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Special Fitness Needs for OLER ADULTS
Stephen A. Black, M.Ed., P.T., A.T.C./L., N.S.C.A.-C.P.T.
Understanding the special needs of older adults can help you to offer a facility and programming that are appropriate for this population
By the year 2020, the number of people in their fourth, fifth and sixth decade of life will triple. According to the International Health, Racquet and Sportsclub Association’s Profiles in Success, the number of fitness center members ages 35 to 54 has grown from 6.3 million to 10.5 million, and the number of members ages 55 and older has increased from 1.9 million to a staggering 4.9 million. So, should you cater to this population? You bet!
The trend for increased activity for older adults offers the fitness industry great opportunities. It is imperative that fitness facility operators offer older-adult-friendly environments. This includes facilities and programming. Don’t fall into the trap of retooling existing programs and facilities, thinking they will be adequate for the older adult population; instead, invest some time, energy and finance into creating a friendly environment for them. Consider the following facility, staffing and programming changes to attract and retain the active older adult population.
Facility Design
Color. An interior decorator who specializes in industrial design can provide the latest in information related to appropriate color schemes, from walls to carpet to print media.
Facility design. Review the literature or hire a consultant with knowledge in facility design for older adults. Simple changes such as additional lighting, a “way finding” system, handrails in the hallways, etc., will assist members throughout your facility. These accommodations should extend into the locker room and shower areas, as well.
Spacing. Additional space in the locker rooms to accommodate seating areas, larger individuals and special care attendants will prove to be a tremendous advantage to older adults. A little investigation into their special needs will assist in a user-friendly environment
Consider equipment spacing as well. The typical 5-square-feet-per-member ratio may no longer be efficient or effective. Older individuals, those with physical limitations and the overweight/obese need additional space between equipment. This is also relevant in group exercise classes. Allow more space between steps, core boards and group cycling apparatus.
Staffing
Hire older staff members. And be sure that staff are appropriately dressed to exude a friendly, safe and comfortable environment. Require evidence-based, peer-reviewed certifications. Look to organizations such as the American College of Sports Medicine, National Strength and Conditioning Association, and American Council on Exercise (clinical exercise specialists) for credible, evidence-based educational programs. Also, create and “expert” in active aging programming in your facility, and give them management and financial support.
Fitness Basics
Physical fitness is to the human body what fine-tuning is to an engine. It enables people to perform up to their potential: the ability to perform daily tasks vigorously and alertly with energy left over for enjoying leisure-time activities and meeting emergency demands.
Physical fitness involves the performance of the heart, lungs, and muscles. Fitness also influences, to some degree, qualities such as mental alertness and emotional stability. Physical fitness is most easily understood by examining its components. The ingredients include to following:
Cardiovascular endurance. Cardiovascular endurance is the ability to deliver oxygen and nutrients to tissues, and to remove waste over sustained periods of time.
Muscular strength. Muscular strength is the ability of a muscle to exert force for a brief period of time
Muscular endurance. Muscular endurance is the ability of a muscle, or group of muscles, to sustain repeated contractions or to continue to apply force against a fixed object.
Flexibility. Flexibility is the ability to move joints and use muscles through their full range of motion. The sit-and-reach test is a good measure of flexibility of the lower back and backs of the upper legs.
Body composition. Considered a component of fitness, body composition refers to the makeup of the body in terms of lean mass and fat mass. An optimal ratio of fat-to-lean mass is an indication of fitness. The right types of exercise will help decrease body fat and increase or maintain muscle mass.
Balance. In the broadest sense, balance involves an individual’s capability to control upright posture under a variety of conditions. Good balance is one of the prerequisites for mobility and activities of daily living.
Armed with this basic information, read on to explore further implications that they have for the aging adult, and for considerations in exercise prescription.
Energy Consumption
A major fraction of total daily energy demand arises from resting metabolism; it is, therefore, important to note that resting metabolism decreases with age by about 10 percent from early adulthood to the age of retirement, and a further 10 percent subsequently. One reason for this is the loss of metabolically active muscle mass, and a parallel increase in metabolically inert deposited fat. Food intake must be correspondingly adjusted for that body fat is not increased further (which necessitates metabolic testing). This gives rise to the opportunity to provide nutritional counseling (a fee-based service) to the older adult population within your facility. Bear in mind that a 1-pound increase in lean mass burns approximately 50 more calories.
Aerobic Performance
Maximal oxygen intake declines by about 5 ml/kg/min/decade from 25 to 65 years of age. Depending on the nature of the task and the working environment, sustained exercise is fatiguing if it demands more than 33 to 50 percent of the person’s maximal oxygen intake. Thus, the aging of oxygen transport systems progressively restricts the ability of older adults to undertake repetitive, stressful activities. It is imperative to conduct testing (anaerobic threshold/Vo2 predicted) and consider the current condition of the individual to supply the appropriate dose of activity. An appropriately graded aerobic training program can augment the aerobic power of an individual by as much as 10ml/kg/min over a three-month period, effectively reducing the biological age of the oxygen transporting system by 20 years (data gleaned from the POLAR 100 program, June to August 2003). A lack of aerobic power should not limit the independence of a well-trained, active individual.
Musculoskeletal Function
Aging leads to a progressive decrease of muscle strength and flexibility. Strength peaks around 25 years of age, plateaus through 35 to 40 years of age, then shows an accelerated decline with 25 percent loss of peak force by age 65. Changes are greater in the legs than in the arms, possibly because there is a greater decrease in use of the legs with aging, unless an appropriate and regular fitness program is initiated and perpetuated.
The good news is that muscle strength can be greatly improved by as little as eight weeks of resistance training, even in 90-year-old individuals. Stronger muscles further enhance function by stabilizing osteoarthritic joints, reducing the risk of falls and lessening the extent of balance disturbances.
At one time, it was feared that resistance exercise might cause a dangerous rise of blood pressure, provoking a hear attack. However, if the individual avoids performing a Valsalva maneuver, and individual contractions are held for no more than a few seconds at 60 percent of peak voluntary force, the rise of blood pressure is no greater than would be anticipated during a typical bout of cardiovascular exercise.
Flexibility
The elasticity of tendons, ligaments and joint capsules decrease with age. Adults lose some 8 to 10 cm of lower-back and hip flexibility, as measured by the sit-and-reach test. Restriction in the range of movement at the major joints can impede the ability to comfortably perform activities of daily living. Flexibility is through to be conserved or improved by gently taking the main joints through their full range of motion every day. If muscle weakness and arthritis are already advanced, such activities are best attempted in warm water. Buoyancy then supports body weight, and warmth increases the immediate flexibility of the joints. Activities such as gentle yoga, tai chi and other non-combative martial arts and aquatic activities are advocated in the maintenance of joint range of motion and core stability.
Bone Structure
Regular load-bearing exercise can halt and sometimes even reverse bone mineral loss through the eighth decade of life. Such a regimen is particularly effective when accompanied by a high-calcium diet (1,500 mg a day). Calcium loss can begin as early as 30 years, and in women, the process accelerates around menopause. In later old age, the bones can become so weak that a mild fall, a bout of coughing or even a vigorous muscle contraction can causer a “pathological” fracture. A deterioration of the vertebrae also contributes to changes in the spine and its ability to transfer and absorb shock. Therefore, early, progressive weight-bearing exercise is imperative.
Risks of Exercise
The risk of a cardiac emergency increases substantially when a person is exercising (a rationale for an AED and training of all staff). A preliminary screening, including an exercise electrocardiogram, is needed for all exercisers or potential exercisers over the age of 40. This is true for both males and females.
Certain precautions can increase the safety of exercise for the older individual. The recommended dose of exercise should do no more than leave the participant pleasantly tired on the following day. Recovery processes proceed slowly; so vigorous training should be pursued on alternative days. In individuals wit pre-existing articular disease, walking should be substituted for jogging, running; fast walking offers an adequate training stimulus, with less risk of slipping and much lower stress on the knees. Weight-supported activities such as swimming and aquatics are particularly helpful for those with joint problems.
Vision, hearing and balance are all poorer in older adults than in younger adults. Seniors should thus avoid sports where there is risk of collision with opponents or stationary objects. If there is a history of falls, special care is needed in pursuing activities that require a good sense of balance, whether climbing, skiing, and cycling, or merely walking on a slippery pool deck (not to discount the necessity of programs for balance training, which can be accomplished in a one-on-one or group setting). Environmental extremes are poorly tolerated, and if the weather is extremely hot or cold, activity should be taken inside. Change in body position should also be given consideration with the elderly or frail. Chair activities are a wonderful and creative alternative.
Benefits of Exercise
Exercise training cannot restore tissue that has been destroyed, but it can protect individuals against a number of chronic diseases of age. More importantly, it maximizes residual function. In some instances, biological age is reduced by as much as 20 years. Life expectancy is increased partial and total disability is delayed, and there are major gains in quality of life. Exercise is, thus, an important component of healthy living for adults of all ages.
FM Resources
Want more information? Try the following sources:
Fiatarone, M.A., E.C. Marks, N.D. Ryan, C.N.
Meredith, L.A. Lipsitz and W.J. Evans. High
Intensity Strength Training in Nonagenarians;
Effects on skeletal muscle. Journal of the American
Medical Association 263; 3029-3034,1990
Kasch, F.W.., J.P. Wallace, S.P. Van Camp and L.
Verity. A longitudinal study of cardiovascular
Stability in active men aged 45 to 65 years.
Physician and Sportsmedicine 16(1):117-126, 1988
Shepard, R.J. Physical Activity and Aging (2nd ed).
Croom Helm Publishing: London, England, 1987
Shepard, R.J. and W.Montelpare. Geriatric benefits of
Exercise as an adult. Journal of Gerontology 43:M86-M90, 1988.
Stephen A. Black, M.Ed., P.T., A.T.C./L., C.P.T. of RockyMountain Human Performance Center Inc. Boulder Colo., provides individualized programs
For athletes, weekend warriors and post-rehab clients. Black has 20-plus years’ experience in the health and wellness industry, and has worked with professional teams, including the NFL, NHL, NBA, WNBA and ABL/NBL affiliates. He is also a presenter for the health and wellness industry. For more information, visit www.clubcoach.net. |
