Helping the Full Range of Older Clients

Many have arthritis and artificial joints. Some have been sedentary their whole lives. Preparation is the key to anticipating their needs.

By Sherry Ballou Hanson
Sep 15, 2016

When new senior clients come to you for physical training, you initially don't know how active they have been since graduating from high school. How much of their leisure time have they devoted to hiking, biking, playing golf, or swimming regularly at the YMCA? And how much of their time have they spent watching TV or, more recently, playing on the internet?

Your senior clients will be everywhere along that continuum. Some will be very fit; others will be sedentary. Many will have chronic conditions like arthritis and diabetes. All can benefit from your services.

Where to Begin

The American College of Sports Medicine (ACSM) recommends that most adults engage in moderate-intensity cardiorespiratory activity at least 30 minutes daily, 5 days a week, or exercise more vigorously at least 20 minutes daily, 3 days a week, or a combination of both. Two to three days should also be devoted to resistance exercises for the major muscle groups. Balance, agility and coordination work become increasingly important as clients age, as does flexibility work (Garber et al. 2011). Older clients are counting on you to help them avoid becoming sedentary.

For a new client you know little about yet, "start slowly with a small amount of activity, such as slow walking for 5–10 minutes, until you see what the older person can do," advises Carol Ewing Garber, PhD, FAHA, FACSM, professor and chair of biobehavioral sciences at Teachers College, Columbia University. From there, you can have the client build gradually and progressively.

Of course, if a client cannot work out at the recommended level, you will modify goals so he or she can exercise at a safe level but still maintain a regular schedule of physical activity.

Considering Chronic Conditions, Joint Replacement, Other Issues

The decades take a toll on critical body parts. Knees are a prime example. Your client's aches and pains might come from years of carrying excess weight, pounding the roads as a runner or laying carpets on the job. Joints wear out or fall prey to arthritis, two of the most common issues for older athletes. Muscle mass declines as the years accumulate.

"An inactive person can lose as much as 3%–5% of muscle mass per decade over the age of 30," says Colin Milner, founder and CEO of the International Council on Active Aging. "However, minimizing this loss by remaining active has a cumulative effect in our later years."

Arthritis Tips

The three best strategies for clients dealing with arthritis are proper movement, weight management and education, says Eric Chehab, MD, an orthopedic surgeon with the Illinois Bone & Joint Institute. People who have arthritis need to know how to move, and they should avoid exercises that require excessive torque or strain.

"Eccentrics work well for people with arthritic conditions," says Chehab. An example of an eccentric exercise is the return part of a biceps curl, not the initial curl itself. The muscle lengthens under load during the return, helping to protect the joints of people with arthritis. The key with eccentric exercise is to perform each move slowly—not just dropping the weight.
Seniors who have arthritis can also be steered toward walking, cycling and swimming, to add more-active pursuits to their training sessions. All are easier on the body and the joints than high-impact activities. This is especially true in the pool: Flotation essentially takes away 90% of body weight, enabling older adults to exercise safely.

Tips for Artificial Joints

Chehab adds that the biggest problem for clients with replacement joints is eventual loosening. Hip, knee and shoulder joints are all vulnerable.

"Don't do military presses, and do not lift anything over 25 pounds in any lifting program," says Chehab. For specifics on a client with a replacement joint, consult with his physical therapist or doctor.

Looking Realistically at Aging

You may have a client running marathons at age 75, but most of your older clients are better suited to activities that are not as hard on the body or as physically taxing for long periods. Some older clients will have high blood pressure or diabetes, and you'll need to target their exercise program to their physical abilities. These clients will be grateful for the proven benefits of better blood pressure, cholesterol count, blood sugar and bone density.

A new client who is very inactive might need to start off with chair exercises. For someone who is already active and wants to do more, "try increasing the intensity or duration up to 60 minutes of total aerobic activity and/or adding other types of exercise such as resistance training, stretching or yoga, tai chi or Pilates," says Garber. This can add interest and variety to an established client's time with you.

Think about adding these favorites to your clients' active lives:

  • Walking. Briskly strolling a few blocks or walking more slowly with faithful old Bowser is energizing, scenic and low impact. Suggest taking in a local park and performing a few modified calisthenics for the upper body on the jungle gym.
  • Running. If they are still fit enough to run, people who have led an active life but need to ease up a bit may find that a slow and steady pace does wonders for them psychologically.
  • Cycling. This is a good way for clients to enjoy more exercise during the week, run errands, or just get from point A to point B if they live in a bicycle-friendly area. It's great for time with the grandkids too!
  • Swimming. Hitting the pool is healthy, low-impact and easy on the body—making it a super activity for people with joint issues and arthritis. If a client is interested in competition, U.S. Masters Swimming has more than 1,500 clubs in the country. Check out www.usms.org. Beginners? With the aid of kickboards, fins or pull-buoys, they have plenty of ways to exercise, no matter their skill level.
  • Rowing. Think beyond the rowing machine or the old-fashioned rowboat. Kayaking, canoeing and standup paddleboarding are great for the upper body and can be adapted to individual strengths and endurance levels.

Questions to Ask a New Client

Prospective clients come to you from all kinds of situations. A current client may refer a new client, or a medical or rehab specialist may suggest you as a personal trainer. Here are a few questions to ask initially:

  • What are your exercise goals?
  • Do you have physical limitations?
  • Have you exercised before?
  • Do you have a joint replacement or medical condition?
  • What medications are you taking?
  • Has your doctor or physical therapist given the okay for you to exercise?

What New Prospects Might Ask You

The ICAA recommends that fitness clients ask these questions of potential trainers (ICAA 2011):

  • Do you work with people my age?
  • Have you had experience working with my condition or medical issue?
  • What is your education, and do you have a fitness certification?
  • Can you communicate with my doctor or physical therapist?
  • Can I have references from past or current clients?
  • What do you charge?
  • Do you have liability insurance?

Check the "ICAA Age-Friendly Personal Trainer Checklist" to get ahead of the game. This page covers experience, education, personality and business practices that will help you prepare for the concerns of clients.

Providing a Fitness Foundation for Seniors

ICAA's Milner puts the importance of working with seniors in context:

"A lifetime of wear and tear catches up with all of us in midlife," he says. "Yet those who have remained physically active, leading a healthy, engaged life, have not only built a foundation for bone density and muscle memory; they have also laid the base for later years.

TIPS FOR ACTIVE AGING WEEK

The International Council on Active Aging has designated the week of September 25 to October 1, 2016, as Active Aging Week, which gives personal trainers an opportunity to address the 10,000 people turning 65 every day in this country (FAI 2016).

Older Americans represent 75% of U.S. income and wealth (FAI 2016). For the next 30 years, this will be the fastest-growing fitness market in the world (FAI 2016). That's all the more reason to encourage older adults to be fit and healthy.

To observe Active Aging Week, help your clients to stay energized and focused by

  • thinking positively every day and focusing on their talents and gifts;
  • trying a new physical activity during this week;
  • inviting a friend to walk or cycle with them;
  • rewarding themselves with a dinner out for staying with your program; and
  • doing something for someone else this week; it could change their life and yours!
HELPING OUR INACTIVE POPULATIONS

The problem of physical inactivity has become global. One study of people in Iceland over several decades found that older seniors are sedentary 80% of the time.

The results of the Age, Gene/Environment Susceptibility (AGES)—Reykjavik Study in Iceland were reported recently by the American College of Sports Medicine. Julianne van der Berg and colleagues recruited 565 adults aged 73–92 out of a larger group selected for the original study (at the average age of 49), and obtained data on the following:

  • demographic factors (e.g., sex, age, marital status)
  • socio-economic factors (e.g., education, housing, occupation)
  • lifestyle factors (e.g., smoking status, physical activity, active commuting, occupation activity)
  • biomedical factors (e.g., BMI, weight, blood cholesterol, heart disease, type 2 diabetes)

Three decades later, the study assessed the participants over several days using an accelerometer to measure how long they were sedentary. Regardless of the current health status and level of physical activity, data showed that unmarried people with a lower education level and poorer housing situations spent more time sedentary in their old age. Being obese and having heart disease also resulted in more inactive time (van der Berg et al. 2014).

Another study—of 7,278 men and 9,735 women aged 18–90, conducted in Canada—found a strong relationship between deaths from all causes and too much sitting, even for participants getting the recommended minimum daily activity (Katzmarzyk et al. 2009). Scientists think that too much sitting prevents fat from the bloodstream getting out into the body, thereby causing a constant elevation of blood fat and upping the risk for cardiovascular disease (Levine 2011).

These studies underline how important it is for fitness professionals to help older clients overcome the rising tide of inactivity.

FIVE FUNCTIONAL LEVELS FOR SENIORS

Five Functional Levels for Seniors

RESOURCES

www.activeagingweek.com—2016 Active Aging Week
www.fitness.gov—President's Council on Fitness, Sports & Nutrition
www.icaa.cc—International Council on Active Aging
www.acsm.org—American College of Sports Medicine
www.projectenhance.org—Enhance®Fitness, senior programs in most states
www.usms.org—U.S. Masters Swimming
www.aaos.org—American Academy of Orthopaedic Surgeons
www.functionalaginginstitute.com—Functional Aging Institute


References

Garber, C.E., et al. 2011. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine &s; Science in Sports & Exercise, 43 (7), 1334—59.
FAI (Functional Aging Institute). 2016. So who are these prospective clients? Accessed Jul. 14, 2016. www.functionalaginginstitute.com/.
ICAA (International Council on Active Aging). 2013. ICAA functional levels. Accessed Jun. 9, 2016. www.icaa.cc/activeagingandwellness/functionallevels.htm.
Katzmarzyk, P.T., et al. 2009. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Medicine & Science in Sports & Exercise, 41 (5), 998—1005.
Levine, J.A. 2011. The extreme dangers of sitting. Neurosynthesis. Accessed Aug. 15, 2016. https://neurosyntesisarchives.wordpress.com/2011/o1/20/the–extreme–dangers‐of–sitting/.
van der Berg, J.D., et al. 2014. Midlife determinants associated with sedentary behavior in old age. Medicine & Science in Sports & Exercise, 46 (7), 1359—65.

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Sherry Ballou Hanson

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