Beyond Boomers: Training 70-and-Over Seniors
Older seniors have specific physical, functional and psychosocial needs that require your attention.
Do you want to build your career around a highly dedicated and underserved fitness niche? Consider the lucrative market of seniors 70 and older.
Though senior fitness tends to have a 50-and-up focus, there are considerable physical, practical and psychosocial differences between a fit 55-year-old and a somewhat frail 80-year-old. Yet the latter could perhaps benefit from your services the most.
“Training older seniors is very gratifying,” says Joan Pagano, personal trainer, author of seven fitness books, and authority on women’s health issues and healthy aging. “They tend to be highly motivated and goal oriented. Seniors are living longer lives and do not want to spend their later years in a debilitated state.” Discovering practical strategies for attracting and successfully training the over-70 crowd can help you build a rewarding and profitable career.
The Perfect Clients
The market for older seniors (70 and over) is growing thanks to the aging of the Baby Boomers. By 2050, 1 in 5 Americans (21%) will be 85 or older— up from roughly 14% in 2010 (Vincent & Velkoff 2010).
“The Baby Boomers will start turning 70 in 2016,” notes Colin Milner, founder and CEO of the International Council on Active Aging and a member of the World Economic Forum’s Global Agenda Council on Ageing. “This group and their parents have 47 times the wealth of the young and will account for 70% of the disposable income in the U.S. by 2017.” Bottom line: “Older” seniors have the desire and the funds to pay for wellness services. They are, in short, the perfect clients, Milner says.
However, it’s important to recognize that not all adults over age 70 are alike, cautions Milner, who is based in Vancouver, British Columbia. In their abilities, they may range from elite masters athletes to those who don’t exercise, but can live independently with ease, to those who need assistance performing the most basic activities of daily living (such as toileting, dressing or eating).
To begin training 70-and-over seniors safely, you must first be aware of their specific physical, practical and psychosocial concerns.
Physical Considerations for Older Seniors
Functional impairment. Roughly one-fifth of men over the age of 70 and almost one-third of women of the same age are unable to perform at least one common functional task such as walking, climbing stairs or stooping. Happily, the flip side of this statistic means that 70%–80% of 70-plus seniors do not have major functional impairments (Sipe & Ritchie).
However, when training an older senior, be prepared to encounter one or more of the following issues, and be aware of the implications:
Chronic disease. Common age-related chronic diseases seen among adults 70 and older include arthritis, hypertension, heart disease, cancer, diabetes and stroke. Of these, osteoarthritis is the most common, affecting roughly half of men and over 60% of women. In second place is hypertension (high blood pressure), which affects approximately 4 in every 10 men and half of all women in this age bracket (Sipe & Ritchie).
Note that deconditioned seniors are also especially at risk for shoulder, spine, neck and knee problems, adds veteran trainer Irv Rubenstein, PhD, exercise physiologist and founder of STEPS, a personal training center in Nashville, Tennessee.
Frailty. This term is a clinical description of the aging body’s decreasing ability to return to homeostasis when influenced by an external stressor. Over age 75, rates of frailty more than double: 7% of seniors aged 65–74 are frail, compared with 18% of those aged 75–84, and 37% of seniors over the age of 85 (UoM 2012). But even frail seniors in their 90s have been known to benefit from a multicomponent exercise program that includes muscle power training as well as balance and gait retraining (Cadore et al. 2014).
Muscle loss. Between the ages of 50 and 70, muscular strength declines, on average, by 30%, with even sharper losses after age 80. This age-related muscle loss (sarcopenia) varies dramatically among individuals and can have a large impact on functional capacity (Sipe & Ritchie). The possible causes of sarcopenia are multifactorial and include poor nutrition, inactivity, hormonal imbalances and neurological decline (Roubenoff 2000).
Hormonal shifts. Hormonal changes associated with age include menopause for women or age-related testosterone deficiency in men. If a client has such concerns, Rubenstein recommends weight-bearing, large-muscle-group exercises and power training (i.e., moving low resistances quickly).
Why? “Besides being more functional, these kinds of exercises are the best way to boost testosterone in both genders and to counteract the effects of postmenopausal body changes [in women].” He notes that power exercises should be done with low loads at high speeds, unless the client is sufficiently strong and the joints are sound enough to train with heavier loads.
Medication. It’s essential to be aware of the side effects of your clients’ medications. For example, some may impact blood pressure or cause dizziness, says Dan Ritchie, PhD, award-winning
trainer, president of the Functional Aging Institute and co-owner of Miracles Fitness in West Lafayette, Indiana—a gym exclusively dedicated to serving seniors. “Certainly be aware when individuals are on three or more medications.”
This is especially important for medications related to diabetes and heart drugs, notes Rubenstein.
Cognitive impairments. Be sensitive to issues such as Alzheimer’s disease and other causes of dementia. These are unique challenges, but they can be addressed until the client gets easily agitated or aggressive, says Ritchie. “The
key is to be consistent with movements and routine. Keep your session order similar and only add one new exercise from session to session.”
For more serious cases, Rubenstein recommends selectorized (fixed) weight machines when free weights become hazardous to use owing to the cognitive complexity of multitasking balance and movement at the same time.
Practical Considerations for Older Seniors
Keep these principles in mind:
Gather essential data. First, take a thorough health history, says Rubenstein. Find out if a client has any conditions—such as arthritis, diabetes, osteoporosis, heart disease or chronic obstructive pulmonary disease—that require special training protocols and/ or guidelines from the client’s physician, says Pagano.
You should also become familiar with assessing age-appropriate fitness norms for a 70-plus individual, says Ritchie. Check out the Senior Fitness Test Manual (2nd edition) (Human Kinetics 2013) by Roberta Rikli and C. Jessie Jones for detailed explanations on this topic.
Warm up gradually. Be sure to warm up gradually before the workout, either with range-of-motion exercises to limber up, or with light cardio to warm up the muscle tissue and core body temperature, says Pagano.
Focus on function. Whenever possible, train clients in a standing position, recommends Ritchie. “Older adults need functional fitness, not basic strength training machines. Think about their everyday activities: picking stuff up from the floor, climbing stairs, getting off the toilet, getting in and out of a car—bending, stooping, turning, lifting, reaching. All these movements should be fundamentals for a training program for older seniors.”
Build intensity. “Don’t train the 70-plus client too lightly or gingerly. It’s a big mistake to train too easily, and no results will be produced,” says Ritchie. “Trainers should not be afraid, but they should always put safety first.” And remember that without your help, clients might get hurt anyway if they strain themselves gardening, hiking, walking or lifting things around the house, he adds. Bottom line: A safe fitness program will decrease an older senior’s risk of injury in everyday life.
Make time for rest. With clients 70 and over, you should allot much more time for rest between sets, for rest between workout days and to achieve expected results, says Rubenstein. “Not only should these clients lift lighter loads with fewer reps, but they should be given more recovery time between sets and days; and [you should not expect] to see the kind of hypertrophy or strength gains one would see in younger adults.”
Bring back balance. Among adults 65 and older, falls are the leading cause of fatal and nonfatal injuries, and 1 in 3 older adults falls each year (CDC 2014). Therefore “after age 70, balance training and fall prevention become a top priority, as does the need to protect the joints,” says Pagano.
This doesn’t mean you should immediately get out the kind of aggressive balance tools (wobble boards, Swiss balls) you might use with a younger clientele. For many older and deconditioned seniors, it’s sufficient to start with completely stable exercises, such as seated or standing tasks next to a wall, in a doorway, or with the back against a Smith machine bar, says Rubenstein. Then, think functional: “In time, practice walking a variety of steps (with gait belts): normal gait, narrow, with high knees, etc. Then add resistance in one arm, such as doing a biceps curl while walking a line. Gradually increase the challenges when you feel it is safe to do so.”
Challenge the core. “One aspect of the training program that can be challenging is helping older seniors develop and use their core muscles,” says Pagano. “Using their abs may be a new concept to them.” She often prescribes non-floor-based core work, such as belly breaths and abdominal compressions in seated or standing positions. “One cue that works well is, ‘Make your pants loose.’ Also encourage them to sit up tall: ‘No leaning allowed. Use your core muscles.’”
Psychosocial Considerations for Older Seniors
Be patient. “Understand that, as we age, comprehension levels may change, and questions may need to be asked multiple times due to low hearing or cognitive issues,” says Milner. “Be patient, graceful and emphatic. Also, be very clear with your explanations, and do not take things for granted.”
Be cerebral. Engaging an elderly trainee’s intellect helps enhance compliance, says Pagano. “My older clients all share an active interest in current events—politics, the stock market and world affairs—and they enjoy the social interaction of discussing these topics while taking a breather during their exercise sessions.”
Be sociable. The elderly may live alone, without daily social opportunities or interactions. “In addition to yielding physical benefits, exercise promotes a can-do attitude, builds self-esteem and lifts spirits,” says Pagano.
Making a Difference
The number-one expense worldwide is the health of seniors, says Milner. “The question is whether they are spending [money] on drugs and assistance, or on a personal trainer who can improve their quality of life and lead them to a happier, healthier, more independent lifestyle. The impact of your effort will be rewarding and transformative, and it will also be visible within a very short period of time.” With compassion, patience and prudence, you can build a rewarding, profitable and sustainable career helping older seniors reap the many rewards of a regular fitness program.
Cadore, E.L., et al. 2014. Multicomponent exercises including muscle power training enhance muscle mass, power output and functional outcomes in institutionalized frail nonagenarians. Age, 36 (2), 773-85.
CDC (Centers for Disease Control and Prevention). 2014. Falls among older adults: An overview. Accessed Nov. 3, 2014. www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.
Roubenoff, R. 2000. Sarcopenia: A major modifiable cause of frailty in the elderly. Journal of Nutrition, Health & Aging, 4 (3), 140-142.
Sipe, C., & Ritchtie, D. Manual of Functional Training for Older Adults. (undated epub). Accessed Nov. 3, 2014. https://s3.amazonaws.com/boomingptprofits/Breakthrough+Functional+Training+for+Older+Adults+Manual.pdf.
UoM (University of Montreal). 2012. Even the very elderly and frail can benefit from exercise. Accessed Nov. 3, 2014. www.sciencedaily.com/releases/2012/09120906182008.htm.
Vincent, G.K., & Velkoff, V.A. 2010. The Next Four Decades: The Older Population in the United States: 2010 to 2050. U.S. Census Bureau Current Population Reports. Accessed Nov. 3, 2014. www.census.gov/prod?2010pubs/p25-1138.pdf.