Taking a LeapofFaith

As you age have you noticed there are certain physical activities you avoid?

That nagging knee injury makes you nervous about skiing. Or that shoulder problem makes you

hold back a little when throwing a ball. Maybe your aging lower back makes you hesitate to take the “big shot” when playing tennis or golf. As fitness professionals, we are aware of our own personal limitations and plan our activities around them. However, for many seniors, injuries like these—
coupled with decreased mobility and function and simple lack of confidence—make strenuous
exercise seem impossible.

If you were asked to stand in front of 1,000 people and juggle, you’d probably feel very anxious. The task would seem inconceivable if you didn’t think you had the necessary skills to perform. Many seniors feel this way about exercise. As people age they experience a decline in aerobic capacity, a loss of flexibility, a decrease in muscle size and an increase in joint-related diseases. Once strong and supple bodies are a distant memory. Many seniors come to believe that there is no way they can perform the exercises younger people can. Unfortunately, this may discourage them from integrating fitness into their lifestyles.

Such anxieties are compounded by ever-changing fitness industry trends. Fitness professionals have
a hard enough time keeping up with the latest industry offerings; imagine how a newcomer to this environment feels. Seniors see a constant barrage of new gimmicks and gadgets on television, and in health and fitness magazines everywhere. This can be confusing and overwhelming. Add a typical gym setting to the mix and you get client “anxiety overload.”

Another strong source of anxiety for seniors is the set of internal standards (Bandura 1986) they have developed based on their past exercise or athletic histories. They may be worried about your evaluation of their abilities. They may be afraid or embarrassed that they are not up to par. Adjusting these internal standards and accepting reality are sometimes difficult both physically and mentally. ‘ IDEA PERSONAL Trainer april 2002

IDEA PERSONAL Trainer april 2002

Point of Anxiety Suggested Solutions

New gyms Give a tour of facility and introduce staff.

Strange equipment Explain/demonstrate machines and have client try each.

Persuasive marketing Give take-home information from reliable sources.

Other (younger) gym goers Introduce them to other members.

Your evaluation of their abilities Don’t “talk down” to seniors or make comparisons with others’ abilities.

Past exercise experiences Base feedback on current performance and ability.

Goal attainment Reduce the number of steps when explaining a process.

Current injuries Use gradual progressions to avoid painful movement.

Possibility of future injuries Introduce new movements carefully and slowly.

Trainer Develop rapport and build trust.

Cost of service Offer free consultations.

Pain associated with exercise Communicate to determine/avoid painful exercises.

Trying something new Explain and demonstrate every exercise.

What is expected of them Give clear instructions and add behaviors slowly.

Failure Increase perception of success/ability by assigning achievable tasks.

Exercising with other people watching Suggest working out at off-peak times or at home.

Identifying the causes of their worries will help older clients reduce anxiety about beginning an exercise program. How can trainers help with this?

A number of registered psychological tests purport to measure anxiety. The problem with many of these is that predictive validity (what they claim to be measuring) is poor, at less than 50 percent (Anatasi 1998). This is understandable given what these tests are trying to measure.

Anxiety is a psychological construct that means something different to each individual. Therefore, anxiety towards personal training and exercise cannot be easily measured by a standardized test.

The best way to measure your client’s anxiety level is to ask questions specific to the individual’s situation. Establish, among other things, your client’s health history and fitness goals. A Physical Activity Readiness Questionnaire (PAR-Q) should be administered prior to the first session. This will give you the opportunity to determine what worries your client has about beginning a personal training program.

You also need to extract additional information from the client that might not be revealed on the PAR-Q. For example, always ask if a client has any injuries. If the response
is, “Yes, I have occasional sciatica that extends down my
leg almost to my knee,” find out how this affects the person mentally. You might counter, “Does this prevent you from doing certain things?” Look for responses that indicate anxiety surrounding the sciatica.

The client might say, “I feel a bit nervous when I’m bent over gardening because that’s usually what sets it off.” Bingo! You now know that your client feels anxious about being bent over. This is valuable information to have when designing a resistance training program. As a result, you probably wouldn’t give this client bent-over barbell rows until you both felt confident about that exercise.

If you discover your client doesn’t like running, follow
up on this information. “Why don’t you like running?” An answer might be, “Well, my knees start hurting.” Now you know when designing the program that knee pain creates anxiety about running.

Your client will indicate uneasiness about certain tasks or situations in many ways. Listen for key phrases such as:

Such words indicate anxiety and a lack of confidence. Less obvious phrases such as, “I never have been good at . . .” or “My _____ troubles me when . . .” may require further investigation to establish if anxiety exists.

Note any apprehensions on the PAR-Q. This is important because your client’s mental state will affect the success of a personal training program. Take a look at the following sample PAR-Q:

Trainer: What fitness goals do you have?

Client: I want to lose about 20 pounds.

Trainer: Tell me about your reasons for wanting to achieve this goal.

Client: My doctor says my “bad” cholesterol is above normal.
I want to get that under control.

Note: Goal is to lose weight; anxious about cholesterol.

Trainer: To help control your cholesterol we will probably have to do some cardiovascular exercise. Do you have a problem with that?

Client: I don’t mind that; I just hate doing it in the gym.

Trainer: Why is that?

Client: I don’t like the loud music and people watching me.

Note: Cardio best done outside or when gym is very quiet, perhaps off-peak.

From this brief exchange we know the client is anxious about cholesterol and exercising in front of others. The logical progression of the conversation would be to address diet in relation to cholesterol. However, to discuss it at this point would most likely create additional concerns for the client. Make a note to discuss diet in a couple of weeks when initial fears about cholesterol and the gym environment are reduced.

History with exercise can be another source of anxiety. Clients may have negative thoughts from bad past experiences and low expectations for future exercise. From experience, clients develop preconceived images of what they believe they can achieve. This belief in one’s abilities is called self-efficacy (Bandura 1986). Self-efficacy beliefs help clients decide whether they have the skills necessary to accomplish a given task.

Several factors may affect self-efficacy:

1. Past Performances. If your client was an elite athlete, she probably feels more confident about what she believes she can achieve in an exercise setting. If she was not involved in sports throughout her life, she may lack confidence in an exercise environment.

2. Social Comparison. If your older clients believe they are in better shape than their friends, they will probably feel like they can do many tasks that others their age cannot.

3. Internal Dialogue. Clients are more likely to succeed if they can psych themselves up or use positive imagery.

4. Present Physical Condition. If your client’s knee is hurting before you ask him to do lunges, he will probably not believe he can complete a full set without pain (Feltz 1992).

The key to improving self-efficacy beliefs lies in identifying actions or behaviors that can be performed to facilitate success. However, this definition of success needs to be qualified. If a client has unreal expectations, she may never be successful (e.g., she wants to run a half marathon in 12 weeks, but has had a recent hip replacement). Her self-efficacy beliefs will not improve if she continues to “fail” in her mind. Alternatively, if the baseline for success is set too low, your client will believe she has not made any progress and her self-efficacy beliefs will remain unchanged (Price 2001).

Discovering exactly what your senior clients are afraid of in certain tasks or situations will help both parties establish a framework of goals wherein these fears are confronted and hopefully overcome. In the initial interview you may have discovered that a client has a knee injury and is afraid to do anything that involves bending the knee. Your goal in the first session might be to achieve range of motion where the knee is bent without pain.

A sample plan of action would be to warm up the client on the recumbent bicycle with little or no resistance. If this is painful for him, take the client off the bike and warm him up with some light massage of the lower limbs. Once the legs are warm, progress to stretching the lower limbs and pelvic girdle. (The muscles of the pelvic region and hip/gluteus complex may be tight from helping to stabilize the knee.) Throughout the course of stretching you should aim to achieve some sort of bent knee range of motion (perhaps while stretching the gluteus muscles). Even if this is all the client achieves today, consider the session successful, as his anxiety about his knee has been reduced and self-efficacy increased. ‘

Now write down some basic massage and stretching exercises he can do between sessions. Make these identical to those he successfully performed that day. Draw pictures or provide reference photos from a book; for solo workouts, it is often helpful for older people to have a visual aid.

This session provided your client with exact behaviors he can do himself, wherein he is bending the knee without pain. Specify how often he should do the take-home exercises. Remember, the first rule of any exercise program is gradual progression. Give him too much work and he won’t do it. If he does not do the exercises, he won’t realize the positive mental benefits of achieving a task he once thought was impossible (i.e., bending the knee with no pain).

If the client follows the take-home regime, the next time you see him he should feel less anxious about bending his knees. You will have built a level of trust, which will make future communication much easier.

Reinforce the client’s success in
performing the exercises as you asked. Find out if he had any problems performing the stretches and emphasize that his actions (doing the stretches) are helping him achieve a pain-free knee. Base your comments and
feedback on his successful behaviors. Compliments such as, “That’s great! None of my other clients work as hard as you,” may make him feel good for awhile; however, they do little to
identify which behaviors were successful or ensure that desired behaviors
are repeated.

Providing specific exercises serves another purpose. When anxious, people often perform rituals to make themselves feel more secure about the task. For example, when you have a job interview, you may check your breath, straighten your clothes and tidy your hair before entering the building. Similarly, having your client always stretch prior to attempting leg work provides a ritual, which also has the residual effect of being physiologically beneficial by reducing the tightness in the muscles that help stabilize the knee.

Now you are ready to progress with the next session. Warm up your client as in the previous session. If he has diligently followed his take-home exercises, warming up on the bike may no longer be painful. After the appropriate warm-up, including the routine stretches you gave him, consider progressing to a partial wall-sit, or equivalent exercise.

If he does not experience pain with this isometric contraction, you could progress to a compound leg exercise in which the joints of the lower limbs are put through a partial range of movement (i.e., half range on the leg press machine). As your senior client successfully progresses, his self-efficacy beliefs will improve and he will be more motivated to adhere to his exercise program.

Senior clients can use many psychological techniques to increase self-efficacy (Loehr 1982). Encourage them to visualize being successful at a task they are nervous about (Ligget 2000).

For example, a client may feel anxious about using the Swiss ball because of the instability. Help her visualize success in using the ball by first explaining what you want her to do. Detail precisely what behaviors she must perform in order to feel safe and describe any sensations she may experience (i.e., “When you sit on this ball it is going to feel a bit like a waterbed”), as the primary goal is to reduce her anxiety. If you don’t eliminate her fears, it will be a long, uphill struggle to reach the point where you can finally correct exercise form and technique.

Focus on the style of language you use to explain any steps. It is crucial to use positive action words so your client can imagine herself doing the task. Words such as “during,” “when” and “while” imply that she will be doing the action herself.

For example, “When you are sitting on the ball, it is important to keep your core muscles activated.” This type of communication helps her visualize doing the task. Also, avoid using technical jargon or slang with older clients, as they may not be familiar with the terminology.

Be cognizant of your tone of voice with seniors, ensuring that you don’t “talk down” to them. They may experience anxiety about exercising; however, they likely feel very competent in other areas. Ask questions about their pasts. Relating stories of past successes in any area of their lives helps build confidence in this new endeavor.

If reducing fear is the first positive step a trainer can take with a senior, then a top rule in getting there is to avoid overloading the client with information.

For example, I get anxious thinking about housework because I am conscious of all the steps involved. First, I must clean the bathroom; then do the dishes; then clean the counters; then put away my clothes; then vacuum the carpet, and so on. Just thinking about all the steps involved before I get started is a daunting prospect and may even prevent me from moving forward with the first step.

The same applies to your elderly clients when you overload them with information about exercise. Leave out unnecessary explanations and take them through the process one step at a time. This will help them view exercise as more easily achievable.

Once you have explained a task, demonstrate it. Once your client sees the behavior first hand, she will have a lasting image in her mind of what is expected. Next, get her to try the exercise. When armed with a specific list of behaviors and a clear picture of what these should look like, your senior client will be much more confident attempting exercises.

For example, encourage the client to describe how her body felt during the movements. If she is unable to tell you, it is likely she was too conscious of the fear of failing to pay attention to what was happening physically. If this is the case, repeat the techniques described above. The second time she attempts the exercise her anxiety should be reduced to a point where she can now focus on the muscles and the relevant movements required from them.

The most important technique for building self-efficacy is to emphasize the mastery of behaviors. Base all your feedback and instructions on identifying actions or behaviors that the client can personally control. For example, “That was good the way you kept your core tight while on the ball. This enables you to keep your balance more easily.” This gives her a workable set
of behaviors she can use as a road map for repeating successes in the future. Again, do not just pamper her ego. This type of feedback does not help
her understand why she was successful at a given task (Gallwey 1974).

Increasing self-efficacy beliefs and reducing anxiety may only help your client stick to a program temporarily. Once he has the necessary skills to accomplish a task, the client’s perception of his abilities changes. He no longer feels helpless or believes he is subject to external circumstances. He believes he can achieve his goals. However, he may not have the mental skills to stick with the program long enough for it to become habitual.

Exercise is most beneficial when the program is maintained for years to come. Therefore, your biggest obstacle now is getting him to continue the program.

The recurrence of excuses about why the client was unable to perform the program or an exercise is a clear sign that he is starting to lose motivation. These excuses are usually classified as “beyond his control” and are usually valid reasons in his mind for not performing the exercises.

For example, he may say he had visitors from out of town and could not exercise while they were around; he may tell you he went out for dinner with friends twice last week but there was nothing on the menus that suited his diet. Attempt to identify these thoughts and behaviors that may indicate a lapse into old tendencies of not exercising or eating right.

Take action when you detect these behavior patterns developing. Encourage him to take full responsibility for adhering to his diet and exercise programs. Together you can generate a list of behaviors he can personally control to overcome these obstacles. For example, if he could not exercise because he had friends visiting, his friends obviously take priority over exercise. Help your client identify ways he can maintain important aspects of his life (friends visiting, eating out, etc.) while retaining personal control of his exercise program.

In this case, ask him if his friends like taking walks, or if his friends are trying to incorporate an exercise program into their lives. An approach such as this will help your client consider ways he can still spend time with his friends while maintaining his exercise schedule.

A good way to help senior clients make exercise part of their daily routines is to design an exercise program that is consistent with their belief systems. A belief system is a culmination of personal past experiences that help individuals shape their thoughts and behaviors (Rejeski 1992). In order to determine a client’s belief system, it may be useful to find out what his typical day is like. ‘

For example, a client who is retired from a military career probably believes in discipline and order. He may enjoy getting up early in the morning and being quite disciplined about the tasks to be accomplished that day. Use this information when tailoring his program. It may be useful for him to have specific times for exact exercise behaviors to help weave the program into his belief system of discipline and order.

Here’s another example: A client who believes in commitment and relationships has been married for 45 years and still spends most of the day with her spouse. Develop a program that includes her husband in the exercise routine. In this way the couple can spend time together and make exercise part of their routine. The possibilities are limitless.

Use your imagination to break out of the traditional mind-set of gym routines. Ask questions and then really listen to what your senior clients tell you. This is the best way to find the information you need to design a program that fits in with their lives and belief systems.

Seniors have developed many thoughts about food and exercise. Some of these are very positive and adaptive thoughts, while others may be quite negative and destructive. Learn to identify negative thought patterns in order to target anxieties that prevent older clients from engaging in exercise. Use plain language and demonstrations to help them overcome fears and increase their beliefs that they can control their environments and bodies.

When anxieties decrease and confidence increases, clients will find the program rewarding. As your clients master exercises, the positive physical and mental changes will become a strong motivator. But be ever-vigilant for warning signs that may indicate a relapse to old behaviors as the program progresses. Use these signs to help clients identify personally controllable actions they can do to make exercise habitual.

In helping senior clients overcome anxieties and making exercise a fun part of the daily routine, you can achieve great things. At a time when they could easily submit to the aches and pains of age, you can give them hope, strength and added years of active living. l

IDEA PERSONAL Trainer april 2002 LeapofFaith

1. Develop rituals.

2. Emphasize specific behaviors.

3. Encourage imagery through the use of positive action words such as “during,” “when” and “while.”

4. Reduce the steps in tasks that seem unmanageable.

5. Identify actions that client can control.

6. Concentrate on teaching mastery of the task rather than building up the ego.

7. Avoid information overload.

IDEA PERSONAL Trainer april 2002

Now

1. Identify thoughts and behaviors that may indicate a relapse to bad habits.

2. Encourage full client responsibility for maintaining the program.

3. Help clients learn to overcome obstacles.

4. Design an exercise program in line with belief systems.

For the Long Term

1. Identify thoughts and behaviors that may indicate a lapse in exercise adherence.

2. Encourage your client to take full responsibility
for “living” the program.

3. Generate a list of options that your client can control to overcome these obstacles.

4. Make exercise a part of your client’s belief system.

IDEA PERSONAL Trainer april 2002 LeapofFaith

IDEA PERSONAL Trainer april 2002 LeapofFaith IDEA PERSONAL Trainer april 2002