STRENGTH TRAINING FOR OLDER ADULTS - WHAT TO EXPECT
By Leonard D. Therry
Many older adults have a negative attitude toward strength training for seniors. Some may remember a time when lifting weights was seen as being only for body builders and when athletic coaches strongly discouraged their athletes from lifting weights, believing it would make them slow, too bulky and inflexible. Many older Americans are just now becoming aware of how much this attitude has changed over time.
Currently, a veritable revolutionary sea change has taken place on this matter. Now Oprah, Diane Sawyer and most of Hollywood have Personal Trainers and are furiously pumping iron. Coaches in virtually every sport, whether at the professional or recreational level, are insisting on the need for resistance and cardio vascular training as essential for success in competition. From Tiger Woods in golf, to every football player in the NFL, basket player in the NBA, and among tennis, hockey, and players from all other sports, each employs a professional staff of full time trainers and athletic coaches who do nothing but design and implement strength training for their teams. Members of the medical and general health care community have now accepted and endorsed the value of safe and effective exercise as one of the best preventative medicines available.
The reasons behind such a change include the many benefits that such training has now been shown to provide. Specifically, what are the benefits one can expect from resistance and cardiovascular training, particularly as this applies to the older population?
Here, among others, are some benefits that may be produced by a professionally designed exercise program:
- Reducing the risk of coronary heart disease and improving post coronary performance.
- Reducing the risk of metabolic disorders such as Diabetes.
- Reducing the risk of hypertension and its accompanying health threats.
- Improving blood lipids (cholesterol/triglycerides) and reducing associated risks of unhealthy levels.
- Building and recovering lost muscle mass and strength.
- Reducing body fat and improving overall body composition.
- Increasing metabolism to assist in maintaining a healthy balance.
- Decreasing lower back pain by strengthening musculature.
- Relieving pain of arthritis by promoting greater flexibility.
- Preventing osteoporosis by using weight bearing exercise to create bone greater density.
- Reducing the risk of colon cancer by promoting rapid transit of body waste through the gastrointestinal system.
- Boosting self confidence, improving appearance and lessening depression.
Coronary heart disease is the Number One cause of mortality among the older population. Exercise provides a preventative as well as a rehabilitative approach, when performed under proper medical guidance and professional direction. Overall, exercise and sound nutrition help to reduce the risk of all major illnesses.
The percentage of our population who are 65 years old and beyond is growing at a very fast pace. For example, at the turn of the century, less than 4% of the population in this country was at 65 years of age or older. By 2020 it is expected that one of every four citizens might be 65 and older. It is by far the fastest growing segment of our population; indeed within this age group, it is the +85 that is growing at the most rapid pace.
Undeniably, with improvements in medical technology as well as access to health care, we are living longer and will continue to do so. The question comes down to this: while we have extended our LIFE SPAN, are we also increasing our HEALTH SPAN? The answer to that is not clear. The growing incidence of obesity, among all segments of our population, suggests that although we have added YEARS to our LIFE, we are not added active LIFE to our YEARS. The number of older, dependent residents of nursing homes is on the rise. But this is not set in concrete and each of us, as we age, has the opportunity to improve the quality of our lives by improving our health and preserving our independence.
We all love our children and grand children dearly but most of us do not want to find ourselves in a situation where our health has deteriorated to the point where we prematurely lose our capability for independent living. Currently, when the average American male turns 65, he can expect to live an additional 11 years and a female, at 65, can expect to live another 20 years. Just how enjoyable and vigorous those years can be may depend, in large measure, on how well we take care of ourselves. We invest time and expense to take good care of our teeth, our general appearance, hair style, etc. and it only seems logical we should dedicate the same attention to proper care of our bodies.
If we do not do so but rather fall into a sedentary lifestyle without exercise, we may face undesirable consequences. Research shows that much of the so-called “aging process” has more to do with our lifestyle than merely the chronology of aging. Aging, in modern analysis, is determined by capacity for function and not simply by counting years. An older individual who remains active, through a moderate exercise program, has approximately the same functional strength as a sedentary individual much, much younger. Our peak strength, among women, generally occurs at about age 20 and in men about age 30 and remains relatively static until about 40 or 50. At that time, given a sedentary lifestyle, strength begins to decline at about 15% per decade between age 50 and 70.
The simple reality is that unless we exercise our muscles properly, we will lose 5 to 7 pounds of muscle tissue each decade of adult life. This is further worsened by an equal or greater gain of fat tissue as our metabolism slows and physical activities decline. This combination of muscle loss and fat gain can be devastating over time, leading to impairments and ultimately to loss of function and to disability. A poor Body Mass Index (relationship between body fat and lean muscle mass), when combined with other risk factors, increases danger of serious illness and disease, and directly impacts mortality.
It is never too late to proactively attack this potential or actual problem. Studies at Stanford University, conducted at veteran’s hospitals among older and deconditioned vets, showed that regular moderate exercise can produce startling improvements in strength, cardiovascular conditioning, flexibility, balance and body composition. Indeed, the greatest improvements were seen to take place among the most severely deconditioned of the older vets. Changes were both physical as well as psychological. Improvements in self-confidence, self-image, and functional capacity all serve to reduce depression and promote a sense of well being.
The senior population can gain strength at approximately the same rate as younger people. Increases in strength as much as 40% have been documented via strength training for persons as old as age 96. Some studies suggest that as little as 3 or 4 months of proper training can reverse as much as 30 years of decline in function.
So, just what kind of exercise and how much of it are recommended for benefits? According to the American College of Sports Medicine (ACSM), training should include workouts of 30 to 60 minutes of moderate exercise, at least twice per week, in non-consecutive days (at least one day of recovery between sessions.) Exercise of all major muscle groups should be done within a protocol of 10 to 15 repetitions, 1 or (later) 2 “sets”, at a level of “moderate intensity” (about 70% of the amount of weight one can lift for a single effort; less for those who are severely deconditioned). This routine has been known to produce safe and effective results when the approach is done “progressively” (gradually increasing weight and modifying the number of repetitions as the individual gets stronger over time).
This is best done under competent supervision since improper form and excessive intensity can produce injury and cessation of exercise. Some form of cardiovascular conditioning should also be incorporated, either within that workout or on alternate days.
This can consist of moderate pace walking or jogging, indoor or outdoor cycling, treadmill, or other cardio work that gets one’s heart rate up to a training level. For otherwise healthy seniors, a suggested beginning is 5 to 10 minutes at 50% of one’s Maximum estimated heart rate, and working gradually up to 85%. For a very deconditioned or post coronary trainee, some benefit is received even at 40% of capacity and need not go higher than 75% to 80%. Instruction in the function and use of a Heart Rate Monitor is highly recommended as well as instruction in one’s Rate of Perceived Exertion (RPE), a subjective evaluation of just how hard you are working.
A benefit not often recognized is a reduced threat of fall as ankle joints are stabilized and thigh musculature is increased. The most common injury among senior walk-ins at Emergency Hospitals is hip or knee injury resulting from a fall, often the consequence of poor balance and loss of leg strength. Competent Certified Personal Trainers can design safe and effective programs, monitor performance, track results and adjust the intensity and volume as appropriate.
What are the risks involved in this form of exercise? As in all forms of human movement under load, there is some risk attached to exercise. One should not embark on such a program without direct consultation with your physician for his approval and possible input into the program. There are some individuals for whom such exercise is medically prohibited. Some conditions, including Diabetes and Coronary Heart Disease, may require the physician to conduct a General Exercise Test (GXT) on a treadmill or stationary bicycle, while monitoring blood pressure, heart rate and carefully observing the trainee’s demeanor. While a Personal Trainer, if properly prepared, can employ some sub-Maximal testing to evaluate and assess the prospective trainee, all Maximal testing should be done under the direct supervision of a physician as such highly demanding testing does involve some additional risk.
What confidence can I have that I have found a competent and well trained Personal Trainer? CBS and others have done a number of programs exposing how simple it is to acquire some “certifications”, online via little or no testing for as payment of a low fee. While this may produce an impressive looking document attesting to status as a Personal Trainer, it has provided almost nothing in real training knowledge and expertise. To combat this, the older adult should seek Personal Trainers from among those who have been certified by nationally recognized fitness. Since training does involve some risks, this can be reduced by seeking out well prepared professionals, certified by national level certifying bodies such as AFPA [American Fitness Professionals & Associates].
You should also expect that your trainer to have a currently valid certification in Cardio Pulmonary Resuscitation (CPR) as well as adequate liability insurance.
In conclusion, there is every common sense reason make a decision to embark upon a journey to health and fitness and no valid reason not to do so, other than being deemed medically inadvisable. We make allowances for expenditure of time and resources to take care of ourselves in other ways and there is even more reason to do so in taking care of this wonderful machine we have been given: our bodies.