Fitness Programs | Training for Older Population, June 2006

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Training for Older Population, June 2006

Baby Boomers Heading to the Gym: Are you ready to train them?

By Marion Webb

With the rising number of people aged 50 and older signing up for health club memberships, trainers have a greater opportunity than ever before to serve this special population.

However, as many of you know, training older adults often involves special considerations such as chronic diseases and other health issues. Some people may have musculoskeletal problems making them more vulnerable to injury or falls.

To help you sort through these issues, we have asked two fitness professionals who have extensive experience in training older adults, Deborah Redder and Gwen Hyatt, and orthopedic surgeon Dr. Nicholas DiNubile, to offer strategies for creating successful training plans and provide advice on how to develop good relationships with medical professionals and learn about different medications.

Redder, creator of the SilverSneakers Group Exercise Class, a strength and flexibility program designed for older adults, says that training the elderly is especially rewarding.

"People say that older adults are hard to work with," Redder says. "Older people have an effective way to critically think through exercises. You just need to change how you resonate with them," says Redder, who is also SilverSneakers' national programs director for Tempe, Ariz.-based Axia Health Management, which manages health improvement programs for consumer groups.

So what makes training older adults special?

Well, it starts with their motivation to exercise.

Unlike their younger counterparts, mature adults tend to put more emphasis on health than looks. Many turn to exercise to age healthfully and remain independent in life.

That means being able to drive safely on the road and comfortably perform various daily activities, such as reaching into a cupboard or lifting grandchildren off the ground, Redder says.

Hyatt, who is the president of Desert Southwest Fitness Inc. in Tucson, Ariz., adds that individuals with age-related chronic disease, such as osteoarthritis, diabetes and heart disease, also turn to trainers to create customized exercise programs allowing them to better manage their health, and thus, improve their quality of life.

Consequently, trainers who work with golden-aged individuals need to be very vigilant when designing exercise programs and be able to customize and modify them, Hyatt notes.

"Trainers have to be more individualized in their training approach- if they have clients with specific conditions, that's different from training healthy clients."

She gave the example of a client with osteoarthritis who may have difficulty performing traditional leg extensions, squats and lunges. Hence, the exercises may need to be modified in terms of number of repetitions performed, amount of resistance used, and the exercise range of motion.

Hyatt and Redder offer helpful strategies

Always prepare aging clients on how to perform exercises, giving clear directions on how to accomplish the exercises, then be prepared to prove that their exercise goals were met.

"An 80-year-old woman doesn't want to be babied," Redder says. "She wants to give her best and be stronger."

She also suggests giving no more than three exercise options in a short timeline.

"For a 30-year-old it's motivating to get options and see what they like best," Redder says. "If you have a 65-year-old come to you, they want clear and precise directions on how to become stronger."

Another suggestion is to introduce changes in the exercise routine slowly.

"While change is good, the response will not be received well if they (your clients) don't trust that the change is organized and specific," Redder notes.

A key aspect in training older people is your ability to show them, in a relatively short period of time, or every four to six weeks, that agreed-upon goals were met.

"The retention of older clients is completely dependent on how you can demonstrate improvement through fitness assessment testing and functional capability improvement testing," Redder says. "They need to know that they are getting stronger. That justifies their ability to live longer in their homes and keep their drivers' licenses."

Fitness tests may include assessing flexibility in the shoulder, overall increased sense of well-being, performing a triceps scratch test, or holding a standing position to test fatigue. Some of your clients, especially those with chronic disease, are likely to be on several medications, which may affect their heart rate, blood pressure, etc.

These clients should be cleared for exercise by a physician with a statement outlining any concerns that you need to be aware of. For most trainers, the relationship with their clients' physicians ends here.

How important is a good relationship with your client's physician?

Both Redder and Hyatt agree that trying to create a good rapport with your client's doctor is wise and can be extremely advantageous.

For one, doctors have a vested interest in seeing their patients' health improve, but many hesitate to entrust their patients with individuals they have little or no relationship. Thus, winning a doctor's confidence is a strong validation of your abilities and good for future business referrals.

Creating a real doctor-trainer relationship can be challenging considering that their input typically ends with the physician's statement and clearance form.

Orthopedic surgeon DiNubile, who runs a private clinic in Havertown, Penn. and serves as a special consultant to the Philadelphia 76ers and the Philadelphia Ballet, is no exception. A member of ACE's board of directors, DiNubile admits that the medical community could play a larger role in the exercise world, but generally lacks the training, and often the time, to do so.

"I don't think the medical community has stepped up to be a resource, which means that trainers are left to their own devices," DiNubile says.

That doesn't mean that the doctor's office is entirely closed off to trainers.

"Trainers need to be smart and sensible when approaching doctors," he says. He feels that clients ultimately are the best conduits and advocates. "When referring patients (to trainers) it's almost like sending someone to physical therapy," he says. "If they say the trainer was great and asked about my bad back, I will remember that person. Referrals go one person at a time."

DiNubile also says that trainers can learn a lot by reaching out to the doctor's staff and other medical professionals, such as physical therapists.

"Talking to a physical therapist can help you get ideas," he says. "Ask them if you can spend an afternoon with them and learn things. Some gyms have physical therapists right there and can (help with the) transition (to trainers)."

How important is it for trainers to gain an understanding of common medications?

While medical decisions are outside the scope of practice for fitness trainers, a basic understanding of the impact of various medications' on the body's physiological responses during exercise testing and training can be quite helpful, according to Hyatt and Redder.

"It's important to have a complete history and list of medications clients are on, (including) changes in dosage and medication," Hyatt says. "The reason it's important is because there are medication categories that affect heart rate and blood pressure."

Redder says if a client takes more than four drugs, he or she is at risk for a fall. Great resources to educate oneself about different medications and their role in exercise are the Internet, the local pharmacist, and specialty books.

"The American Council on Exercise and American College of Sports Medicine publish great books and articles about exercise programming for individuals on medications or with certain medical ailments," DiNubile adds. "Or you can read my book (entitled FrameWork: Your 7-step Program for Healthy Muscles, Bones, and Joints) from the orthopedic standpoint."

Lessons learned

Injury and illness are among the chief reasons why older people discontinue training, which makes your client's safety your No. 1 priority, Hyatt says.

"Falls are very common, so when it comes to exercise design, not having clients do too much, too heavy and too hard, and designing exercise for functional ability and lifestyle (are best)," she adds.

She also finds that particularly younger trainers (younger than age 45) sometimes lack the sensitivity to appreciate the age-related anatomical and physiological changes occurring in their older clients.

"There are trainers out there who are doing wonderful work, but I see it frequently (that younger trainers need help)," Hyatt says.

Redder however, has a different experience. In her view, as long as trainers have good leadership and communication skills, that's all that matters.

"A 19-year-old trainer can be just as good as a 50-year-old trainer," she says.

Perhaps the bottom line for trainers working with the elderly is a combination of all the above-having the right leadership and communication skills, a sensibility and sensitivity to your clients' needs and aging bodies, and the drive to continually further your knowledge and skills about training this special population.