Strength Programs for
Older Adults
How to Complete this Program
Thank you for choosing Exercise ETC’s
RACE
correspondence program for your
continuing education needs. To earn your CECs/CEUs you will need to read the following
article,
“Strength Programs for Older Adults.”
After you have read the article, take the test
that appears at the end of the article. Remember to choose the best or most correct answer.
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1. On the subject line type "RACE PROGRAM”
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and expiration date, and the total number of tests you are submitting.
3. Type the name and number of the RACE course and then list your answer for each
question 1 - 20. If you are submitting multiple tests, continue listing course title and
number and then the answers for that test. Continue until you have listed all the tests you
are submitting.
4. Make sure we have your answer sheet by 12 noon EST and you will have your
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PM EST.
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Learning Objectives
After reading
“Strength Training for Older Adults”
you should be able to:
1.
Recognize the impact that exercise can have on the loss of functioning associated
with aging.
2.
List several documented effects of aging on the muscular system and relate
these changes to loss of functioning in activities of daily living (ADL).
3.
Explain several benefits of strength training for older adults and how these benefits
may affect overall quality of life.
4.
Understand the guidelines and considerations regarding strength training programs
for older adults.
5.
Define the focus of a strength training program based on function rather
than on general strength improvement.
6.
Name a least one functional exercise to improve the ability to push, pull, grip,
maintain torso stabilization, get up and down and ambulate.
Strength Training For Older Adults
The Aging Population
Individuals age 65 and older represent the fastest growing segment of the US population. In 1900 only 4% of the population in North America was 65 or older; by the year 2030, 20% of the population will be over the age of 65. With this increase in the aging population, there is a need for Fitness Professionals who understand the needs of older adults who want to keep fit and mobile. A study published in the
Journal of Gerontology illustrates the difference between the aging process of people who exercise and those who do not. The study tested the rate of decline in athletic performance as a more accurate representation of aging than deconditioning.
By collecting data from the Masters Track and Field Organization and the U.S. Masters Swimming Congress, they found the average aging-related rate of decline was 0.5% per year (12.5% over the 25 year study) for older exercisers. This is approximately the same rate of aging found in other body tissues, such as the skin and fingernails, which are not related to physical conditioning. The average rate of decline for sedentary individuals was 2% per year, or 50% over the same 25 year span. At this rate, by age 70, many of the sedentary population would be categorized as frail (only 30% of functional capacity remaining) while the exercisers would remain highly functional, having a long way to go before becoming frail.
The question most frequently asked about the older adult is, “When does old age begin?” This is not so easy to answer as you may think. Traditionally, we have looked at aging as a chronological process, and used the age of 65 as the point when someone was considered “older”. What is inescapable, however, is the fact that much of what we traditionally considered to be part of the “normal” aging process is due as much to inactivity and sedentary lifestyle as chronology. Frequently, we now regard the aging process as one of function: what is the older client capable of doing? What Activities of Daily Living (ADL) can they perform?
ADLs are divided into two categories; the first are the basic ADLs, which pertain to the client’s ability to perform their own self-care. The basic ADLs include:
• Dressing • Eating • Ambulating • Toileting • Hygiene
Instrumental (advanced) ADLs demonstrate a higher functional level. These ADLs can be described as follows: • Shopping • Housework • Accounting • Food preparation • Transportation
From a functional standpoint, the aging process truly begins when one or more of these ADLs becomes impaired. An important focus of training the older adult client is to maintain these basic and advanced ADLs for as long as possible to allow the client to live and function independently for as long as possible. A final way to approach the aging process is to evaluate at what age the risk for heart disease, the number one killer of Americans of both genders, increases. The American College of Sports Medicine (ACSM) has defined this age to be 45 for men and 55 for women. For the purposes of this article, conservative as it may seem, we shall define the aging process as beginning at age 45 for men and 55 for women. It is at this age, according to ACSM definition, that an adult has a moderate risk of developing heart disease and must be evaluated and released by a physician prior to embarking on an exercise program
Effects of Aging on the Musculoskeletal System
There is a loss of mass in muscle tissue and a progressive loss of strength and mobility associated with aging. Cross sectional muscle area peaks in females between the ages of 16 and 19 and in males between the ages of 18 and 24. Muscle mass decreases approximately 10% between the ages of 24 and 50, with an accelerated decline of about 30% between the ages of 50 and 60. It appears that muscle mass and strength are better maintained in the upper body than the lower body. Some studies have shown increased atrophy, particularly in fast twitch Type IIb fibers, as compared to slow twitch Type I fibers, in people over age 70. With aging there appears to be a loss of motor units and a regrouping of muscle fiber; this results in an enlargement of motor unit size and less distinction between muscle fiber types, making them more homogenous.
Peak muscular strength in females occurs around age 20, and in males around age 30. Aging is associated with a gradual loss of strength that corresponds the loss of muscle mass. According to surveys conducted in the USA, 28% of older men and 66% of older women cannot lift objects weighing 10 pounds There is a degree of inconsistency in the research literature regarding the exact amount and timing of strength declines associated with the aging process. Some declines in strength (about 10%) is seen even as young adults, but as a rule, strength remains relatively intact until about age 40 or 50. As the sedentary individual approaches middle age, strength gradually declines, so that between ages 50 and 70 a loss of approximately 15% per decade is experienced. Strength losses of up to 50% are not unusual for very old individuals. Aging is also associated with a decline in the anabolic hormones testosterone and human growth hormone.
Benefits Of Strength Training For Older Adults
There are numerous reported benefits to strength training for the older adult client. Any of these individually would indicate the need for an older client to begin a weight training program, but put them all together and the benefits of strength training become even more compelling. Here are some of the documented benefits of strength training for the older adult:
• Increased Strength
Older adults gain strength at approximately the same rate as younger individuals. Increases in strength as great as 40% have been documented with high-intensity strength training up to age 96. There is also a corresponding increase in connective tissue strength associated with strength training. Some studies have indicated that in the 90 to 120 days immediately following the start of a weight training program the older client can reverse as much as three decades of functional decline.
• Increased Lean Mass
Earlier studies concluded that increases in strength found in older adults performing resistance training was due primarily to neurological factors rather than hypertrophy. With the advent and use of more sophisticated techniques, however, it has been shown that some of these documented strength gains are due to increases in cross sectional area; muscle hypertrophy resulting from resistance training has been documented in individuals in their nineties. These increases are due to an increase in the rate of protein synthesis. Young & Skelton, 1994, found that men in their seventies who started, and continued, strength training before age 50 had strength and muscle cross sectional areas similar to sedentary 28-year-olds.
• Decreased Fat Mass
Resistance training is associated with an increase in lean mass and a decrease in fat mass in older adults. Resting metabolic rate decreases with aging, resulting in a loss of lean tissue. The fat mass increases associated with aging are due to a decrease in resting metabolic rate and the way in which the older adult’s lean to fat ratio changes as lean mass is lost. The decrease in fat mass associated with strength training cannot be fully explained by caloric expenditure during training; increases in lean mass result in an increase in resting metabolic rate, which partially explains the reduction in body fat percentage and an overall improved lean to fat ratio.
• Improved Mobility and Independence
Aging and a sedentary lifestyle create a cycle of loss of muscle function which leads to less mobility. This causes a further loss of muscle function and even more immobility, finally culminating in a loss of independence and a need for constant assistance. Activities of daily living (ADL) such as climbing stairs or getting up from a chair can require as much as 100% of the strength capacity (100% 1RM) in the muscles used in those particular activities. Improved strength as a result of resistance training encourages more movement and can help to maintain the ability to perform ADLs. In one short term study conducted in a nursing home, participants in a strength training program documented, on average, an 11% increase in gait velocity, a 28% increase in stair climbing power, and a 34% increase in spontaneous physical activity.
• Reduced Bone Loss
Increased bone density is a well established benefit of resistance and weight bearing exercise. In fact, lack of weight bearing exercise is a contributing factor to bone loss. Of particular concern are postmenopausal women: the loss of estrogen results in a dramatic increase in the rate of bone loss and increases the risk of osteoporosis.
• Prevention or Modification of Chronic Disease
A number of health benefits have been associated with resistance training which were previously thought to occur only with aerobic exercise. Strength training can decrease resting heart rate, reduce blood pressure, improve cholesterol profiles and decrease insulin resistance.
• Prevention of Falls and Fractures
Falls are the leading cause of injury to older adults. Thirty to 50% of individuals over age 65 fall each year resulting in serious injuries in 10 to 15% of those who fall. Twenty five percent of those who incur fractures lose their independence, and about 10% of those who fall will die of complications as a result of that fall. A fear of falling can lead to even greater immobility and a further decline in muscle strength. Increased strength and mobility can improve balance and co-ordination, reducing the risk of falls.
• Improved Mood
Exercise has been associated with improvements in psychological well-being as well as a reduction in stress, anxiety and depression. Exercise often provides an opportunity for social interaction; this may contribute to an overall sense of well-being. Exercise has also been associated with improved sleep, a benefit for older adults who suffer from insomnia.
ACSM Guidelines For Strength Training
Programs For Older Adults
A thorough health screening and evaluation, including, possibly, a medical exam should be the first step in developing a progressive resistance program for all men over the age of 45 and women over the age of 55. This will allow the Fitness Professional to identify any problems or potential problems as well as identify any modifications that must be made. The main reasons for screening the older client include:
• Identify risk factors for heart disease • Identify any known, diagnosed disease
• Identify a history of musculo-skeletal problems • Determine if the client has had recent surgery
• Determine if any prescribed medications may affect their heart rate, balance or ability to exercise.
The American College of Sports Medicine (ACSM) recommends a frequency for strength training of at least 2 days a week, allowing a minimum of 48 hours between sessions. Older adults tend to have more soreness following training than younger adult, so a longer recovery period (3 to 4 days) between sessions
may be necessary. Start with one set of 10-15 repetitions that result in a rating of perceived exertion (RPE) of 12 to 13 (mild to moderate). Gradually increase the number of sets to 2 or 3 and the intensity between 70-80% of one repetition maximum (1 RM) as the individual progresses. Include at least one exercise for all major muscle groups, with a preference towards functional multi-joint exercises (squats, chest presses) as opposed to single joint activities, (leg extensions, triceps extensions) which are less functional. For many clients, however, you will probably begin working your client on single joint, machine exercises, because they will be perceived as “easier” and progress them to multi joint activities as they become accustomed to exercise.
Ideally, the strength training session should be completed within 30 minutes; sessions lasting longer than 60 minutes may have a negative effect on exercise adherence and increase the risk for overuse injury and discomfort. Additional strength training considerations include the following:
• the first eight weeks should employ minimum resistance to allow for connective issue adaptation;
• the first several sessions should be carefully supervised by trained personnel; • emphasize proper technique in a pain free range of motion
• encourage participants to maintain normal breathing;
• initial overload should be achieved by increasing the number of repetitions and then by increasing the weight;
• when returning from a layoff, use a resistance that is < 50% of the previous intensity and gradually increase the resistance;
• strength training should be performed year round and not on a hit and miss basis;
• avoid isometrics and exercises that cause high elevations in blood pressure in those individuals with hypertension or related illnesses;
• work large muscle groups first and opposing muscle groups in succession; • machines would be preferred over free weights at least initially.
It should be noted that exercise machines offer greater back support and a predetermined range of motion that might be ideal for beginners; using free weights, however, challenges the muscles that stabilize the body in the upright position and will result in better functional improvements. Since the use of free weights requires a great deal more knowledge of form and technique, it is probably best to begin with machines and progress to free weights.
Risk of Injury
Currently there is very little information in the literature regarding the safety of strength training for older adults. Pollock, et al compared cardiovascular training in the form of a walk/jog to a progressive resistance program and incidence of injury in older adults. The study showed a lower rate of injury with the strength training program. It is important to note that subjects trained to volitional fatigue and were given 13 weeks of the 26 week study period to work at lower intensities to allow for a gradual adaptation to the exercise. Caution should be used when performing eccentric contractions as they have the potential to cause greater muscle soreness and require a longer recovery period.
Strength Programming
Physiologically, strength training programs for older adults are not that much different from strength training programs for younger individuals. The same basic principles of overload and specificity apply. What is different, however, is that older adult exercise programs tend to move and progress less aggressively. Fitness Professionals are in the best position to offer older adults effective strength training programs emphasizing function. Functional fitness for an older adult relates to physical independence in terms of standing and walking, self care such as bathing and grooming, performing household tasks, shopping and, finally, pursuits that enhance quality of life such as traveling, sports participation, gardening, etc. Ideally, functional strength training programs should closely mimic day-to-day activities that older adults perform. For very deconditioned older adults it may be best to begin with a basic strength training program utilizing machines until baseline strength, proper breathing patterns, form and technique are achieved. Always emphasize that the older client should work through their pain free range of motion…..exercise should not hurt!
Exercises that improve the ability to stabilize the torso
Virtually all ADLs require the older client to stabilize the spine, and core stabilization activities are usually the first part of a progressive strength training program. Muscles involved in this stabilization include the erector spinae, rectus abdominus and obliques, all working together to keep the vertebral column balanced. The stability ball is a good tool for improving torso stabilization. Basic exercises include sitting on the ball while maintaining good posture. This can progress to a series of arm or leg lifts while sitting on the ball, followed by activities like keeping a balloon aloft or playing catch.
Exercises that improve the ability to push
Pushing motions are very functional activities for older adults. Examples of pushing movements include moving furniture, rolling dough, placing items on a shelf, pushing a shopping cart or a stroller, and closing a stubborn dresser drawer. Muscles used to push include the triceps, pectoralis major, anterior deltoid, coracobrachialis, pectoralis minor and serratus anterior. Some functional exercises that would improve the ability to push include wall push-ups, forward and overhead medicine ball presses or even just squeezing a balloon. Traditional gym exercises with a correlation to pushing ADLs include multi-joint activities such as a vertical (seated) chest press, angled shoulder press or even a push up.
Exercises that improve the ability to pull
Examples of pulling motions include raking leaves, opening doors, removing laundry from the dryer, taking groceries from the trunk of a car, and picking up a grandchild or a cat.The latissimus dorsi, teres major, posterior deltoid, biceps, trapezius and rhomboids are used in most pulling motions. Using elastic resistance and performing rowing exercises from a variety of angles and body positions requires core stabilization and are some examples of functional exercises that enhance the ability to pull. Traditional gym exercises to improve the ability to pull include seated rows and reverse flyes. Isolated scapula adduction, done at a rowing machine or with elastic tubing, will help to maintain good upright posture, which also has the effect of minimizing the risk of falling.
Exercises that improve grip strength
Activities such as opening lids, using tools such as hammers and screwdrivers, and holding a pen or a fork require sufficient grip strength. Dexterity in the hands is also important for a number of daily tasks such as sewing, doing simple repairs around the house or picking up small objects. To improve dexterity and strength in the hands, have the individual scrunch up a piece of newspaper with their hands or squeeze a ball. A rubber band placed around the fingers while the participant works on opening up the hand can be very effective, as can “finger to finger” drills, in which the participant touches their thumb, sequentially, to each of the other four fingers on their hand. Eventually, working with a series of jars with lids that are progressively tighter would be an example of a functional exercise.
Exercises that improve the ability to get up and down
Climbing stairs, getting into and out of chairs or cars, or getting on and off the toilet are common actions requiring the combined efforts of the large muscles of the lower body (quadriceps, gluteals and hamstrings) as well as a great deal of torso stabilization. Functional exercises include squats on a stability ball, lunges and step-ups. Chair squats are another functional exercise for the older client. Beneficial traditional gym exercises would include leg presses, hack squats or, perhaps, squats on the Smith machine. You will probably want to avoid leg extensions for the older client; the risk of shear and compression at the knee will probably make the risks of this activity outweigh the benefits for most older clients. Don’t forget the hamstrings and hip adductors for balance, and to help stabilize the spine.
Exercises that improve mobility
Walking is the most popular cardiovascular activity for older clients, and is highly functional; strength training can improve the ability of the client to ambulate. The lower body muscles discussed above will help your client’s mobility, but also pay attention to the ankle: the tibialis anterior, gastrocnemius and soleus should be exercised as well. Treadmill walking, especially with a slight incline, can help increase strength and endurance in the leg muscles while improving walking speed and balance. Obstacle courses that require stepping over and around objects can also be very functional. Step-ups onto a low aerobic bench will simulate going up and down curbs. These step-ups can be done while holding or carrying an object, and should be done forwards, laterally and, with care, even backwards, always emphasizing good posture.
Conclusion
Strength training should become a long term part of your client’s life. The long term and short term benefits of weight training are well documented. Even apart from the benefits of increased metabolism, reduction in body fat, reduction of cardiac risk factors, improved sleep patterns and enhanced mood, the ability of exercise to preserve function and maintain independence is not to be minimized. Whether or not an effective strength training program will actually add years to your client’s life has not yet been definitively documented. What is inescapable, however, is that exercise can greatly increase the client’s quality of life and add “life to their years.”
Bibliography
Adams, K., O’Shea, P., O’Shea, K. (1999). Aging: Its effects on strength, power, flexibility, and bone density. Journal of Strength and conditioning Research. 21 (2), 65.
American College of Sports Medicine. (2000). ACSM’s Guidelines for Exercise Testing and Prescription. Philadelphia: Williams and Wilkins.
American College of Sports Medicine. (2001). ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. Philadelphia: Williams and Wilkins.
American Council on Exercise. (1999). Clinical Exercise Specialist Manual. San Diego: American Council on Exercise.
American Council on Exercise. (1998). Exercise for Older Adults. Champaign, Ill: Human Kinetics. American Council on Exercise. (1996). Personal Trainer Manual. San Diego: American Council on
Exercise.
Baechle, T. R. (1994). Essentials of Strength Training and Conditioning. Champaign, Il: Human Kinetics.
Baechle, T. R., and Barney, G. (1992). Weight Training-Steps To Success. Champaign, IL: Human Kinetics.
Brooks, Douglas S. (2001). Effective Strength Training. Champaign, IL: Human Kinetics Ellenbecker, Todd and Davies, George. (2001). Closed kinetic chain exercise: A
comprehensive guide to multiple joint exercises. Champaign, Ill: Human Kinetics. Fleck, S. and Kraemer, W. (1997). Designing Resistance Training Prgrams. Champaign, IL:
Human Kinetics.
Hedrick, Allen. (1998). Resistance training with older populations: Justifications, benefits, protocol. Journal of Strength and conditioning Research. 20 (2), 30.
Kallman, D.A. et al. (1990). The role of muscle loss in the age related decline of grip strength: Cross-sectional and longitudinal perspectives. Journal of Gerontology. 45 (3), 82.
Lephart, SM, Fu, FH, eds. (2000). Proprioception and Neuromuscular Control in Joint Stability.
Champaign, Ill: Human Kinetics.
McArdle, W. et al. (1996). Exercise Physiology-Energy, Nutrition, and Human Performance. 4th ed. Philadelphia, PA: Lea & Febiger.
National Strength and Conditioning Association. (2000). Essentials of Strength Training and Conditioning. Champaign, Ill: Human Kinetics.
Parakh, A. and Domowitz, F. (2000). Roundtable Discussion: Machines versus free weights.
Journal of Strength and conditioning Research. 22 (6), 18.
Pyka, G. et al. (1994). Muscle strength and fiber adaptations to a year-long resistance training program in elderly men and women. Gerontology. 491 (1), M22.
Reed, R. L. et al. (1991). The relationship between muscle mass and muscle strength in the elderly.
Journal of the American Geriatric Society. 39, 555.
Westcott, W.S. and Baechle, T.R. (1998). Strength Training Past 50. Chanpaign, IL: Human Kinetics.
CEC/CEU Test For “Strength Training for Older Adults”
1. Which of the following is not a benefit associated with strength training for older adults?
A. Improved mood and well-being B. Increased strength and lean mass C. Adding 10 years to life expectancy D. Increased cross sectional area 2. Which of the following is a characteristic of aging muscle?
A. There is greater atrophy in the slow twitch fibers versus the fast twitch B. Concentric contractions result in more muscle soreness than eccentric C. There is an increase in the number of motor units
D. Upper body strength is better maintained than lower body strength 3. Which of the following is/are true regarding the strength gains seen in older adults as a result of resistance training?
A. Gains are thought to be from only neural factors
B. Older adults lack sufficient amounts of testosterone and growth hormone for hypertrophy to occur
C. Hypertrophy has been documented in older adults
D. A and B
4. According to ACSM, strength training programs for older adults should initially consist of
_____________ repetitions. A. 6-12
B. 10-15 C. 15-25 D. 20-30
5. The percentage of adults over the age of 65 who fall every year is:
A. 70-80 B. 30-50 C. 50-75
D. 20-30
6. The most important goal when designing strength training programs for older adults is to increase or improve:
A. Muscle size B. Muscle strength C. Muscle mass D. Function
7. An appropriate RPE for an older adult performing strength training is:
A. 8-10 B. 16-18 C. 19-20 D. 12-13
8. Which of the following is true regarding the number of days per week older adults should train?
A. A minimum of 4 days per week is recommended
B. A minimum of 2 days per week is recommended
C. Older adults can strength train more often than younger adults since they are using a lower percentage of 1 RM D. Older adults should train 1 day per week in order to insure adequate recovery 9. At approximately what age range does the decline in muscle mass begin to accelerate?
A. 30-40 B. 40-50 C. 50-60 D. 60-70
10. Which of the following are true in regards to strength training program design for older adults?
I. Progress from machines to free weights II. Progress from free weights to machines III. Use pain free range of motion
IV. Emphasize isometrics A. I and III
B. I and IV C. II and III D. II and IV
11. The rate of aging found in other body tissues and functions not related to conditioning is:
A. 1% per year B. 2% per year C. 5% per year D. 0.5% per year
12. Peak muscle strength in females occurs around age ____ in females and ____ in males.
A. 30; 40 B. 20; 30 C. 20; 20 D. 25; 35
13. Which of the following is the most appropriate recommendation regarding rest between training days in older adults.
A. 96 hours B. 24 hours C. At least 48 hours D. At least 24 hours
14. In order to maximize motivation and adherence to a strength training program involving older adults, the training session should be completed:
A. Within 30 minutes B. In 60 minutes C. In 45 minutes D. Within 15 minutes
15. Initially, progression in a strength training program for an older adult should focus on:
A. Intensity B. Sets C. Repetitions
D. Decreasing the rest between sets
16. Older adults with hypertension should avoid:
A. High repetitions and low resistance B. Isometrics
C. Breathing during the concentric phase D. Breathing during the eccentric phase 17. Older adults should be instructed to move the resistance:
A. Through a full range of motion B. Several inches further after discomfort is felt
C. Through a pain free range of motion D. Through an extended range of motion 18. Which of the following would be most appropriate for improving walking speed, gait, balance, and leg muscle strength and endurance?
A. Performing squats while holding onto a chair
B. Performing hip extensions from a prone position
C. Treadmill walking with a slight incline D. Hamstring curls from an all fours position
19. Which of the following factors that impact on cardiovascular health are associated with strength training?
A. Decrease in resting heart rate B. Reduction in blood pressure C. Decreased insulin resistance D. All of the above
20. The intensity of strength training programs for older adults should gradually be increased to:
A. 70% to 80% of the one repetition max B. An RPE of 17 to 20
C. 40% to 60% of the one repetition max D. B and C
