Chap. 18b Elderly Clients

1. Chap. 18b Elderly Clients Exercising the Elderly

2. Introduction • The baby boomer generation is now becoming a large percentage of the elderly population • As more people become senior citizens the need for increased fitness levels is necessary • Most people are considered seniors at the age of 50+, however be careful in that determination as it does not fit many people that age

3. Older Adults • When working with older adults it is common to have clients with various medical conditions • Cardiovascular disease, diabetes, osteoporosis, low back pain, obesity, and general frailty. • Make sure to seek out physician approval for exercise participation

4. Older Adults • Health Benefits of Senior Exercise • Aerobic Training • Exercises such as walking, jogging and cycling improve cardiovascular fitness • Reduced body weight from aerobic conditioning may lessen high blood pressure risk, type 2 diabetes and obesity • Reduced psychological stress • Improved sleep • Improved digestion and elimination

5. Older Adults • Health Benefits of Senior Exercise • Aerobic Training • Reduced risk of cardiovascular disease, stroke, osteoporosis, certain types of cancer, and phychological stress • Increases in the gray and white matter in various regions of the brain after six months of training.

6. Older Adults • Resistance Training • Cardiovascular Disease • How does resistance training lower risk of cardiovascular disease? (4 ways) • Decreases body fat • Decreases resting blood pressure (systolic, diastolic or both • Improvement in blood lipid profiles • Significant decreases in LDL’s • Enhances vascular condition, which facilitates circulation and arterial blood flow

7. Older Adults • Colon Cancer • Slow gastrointestinal transit speed appears to be associated with an increased risk of colon cancer • Aerobic exercise and resistance training have been shown to speed up GT speed • Exercise in general can be used as an effective intervention for age-related GT movement

8. Older Adults • Type II Diabetes • Increased sedentary lifestyle among people has contributed to tremendous increases in type II diabetes among men and women • Resistance training has been shown to utilize glucose better in terms of uptake in diabetic patients • Increased exercise levels among adults can preserve lean body mass thereby reducing muscle myopathy, ultimately leading to reduced risk of type II diabetes

9. Older Adults • Osteoporosis • A degenerative disease of the skeletal system resulting progressive bone protein and mineral loss • Regular resistance training can take bone loss and change it to bone gain in elderly clients

10. Older Adults • Low Back Pain • Not a life-threatening condition, but still very serious as it is the most prevalent medical problem in the United States (why do you think this is?) • Correlation between weak low back muscles and low back pain • Resistance training that strengthens low back muscles may lessen or alleviate the pain in some clients

11. Older Adults • Arthritis • Stronger muscles may improve joint function and reduce the discomfort associated with arthritis • Depression • Significant reductions in depression have been seen in clients after 10 weeks of resistance training • Why would exercise in general be good psychologically for elder clients?

12. Older Adults • Muscle Loss and Metabolic Rate Reduction • One of the greatest benefits of resistance training for seniors is the replacement of muscle tissue and recharging of the metabolic process • These have been shown to be probably the most severe problem of aging men and women • Adult men and women lose about one half pound of muscle per year during their 30’s and 40’s (called sarcopenia) • Rate of 1 pound per year of muscle loss is possible in adults 50 yrs of age or older

13. Older Adults • Muscle Loss and Metabolic Rate Reduction • Each decade of life Americans add around 10 pounds of body weight, however, its really 5-10 pounds less of muscle and 15-20 pounds of fat! • Slow resting metabolic rate is also due to this increase…slow resting metabolism means calories used for energy before for high energy muscles are now used to store fat

14. Older Adults • Muscle Loss and Metabolic Rate Reduction • Resistance training can maintain muscle tissue to continue physical activity and enhance energy utilization by body throughout the senior years • Resistance training is the ONLY type of exercise that can maintain muscle and metabolism as people age • It is imperative that it is the essential component of the senior fitness program

15. Older Adults • Resistance Training Guidelines for Seniors • Include: • 2-3 non-consecutive days per week • Single and multiple joint movements • Single or multiple sets • Variety of exercises using major muscle groups (quads, hamstrings, pecs, lats, biceps, triceps, deltoids, etc.) • Controlled exercise speeds (4-6 sec. per repetition • Resistance training range can be 60-90% (4-16 reps) of maximum depending upon ability and health • Older adults are advised to begin their strength training program with exercise resistances that permit 10 to 15 repetitions, corresponding to approximately 75-60% of 1RM. • Give competent instructions and careful supervision

16. Older Adults • Instructional Model for Training/Teaching Seniors • Demonstrate how the exercise is performed • Explain precisely each movement phase and the proper breathing pattern • Demonstrate the exercise again with emphasis on exhaling during the lifting phase and inhaling during the lowering phase • Provide positive reinforcement for correct technique with specific feedback and suggestions for improvement

17. Older Adults • Aerobic Endurance Training Guidelines for Seniors • 2-5 days per week • 20-60 minutes per session • 60-90% of maximum heart rate, however, training usually around 75% • Assess exercise intensity in older adults by heart rate and RPE (Borg) scale • 75% max HR = 12-14 RPE • Talk test is another way to assess exercise intensity in senior citizens

18. Older Adults • Aerobic Endurance Training Guidelines for Seniors • For older adults with limited cardiorespiratory fitness they may begin with only 5 to 10 minutes of physical activity at approximately 40% of maximum heart rate. • ASCM and the AHA present two aerobic training protocols that can be exclusive or performed together: • 30 min. of moderate intensity endurance exercise (walking) five days a week • 20 min. of vigorous intensity endurance exercise (jogging) three days a week

19. Older Adults • Screening and Program Design for Seniors • First step is to check with the client’s personal physician for specific exercise guidelines and training modifications • Be observant for any exercise contraindications or undesirable responses • Keep careful and detailed record of exercise sessions and fitness assessments

20. Older Adults • Exercise Order • If doing both aerobic and resistance training exercises…always begin with aerobic activity first (including warm up and cool down phases of course) • Resistance training would be next in order and concluding with static stretching • If they only do resistance training then a light 5-10 minute aerobic warm up is sufficient, then flexibility is necessary after resistance training

21. Older Adults • Safety and Comfort (table 18.1, pg. 476) • Certain conditions associated with elderly clients can cause discomfort during exercise…let’s look at a few: • Dry Skin: apply lotion to elbows, knees, etc. before exercising • Poor Balance: weight supported resistance and aerobic machines first before free weights and treadmill walking, etc. Avoid hard to control exercises (e.g. lunges), seated or lying position instead of standing if need be • Propensity for Injuries: train in uncluttered facility, controlled movement speeds, proper posture • Susceptibility to Cold and Flu: drink plenty of fluid, obtain ample rest, shower after exercise • Reduced flexibility: warm up well before exercise, appropriate stretching exercises at end of training session • Difficulty Seeing or Hearing: speak clearly and concisely with sufficient volume, use large print materials and cards, frequently ask clients if they understand • Reduced Tolerance for Heat: climate controlled facilities, training sessions early in the day, light colored clothing and drink plenty of fluids