chap. 18b elderly clients

Chap. 18b Elderly Chap. 18b Elderly ClientsClients

Exercising the ElderlyExercising the Elderly

IntroductionIntroduction

The baby boomer generation is now The baby boomer generation is now becoming a large percentage of the becoming a large percentage of the elderly populationelderly population

As more people become senior citizens the As more people become senior citizens the need for increased fitness levels is need for increased fitness levels is necessarynecessary

Most people are considered seniors at the Most people are considered seniors at the age of 50+, however be careful in that age of 50+, however be careful in that determination as it does not fit many determination as it does not fit many people that agepeople that age

Older AdultsOlder Adults

When working with older adults it is When working with older adults it is common to have clients with various common to have clients with various medical conditionsmedical conditions

Cardiovascular disease, diabetes, Cardiovascular disease, diabetes, osteoporosis, low back pain, obesity, osteoporosis, low back pain, obesity, and general frailty.and general frailty.

Make sure to seek out physician Make sure to seek out physician approval for exercise participationapproval for exercise participation


Health Benefits of Senior ExerciseHealth Benefits of Senior Exercise• Aerobic TrainingAerobic Training

Exercises such as walking, jogging and Exercises such as walking, jogging and cycling improve cardiovascular fitnesscycling improve cardiovascular fitness

Reduced body weight from aerobic Reduced body weight from aerobic conditioning may lessen high blood pressure conditioning may lessen high blood pressure risk, type 2 diabetes and obesityrisk, type 2 diabetes and obesity

Reduced psychological stressReduced psychological stress Improved sleepImproved sleep Improved digestion and eliminationImproved digestion and elimination


Health Benefits of Senior ExerciseHealth Benefits of Senior Exercise• Aerobic TrainingAerobic Training

Reduced risk of cardiovascular disease, Reduced risk of cardiovascular disease, stroke, osteoporosis, certain types of cancer, stroke, osteoporosis, certain types of cancer, and phychological stressand phychological stress

Increases in the gray and white matter in Increases in the gray and white matter in various regions of the brain after six months various regions of the brain after six months of training.of training.


Resistance TrainingResistance Training• Cardiovascular DiseaseCardiovascular Disease

How does resistance training lower risk of How does resistance training lower risk of cardiovascular disease? (4 ways)cardiovascular disease? (4 ways)

• Decreases body fatDecreases body fat• Decreases resting blood pressure (systolic, Decreases resting blood pressure (systolic,

diastolic or bothdiastolic or both• Improvement in blood lipid profilesImprovement in blood lipid profiles

Significant decreases in LDL’s Significant decreases in LDL’s • Enhances vascular condition, which facilitates Enhances vascular condition, which facilitates

circulation and arterial blood flowcirculation and arterial blood flow


Colon CancerColon Cancer• Slow gastrointestinal transit speed Slow gastrointestinal transit speed

appears to be associated with an appears to be associated with an increased risk of colon cancerincreased risk of colon cancer

• Aerobic exercise and resistance training Aerobic exercise and resistance training have been shown to speed up GT speedhave been shown to speed up GT speed

• Exercise in general can be used as an Exercise in general can be used as an effective intervention for age-related GT effective intervention for age-related GT movementmovement


Type II DiabetesType II Diabetes• Increased sedentary lifestyle among people Increased sedentary lifestyle among people

has contributed to tremendous increases in has contributed to tremendous increases in type II diabetes among men and womentype II diabetes among men and women

• Resistance training has been shown to utilize Resistance training has been shown to utilize glucose better in terms of uptake in diabetic glucose better in terms of uptake in diabetic patientspatients

• Increased exercise levels among adults can Increased exercise levels among adults can preserve lean body mass thereby reducing preserve lean body mass thereby reducing muscle myopathy, ultimately leading to muscle myopathy, ultimately leading to reduced risk of type II diabetesreduced risk of type II diabetes


OsteoporosisOsteoporosis• A degenerative disease of the skeletal A degenerative disease of the skeletal

system resulting progressive bone system resulting progressive bone protein and mineral lossprotein and mineral loss

• Regular resistance training can take Regular resistance training can take bone loss and change it to bone gain in bone loss and change it to bone gain in elderly clientselderly clients


Low Back PainLow Back Pain• Not a life-threatening condition, but still Not a life-threatening condition, but still

very serious as it is the most prevalent very serious as it is the most prevalent medical problem in the United States medical problem in the United States (why do you think this is?)(why do you think this is?)

• Correlation between weak low back Correlation between weak low back muscles and low back painmuscles and low back pain

• Resistance training that strengthens low Resistance training that strengthens low back muscles may lessen or alleviate back muscles may lessen or alleviate the pain in some clientsthe pain in some clients


ArthritisArthritis• Stronger muscles may improve joint Stronger muscles may improve joint

function and reduce the discomfort function and reduce the discomfort associated with arthritisassociated with arthritis

DepressionDepression• Significant reductions in depression Significant reductions in depression

have been seen in clients after 10 weeks have been seen in clients after 10 weeks of resistance trainingof resistance training

• Why would exercise in general be good Why would exercise in general be good psychologically for elder clients?psychologically for elder clients?

Older AdultsOlder Adults Muscle Loss and Metabolic Rate ReductionMuscle Loss and Metabolic Rate Reduction

• One of the greatest benefits of resistance One of the greatest benefits of resistance training for seniors is the replacement of training for seniors is the replacement of muscle tissue and recharging of the metabolic muscle tissue and recharging of the metabolic processprocess

• These have been shown to be probably the These have been shown to be probably the most severe problem of aging men and womenmost severe problem of aging men and women

• Adult men and women lose about one half Adult men and women lose about one half pound of muscle per year during their 30’s and pound of muscle per year during their 30’s and 40’s (called sarcopenia)40’s (called sarcopenia)

• Rate of 1 pound per year of muscle loss is Rate of 1 pound per year of muscle loss is possible in adults 50 yrs of age or olderpossible in adults 50 yrs of age or older


• Muscle Loss and Metabolic Rate Muscle Loss and Metabolic Rate ReductionReduction

Each decade of life Americans add around Each decade of life Americans add around 10 pounds of body weight, however, its 10 pounds of body weight, however, its really 5-10 pounds less of muscle and 15-20 really 5-10 pounds less of muscle and 15-20 pounds of fat!pounds of fat!

Slow resting metabolic rate is also due to Slow resting metabolic rate is also due to this increase…slow resting metabolism this increase…slow resting metabolism means calories used for energy before for means calories used for energy before for high energy muscles are now used to store high energy muscles are now used to store fatfat


Muscle Loss and Metabolic Rate ReductionMuscle Loss and Metabolic Rate Reduction• Resistance training can maintain muscle tissue Resistance training can maintain muscle tissue

to continue physical activity and enhance to continue physical activity and enhance energy utilization by body throughout the energy utilization by body throughout the senior yearssenior years

• Resistance training is the ONLY type of Resistance training is the ONLY type of exercise that can maintain muscle and exercise that can maintain muscle and metabolism as people agemetabolism as people age

• It is imperative that it is the essential It is imperative that it is the essential component of the senior fitness programcomponent of the senior fitness program


Resistance Training Guidelines for SeniorsResistance Training Guidelines for Seniors• Include:Include:

2-3 non-consecutive days per week2-3 non-consecutive days per week Single and multiple joint movementsSingle and multiple joint movements Single or multiple setsSingle or multiple sets Variety of exercises using major muscle groups (quads, hamstrings, Variety of exercises using major muscle groups (quads, hamstrings,

pecs, lats, biceps, triceps, deltoids, etc.)pecs, lats, biceps, triceps, deltoids, etc.) Controlled exercise speeds (4-6 sec. per repetitionControlled exercise speeds (4-6 sec. per repetition Resistance training range can be 60-90% (4-16 reps) of maximum Resistance training range can be 60-90% (4-16 reps) of maximum

depending upon ability and healthdepending upon ability and health Older adults are advised to begin their strength training program Older adults are advised to begin their strength training program

with exercise resistances that permit 10 to 15 repetitions, with exercise resistances that permit 10 to 15 repetitions, corresponding to approximately 75-60% of 1RM.corresponding to approximately 75-60% of 1RM.

Give competent instructions and careful supervisionGive competent instructions and careful supervision


Instructional Model for Training/Teaching Instructional Model for Training/Teaching SeniorsSeniors• Demonstrate how the exercise is performedDemonstrate how the exercise is performed• Explain precisely each movement phase and Explain precisely each movement phase and

the proper breathing patternthe proper breathing pattern• Demonstrate the exercise again with emphasis Demonstrate the exercise again with emphasis

on exhaling during the lifting phase and on exhaling during the lifting phase and inhaling during the lowering phaseinhaling during the lowering phase

• Provide positive reinforcement for correct Provide positive reinforcement for correct technique with specific feedback and technique with specific feedback and suggestions for improvementsuggestions for improvement


Aerobic Endurance Training Aerobic Endurance Training Guidelines for SeniorsGuidelines for Seniors• 2-5 days per week2-5 days per week• 20-60 minutes per session20-60 minutes per session• 60-90% of maximum heart rate, however, 60-90% of maximum heart rate, however,

training usually around 75% training usually around 75% • Assess exercise intensity in older adults by Assess exercise intensity in older adults by

heart rate and RPE (Borg) scaleheart rate and RPE (Borg) scale 75% max HR = 12-14 RPE75% max HR = 12-14 RPE

• Talk test is another way to assess exercise Talk test is another way to assess exercise intensity in senior citizensintensity in senior citizens


Aerobic Endurance Training Aerobic Endurance Training Guidelines for SeniorsGuidelines for Seniors• For older adults with limited cardiorespiratory fitness For older adults with limited cardiorespiratory fitness

they may begin with only 5 to 10 minutes of physical they may begin with only 5 to 10 minutes of physical activity at approximately 40% of maximum heart rate. activity at approximately 40% of maximum heart rate.

• ASCM and the AHA present two aerobic training ASCM and the AHA present two aerobic training protocols that can be exclusive or performed together:protocols that can be exclusive or performed together:

30 min. of moderate intensity endurance exercise 30 min. of moderate intensity endurance exercise (walking) five days a week(walking) five days a week

20 min. of vigorous intensity endurance exercise 20 min. of vigorous intensity endurance exercise (jogging) three days a week(jogging) three days a week


Screening and Program Design for Screening and Program Design for SeniorsSeniors• First step is to check with the client’s First step is to check with the client’s

personal physician for specific exercise personal physician for specific exercise guidelines and training modificationsguidelines and training modifications

• Be observant for any exercise Be observant for any exercise contraindications or undesirable contraindications or undesirable responsesresponses

• Keep careful and detailed record of Keep careful and detailed record of exercise sessions and fitness exercise sessions and fitness assessmentsassessments


Exercise OrderExercise Order• If doing both aerobic and resistance training If doing both aerobic and resistance training

exercises…always begin with aerobic activity exercises…always begin with aerobic activity first (including warm up and cool down phases first (including warm up and cool down phases of course)of course)

• Resistance training would be next in order and Resistance training would be next in order and concluding with static stretchingconcluding with static stretching

• If they only do resistance training then a light If they only do resistance training then a light 5-10 minute aerobic warm up is sufficient, then 5-10 minute aerobic warm up is sufficient, then flexibility is necessary after resistance trainingflexibility is necessary after resistance training

Older AdultsOlder Adults Safety and Comfort (table 18.1, pg. 476)Safety and Comfort (table 18.1, pg. 476)

• Certain conditions associated with elderly clients can Certain conditions associated with elderly clients can cause discomfort during exercise…let’s look at a few:cause discomfort during exercise…let’s look at a few:

Dry SkinDry Skin: apply lotion to elbows, knees, etc. before : apply lotion to elbows, knees, etc. before exercisingexercising

Poor BalancePoor Balance: weight supported resistance and aerobic : weight supported resistance and aerobic machines first before free weights and treadmill walking, machines first before free weights and treadmill walking, etc. Avoid hard to control exercises (e.g. lunges), seated or etc. Avoid hard to control exercises (e.g. lunges), seated or lying position instead of standing if need belying position instead of standing if need be

Propensity for InjuriesPropensity for Injuries: train in uncluttered facility, : train in uncluttered facility, controlled movement speeds, proper posturecontrolled movement speeds, proper posture

Susceptibility to Cold and Flu: drink plenty of fluid, obtain Susceptibility to Cold and Flu: drink plenty of fluid, obtain ample rest, shower after exerciseample rest, shower after exercise

Reduced flexibilityReduced flexibility: warm up well before exercise, : warm up well before exercise, appropriate stretching exercises at end of training sessionappropriate stretching exercises at end of training session

Difficulty Seeing or HearingDifficulty Seeing or Hearing: speak clearly and concisely : speak clearly and concisely with sufficient volume, use large print materials and cards, with sufficient volume, use large print materials and cards, frequently ask clients if they understandfrequently ask clients if they understand

Reduced Tolerance for HeatReduced Tolerance for Heat: climate controlled facilities, : climate controlled facilities, training sessions early in the day, light colored clothing and training sessions early in the day, light colored clothing and drink plenty of fluidsdrink plenty of fluids

chap. 18b elderly clients

Documents

months of training

painresistance training

womenresistance training

high blood pressure

reduced risk of type

necessarymost people

bone loss

blood pressure systolic