Working with Older Adults
‘It is not enough to just walk’
For the past 4 years I have shifted my focus more towards the older adult demographic. The reasons for this shift were accelerated through my Functional Aging certifications as well as my own age, thereby making what I know and believe, to be both scientifically researched and supported with a lifetime of personal experience.
The importance of exercise and more critically the necessity to maintain or build muscle, the vital component for skeletal stability and structure, strength and power as well as for ongoing functional movement patterns to improve gait, mobility, agility, balance to prevent falls or injury is being supported with more scientific research and studies now than ever before.
Falls are a major concern for older adults. Falls are the leading cause of injury deaths for older adults. Approximately 5% of falls result in fractures with hip fractures being the most common. Of those who suffer a hip fracture 50% never regain their ability to walk and 20% die within six months.
Falls are due to several intrinsic and extrinsic factors. Intrinsic factors that increase fall risk include a history of falls, age, living alone, certain medications, impaired mobility and gait, sedentary behavior, visual impairments, poor lower extremity strength and fear of falling (Todd 2004). Extrinsic risk factors include environmental hazards (poor lighting, slippery floors, uneven surfaces, etc.) (Todd 2004). Exercise has been identified as the best single intervention to prevent falls in older adults with up to 42% of falls being preventable by a well-designed exercise program (Todd 2004; Gillespie et al 2009). Other effective interventions include home safety modifications, medication reduction or substitution (especially psychoactive or CNS depressant medications), reducing fear of falling and surgery to correct cataracts.
Balance is a multi-dimensional concept as it is controlled by multiple sensory and motor control systems. The visual, vestibular, and somatosensory systems send information about the environment to the central nervous system which then determines which bodily movements to make to balance (seated or standing).
Exercise must provide a moderate or high challenge to balance. Reducing the base of support, movement of the center of gravity and reducing the need for upper limb support during standing exercise. This in addition to walking and strength training.
Falls prevention exercise should be targeted at the general community as well as those at high risk for falls. Falls prevention exercise can be undertaken in a group or home-based setting.
The key principles of the Functional Aging Training is not a fixed program. Rather it provides a philosophy of training to ensure that one can independently perform acts of daily living (ADL’s).
Performing exercises with correct or proper form is critical to prevent injury. Learning how to recognize your own form breakdowns and then correct them can be incredibly helpful. Mature adults do not need to ‘take it easy’ or only use light weights. In fact, if you do you are likely to realize little, if any, significant results. Physiologically you need to be overloaded to stimulate improvements just like everyone else. This is often a lack of understanding of how hard to exercise or for being sedentary too long.
Functional exercise movements by their nature focus on challenging and improving many more variables than just strength. While muscle strength is essential to successfully completing many functional tasks, muscle power is even more important for many tasks such as stair-climbing and rising out of a chair, as well as sporting activities. Muscle power decreases more rapidly than muscle strength with advancing age indicating that movement velocity also decreases.
Mature endurance athletes will need to include resistance training as an integral part of their routine. Muscle power, the ability to generate force quickly, is a key aspect of many competitive events.
It is important to take a whole-body approach. Whole-body functional routines that integrate movement patterns and utilize multiple muscle groups simultaneously will be the most advantageous in enhancing performance and health as well as achieving functional longevity. Using multi-dimensional movement in combination with all planes of motion will challenge the integration of all these muscles by causing them to work together in a coordinated fashion. This allows for more efficiency.
According to Paul Holbrook, Exercise physiologist and Functional Aging Institute Advisory Board Member, older adults should not limit themselves to light or moderate exercise. Wisloff demonstrated that HIIT (High Intensity Interval Training) with individuals with an average age of 75.5 years was effective. Broman et al showed significant cardiovascular improvements from HIIT with woman whose average ages was 69.2. Additionally, research has shown that leg power is strongly correlated to functional independence. Finally, regarding fall prevention, lower limb explosive power is the most important factor to consider. In conclusion HIIT – type of training with older adults needs to take multiple factors into account (i.e. risk/reward; safety; appropriateness) and should be modified to meet the needs of individual adult populations.
Group Class Experiences provide:
· Opportunity - large and growing number of mature adults
· Programming Diversity - range of functional and health levels
· Efficiency – accomplish a lot in a short amount of time
· Group Dynamics – creates a fun, interactive, and social atmosphere
2016 Functional Aging Institute