Vol. 15 •Issue 3 • Page 57
Issue Date: January 26, 2004
Motivated to Move

To help your elderly patients reap the many benefits of strength training, you have to getand keep—their interest

By A. Roxanne Foltz, CTRS/CPRP

At about age 25, we start to lose as much as a half of a pound of muscle mass every year.¹ We often correlate the decline in physical ability to age, but it is actually due to inactivity.²

But strength training—which increases the resistance placed on a muscle, overloads it and makes it do more—can help prevent and even reverse this decline. In fact, strength training can increase muscle and bone mass, muscle strength, flexibility, dynamic balance, self-confidence and self-esteem. It can also help reduce the symptoms of various chronic diseases such as arthritis, depression, type 2 diabetes, osteoporosis, sleep disorders and heart disease.³

But seniors aren't embracing this information. National surveys show that less than 10 percent of people ages 65 or older routinely engage in activities designed to maintain or increase strength. For people ages 75 and above, these numbers are even lower.⁴ By age 70, loss of muscle strength can be great enough to limit activities of daily living. We can increase these percentages by encouraging seniors to participate in strength training programs.

Changing Perceptions

First, we need to change seniors' perceptions about strength training. Many of our elderly patients have physically worked hard all their lives and never needed to exercise beyond that. Working out in a gym is a new concept to most of them. When thinking of strength training, they picture grunting, muscle-bound men competing to lift the most weight.

Since most seniors aren't interested in training for competition, tell them about the benefits that are relevant to their lives. Educate them on how strength training can improve their functional fitness and help reduce low-back pain, the risk of falling and the severity of injury if a fall does occur. Explain how it can increase their capacity to perform normal everyday activities safely and independently without undue fatigue.

Stress how strength training can improve their ability to lift and carry grandchildren, transport groceries or maneuver the overhead garage door, climb stairs, rise from a chair or get in and out of a bathtub.

Fitness Testing

Another valuable motivational tool is fitness testing to evaluate physical capacities. Gear this test specifically for the senior population, pointing out where each person's physical capacities rank compared to others of the same age and gender. Show seniors how close they are to the threshold scores that may signify being at risk for losing functional independence.

You can also track scores at regular intervals to help people monitor whether they're improving or declining. This can help them detect weaknesses before causing serious functional limitations.

For instance, California State University at Fullerton's Senior Fitness Test, which is designed for people 60 and over, has seven test items that correspond to functional fitness. For example, a chair stand test assesses lower body strength for maintaining balance or getting out of a bathtub, while an arm curl test measures upper body strength for lifting and carrying.

If a senior has weakness in a particular area, you can then begin to build a targeted strength training program to address it.

Staff Training

Because strength training is a new and somewhat intimidating venture for many mature adults, facility staff plays an integral part in the program's success. That means that staff members need a solid education on senior fitness first. Advise your staff to obtain certification from a nationally recognized senior fitness organization. This certification should include information on the impact of medications and how to work with people with various age-related health issues.

Consult the International Council on Active Aging (http://www.icaa.cc/) and the Fitness Educators of Older Adults Association (http://www.fitnesseducators.com/) for additional resources.

Developing a Program

Educated staff members can then help seniors develop safe and correct techniques, whether they're using free weights, elastic exercise bands, exercise machines or their own body weight and gravity. Some key recommendations include the following:

• Seniors should lift weights in a controlled manner and avoid jerking their bodies.
• They should keep their body weight over their cores and their heads in line with their spines.
• They should focus on rhythmic breathing.
• All exercise sessions should include warm-up and cool-down periods.
• Seniors should start with low weights/resistance levels and make small incremental increases.

Encourage seniors to perform strengthening exercises two to three times per week with at least 48 hours between sessions. Experts recommend that older adults increase strength by performing 10 to 15 repetitions of a particular strengthening exercise using a weight/resistance that would cause the muscles to fatigue. Fatigue means that the muscle cannot perform another repetition using proper form.²

Seniors can increase the weight and resistance as strength improves and they can complete more than 15 repetitions without fatigue. As with any exercise program, seniors should get physician approval to start a program.

When developing a facility program, consider accessibility for those using walkers and wheelchairs, parking, lighting, cleanliness and hours of operation. Use equipment that has simple, easy-to-read display panels. Make sure that seats are comfortable and that seniors with a variety of functional abilities and disabilities can easily enter and exit the equipment.⁵

A. Roxanne Foltz is director of therapeutic recreation at Brethren Village, a retirement and health care community in Lancaster, PA. She is a certified instructor trainer for the Arthritis Foundation and the American Red Cross. She has more than 15 years experience in geriatrics and her programs have received awards and international media coverage.

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