Seniors vary in function
The older adult can vary in functional capacity ranging from master’s athletes to frailty. Given this, exercise programming has a high degree of individualization and specificity.
There is a stereotyping that older adults should partake only in mild exercise programs due to weakness and frailty associated with aging. This is not the case, the older adult may successfully and safely participate in resistance training programs and with proper progression can achieve significant intensity (Baechle & Earle, 2008; Fleck & Kraemer, 2014; McArdle, Katch, & Katch, 2015). Seniors should not be automatically relegated to automatic gentle exercise. Rather, incorporating proper screening and assessment, warm-up and cooldown, expert program development, instruction, and supervision, flexibility exercises, starting with proper intensity and volume, allowing for proper recovery, and progressing the exercise only when the client has mastered the requisite movements will go a long way to maintain safety.
There are some basic factors that are involved with the safety for all populations, regardless of age, including; insufficient warm-up and cooldown, unresolved muscle imbalances, weaknesses, inflexibilities, and postural impairments, overuse/overtraining, poor form under heavy loads, and lack of coaching or supervision (Weight Training Injury Risk Factors, n.d).
Older adults have health issues that affect movement
Having said that, it would be unwise not to recognize that seniors have health problems that may limit exercise prescription. Older adults may experience changes in cardiovascular and musculoskeletal function that can impact the ability to exercise safely. Reduced muscular strength, power, and endurance are primarily due to a reduction in the number, size, and type of muscle fibers in the older adults (Van Norman, 2010). Additionally, due to inactivity, the muscle fibers react more slowly to nerve stimulation and with less efficient reflex.
It does not require great deficits in muscular strength for the older adult to lose functional independence. For example, low ankle strength alone has been correlated with an increased risk of falling (Van Norman, 2010). The older adult can lose up to 25 to 30 percent of flexibility by the age of 70 without intervention (Van Norman, 2010). These reductions can lead to significant loss of joint mobility which alters the structure of cartilage, tendons, and muscles on a given joint thus increasing the risk of injury (Levangie & Norkin, 2015). Boney structures are also affected as one ages. One example is osteoporosis, a reduction in bone mineral density resulting in frail bones. This increases the risk of fractures in older adults.
From a nervous system perspective the older adult experiences slower reaction and movement times and use reactive control rather than predictive control which increases the risk of falling (Van Norman, 2010). The older adult may have an altered ability to use sensory inputs such as vision and hearing which worsens the situation (Levangie & Norkin, 2015; Van Norman, 2010). The good news is that physical activity including structured exercise can prevent, slow, or improve many of the age-related declines that older adults experience (Fleck & Kraemer, 2014).
General movements for populations and situations that can cause problems
For various conditions, some basic movement principles can be applied. For example, persons with osteoarthritis (OA) should avoid ballistic movements which may put the joint at risk for harm. For persons with severe OA may wish to avoid weight-bearing activities in favor of non-weight bearing exercise to reduce the strain on joints. Additionally, working activity in its pain-free range of motion is important for the older adult.
Another example is osteoporosis (OP). People with OP generally do not experience pain due to the disorder, so it is one of many conditions known as a “silent disease” (Cassata, 2018). Sometimes, the first sign is a fracture. Like in OA, avoiding ballistic movements is appropriate. Positions in which require one-legged stances should be held for short periods or avoided completely due to the risk of fracture (Van Norman, 2010). For this population avoiding movements that involve spinal flexion is important as this may lead to spinal fractures and damage to already crowded internal organs which occurs due to changes in the spinal column (Van Norman, 2010). Other areas of concern are undue stress on the hips, back, and wrists.
Some older adults may have old injuries that have healed but went untreated thus causing long-term disability. Also, periods of bed rest and being chair-bound may cause deconditioning and dysfunction. In these cases, it is best for the client to have a referral to a physiatrist and/or physical therapist to begin a comprehensive rehabilitation program.
Sometimes the mode is a problem
It has been demonstrated that both free weight and resistance training machines are effective and safe for the older adult and can be included as part of a well-planned strength training program (Fleck & Kraemer, 2014).
At commercial gyms, it is common for older adults to use variable resistance training machines. The senior fitness instructor should be aware that not all exercise equipment is created equal. Any strength equipment used by an older adult must be able to adjust to the older adult to allow for proper body mechanics.
If the resistance training equipment cannot be adjusted to meet the needs of the older adults, the activity is not safe. Some equipment may have too much initial resistance and/or inappropriate load intervals (Fleck & Kraemer, 2014). Weight machines also may allow the exerciser to push through repetitions they could not with using free weights, thereby causing problems with exercise technique as it may precipitate undue fatigue (Fleck & Kraemer, 2014). In the absence of contraindications properly selected free weight and power exercises can be used for developing strength and balance (Fleck & Kraemer, 2014).
Cardiorespiratory, strength training and flexibility activities
For the older adult, walking is one of the best activities for general fitness and although not considered strength training is associated with increased strength in older adults (Mccray & Bell, 2013). A program of walking can reduce the risk of cardiovascular disease, death from heart disease, death from cancer, all-cause mortality, diabetes, hypertension, blood lipids and improve strength, cardiorespiratory fitness, body composition (McArdle, Katch, & Katch, 2015). Additionally, walking is associated with lower rates of depression and anxiety and improves cognitive function (Sabgir, 2018). Clearly, walking is a powerful tool in the senior fitness instructor’s toolbox.
Although safe, some general guidelines regarding walking should be heeded. First, people with balance problems, unstable joints or other musculoskeletal problems that make walking risky should consider non-weight bearing activities to reduce the risk of falling or injury (Senior Fitness Instructor Training Manual, 2017). The older adult should start a walking program on level surfaces progressing to hilly and/or uneven terrain as fitness and balance improves terrain (Senior Fitness Instructor Training Manual, 2017). Adding hand weights increases the likelihood of injury and is not recommended (Senior Fitness Instructor Training Manual, 2017). Even though not germane to the movement itself, the walking surface should be free of hazards and done in a safe area. In all cases running and/or jogging is not indicated for the uninitiated older adult.
Seated activities are suited best for some populations. Situations in which standing exercise is contraindicated seated exercise can provide significant benefits across fitness domains. Although safe, some movements should be avoided. When clients do a lot of sitting allow for times of readjustment and shifting in the chair to avoid sores. When doing aerobic activities in a chair avoid overuse of the arms and attempt to include the legs. Using arms during aerobic work can lead to premature fatigue due to smaller amounts of muscle mass involved (Senior Fitness Instructor Training Manual, 2017). Avoiding arm exercises that are overhead may be indicated for persons with postural deviations and cardiovascular disease (Senior Fitness Instructor Training Manual, 2017).
Like seated activities aquatic-based exercise can help persons with mobility, joint, and/or bone problems participate in a program of structured exercise. The senior fitness instructor should limit activities that require extended periods of time on the toes. Many older adults have poor ankle strength and this may lead to fatigue of the calves and cramping (Senior Fitness Instructor Training Manual, 2017). The instructor should limit activities that require the senior participant to hang on the side of the pool supporting their body weight (Senior Fitness Instructor Training Manual, 2017). This may increase the risk of should, arm, wrist, or hand injury.
In general, there are movements (vs. Specific exercises) that are controversial and considered risky. Below are some selected movements I would avoid or modify. For example, pressing the head backward or doing neck rolls can cause cervical compression and dizziness (Senior Fitness Instructor Training Manual, 2017; Van Norman, 2010). Always avoiding fast jerky movements at the neck which can cause neck muscle strains.
For standing activities keeping the senior’s knees with a small degree of flexion will prevent stress on the low back. Additionally, when the knee is in a fully extended position with a concomitant locking where the tibial tubercles become lodged in the intercondylar notch the menisci are tightly interposed between the condyles and all ligaments are taught (Levangie & Norkin, 2015). When the knee attempts to flex and if it experiences a lateral resistance during the unlocking, the joint surfaces, ligaments, and menisci can be damaged (Levangie & Norkin, 2015). Thus, it is important to avoid the screw home mechanism in the knee by keeping flexion of at least 10%.
Movements that cause crossing or twisting motions in the spinal column are contraindicated in the senior population. It has been known that the risk of rupture of the vertebral disk is highest when torsion, axial compression, and forward bending are combined (Levangie & Norkin, 2015). Given this, bending rotational toe touches are unwise.
Other movements may cause a shear force on the vertebra. The double leg lift requires activation of hip flexors with origin in the lumbar spine and causes the low back to hyperextend. Another activity that is dangerous to the spine is uncontrolled spinal hyperextension which can lead to can damage the vertebrae and spinal discs.
Knee flexion and extension machines can be problematic for the older adult. In full extension, the exerciser will experience significant shear forces on the knee, especially in last 5 to 10-degrees of extension and in the hyperextended knee. In knee hyperflexion, the patella will experience significant compression. Thus, the older adult must limit range of motion with these activities or find others that do not stress the knee joint such as the leg press (Levangie & Norkin, 2015). Stretching activities such as the hurdlers stretch should be avoided or modified. The traditional hurdlers stretch for Hamstrings put one knee at end of flexion and subsequent rotational forces on hinge joint may stress the medial collateral ligament and menisci (Kwon, lecture n.d.).
The exercise known as the plough causes loaded neck flexion which can lead to cervical vertebrae and disc damage (Senior Fitness Instructor Training Manual, 2017). This is especially dangerous to patients with osteoporosis. Additionally, the plough causes compression of the thoracic cavity and increases intrathoracic pressure and reduces breathing efficiency which may be detrimental to persons with vascular problems.
In most cases, over the head activities are advanced exercises (e.g. lat pulldown) and due to all too common postural deviations that older adults experiences should be avoided. Activities that require behind the neck presses or pulldowns (e.g., shoulder press behind the neck) are high risk and contraindicated. These activities put shoulder and neck structures at risk. Not to mention the potential for head injury, which if the client is taking a blood thinner could be life-ending!
In sum, the exercise professional can avoid risky movements. More importantly, knowing the medical and exercise history and limitations of the client are critical as almost any movement can be “risky” if not properly prescribed, instructed, progressed, and supervised.
Cassata, C. (2018, April 26). Osteoporosis: Risk Factors, Treatment, Diet, and Exercise. Retrieved November 13, 2018, from https://www.everydayhealth.com/osteoporosis/guide/
Kwon, Y. (n.d.). Contraindicated and High-Risk Exercises. Lecture.
Levangie, P. K., & Norkin, C. C. (2015). Joint structure and function: A comprehensive analysis (5th ed.). Philadelphia, PA: F A Davis.
McArdle, W. D., Katch, F. I., & Katch, V. L. (2015). Exercise physiology: Nutrition, energy, and human performance (8th ed.). Baltimore: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Sabgir, D. (2018, February 07). The Power of Walking. Retrieved November 13, 2018, from https://www.acefitness.org/education-and-resources/professional/expert-articles/6930/the-power-of-walking
Senior Fitness Instructor Training Manual. (2017). New Smyrna Beach, FL: American Senior Fitness Association.
Van Norman, K. A. (2010). Exercise and wellness for older adults: Practical programming strategies (2nd ed.). Champaign, IL: Human Kinetics.