Over 60 – and overlooked? Assessing and training a growing market

Training older adults needn’t be about what they can’t do, but instead what they can do to not only maintain, but improve their quality of life, says personal trainer Kate DeMayo.

  • While older adults vary enormously in their fitness, strength and agility, there are a few areas of fitness that have particular benefits for most of them
  • Balance training has been shown to be effective in preventing falls, which affect one in three people over the age of 65 every year
  • Balance and stability can be incorporated into a strength training regime by featuring exercises that include weight shifting, unilateral movements and exercises done standing on one leg.

In recent years, study after study has shown decisively how important exercise is for older adults. We now know that exercise lowers the likelihood of developing a range of chronic conditions, including cancer and diabetes; improves memory and cognitive functioning; reduces the incidence of falls; and combats osteoporosis by improving the health of bones. And that’s just the start.

We know a lot about why older people should exercise – but do many of us who work as trainers and instructors feel confident in knowing how? Faced with clients aged in their 60s, 70s and 80s, do we understand the kinds of exercise regimes that will maximise their chances of maintaining, even improving, their quality of life?

What not to do?

When I studied to be a personal trainer over 15 years ago, much of the conventional wisdom on older adults stressed what not to do with them. No deep squats, because that might aggravate knee arthritis. No twisting, bending or high impact. And no lunging (never mind that half of my clients play lawn bowls, which involves repeated movements that look an awful lot like lunges…).

More recently, an article in Readers Digest on ‘14 exercises to never do after the age of 50’ drew criticism from numerous exercise and health professionals, especially physiotherapists, for its age-based assumptions and overly cautious advice based on chronological age. The article title was subsequently changed to ‘14 exercises to modify after the age of 50’.

There seems to be plenty of cautionary advice on what to avoid, and far less on what to emphasise. Thankfully, that is changing, though much of the knowledge gained from research has yet to trickle down to regular practice.

What to do!

The American College of Sports Medicine (ACSM), widely considered the leading authority on exercise research and recommendations, suggests that programs for older people include four components: aerobic fitness; strength; flexibility and balance. That last one in particular is crucial for this age group; balance declines with age, unless it is practiced regularly. In fact, the ACSM now stresses the importance of what is called neuromotor training – balance, agility and coordination – for people of all ages, noting that it is particularly important for older people.

Anyone over the age of 65 has a one-in-three chance of falling each year. Yet we have ample evidence that specific balance training, performed frequently, decreases the likelihood of a fall. If you aren’t including a balance component in your work with older adults, now is the time to start! We know the enormous benefits of strength training for this age group, including its effect on bone density. Yet developing the right strength program, particularly for older clients who present with chronic conditions such as arthritis or osteoporosis, or who may have been sedentary for decades, can be challenging. We need to keep our clients safe, but if we simply sit them at fixed machines and count their reps, we are not challenging them physically or mentally.

Of course, when we talk about older adults, we have to acknowledge the enormous variations within this group, from the 82-year-old who plays tennis three times a week to the 60-year-old who’s been sedentary for three decades. Yes, we are training individuals, not age groups. That said, I would like to offer a few suggestions that will apply to many older clients (most of whom will not have been exercising regularly all their lives) based on the available research and my own experience of training dozens of older adults.

Ask and assess

As well as having new clients fill out a standard health questionnaire, I ask them if they have had a fall in the past five years and whether they have had a bone density test (if so, I ask to see the results).

I also run them through a 5-minute balance test (see box). Someone who has difficulty completing all levels of the test is at increased risk of falling and needs to start with basic balance exercises. Someone who is able to complete all phases will still benefit from balance training, but can start at a more advanced stage.

A basic postural assessment may show up another common issue with this age group. By the time they reach their 60s and 70s, many people, even strong, fit ones, have experienced shoulder problems such as shoulder impingement or frozen shoulder. Many more will present with forward head posture and rounded shoulders. For them, it’s important to pay close attention to posture; allow plenty of stretching of shoulders, chest and upper back; avoid, at least initially, overhead lifts; and focus primarily on pulling exercises such as rows and vertical pulls, rather than pushing ones like the bench press, chest press and shoulder press.

Exercises for this age group

These are some great ‘go-to’ exercises for use in training sessions with older clients.

Sit to stand

One of the most practical exercises you can do. There’s a lot of talk about functional training in our industry – well, it doesn’t get more functional than this. This exercise is a beauty, because the ability to get out of a chair is crucial to people’s ability to live independently. For those with poor lower body strength, you can build up a step to the necessary height. Have the seat low enough so that the person needs to make an effort to stand, but high enough so that he or she can stand up from it without using their arms. For those with poor balance, have support available.

Cable horizontal pull

The target muscles are similar to those of a seated row machine, but if your client can stand and use a cable machine with the arm set at around waist height, he or she will be using many other muscles and getting practice in balance and stability. This exercise will work the muscles of the upper back, so it’s great for posture and shoulder health. Pay close attention to technique; watch for raised, hunched shoulders and forward head.

Swiss ball wall squat

This allows clients who struggle with unsupported squats to perform a squat with support, thereby using the large muscle groups in the legs while decreasing pressure on the knees.

Balance test exercises

All the stages in the balance test can be used as exercises as well as assessment tools. Have the client hold the position for up to 30 seconds. Once they master one level, without needing to hold on, they can move to the next one.

General guidelines for senior training

  • Ensure your client can perform an exercise on a stable surface before moving to an unstable one. While Swiss balls, BOSUs and unstable surfaces are fantastic for some clients, ensure your client is ready for an unstable surface – by showing proficiency performing the action on a stable one – before you introduce them.
  • Don’t make the common mistake of believing that to do core exercises your client needs to get on the floor. For some older clients, getting up and down off the floor can be awkward, time consuming and embarrassing. If this is the case, use another mode of core exercise.
  • Try to incorporate some balance, stability and agility work into each session. Try, for example, exercises that involve weight shifting, such as sideways cable pulls; standing on one leg if your client has adequate balance (many upper body exercises can be performed on one leg); and unilateral movements (one arm bicep curls, for example) to challenge stability. Specific balance exercises, such as heel to toe walking can also be part of a session – just be mindful of trip hazards, and ensure clients have something nearby for support if needed.
  • Enlist the support of other health professionals, particularly if clients present with significant health issues such as severe osteoporosis or heart problems, have had major surgeries or have health conditions that may affect their exercise. Asking others for advice will not only keep your clients safe, it will enhance your own credibility as a professional.
  • Remember that whether your clients are 19 or 90, they are first and foremost individuals – so keep the personal in personal training!

Our ageing population means there’s a growing market for training older adults. By assessing older clients’ abilities and training them according to their stage, not their age, you can help them reduce their falls risk and maintain their independence, while also growing your business.

Catherine (Kate) DeMayo of Extra Mile PT has been a personal trainer and group fitness instructor since 2004. She is a franchised personal trainer at a major gym, teaches group fitness and has recently launched a new balance-oriented group fitness program ‘Steady, Stable and Able’. catherinedemayo.ptenhance.com