Chapter 27,28 programs for older adults

1. Exercise Programming for
Older Adults

3. 40 years old
on 50 mile
run
60 years old finishing
4300 mile ride

4. Important Considerations
 The goal is to maintain the basic and advanced
activities of daily living (ADL) for as long as
possible to allow for independent functioning
as long as possible.
 The key is to accentuate the movements they
CAN do rather than to dwell on what they can’t
do.
 Consider what activities they might enjoy doing
– let them pick!

5. Demographics
 Those age 65+ represent the fastest growing
segment of the US population.
 By the year 2030 the population of those over
age 65 will have doubled (to over 63 million).
 1 out of every 8 Americans is > 65
 In US in 1998, there were:
34 m people over age 65
 20 m older women
 14 m older men
 Ratio of 10 women to 7 men BUT…
 As reach age 85, the ratio changes to 10:5

6. Demographics - Future
 The dramatic growth of seniors is expected to
continue.
 The ranks of the oldest-old will swell five-fold to
more than 19 million people in the year 2050.
 Greater need for exercise programs and
professionals to lead them.

7. Rate of Decline
 Data collected from the Masters Track & Field Org
and US Masters Swimming Congress found the
average aging-related rate of decline was 0.5% per
year for older exercisers (12.5% over 25 years).
 In sedentary people, the rate of decline was 2%
per year  50% over 25 years.
 Those seniors who are only at 30% of their
functional capacity are considered “frail”.
 Those seniors who remain engaged in an exercise
program will likely remain highly functional.

8. Leadership Tips
Motivating seniors
Understand chronic conditions
Accommodate programs to meet needs
Adjust FITT principle accordingly
Purchase resources to learn more

9. Incentives & Motivators
Ambiance should be inviting to elders
Consider music selection
Social opportunities
Intergenerational exercise programs
Awards
On-going fitness assessments

10. Safety & Guidelines
Obtain medical clearance
First Aid & CPR certifications
Before developing a program, get a
complete lists of client’s medications…
know side effects
Knowledge of intensity levels: target
training zone, rated perceived exertion,
Talk
Group formations – circles and semis

11. Safety & Guidelines
Encourage immediate notification if feeling
ill
Breathing techniques
Clothing and shoes
Include warm up and cool down
segments
Include flexibility program
Reducing fear and anxiety

12. When Does Old Age Begin?
Chronologically considered ~ 65 y.o.
50+ is often referred to as an older adult
or senior.
Inactivity and sedentary lifestyle
influence this number greatly.
Regard the aging process as one of
function  what is the older client
capable of doing?

13. Activities of Daily Living (ADL)
Basic ADL:
Dressing
Eating
Ambulating
Toileting
Hygiene
Advanced ADL:
Shopping
Housework
Accounting
Food Prep
Transportation

14. Categories for Physical Functioning
Physically:
Elite
Fit
Independent
Frail
Dependent

15. The Senior Fitness Test
(Developed by Rikli & Jones, Scanned from Health Fitness Instructor’s Handbook,
Howley & Franks)

16. Effects of Aging on the MS
 Loss of muscle mass, strength and mobility is
associated with aging.
 Adults lose ~ ½ pound of muscle per year during
30’s & 40’s
 As a rule, strength remains relatively intact until ~
age 40-50.
Muscle mass decreases ~ 10% between ages
24-50.
 There is an accelerated decline of muscle mass
of ~ 30% between ages 50-60.
 Sedentary folks between 50-70 y.o. experience
strength declines of ~ 15% per decade.

17. Effects of Aging on the MS
Muscle mass is better maintained in the upper
body vs. lower body.
 Aging is also associated with a decline in
testosterone and human growth hormone.
 Some studies have shown increased atrophy in
fast twitch type IIb fibers in those over 70.
 Due to a loss of motor units and a regrouping of
muscle fiber, there is an enlargement of the
motor unit size, but less distinction between
muscle fiber types.

18. Effects of Aging on the musculoskeletal
system
Peak muscle strength in females occurs
~ age 20; males age 30.
Surveys conducting in the US indicate
that 28% of older men and 66% of older
women cannot lift objects weighing 10
lbs.

19. Strength Training for
Older Adults

20. Benefits of Strength Training
 Increased Strength
 Increased Lean mass
 Improved Mobility & Independence
 Reduced Bone Loss
 Prevent or Modify Chronic Disease
 Fall Prevention
 Improved Mood

21. Benefits – Increased Strength
 Older adults gain strength at ~ same rate as
younger adults
 Strength increases as great as 40% have been
seen with high-intensity strength training up to
age 96.
 Some studies have shown that in the 3-4
months following the start of a strength training
program for the older client that as much as 3
decades of functional decline can be reversed.

22. Benefits – Increased Lean Mass
 RMR decreases with aging
 ST increases lean mass  increases basal
metabolic rate
Muscle hypertrophy resulting from resistance
training has been documented in folks 90+ y.o.
 Study found that men in their 70’s who started
and continued strength training before age 50
had strength and muscle cross sectional areas
similar to sedentary 28 y.o. (Yound & Skelton, 1994)
 An increase in body fat with age is attributed
more to a decrease in physical activity than an
increase in caloric intake.

23. Benefits – Reduced Bone Loss
 Increased bone density through strength
training and weight bearing exercises.
 Especially a concern of post-menopausal
women.
 The type of exercise DOES matter  see next
slides!

24. Types of Exercise
(Dr. Ginger Schirmer, PH.D, RD, Med 2000 Inc., Version 7,
Women’s Health & Stress Management. 2001)
Weight Bearing / High Impact
 Stair Climbing
 Hiking
 Dancing
 Jogging
 Downhill Skiing
 Aerobic Dancing
 Volleyball
 Basketball
 Gymnastics
 Strength Training –
can be high/low
impact

25. Types of Exercise
(Dr. Ginger Schirmer, PH.D, RD, Med 2000 Inc., Version 7,
Women’s Health & Stress Management. 2001)
 Non Wt Brg/Non-
Impact
Lap Swimming
Indoor Cycling
Stretching
Wt Brg/Low-
Impact
Walking
Cross-Country Skiing
Ski Machine
Stair Step Machine
Rowing
Water Aerobics
Deep Water Walking
Low Impact Aerobics

26. ACSM Exercise Guidelines for
ST Programs for Seniors
 Thorough health screening and medical exam
needed.
 Frequency of strength training  2 days/week
 Rest  Minimum of 48 hours between
sessions
Seniors tend to have more soreness and may need
a longer recovery up to 3-4 days.

27. ACSM Exercise Guidelines for
Strength Training Programs for
Seniors
Sets/Reps 
Start with 1 of 10-15 reps.
Gradually increase to 2 or 3 sets
Intensity 
Start with 40-60% of 1 rep max
Gradually increase to 70-80% of 1 rep max
Rated Perceived Exertion 
12-13 (mild to moderate)

28. ACSM Exercise Guidelines for
Strength Training Programs for
Seniors
 Include at least one exercise for all major
muscle groups. Which are?
 Focus upon functional, multi-joint exercises.
Examples are?
 For many clients, you many need to start with
single joint exercises / machine exercises 
perceived as easier by the client.
 Progress them from machine to functional
when they become accustomed to the
exercise.

29. ACSM Exercise Guidelines for
Strength Training Programs for
Seniors
Complete session within 30 minutes
1st 8 wks should use only minimal
resistance to allow for connective tissue
adaptation.
1st few sessions should be supervised.
Emphasize proper technique within a
painfree range of motion
Encourage normal breathing pattern.

30. ACSM Exercise Guidelines for
Strength Training Programs for
Seniors
Initial overload should be achieved by
increasing the number of reps then the
weight.
When returning from a layoff, use a
resistance of 50% of the previous
intensity.
Should be a year-round program.

31. ACSM Exercise Guidelines for
Strength Training Programs for
Seniors
Avoid isometrics and other exercises that
may increase blood pressure.
Work large muscle groups first and
opposing muscle groups in succession.
Machines preferred over free weights
initially.

32. Risk of Injury
 Consider the learning curve.
 Watch form and technique.
 Use caution when performing any eccentric
contractions due to the potential for increased
muscle soreness and longer recovery period.
 Consider any pre-existing conditions or illnesses
the older client may have.
 Consider medications effect during exercise
session.

33. Strength Programming Guidelines
Be aware that the senior will tend to
move and progress slower.
Design program to emphasize function.
Work only through the pain-free range of
motion  No Pain!

34. Program Structure
Should consist of exercise to improve the
ability to:
Stabilize the torso
Push
Pull
Grip
Get up & down
Move

35. Stabilizing The Torso
 Activities: All activities of daily living involve the
torso.
Muscles: Erector Spinae, Rectus Abdominus,
Obliques.
 Exercises: Stability Ball
Sitting
Marching
Arm/Leg lifts
Catching drills

36. Pushing
 Activities: Need to move furniture, kitchen
activities, putting things away, shopping cart.
Muscles: Triceps, Pects, Anterior Deltoid
Coracobrachialis, Serratus Anterior.
 Exercises:
Wall push ups
Fwd/overhead med ball press
Squeezing a balloon
Seated chest press
Shoulder press
Push up

37. Pulling
 Activities: Need to rake leaves, open doors,
laundry, groceries from trunk, picking up the
cat!
Muscles: Lats, teres major, post. delt., biceps,
traps, rhomboids.
 Elastic tubing exercises:
Rowing
Vary Angles
Seated Row
Reverse Flys

38. Grip Strength & Dexterity
 Activities: Need to open lids, use tools, writing,
eating, sewing, buttoning, etc.
Muscles: Forearm and intrinsic muscles of the
hand.
 Exercises: Towel rolls, ball squeezes, rubber
band exercises, dexterity drills, progressively
tighter jar lids (series).

39. Getting Up & Down
 Activities: Needed to climb stairs, getting in/out
of chair/car, toileting.
Muscles: Quads, gluts, hams, torso.
 Functional Exercises:
Ball Squats, chair squats
Lunges
Step ups
 Traditional Gym Exercises:
Leg press
Hack squat
Smith Machine Squat
Abduction/Adduction exercises
 Avoid:Leg extension due to shear forces

40. Improve Mobility
 Walking is the most popular and is highly
functional.
 Strength Training will improve the client’s ability
to walk.
 Take note of the muscles around the ankle –
note strength and flexibility.
 Treadmill walking with a slight incline can help to
improve strength & endurance in the leg
muscles. Also improves speed and balance.
 Consider age appropriate obstacle courses.
 Low step ups  holding on or carrying
something. Do forward, backward, laterally.

41. In A Nutshell
Strength training benefits for seniors is
well documented.
Should be a long-term part of client’s life.
Remind seniors that strength training will
improve their cardio program as well.
Greatly increases the client’s quality of
life and adds “life to their years.”