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Suspension Exercise for Older Adults

by Christian J. Thompson, PhD on Apr 24, 2013

Use a multimodal approach to help aging adult clients regain key functional abilities.

Suspension exercise (SE) is a popular way to get fit for many people, and it’s no secret as to why. This method of exercise, where an apparatus attached to a single overhead anchor point supports the hands or feet, offers numerous benefits. Due to its popularity and the results people see from performing SE, programming has evolved to a point where fitness professionals are introducing it to their older-adult clients in the 65–80 and older age range.

The American College of Sports Medicine’s annual survey of health and fitness professionals listed body weight training as one of the top three fitness trends for 2013 and pointed to the continued emergence of SE as a primary reason (Thompson 2012). There are many suspension systems in the fitness marketplace. This equipment is adjustable, lightweight and portable, and supports a wide range of athletic, fitness and rehabilitative exercise options.

A primary benefit of this specialized equipment is that users can modify body position, base of support and stability. Fitness professionals can create programs that range from simple movements where the SE system unloads the body and offers external support to dynamic movements that challenge both the neuromuscular and metabolic systems. Users can also manipulate speed, range of motion and training volume. Individuals rehabilitating from musculoskeletal injuries, clients who have significant functional limitations and athletes preparing for competition can all benefit from SE (Halvorson & Sonnemaker 2010).

This article looks at research that supports SE as a solid training method and expounds on its usefulness, benefits and practicality in training older-adult clients from a multimodal approach.

Suspension Exercise Research

Studies have demonstrated that SE is effective for injury rehabilitation, improved functional capacity and increased athletic performance (Cheatham & Kolber 2012; Dudgeon et al. 2011; Willardson 2007). SE systems create both static and dynamic conditions that help develop stability and balance in concert with other objectives, such as muscle strength, joint mobility, sensory enhancement or gait enhancement. When a movement involves an unstable platform or weight, the body is forced to compensate and recruits more muscle fibers to maintain stability—particularly core muscles (Anderson & Behm 2005), which facilitate whole-body neuromuscular control.

Core activation is a central component of many fitness and wellness programs, and SE effectively trains the core. Abdominal muscle recruitment has been shown to increase intra-abdominal pressure, which reduces load on the lumbar spine. The transversus abdominis is the first muscle activated during unexpected self-loading of the trunk, including both upper- and lower-extremity movements in any direction (Hodges & Richardson 1997; Anderson & Behm 2005; Pastucha 2012; Willardson 2007). The core muscles fire prior to movement, anticipating changes in the center of gravity and providing a more stable base (Anderson & Behm 2005; Pastucha 2012; Whitehurst et al. 2005). Schoffstall and colleagues (2010) determined that the abdominal-musculature EMG activity during an isometric prone V-up using a TRX Suspension Trainer was similar to the activity during other isometric abdominal exercises, indicating that SE is effective in isometric training in addition to dynamic exercise.

Core stability improves both balance maintenance and balance recovery, making it essential when training older adults with an elevated risk of injurious falls (Skelton & Dinan 1999). SE systems safely challenge stability and balance during dynamic functional movements, and this, combined with the direct application to activities of daily living, is why SE is a good programming option to use with older adults.

Suspension Exercise and Older Adults

Although usually marketed as a training method to enhance athletic performance and metabolic conditioning, SE can improve functional capacities in older adults, including those whose levels of function are significantly reduced. Of particular interest is lowering fall risk among the elderly.

Over 30% of community-dwelling older adults aged 65 and older fall once a year, and 10%–20% fall twice or more (Gregg, Pereira & Caspersen 2000). A fall can lead to bed rest or even death. In fact, falling contributes to 90% of hip fractures in the United States (Carter, Kannus & Kahn 2001). The risk of falling increases linearly with the number of risk factors present (Tinetti 1988). Some of these factors are conditioning related; they include decreased lower-extremity strength, poor static and dynamic balance, gait impairments, joint mobility limitations, postural problems and poor reaction time. Fortunately, these risk factors are physiological characteristics that may improve with well-designed exercise interventions that feature an SE system.

Program Design Guidance for Older Adults

Older adults can tolerate moderate- to high-intensity multimodal exercise training programs and can improve functional fitness, including muscle strength, agility, dynamic balance, joint mobility and reported sensations of physical health (Thompson, Myers Cobb & Blackwell 2007; Whitehurst et al. 2005). SE systems have a “built-in” modification model that is well suited to this population.

It is possible to progress or regress stability and load in a number of ways. Exercise professionals can modify stability by altering the base of support or degree of connection between the body and the suspension system (Bettendorf 2010). For example, with a standing suspension exercise, trainers can progress the base of support from the most basic wide two-legged stance to a narrower two-legged stance or to a single-leg stance. Similarly, the connection between the body and the SE system can progress from the most basic two-handle mode, where the hands are holding each handle separately, to the mode where the hands are holding the handles together or to a single-handle orientation.

Fitness professionals can modify load by altering the body’s angle relative to the ground or the amount of unloading by the SE system (Bettendorf 2010). For example, during a standing exercise, body angle can progress from the most basic vertical position (90 degrees) to more acute angles. Using the SE system’s handles to help “unload” the lower extremity will make a lower-body exercise easier.

Multimodal Programming

Since several functional parameters are closely related to fall risk, effective programming must be multimodal in nature. The adaptable nature of SE systems makes it perfect for a variety of movements. The following sections detail suspension exercises for joint mobility, sensory enhancement, muscle strengthening and gait enhancement—all crucial elements for a balanced training program for older adults (Province et al. 1995).

Joint Mobility

Joint mobility is necessary for proper sensory and motor function, particularly during ambulation. Loss of joint mobility is commonplace with aging, when changes in muscle structure and connective tissues cause a decrease in flexibility. More specifically, levels of the rigid connective tissue collagen increase relative to those of the more flexible protein elastin, thereby lessening tissue compliance and contributing to muscular stiffness (Ferber, Osternig & Gravelle 2002). This shift, combined with the effects of gravity and loss of strength and confidence, can cause the ankle, hip, thoracic spine and shoulders to become less mobile with age. The following joint mobility suspension exercises include both open- and closed-chain exercises to enhance neural drive to the musculature and utilize momentum and gravitational forces.


Ankle Circles

Benefits. Improves ankle joint flexibility and standing balance.

Setup. Shortened straps, single-handle mode, hands in foot cradles, palms down, arms extended at chest height.

Exercise. From hip width stance, lift one leg off floor slightly in front of body. Perform 15 slow, clockwise ankle rotations, moving foot to greatest degree possible. Repeat counterclockwise; switch legs.

Regressions. Provide chair or some other stable object for client to hold onto with one hand to maintain balance, or switch to double-handle mode and bring elbows to sides in row position.

Correcting common faults:
  • If upper body falls forward during movement, cue: “Stand tall, keep the chest lifted and activate the abdominals.”
  • If client has difficulty maintaining single-leg balance, use double-handle mode and/or cue: “Stand tall, keep the chest lifted and activate the abdominals.”
  • If client uses incomplete range of motion, ask him to imagine tracing a circle with tip of his toe during the movement. Manually assist to enhance movement.

Hip Circles

Benefits. Improves hip joint flexibility and standing balance.

Setup. Shortened straps, single-handle mode, hands in foot cradles, palms down, arms extended at chest height.

Exercise. From hip width stance, lift one leg off floor in front of body. Perform 15 slow outward leg rotations, making sure knee bends to 90-degree angle at top of rotation. Then do 15 slow inward rotations. Switch legs.

Regressions. Use double-handle mode, elbows to sides in row position. If client has had hip replacement, do not let her lift leg beyond 90 degrees of hip flexion.

Correcting common faults:
  • If upper body falls forward during movement, cue: “Stand tall, keep the chest lifted and activate the abdominals.”
  • If client has difficulty maintaining single-leg balance, use double-handle mode and/or cue: “Stand tall, keep the chest lifted and activate the abdominals.”
  • If client uses incomplete range of motion, ask her to imagine tracing a circle with her knee during the movement. Manually assist to enhance movement.

Leg Swings

Benefits. Improves hip joint flexibility and standing balance.

Setup. Shortened straps, single-handle mode, hands in foot cradles, palms down, arms extended at chest height.

Exercise. From hip width stance, lift one leg off floor in front of body. Swing leg slowly forward to full knee extension and slowly backward to maximum degree of hip extension while maintaining erect posture. Perform 15 repetitions; switch legs.

Regressions. Use double-handle mode, elbows at sides in row position.

Correcting common faults:
  • If body rocks back and forth during movement, cue: “Stand tall, keep the chest lifted and activate the abdominals.”
  • If client finds it difficult to maintain single-leg balance, use double-handle mode.
  • If range of motion is incomplete, ask client to imagine he is cross-country skiing. Manually assist to enhance movement.

Ta-Das

Benefits. Mobilizes ankle, hip, thoracic spine and shoulder joints; improves dynamic balance, eccentric control and concentric force production. This is a triplanar, closed-chain exercise.

Setup. Shortened straps, single-handle mode, right hand in foot cradles, palm down, left arm partially extended at waist height.

Exercise. From shoulder width stance, perform shallow squat while rotating upper body to allow right hand to touch left leg (as low as possible while keeping chest lifted). Drive right hand up high and around body diagonally, causing body to lift into extension as hips follow hand around to right. Allow left foot to rotate into toe-down position at end of movement. Keep anchor hand and SE system stationary. Perform 15 repetitions; switch sides.

Regression. Cue shallower squat and less rotation.

Correcting common faults:
  • If body bends from waist rather than flexing at knee and hip, cue: “Keep the chest lifted and eyes forward during the squat.”
  • If anchor hand and SE system rock back and forth, cue: “Press down slightly on the foot cradle and imagine you are holding onto an immovable object (such as the back of a chair).”
  • If client loses balance because stance is too narrow, have her step just beyond shoulder width during preparation.
Sensory Enhancement

The aging process causes progressive losses in the body’s three balance maintenance systems—vision, vestibular and somatosensory (Carter, Kannus & Khan 2001; Manchester et al. 1989). These changes may lead to loss of balance due to central disorientation or poor sensorimotor integration between the central nervous system and the musculoskeletal system. However, research has shown that targeted interventions can improve sensorimotor integration. The following sensory-enhancement suspension exercises stimulate the visual, vestibular and somatosensory systems to improve proprioceptive function and balance maintenance.


Shifting Eyes

Benefits. Improves balance by recruiting vestibular and somatosensory systems.

Setup. Shortened straps, single-handle mode, nondominant hand in foot cradles, palm down, arm partially extended at chest height, dominant hand in front of face, index finger extended.

Exercise. From hip width stance, shift index finger briskly right and left. Eyes follow finger and head stays still. Objective is to see finger clearly; all other parts of visual field are blurred. Perform for 60 seconds and have client blink several times to regain equilibrium.

Progression. Add marching while following finger with eyes.

Correcting common faults:
  • If client’s head rotates with eyes, cue: “Keep the head still; the eyes are the only thing to move.”
  • If client finds it difficult to maintain balance, cue: “Stand tall, keep the chest lifted and activate the abdominals.”
  • If client’s eyes don’t follow finger or finger moves too slowly, cue: “Watch the finger; everything else should seem blurry.”

Rotating Head

Benefits. Improves balance by recruiting visual and somatosensory systems.

Setup. Shortened straps, single-handle mode, hand in foot cradles, palms down, arm partially extended at chest height.

Exercise. From hip width stance, repeatedly turn head fully from left to right at brisk pace while keeping eyes fixed on anchor point. Perform for 60 seconds. Have client blink several times to regain equilibrium.

Progression. Add marching while turning head.

Correcting common faults:
  • If eyes shift while head turns, cue: “Keep the eyes focused on the anchor point.”
  • If client finds it difficult to maintain balance, cue: “Stand tall, keep the chest lifted and activate the abdominals.”
  • If head moves too slowly, cue: “Turn the head briskly, as if shaking it to say, ‘No!’”
Muscle Strengthening

Loss of muscle strength is a common issue among older adults. Both reduced neural drive and reduced muscle protein synthesis contribute to this phenomenon (Goodpaster et al. 2006). Research shows that resistance training improves both motor unit recruitment and muscle size and strength in older adults (Latham et al. 2004; Seguin & Nelson 2003). SE is particularly useful for developing lower-body strength because many older adults have osteoarthritis in one or more lower-extremity joints and an SE system assists with both the concentric and eccentric portions of a strength training exercise. This enables more complete and mechanically sound movement to occur. Enhance both concentric and eccentric muscle strength with the following exercises.


Assisted Squat

Benefits. Improves lower-extremity strength.

Setup. Shortened straps, double-handle mode, row grip with palms facing inward, elbows fully bent with hands at chest height.

Exercise. From hip width stance, have client slowly flex at hip and knee, allowing buttocks to move back and down as if sitting on low chair. SE system provides assistance in movement’s eccentric phase while arms extend outward in front of chest. When buttocks are slightly above knees, rise back to start position. Allow system to assist in concentric phase as client pulls handles and elbows bend. Do 3 sets of 6–15 repetitions, depending on client’s capabilities and whether program is intended for muscle strength or muscle endurance.

Regression. Put chair behind client and allow buttocks to lightly touch chair.

Progression. Use single-handle mode and place hands together, palms down. Extend arms forward during squat to lessen assistance from system.

Correcting common faults:
  • If client’s heels rise off ground, cue: “Keep your feet on the ground and make sure the elbows are fully flexed at the start of the repetition.”
  • If body falls forward and shoulders round, cue: “Stand tall, keep the chest lifted and activate the abdominals. Keep eyes fixed straight ahead.”

Assisted Row

Benefits. Improves back and biceps strength.

Setup. Shortened straps, double-handle mode, row grip with palms facing inward, elbows fully bent with hands at chest height, offset stance.

Exercise. Have client slowly move upper body away from hands. Ensure that back stays straight and that knees and hips flex as body moves backward. When client is at full arm extension, ask her to pull handles to bring body back to start position. Back stays straight as knees and hips extend. Perform 3 sets of 6–15 repetitions, depending on client’s capabilities and whether program is intended for muscle strength or muscle endurance. Regression. Perform partial repetitions—arms not fully extending in front of chest.

Progression. Perform in hip width stance—feet side by side, standing closer to system for greater angle of movement.

Correcting common faults:
  • If client’s chin juts forward, cue: “Keep the eyes focused on the anchor point and keep a gap between your chest and chin.”
  • If client’s back rounds during eccentric phase of movement, cue: “Stand tall, keep the chest lifted and activate the abdominals. Focus your eyes on the anchor point.”
  • If there isn’t enough tension on SE system, cue: “Your hands do not move; the body simply moves away from your stationary hands and back toward them.”

Assisted Chest Press

Benefits. Improves chest and triceps strength.

Setup. Shortened straps, facing away from system, double-handle mode, press grip with palms facing down, elbows fully extended with hands at mid-torso height, offset stance.

Exercise. Have client slowly move upper body toward hands, ensuring that back stays straight and knees and hips flex as body migrates forward. Once chest is between hands with elbows fully flexed, have client push body back to start position. Back stays straight, and knees and hips extend. Perform 3 sets of 6–15 repetitions, depending on client’s capabilities and whether program is intended for muscle strength or muscle endurance.

Regression. Perform partial repetitions—body does not fully come in toward hands.

Progression. Perform in hip width stance—feet side by side, standing closer to system for greater angle of movement.

Correcting common faults:
  • If client’s chin juts forward, cue: “Stand tall, keep the chest lifted, activate the abdominals and keep the eyes focused forward.”
  • If client’s shoulders move up toward ears, cue: “Keep the shoulders down and back.” Press down on shoulders and have client relax.
  • If there isn’t enough tension on SE system, cue: “The hands do not move in this exercise. The body simply moves toward and away from your stationary hands.”
Gait Enhancement

The restricted and slowed gait pattern typical in older adults can be attributed to losses in joint mobility, muscle strength and reaction time. These issues can lead to an increase in fall risk and decreased ability to recover from a slip, trip or stumble (Lockhart, Wolstad & Smith 2003). An SE system is a great tool for enhancing gait in older adults because you can use the system to maintain balance and create a safe environment while clients practice new gait patterns. Improve gait with the following exercises.


Side Steps

Benefits. Improves frontal-plane movement capacity.

Setup. Shortened straps, single-handle mode, hands in foot cradles, palms down, arms partially extended with hands at chest height, feet together (or as close as possible while maintaining safety).

Exercise. Ask client to take full step sideways with right leg. Lift foot to height that enables stepping over curb. Step with left leg in same fashion to bring feet together again. Perform three steps to right and three steps to left. Repeat for 90 seconds.

Regression. Take smaller steps and/or extend arms in front of body for counterbalance.

Progression. Incorporate partial squat while stepping, to enhance muscle strength. Use tandem or single-leg stances.

Correcting common faults:
  • If client’s back rounds during stepping movement, cue: “Stand tall, keep the chest lifted and activate the abdominals. Focus on the anchor point.”

Multiplanar Lunge Patterns

Benefits. Improves lower-extremity strength and movement capacity in all three planes of motion.

Setup. Shortened straps, facing away from system, double-handle mode, press grip with palms facing down, elbows fully extended, hands at mid-torso height, feet side-by-side, hip width stance.

Exercise. In sagittal plane: Have client step forward with right leg into shallow lunge. Chest moves toward hands. Ensure that back stays straight as body moves forward. Have client step right leg back to start position. Repeat for 90 seconds; switch legs.

In frontal plane: Cue client to step right foot sideways into shallow lunge. Right knee is bent, and left leg remains extended. Back stays straight as body moves sideways. Ask client to step right leg back to start position and repeat for 90 seconds; switch legs.

In transverse plane: Have client step right leg rotationally to right into shallow lunge. Right knee bends, and left leg pivots right. Back stays straight as body rotates. Have client step right leg back to start position. Repeat for 90 seconds; switch legs.

Regression. Perform partial repetitions.

Progression. Vary hand movements—arms can press away or overhead during lunge.

Correcting common faults:
  • If client is lunging too far forward, cue: “Keep the knee over the foot.”
  • If client’s body bends forward during lunge, cue: “Stand tall, keep the chest lifted and activate the abdominals. Keep your eyes focused forward.”
  • If client is starting too close to anchor point and isn’t keeping enough tension on SE system, cue: “Take a partial step forward until you feel tension. Maintain tension for the entire repetition.”
Explore all Angles

The face of fitness has evolved rapidly over the past 20 years, and there are numerous paths to optimal health and wellness, as well as a diverse population seeking advice. Fitness professionals are fortunate to be able to choose from a wide variety of programming options, techniques and equipment to help people meet their many goals. Utilize suspension exercises in new and different ways to supplement older-adult clients’ existing programs and to improve function in this population.

References

Anderson, K., & Behm, D.G. 2005. The impact of instability resistance training on balance and stability. Sports Medicine, 35 (1), 43-53.

Bettendorf, B. 2010. TRX Suspension Training Bodyweight Exercises: Scientific Foundations and Practical Applications. San Francisco: Fitness Anywhere.

Carter, N.D., Kannus, P., & Kahn, K.M. 2001. Exercise in the prevention of falls in older people: A systematic literature review examining the rationale and the evidence. Sports Medicine, 31 (6), 427-38.

Cheatham, S., & Kolber, M.J. 2012. Rehabilitation after hip arthroscopy and labral repair in a high school football athlete. International Journal of Sports Physical Therapy, 7 (2), 173-84.

Dudgeon, W.D, et al. 2011. Effects of suspension training on the growth hormone axis. Journal of Strength and Conditioning Research, 25 (3 Supplement), S62.

Ferber, R., Osternig, L.R., & Gravelle, D.C. 2002. Effect of PNF stretch techniques on knee flexor muscle EMG activity in older adults. Journal of Electromyography and Kinesiology, 12, 391-97.

Goodpaster, B.H., et al. 2006. The loss of skeletal muscle strength, mass, and quality in older adults: The Health, Aging, and Body Composition Study. Journal of Gerontology: Biological and Medical Sciences, 61 (10), M1059-64.

Gregg, E.W., Pereira, M.A., & Caspersen, C.J. 2000. Physical activity, falls, and fractures among older adults: A review of the epidemiologic evidence. Journal of the American Geriatrics Society, 48 (8), 883-93.

Halvorson, R., & Sonnemaker, W. 2010. Fast, furious, and functional: Three trends shaping today’s fitness landscape. IDEA Fitness Journal, 7 (5), 36-41.

Hodges, P.W., & Richardson, C.A. 1997. Contraction of the abdominal muscles associated with movement of the lower limb. Physical Therapy, 77 (2), 132-44.

Latham, N.K., et al. 2004. Systematic review of progressive resistance strength training in older adults. Journal of Gerontology: Biological and Medical Sciences, 59 (1), M48-61.

Lockhart, T.E., Woldstad, J.E., & Smith, J.L. 2003. Effects of age-related gait changes on the biomechanics of slips and falls. Ergonomics, 46 (12), 1136-60.

Manchester, D., et al. 1989. Visual, vestibular, and somatosensory contributions to balance in the older adult. Journal of Gerontology: Biological and Medical Sciences, 44 (4), M118-27.

Pastucha, D. 2012. Clinical anatomy aspects of functional 3-D training: A case study. Biomedical Papers of the Medical Faculty at the University of Palacky, Olomouc Czech Republic, 156 (1), 63-69.

Province, M.A., et al. 1995. The effect of exercise on falls in elderly patients, a preplanned meta-analysis of the FICSIT trials. Journal of the American Medical Association, 273 (17), 1341-47.

Schoffstall, J.E., Titcomb, D.A., & Kilbourne, B.F. 2010. Electromyographic response of the abdominal musculature to varying abdominal exercises. Journal of Strength and Conditioning Research, 24 (12), 3422-26.

Seguin, R. & Nelson, M.E. 2003. The benefits of strength training for older adults. American Journal of Preventative Medicine, 25 (3), 141-49.

Skelton, D.A., & Dinan, S.M. 1999. Exercise for falls management: Rationale for an exercise programme aimed at reducing postural instability. Physiotherapy Theory and Practice, 15 (2), 105-20.

Thompson, C.J., Myers Cobb, K., & Blackwell, J. 2007. Functional training improves club head speed and functional fitness in older golfers. Journal of Strength and Conditioning Research, 21 (1), 131-37.

Thompson, W.R. 2012. Worldwide survey of fitness trends for 2013. ACSM’S Health & Fitness Journal, 16 (6), 8-17.

Tinetti, M. 1988. Risk factors for falls among older adults living in the community. New England Journal of Medicine, 319 (26), 1701-1707.

Whitehurst, M.A., et al. 2005. The benefits of a functional exercise circuit for older adults. Journal of Strength and Conditioning Research, 19 (3), 647-51.

Willardson, J.M. 2007. Core stability training: Applications to sports conditioning programs. Journal of Strength and Conditioning Research, 21 (3), 979-85.

IDEA Fitness Journal, Volume 10, Issue 5

© 2013 by IDEA Health & Fitness Inc. All rights reserved. Reproduction without permission is strictly prohibited.

About the Author

Christian J. Thompson, PhD IDEA Author/Presenter