Research supports a specific exercise program sequence for older-adult clients.
Four types of training—aerobic, resistance, flexibility and balance—are each critically important for the overall health, functional capacity and quality of life of our senior clients. Health and fitness professionals can follow readily available evidence-based guidelines, provided by major health organizations, when designing training programs to positively modify these fitness components. However, when it comes to combining multiple fitness components in the same exercise session, there are no current recommendations for the most appropriate exercise program sequence. This is unfortunate because the order of exercise components does matter!
For example, performing flexibility training prior to resistance or balance training can both decrease the effectiveness of the later routines and increase the risk of falls (ACSM 2010; Behm et al. 2004). Conversely, doing aerobic exercise prior to resistance training will result in a greater caloric expenditure both during exercise and afterward, thus optimizing the weight management program (Drummond et al. 2005). Intrigued? This article will provide exercise professionals with clear, evidence-based guidelines for safe and effective exercise program sequencing.
When designing physical activity programs for older adults, health and fitness professionals should keep in mind three primary goals (ACSM 2010):
These goals can be achieved with a comprehensive program that includes the four training activities. Let’s briefly examine the rationale for including each component.
Aerobic Activity. Cardiorespiratory fitness is arguably the most important goal of an exercise program for older adults, as low cardiorespiratory fitness may contribute to premature mortality in middle-aged and older adults (Franklin 2007). Moreover, decreased cardiorespiratory fitness contributes to a reduction in physiological functional capacity and can eventually result in loss of independence (Nelson et al. 2007). Aerobic activity is best suited for modifying cardiorespiratory fitness.
Resistance Activity. Aging is associated with a reduction in muscle mass, which in turn contributes to decreased muscle strength and a decline in functional capacity. Undeterred, the process can ultimately result in balance impairments, mobility problems and lack of independence (ACSM 2010). Furthermore, decreased muscle mass plays a role in the development of glucose intolerance and type 2 diabetes. For these reasons, health and fitness professionals should recognize the importance of implementing a resistance training program for older-adult clients in order to attenuate the loss of muscle mass (Warburton, Nicol & Bredin 2006).
Flexibility Activity. An essential component of fitness, flexibility decreases with age and physical inactivity. Poor flexibility, coupled with reduced musculoskeletal strength, has been associated with a diminished ability to perform activities of daily living (ADL) (ACSM 2010). Consequently, the beneficial effect of static stretching (slow and sustained to increase movement at a particular joint) on the achievement and maintenance of flexibility should not be overlooked.
Balance Exercise. Fall incidence rates currently pose a serious health problem for older adults. Diminished balance is attributable to an age-related decline in multiple physiological systems that contributes to loss of muscle flexibility and strength, reduced central processing of sensory information and slowed motor responses (Moreland et al. 2004). In addition to an increased risk of falls, poor balance and mobility may limit ADL or participation in leisure-time activities. Accordingly, physical activity programs for older adults must include balance exercises.
If we are to fulfill the minimum frequency requirements of each form of activity in Table 1, our clients will need to perform at least two (or more) activities the same day, and most likely within the same exercise session. Unfortunately, there are no clear guidelines for the most appropriate sequencing of activities in a single session. This gap is problematic because exercise order can play a vital role in the safety and effectiveness of each session (and of the overall program). There are five things to keep in mind when it comes to proper activity sequencing:
1. Aerobic activity should come first in the session. The benefits accrued from engaging in regular aerobic exercise far exceed those received from other forms of physical activity (Warburton, Nicol & Bredin 2006; Nelson et al. 2007). Scientific research has demonstrated that there is a dose-response relationship between volume of aerobic exercise and multiple health outcomes, including risk of heart disease and all-cause mortality, obesity, dyslipidemia, type 2 diabetes and, perhaps most importantly, cardiorespiratory fitness (Warburton, Nicol & Bredin 2006). The caloric expenditure from aerobic activity is also superior to the expenditure from the other three activities (ACSM 2010). For clients primarily interested in weight loss goals, maximizing the energy expenditure of the training program by first fulfilling aerobic activity recommendations should be a priority.
2. Balance training comes before resistance and flexibility activities. Research has reported that participation in either resistance or flexibility activities prior to balance exercise can negatively impact performance (Behm et al. 2004; Moreland et al. 2004). For the senior client who may already face significant balance challenges, it would be inappropriate (and possibly harmful) to create additional perturbations through improper activity sequencing. Balance training (when combined with resistance and flexibility activities) should be performed first. On the other hand, as recommended above, it should follow aerobic activity.
3. Flexibility activity always comes last in the session. The past 10 years have seen much scientific inquiry into how stretching relates to performance and risk of injury. Collectively, present research findings suggest that there are no ergogenic benefits while there are potentially detrimental effects (decreased muscle strength and endurance, impaired balance, diminished reaction time) to incorporating static stretching exercises into the warm-up routine (ACSM 2010). Health and fitness professionals should be mindful of this evidence when designing programs and should sequence the workout so that flexibility activities follow the aerobic, balance and resistance training components.
4. Aerobic plus resistance activity equals greater caloric expenditure than either of them alone. Combining aerobic and resistance activities within the same session (frequently referred to as concurrent training) is a time-efficient tactic. Sequencing these activities to target aerobic activity first, followed by resistance activity, is the correct order. This approach achieves two advantages. First, performing resistance training prior to aerobic exercise has been reported to impair muscle metabolism and contraction, contributing to premature fatigue, whereas the reverse order is not as limiting (Drummond et al. 2005). Second, and perhaps more important, performing aerobic activity before resistance exercise maximizes the caloric expenditure of the session, both during the exercise and afterward (known as excess postexercise oxygen consumption, or EPOC).
5. Performing aerobic activity prior to resistance training does not compromise muscular fitness development. This common misconception is speculative and not supported by scientific literature. As described above, there are significant benefits to sequencing aerobic activity prior to resistance activity. Research has demonstrated that concurrent training yields improvements in muscular strength and positively modifies body composition (Takeshima et al. 2004).
For a sample workout program that takes the four training activities and five sequencing guidelines into account, take a look at the sidebar “Exercise Sequencing: A Case Study.”
A comprehensive physical activity program for older adults will include aerobic, resistance, balance and flexibility components. It will also follow the sequencing guidelines outlined here. Careful planning of the sequence of these activities will ensure a successful outcome for your senior clientele. When designing your workouts, remember, order matters!