are not over loading themselves. The American College of Sports Medicine (ACSM) has set guidelines for Senior Fitness. You can reach them from our website.

There are essentially two types of senior populations those that are reasonably healthy and fit (A-List) and those that are frail and disabled (B-List). This course will target the former group; i.e., the reasonably healthy and fit A-List populations. No attempt will be made to discuss fitness programs for the frail or disabled elderly or B-List populations. The personal trainer will not train anyone who is disabled or has any pathological conditions that requires special training considerations. These situations are the responsibility of the Physical Therapist under the supervision of a doctor and NOT the personal trainer regardless of the client's age.

Aging has been referred to as a disease. Aging can be the result of lifecycle, environment or lifestyle. Exercise and healthy lifestyle have been shown to delay and even reverse some of the effects of aging. Specific systems that undergo changes during the aging process are:

  • Cardiovascular System
  • Respiratory System
  • Muscular System
  • Skeletal System
  • Digestive System
  • Endocrine System
  • Nervous System
  • Immune System
Physiological Effects of Aging

Cardiovascular Effects

This Cardiovascular system includes the heart and the blood vessels. Due to an increase in the size of individual heart muscle cells, the heart tends to enlarge resulting in thicker walls, slightly larger chambers and reduced elasticity of the heart muscle resulting in a reduced cardiac output. Heart valves can thicken and not fully seat (murmur). The heart's natural pacemaker cells decrease causing arrhythmias or irregular heartbeats.

The older heart functions at a lower heart rate at rest. However, during exertion, it is not able to increase the amount of blood flow as compared to a younger heart. The heart cannot respond as quickly, or as forcefully, to an increased workload. Blood vessels can become brittle and the passages narrow due to arterial plaque (arteriosclerosis) resulting in a decreased blood flow and higher blood pressures (hypertension). An increased risk of aneurysms can be a result of lost elasticity.

A reduction in blood flow results in a decrease in the amount of oxygen that can be delivered to the other systems. This is measured as VO2 MAX and defined as the maximum amount of oxygen that can be utilized per minute. Reduced blood flow can result in shortness of breath, dizziness and in extreme cases Cyanosis characterized by a bluish discoloration of the skin. Many of these effects can be reduced by exercise.

Higher blood pressures are also a result of the heart's inability to fully relax (diastole) in order to fill with blood before the next contraction (systole). High blood pressure causes the left ventricle to work harder to push blood into narrowed and inflexible pathways. It may enlarge and outgrow its blood supply and thus becomes weaker. Blood pressure is normal during the diastolic phase and high during the systolic phase. This is common condition in the elderly and is called Isolated Systolic Hypertension. Almost half of all heart failures are due to failure of the heart in the diastolic phase. During diastolic heart failure, heart function appears normal, but the stiffened heart muscle causes excess fluid to build up in the lungs, feet, ankles, and legs. Blood may pool in the veins of the legs because the valves are not able to function correctly. This can also cause swelling of the lower extremities.

Reduction in hematocrit, which is a measure of both the number of red blood cells and the size of red blood cells, which can lead to anemia. Constriction or blockages of peripheral veins can cause the formation of clots, which can then dislodge causing an embolism in the lungs or stopping circulation in extremities. Phlebitis, which is an inflammation of the vein also occurs more often in the elderly. Blood glucose levels increase with age but not because of changes in the blood. Rather, it is the result of age-related insulin changes. Bone marrow decreases with age, causing a decrease in the number of new blood cells. As a result, bleeding will not stop as quickly.

The liver receives a smaller supply of blood due to shrinkage. This reduces the rate of drug detoxification, which can exaggerate the effects of drugs predisposing the elderly to drug overdose. By age 70, the weight of the liver has decreased by roughly 20%.

Specially adapted nerve fibers in the larger blood vessels and heart called beta adrenergic receptors (bAR) become less sensitive and, as a result, cardiovascular adjustments to changes in position are slowed, causing an increase in dizziness and falling. Fluid balance or pH usually remains constant unless there is an incidence of disease or damage to a particular organ.

Respiratory Effects

The Respiratory or Pulmonary system consists of the airway passages, the lungs and the supporting muscles. Due to calcification the airway passages can become less flexible. The muscle fibers, air sacs (alveoli) and connective tissues in the lungs are less able to expand and contract requiring more effort to inhale and exhale. Supporting muscles that assist the expansion and contraction of the lungs including the diaphragm can become hardened and less flexible thereby increasing the breathing effort and reducing Vital Capacity (the maximum amount of air that can be forcibly exhaled after a full inhalation). Generally, Vital Capacity is reduced to sixty-five percent by age 50 and to forty percent of the initial capacity by age 70. Cardiovascular training can reverse the effects of aging by increasing the strength and flexibility of the muscles associated with breathing and strengthens the heart muscle.

Breathing and Vital Capacity is further decreased due to arthritic conditions of the cartilaginous rib joints. A decreased in ciliary action (hair-like fibers that act like cleaning brushes) in the lungs results in an inability to remove mucous in the lungs thereby restricting oxygen intake.

The chronic lack of oxygenation of the alveoli, as is the case in diseases such as emphysema or bronchitis, may lead to pulmonary hypertension. This condition can further result in an overworked right ventricle of the heart. A weakened the left ventricle can lead to congestive heart failure (CHF) and pulmonary edema in which excess fluid collects in the alveoli decreasing gas exchange.

Muscular Effects

Starting at about 40 years of age there is a general atrophy of muscle (Sarcopenia) and an increase in adipose tissue (fat cells). By the age of 80 years old, there is an estimated fifty-percent reduction in muscle mass. The Muscular system includes muscles that are responsible for structure and strength such as the muscles of the shoulders, neck, arms, legs, back and abdomen. As the number and size of the muscle fibers decrease, muscles will reduce in size and strength until they are no longer able to perform their intended function. Tendons become rigid and less elastic and therefore unable to tolerate stress. Muscles continue to atrophy or reduce in size, not so much with age, as with disuse. It just becomes more apparent as one ages. Weight training can increase muscle mass and strength and counter the effects of aging. Skeletal muscle fibers decrease in diameter, particularly in the extensors and flexors, resulting in a curved posture and an abnormal bending of the hips and knees. Muscle growth as a result of exercise (hypertrophy) is slowed by the decrease in blood flow.

Exercise tolerance decreases partly due to fatigue. Thermoregulation is affected, which can lead to rapid overheating. Extreme exercise must be avoided since joints, tendons and ligaments have been compromised. Recovery from injuries will be slower. In the elderly, scar tissue will form faster than tissue repair thereby decreasing mobility. Mitochondrial functionality decreases with age, which reduces the effectiveness of exercise and will therefore slow new muscle tissue growth (hypertrophy). Free weights for the elderly present an additional risk since muscle reflexes have been slowed.

As tendons and ligaments become less flexible, joint range of motion decreases. A thinning of the joint cartilage and calcium deposition contributes to joint stiffness which, if not exercised, will cause permanent immobility.

Bladder control function diminishes as sphincter muscles become lose their tone resulting in incontinence or bladder leakage. This can become problematic during strenuous exercise. Although considered normal, it is important for trainers to be aware and realize the embarrassment that this may cause.

Skeletal Effects

The Skeletal system consists of the bones and therefore the structural strength of the body. Bones are normally dense and comprised mainly of calcium. Throughout the lifecycle, bones are constantly reforming in a process defined as remodeling. Bones absorb and release calcium as the body requires it. By age 30 bones begin to lose mass (Osteoporosis). Bone absorption of calcium is called Osteoblast activity and is required for bone production. When the body requires more calcium than is being taken in from diet, the body will catabolize calcium from the bones. Bone reabsorption or giving up calcium is called Osteoclast activity. This process if continued will leave the bones brittle and porous. This can also result in weakened tooth sockets and eventual tooth loss. In aging, the bones are unable to absorb the same amount of calcium as when they were younger and a negative effect occurs depleting the bones of calcium and reducing tissue.

As bones lose tissue, osteoporosis develops. In the spine, osteoporosis can lead to small fractures of the vertebrae along with the shrinkage of cartilaginous discs results in a curved spine (kyphosis or lordosis) and loss of height. Osteoporosis is also responsible for almost all hip fractures in older men and women. Cartilage also deteriorates, which provides the cushioning between bones. With less cellular water content, the cartilage becomes more brittle and susceptible to stress leading to arthritis.

In addition, the ligaments, which are the connective tissue between bones, become less elastic and reduce in flexibility. Due to deterioration in cartilage and stiffening of tendons and ligaments, the motion of joints becomes more restricted thereby decreasing flexibility. As the cushioning cartilage begins to break down from a lifetime of use, joints become inflamed and arthritic. Stretching can help maintain joint flexibility. Weight training can increase bone density and counter the effects of aging.

For both sexes, bone density, a measure of bone mass per unit volume, decreases at disproportionate rates throughout the body. Bones in the vertebrae, jaw and the heads of the long bones (epiphyses) decrease more rapidly resulting in a curved spine, tooth loss and limb fractures. During growth years, women accumulate less bone density, particularly during puberty, than men, resulting in smaller, narrower, and therefore more fragile bones. In aging, a reduction in sex hormones in men (testosterone) and women (estrogen) results in bone loss.

Bone density is measured in standard deviations from the normal or young adult density. Less than 1 SD is considered normal. Between 1 and 2.5 is considered osteopenia (bone loss). Greater than 2.5 SD is considered Osteoporosis. Roughly 54% of postmenopausal Caucasian women are considered osteopenic and 30% are osteoporotic.

Therefore, the consequences of bone loss as a result of age are greater in women who experience up to three times more fractures than men. Bone mass deterioration may be slowed by calcium supplements and weight bearing exercises.

Digestive System Effects

Intestinal muscle tone decreases, causing a decline in peristaltic contractions causing constipation. Straining to eliminate can stress the walls of blood vessels, causing hemorrhoids. The walls of the colon lose firmness and can produce symptoms of painful and dangerous diverticulitis. Sphincters muscles can reduce functionality leading to esophageal reflux and heartburn. The mucosal lining of the small intestine becomes thinner thereby decreasing the efficiency of nutrient absorption. Digestive enzymes decrease affecting impairing the absorption of vitamins and minerals in particularly B12, iron and calcium. Olfactory senses (smell) are diminished and along with tooth loss gastric sensitivity can lead to dietary changes that affect the entire body.

Nutritional requirements do not necessarily change, caloric requirements do. During each decade after 50, caloric requirements are reduced by ten percent due to changes in metabolic rates, body mass, activity, and exercise. There is still much study going on with regard to elderly nutritional requirements. However, the elderly require Vitamin D supplementation if they are to absorb calcium efficiently. This is due to changes in the skin, which leads to a decreased tolerance to heat and may cause the elderly avoid the sun. Reduced sun exposure can result in a decrease in the absorption of Vitamin D. Vitamin D is normally converted to the hormone calcitriol, which stimulates calcium absorption in the small intestine. Since the synthesis of proteins and digestive enzymes decreases with age, the elderly should eat more easy-to-digest proteins, i.e., more vegetable proteins and less animal proteins.

Endocrine System Effects

Metabolism is a function of the Endocrine system. The body's metabolic rate (how quickly the body converts food into energy) slows. This can lead to obesity and an increase in LDL "bad" cholesterol levels. Due to aging, changes in the endocrine system result in reduced levels of hormones, which does not normally lead to hormonal deficiencies.

A decrease in thyroxine secretion by the thyroid gland results in a decrease in the metabolic rate, which is one of the reasons the elderly are intolerant to cold.

Decreased function of the anterior pituitary produces less of the growth hormone resulting in a decrease in protein synthesis used for developing muscle mass. In addition, growth hormone reductions are responsible for an increase of fat storage and the reduced ability to utilize fat for energy.

Decreases in the levels of adrenal cortical hormones reduce inflammatory responses, protein synthesis and salt balance. However, the levels are usually sufficient to maintain homeostasis (balance) of water, electrolytes, and nutrients. The adrenal glands (atop the kidneys) produce less cortisol, which regulates blood pressure, cardiovascular function and the body's use of proteins, carbohydrates, and fats. The reduction of cortisol affects the body's ability to convert glucose to glycogen by the liver. Norepinephrine is also secreted by the adrenal glands is used for the reverse conversion of glycogen to back to glucose and fats to fatty acids for energy. Both Norepinephrine and Epinephrine (adrenaline) are secreted by the adrenal glands as part of the "fight or flight" response, thereby raising heart rate and blood pressure.

The pancreas produces digestive enzymes and insulin. Insulin production diminishes with age, which limits conversion of glucose to glycogen in liver and muscles for later energy use. In general, insulin acts to reduce levels of glucose. In muscle, insulin assists in protein synthesis, as well as, the cellular uptake of glucose and facilitates its conversion to glycogen used for muscular energy. In adipose (fat) tissue, insulin assists in the cellular uptake of glucose and its conversion to fatty acids as triacylglycerols for storage. In the liver, insulin facilitates glucose conversion to glycogen for energy. Reduction in insulin production can reduce the level of cellular energy since the cells cannot access the calories contained in the glucose.

In general, unless there are pathological conditions, the endocrine system functions near normal levels into aging.

Nervous System Effects

Neurons begin to decrease at around 30 years of age. Luckily nature has created an over abundance of brain cells so mental impairment does not occur. Short-term memory decreases and becomes more difficult to access. A significant decrease in metal functioning is generally the result of a pathological condition such as arteriosclerosis. Reflex response decreases by approximately ten-percent as a result of a reduction in the number of neurotransmitter and receptor sites by age 50. Motor skills and reaction times can become dangerously slow or wholly inaccurate.

Brain size and weight decrease with age. The decrease is mostly in the area of the cerebral cortex, the area associated with higher level functions. Decreased blood flow is usually the result of arterial narrowing, which increases the risk of stroke. An Ischemic Stroke is one in which a blood vessel in the brain becomes blocked as a result of a clot either in the brain or traveling to the brain. A Hemorrhagic Stroke is the result of a burst blood vessel. Both types of strokes result in a loss of blood flow to the affected area of the brain. It is extremely important to follow the recommended breathing recommendation when lifting weights to avoid drastic increases in blood pressure, which can easily bring on a cardiovascular event in the elderly.

There are continued debates and studies to fuel the debates as to whether neurons are replaced in the brain. However, it may still be said that what you use develops, what you do not use atrophies or wastes away.

The sensory system becomes less sensitive with regard to vision, hearing, smell, and taste. At the same time, the senses may become more sensitive to harsh condition such as bright lights and loud noises.

Near vision becomes impaired due to stiffening of the cornea (lens). This can result in potential exercise injury as well due to the inability to judge distances and focus. As a reference, inner limits of vision range from about 3 inches (7.6cm) in children to 32 inches (81.3cm) at age 60. Overall vision may be impaired in the elderly due to macular degeneration (retinal scarring) or cataracts. Color perception may also be affected and care is necessary where color identification of gym equipment is necessary.

Older populations lose the ability to hear high frequency (high pitched) sounds. Certain consonant identification is affected as well; i.e., f, g, s, t, z, ch, sh, and th. Therefore instructions must be clearly defined and in a tone readily identifiable to the hearing impaired to avoid confusion or injury.

Although exercise has not been proven to increase cognition, it has been shown to reduce depression and improve self-confidence.

Immune System Effects

The Immune System becomes less effective in fighting off infections by roughly fifty-percent. The reduction of T-cell response to infection is due to the reduced functionality of the thymus gland. Reduced antibody production results in a decreased ability to destroy viral and bacterial components. Cancer is another possible result of a deficient immune system, which does not react to and destroy the runaway growth of tumor cells. It is interesting to understand the interaction of lymphocytes and macrophages in the Immune System, although it is recommended study, it is beyond the scope of this course. In many cases, the elderly immune system is compromised by drug therapy, i.e., steroidal arthritis drugs, cancer treatments. Increases in the levels of autoantibodies result in an increased incidence of autoimmune diseases in the elderly.
Fitness Testing
The personal trainer does not have the qualifications to stress test anyone let alone a senior. This is the function of a trained medical person. The following are testing methods to determine if the prospective client is trainable by a personal trainer or should be referred to a physical therapist. These tests are required for all people who are 65 and older. However, they may also be used at the trainer's discretion for younger populations where there trainer deems additional risks may be present. Clients that perform to the below average level of any section of fitness testing should be referred to a physical therapist before beginning a training program.
Balance Testing
"Balance is defined as the ability to maintain the body's center of mass over its base of support against the forces of gravity and acceleration" (Shumway-Cook, 2001). Balance is a function of the interaction of various systems. The brain receives information from the eyes, inner ears, joints and muscles.

Falls in the elderly (65 and older) account for 40 percent of hospital admissions (Stevens, 1999). Between 30% and 40% of 65 and older people are subject to one or more falls annually and even higher for those over 80 years old. For those that have experienced falling, whether injured or not, have an increase in fear of future falls and a reduced activity level.

To be effective and safe, personal trainers need ways to assess a client's risk of falling. Fear of falling, which is a major concern of the elderly along with other factors including dementia, certain medications and physiological or pathological conditions can all have a adverse affect on balance.

There are a number of balance tests that are available for use. Some methods have proven better than others for predictive falling. Only one of the following tests need to be performed to determine a balance assessment of the prospective client. If the client does not pass the administered test, then the trainer should refer the client to a physical therapist prior to beginning a training program.

The Dynamic Gait Index (DGI), developed by Shumway-Cook and Woollacott, is a method of balance assessment which can demonstrate a person's postural stability while changing tasks. The DGI test assesses balance during eight different tasks including walking, changing gait speed, and walking with head turns in the vertical and horizontal planes, stepping over and around an obstacle, and stair ascent and descent. The DGI can be administered in approximately 10 minutes. The best score is 24. Scores of 19 and lower indicate an increased risk of falling. Score results below 19 are more useful to the Physical Therapist in rehabilitation rather than the trainer.
Cardiovascular Testing
Stress testing should be performed by a doctor. Once the doctor has given the written approval with a list of limitations, the trainer must then determine the fitness level of the cardiovascular system by performing fitness testing. Testing should not be performed on clients who have tachycardia. Fitness tests should be performed on an individual basis and not as a group to avoid competitive results.

The Six-Minute Walk Test is used to measure aerobic endurance. The client will walk at their fastest pace around a rectangular track whose length is 50 yards (45.7m) and width is 5 yards (4.6m). The trainer will use a stopwatch to start and stop at the 6 minute point record laps either on a lap counter or paper. Each full lap would be a total of It is recommended that the trainer provide verbal encouragement as the test progresses. If the client becomes fatigued, they are instructed to rest if necessary but the timer will continue to run up to the 6 minute period. When the 6 minutes have elapsed, the trainer instructs the client to stop where they are. Record the amount of distance that they have covered in the partial last lap and add that to the total. Discontinue the test if discomfort or pain results.

The following table lists average distances based on age. Scores lower than these figures are considered below average. Scores higher than these figures are considered above average.

The Two-Minute Step Test is used to determine aerobic endurance. The client will step using alternate legs in place as many times as they can in a 2 minute period. Each step must raise the knee to height of the mid-point of the thigh. The trainer will record only the right step using a counter and will only count steps that meet the height requirement. It would be helpful if a chair is place on either side. The chair would be helpful for added stability if it is needed and for a marking point to which they must raise their knee up to. At the end of two minute period, the trainer instructs the client to stop and records the results. Discontinue the test if discomfort or pain results.

The following table lists average steps based on age. Scores lower than these figures are considered below average. Scores higher than these figures are considered above average.

Only one of the above tests needs to be performed to determine cardio endurance. In each case monitor the client for signs of over-exertion.

Measure the client pulse while sitting and at rest. Using a treadmill, have the client walk for 5 minutes at 3 mph. If this is too strenuous, then have them walk at a comfortable pace. If they appear to be stressed, stop the test and recommend physical therapy. At the end of the 5 minute period measure the pulse rate. It should be between 60% and 70% of the maximal. Wait 5 minutes and again measure the pulse. It should be below 60% and closer to the pre-measured pulse rate.

Cardiac Limited Clients

According to the ACSM, clients who are taking beta-blockers or have rate-limiting pacemakers will adapt to a program for physical conditioning. However, determining and verifying the target heart rate would be difficult. In this case, it is recommended that the Rate of Perceived Exertion (RPE) method be used.
Strength Testing
The Arm Curl Test measures upper arm strength, which is indicative of upper body strength.

The client is to be seated on a chair. Only one side needs to be tested, preferably the dominant side. A 5 pound (2.3kg) weight is to be used for women and an 8 pound (3.6kg) weight for men. Have the client move slightly toward the side to be tested so that the arm and the weight may be hung straight down at the side clearing the seat of the chair. Start with the arm down and perpendicular to the floor. The palm should be in the natural position facing the side. Have the client slowly raise the weight gradually rotating the weight so that the palm is facing upward as the arm is brought up to full flexion. Using a stopwatch and counter, have them perform as many curls as they can using proper form in 30 seconds. At the end of the 30 second period have them stop and record the results. Discontinue the test if discomfort or pain results.

The following table lists average curls based on age. Scores lower than these figures are considered below average. Scores higher than these figures are considered above average.

The Chair Stand Test measures lower body strength.

The client is to be seated in a chair without side arms. Please the chair on carpet or against an object or wall to prevent slippage. The client will sit squarely on the chair with arms crossed in front of the chest. Better balance may be achieved by crossing the arms at the wrist instead of folding arms. At the start signal, the client will rise from the chair to a standing position and then return to a seated position. Arms are to remain folded throughout the cycle. The trainer will record the number of stand/sit cycles that can be completed in 30 seconds while maintaining proper form and stability. Discontinue the test if discomfort or pain results.

The following table lists average stands based on age. Scores lower than these figures are considered below average. Scores higher than these figures are considered above average.

Flexibility Testing
Each test should be performed using a couple of practice trials before actually recording scores.

The Chair Sit and Reach Test measures hamstring flexibility, which is indicative of lower body flexibility. A chair is preferred with forward extended legs like a folding chair to avoid tipping it over. The client will sit with one knee flexed at 90 degrees (lower leg perpendicular to the floor) and the test leg extended (straight) so that the heel only rests on the floor. Have the client reach with both hands toward the toes of the extended foot. Overlap both hands, one on top of the other and try to touch the toes with the middle fingers of each hand while keeping the leg straight. If the leg begins to bend, have them back off until the leg is able to remain in the straight position. Have them hold this position for two seconds. Have them make two attempts and record the best try of the two. Measure and record the distance from the middle fingers to the toes or tip of the shoe.

The following table lists average distances based on age. Scores lower than these figures are considered below average. Scores higher than these figures are considered above average.

The Back Scratch Test measures shoulder flexibility, which is indicative of upper body flexibility. The client will stand straight and reach behind the back and try to touch both hands together. On arm reaches from above and the other is wrapped behind the waist reaching up to the other.

The following table lists average distances based on age. Scores lower than these figures are considered below average. Scores higher than these figures are considered above average.


Warm-up exercise

Begin with a 10 minute warm-up session. Walking on a treadmill is recommended. It is also recommended to swing the arms while walking. Follow with a 10 minute stretching session for legs and lower back. Perform leg and back stretches on the floor or seated. All exercises should be performed to the extent that the client can still talk while exercising and not to maximal exertion. Clients should be encouraged to breathe through pursed-lips. According to the ACSM, this method provides more control over breathing.

Weight resistance is initially not recommended. It should only be used with the experienced exerciser. Add light resistance rubber exercise bands and then light weight hand weights. Keep in mind that getting up and down for the older population may be difficult. Therefore, floor exercises may be difficult. Develop routines that use a chair or the wall for support. Try single leg raises while seated. Upper body exercises may be done while seated. Arm raises both front and side, leg extension, Biceps flexion and upright row can all be done while seated to avoid stressing the client. Avoid exercises that allow the head to be in extreme positions or move rapidly so as not to invoke dizziness.

Aerobic Training

The ACSM recommends a program of aerobic activities such as walking, running, cycling or swimming for seniors because they will most likely be familiar with these activities making them easier to do. Walking is an excellent aerobic exercise even if done in place. Jogging is high impact and should only be done by the experienced client. Swimming, also an aerobic exercise, should only be attempted by the experienced client. Water aerobics is an excellent exercise for the older population. It provides light resistance without impact. Water temperature may be more critical in older populations. Those with arthritis may be more comfortable in 85 degree water. However, the higher temperature results in vasodilation. This lowers the blood pressure while raising the heart rate, which may cause someone who has treated hypertension to be unable to sufficiently maintain adequate blood pressure during vasodilation.

ACSM guidelines recommend a beginning aerobic exercise program minimum duration of 20 minutes and a frequency of three times per week. It is important to remember that flexibility and bone strength are reduced in the senior client. Low impact exercises are recommended, never high impact. Light to moderate intensity activities can reduce blood pressure and the rate of age-related deterioration. Exercise sessions require a warm-up period that may be equal to or exceed the actual exercise period but should be sufficient to load the cardiovascular, pulmonary, and musculoskeletal systems without straining them. The ACSM recommends an intensity level of 50 to 70% of the maximum heart rate using the Karvonen Method for older adults.

The heart rate must be constantly monitored by electronic means or using the Borg Scale of Perceived Exertion so as not to exceed the training level. ACSM guidelines indicate a frequency of training for older populations of 3 to 5 times a week. Here again, it is not the goal to do a lot each day so long as something is done each day. Increasing exercise duration each day is preferred to increasing exercise intensity.

Since the senior's hearing may be more sensitive to loud noise, music should be kept to a comfortable 60 to 70 db and low enough for the participants to hear your instructions. Be sure to combine voice instruction with hand signals and in sufficient time for the seniors to make the change. Class tempo should not be the driving force and should match the capabilities of the seniors that you have in class. Environmental conditions are also more critical to the senior participant. Room temperature should be kept no higher than 70 to 75 degrees with a relative humidity of 60%. Choose appropriate genre of music. Hip Hop may appear as simply noise to the senior ears. Traditional dances done at weddings are a good idea. The dances are simple, well known and not strenuous. They also provide a mood-lifting environment that promotes good health.

When conducting group exercise classes, the instructor should maintain a smaller class than normal (no more than 20) to be able to observe each participant for signs of faintness, confusion, weakness or lack of coordination. Classes can be conducted in excess of twenty participants if an assistant is present. For a one-hour class warm-up and cool-down/stretching sessions should be 15 minutes using slow rhythmic limbering type exercises. For less fit seniors, the class should be reduced in length to 30 minutes and consist of mostly warm-up and stretching exercises. The tempo (bpm) of music should match the level of the seniors in class and not the level of the instructor. The class tempo should not be standard as it is for younger population classes. The instructor must set the tempo according to the capabilities of each senior group class. The instructor should not use class time for there own exercise time since the seniors will try to follow what you are doing.

Heart rate checks may be inconclusive since heart response is slowed. Therefore, the Rate of Perceived Exertion (RPE) along with a heart rate check might be a better indicator. The RPE is subjective and may be clouded by the client's willingness to get in shape. In addition, the trainer must use other signs as feedback, i.e., facial expressions, breathing, eye movements, skin color, etc.

Perform a pulse check more often than a regular class. If you see that they are becoming fatigued, use the time to do a pulse check and get a drink of water. Bathroom breaks may be required more often. Encourage participants not wait for water or bathroom breaks and leave if necessary. Movements should be smooth and continuous without abrupt changes. Some senior may have had knee or hip replacements. Even with a doctor's approval care must be taken to avoid abrupt changes or twisting movements of the knee and hip. They should be advised by their doctor as to what care needs to be taken to protect the artificial joint. In all cases, avoid joint twisting movements. Seniors also have a more difficult time with lateral moves than forward and back moves.

When doing floor work, be aware that some seniors may need assistance in getting down or up off the floor and are more prone to dizziness when the head is lower than the heart. The prone position may make it more difficult to breathe for some seniors. Small classes are therefore desirable for the instructor's individual attention. Weights are never to be used in a senior cardio portion of class. Weight training should be conducted in the gym environment on a one to one basis. Keep the moves simple with changes no sooner than counts of 8 or even 16 depending on the level of the class. Avoid moves that change both arms and legs at the same time. Providing simple and easier exercises will inspire confidence.

Stretching is important and should be kept to less than full range of motion followed by static stretches. Be careful not to over stretch. Concentrate on slow, sustained stretching. Overhead arm stretches assist in breathing and allow the entry of more oxygen into the lungs opening up the thoracic cavity. The atrophication of chest muscles can cause breathing difficulty. These muscles are used to lift and expand the thoracic cavity during inhalation.

Strength Training

A strength training program can reverse bone loss and muscle weakness in seniors. For weaker seniors, rising from a chair with arm rests using the arms for support will work large muscle groups. Repeat this 12 to 15 times. Eventually, increase to three sets. This should be performed every other day to allow muscles to recover. Care needs to be maintained when doing Isometric exercises since there is a greater tendency to hold the breath, which can raise blood pressure to dangerous levels and can even cause eye damage.

ACSM recommends using 60% of the 1 RM as a starting point. To determine the 1 RM, have them choose a weight that they can lift only once. For example, if the heaviest weight they can lift is 10 pounds (1 RM), then the starting weight should be 60% of that or 6 pounds. Another method to determine the working weight is to start with a low single hand weight, 5 pounds if necessary. In a sitting position, have them do a bicep curl lifting the weight as many times as they can. If they can lift it more than 15 times then the weight is too light. If they can lift it less than 10 times, it is too heavy. Choose a weight that can be lifted about 12 times in one set. Observe proper breathing methods and maintain a smooth movement of the weights. Either of these methods can be used for other muscle groups as well.

Twisting movement of the spine should be done without weights to avoid disc compression. It is important to try to incorporate full range of motion in weight training exercises. However, seniors may have a more limited range of motion than a younger person. Do not try to expect a younger person's range of motion. If pain is experienced, then physical therapy may be indicated. The ACSM recommends 8 to 10 exercises that will target all the major muscle groups using 8 to 12 repetitions of each and 1 set each. When able, increase the weights by no more than 10% per week. ACSM recommendations are two sessions per week for the same muscle groups. You can work other muscle groups on alternate days. However, be aware that seniors may require more time to recover. So in order to avoid over-training, keep the daily sessions short and spread it out over the week working the same muscle groups still only twice a week. Or, alternately, do only 2 or 3 sessions per week depending on your clients schedule and preference.

Be aware of clients that have arthritis. Exercising through a joint that is painful, swollen or warm is not recommended. Inflamed joints require the attention of a doctor or an exercise program prescribed by a physical therapist or other medical professional.

Seniors who cannot walk well or use assisted walking can still do cardio training using an ergometer. This device is essentially a hand type bicycle. It is imperative that the trainer work closely with the client's doctor to determine any limitations and changes in limitations that may occur over the course of the training program.

Balance Training

To reduce the risk of falls, an exercise program should include balance training, walking, and body weight transfer. Standing with free weights should be used to improve balance and coordination.

Flexibility Training

The ACSM recommends exercises to increase joint range of motion, such as walking, aerobic dance, and stretching.

Some of the stretching exercises that can be performed are:
  • Lateral Neck Flexion
  • Neck Rotation
  • Shoulder Shrugs
  • Posterior Arm Reach
  • Spinal Flexion and Extension
  • Hip Extension and Flexion
  • Seated Hamstring Extension
  • Gluteal Flexion and Extension
  • Foot Rotations
  • Arm Rotations
  • Overhead Reach
  • Shoulder Flexion and Extension
  • Upper Back Flexion and Extension

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