Safety / Injuries
Corrective Exercise for Seniors
Although many seniors may have movement issues or poor health, these are not inevitable with aging. The best plan of action is prevention. But if a client turns to you for help getting active and they’ve got some health obstacles to overcome, corrective exercises will get them started safely.
What are Common Fitness Issues Among Seniors?
Most “age-related” disorders would be more appropriately called “lifestyle-related” disorders. However, not all ailments result from poor lifestyle choices. Here are some common issues seen in the senior population and possible causes. Fitness professionals need to be aware of these and identify the symptoms of each before working with older adults.
Poor balance may be the result of an inner ear infection or vestibular disorder. It may also result if a client has poor core strength or vision impairment. Certain neurological disorders also affect balance such as Parkinson’s disease and dementia. Nerve damage from diabetes or multiple sclerosis can also cause poor balance.
A loss of strength is most strongly associated with deconditioning. Older adults who have maintained an active lifestyle do not often suffer from a loss of strength. However, those who had sedentary careers before retirement, or who decided to “take it easy” in retirement, may become deconditioned. Muscle mass begins to gradually decline with age, but losses are greater with inactivity.
Among the most common fitness issues for seniors, joint pain is a top complaint. Arthritis may be a cause, so may obesity or overweight. Depending on the type of arthritis, affected joints may be bilateral—in both knees, elbows, ankles, etc.—or on just one side of the body as in cases of osteoarthritis. In rheumatoid arthritis, all the joints may be affected and painful.
Clients diagnosed with fibromyalgia may also complain of joint pain and often in several joints at once. Bursitis is the inflammation of the bursa—the liquid-filled sac found at joints which protects bones from rubbing. A client diagnosed with bursitis will also feel pain in the joints.
Clients who do not, or have not committed to a stretching routine will not have good flexibility. Poor flexibility can cause joint stiffness, muscle tightness, and lower back pain. Each of these consequences of poor flexibility will deter a client from exercising. So, if you’re training younger clients now, emphasize the importance of staying flexible throughout life.
Read this short article about the importance of flexibility training and range of motion.
Low Cardiovascular Capacity
Older adults who score low on a cardiovascular endurance test have likely neglected aerobic activity for some time. Aerobic exercise ensures proper function of the cardiovascular and respiratory systems. Without the prescribed amount of aerobic exercise—at least 150 minutes of moderate activity or 75 minutes of vigorous activity per week—the cardiovascular and respiratory systems decline.
Diets high in saturated fat also contribute to the functional decline of the cardiovascular system. Too much saturated fat in the diet can cause heart disease or stroke. Saturated fat increases the level of LDL cholesterol in the blood. When levels of LDL cholesterol are high, the particles attach to the walls of the blood vessels and cause blockages and hardening.
Increased Body Fat
Most clients come to the gym to reduce body fat or maintain a healthy body composition. Older adults will likely have the same goals. Metabolic rate starts to decline in the 30s. Yet people continue to eat the same diet they did in their 20s, often into their 40s or 50s. Of course, this causes excess weight gain in the form of body fat.
Another lifestyle-related condition, seniors will not be as agile as they once were. This is the result of little or no physical activity. Poor balance, as discussed earlier, also contributes to reduced agility. Muscle weakness can also make it difficult to move quickly.
What Causes Fitness Problems in Seniors?
Most of the common fitness issues for seniors can be attributed to one of the following four causes:
In addition to living a sedentary lifestyle at younger ages, sedentariness in seniors causes many fitness problems. The following statistics are from a 2013 review:
- Almost 60% of older adults sit more than 4 hours per day
- 65% of older adults sit in front of a screen for more than 3 hours daily
- Over 55% watch more than 2 hours of TV daily
- Overall, 67% of the older population report being sedentary for more than 8 and a half hours daily
According to the National Council on Aging, about 80% of older adults have at least one chronic disease. Of those, nearly 80% have at least two chronic diseases. Heart disease, cancer, stroke, and diabetes cause about two-thirds of all deaths each year.
Chronic disease, although a fitness issue in its own right, causes other health and fitness issues to arise. Clients battling cancer may have weakened immune systems or muscle atrophy from treatments. Heart disease can lead to stroke. Diabetes can result in nerve and kidney damage, damage to the eyes and feet, and certain skin conditions.
Many people sustain injuries throughout life. Fitness professionals almost always come across a client complaining about an old high school or college football injury. Others may have hurt themselves at work. And roughly two million drivers in the US suffer permanent injuries each year in car accidents. Suffering a physical injury can derail any fitness program but the consequences in older age are even worse.
The National Council on Aging cites that approximately one in four Americans aged 65 or older falls each year. An older adult is admitted to the emergency room every 15 seconds due to falls. Falling can cause severe damage to bones—causing them to break or shatter—and internal organs. Having a fall in older age may even cause death.
A 2017 study of older adults in the US found that only 6% of the Senior population is free of sensory impairments. Over two-thirds of the population has two or more sensory impairments and 27% had just one. Here are the findings:
- 74% impaired sense of taste
- 70% impaired sense of touch
- 22% impaired sense of smell
- 20% impaired corrected vision
- 18% poor corrected hearing
It may seem obvious that vision loss or hearing loss might impact a client’s safety in the gym. However, taste and smell can impact satiety and hunger. If someone eats a meal they cannot taste, they may feel unsatisfied and continue to eat, even if they feel full. An impaired sense of touch can also be dangerous. Each of these impairments may seem like a barrier to a Senior client who wants to improve their health.
How Can Corrective Exercises Help?
In general, exercise slows the aging process and help maintain proper function of bodily systems. Physical activity improves overall health, reduces symptoms of chronic diseases, and improves motor function. Research has found that seniors who are more physically active than their peers are at a lower risk for walking difficulties and movement problems. A 2015 study found that more physical activity was associated with better motor function and that it was brain-protective. Study participants who developed age-related brain lesions but were still physically active, did not experience a decline in motor skills from the effects of the lesions. One of the researchers stated, “Physical activity may create a ‘reserve’ that protects motor abilities against the effects of age-related brain damage.”
Strength training is appropriate for people of all ages and should be included into every older adult’s fitness program. Read our article, The Importance of Strength Training for Seniors, to learn all about the benefits of strength training for seniors.
What are Some Common Movement Issues Among Seniors?
Movement issues impact total fitness, quality of life, relationships, health, and well-being. The following are common movement issues for seniors.
Parkinson’s disease is a common disease. About 60,000 Americans are diagnosed with Parkinson’s disease each year. It is a disorder affecting the central nervous system. Coordination and movement are impaired and often include tremors—involuntary shaking.
Ataxia can be the result of brain damage and includes poor coordination, impaired balance, and loss of muscle control during voluntary movements.
Clients may suffer from tremors if they involuntarily shake or experience other involuntary movements such as a head jerk. Tremor may be slight or severe and most commonly affects the hands, legs, face, head, or vocal cords.
What Causes Movement Issues in Seniors?
Arthritis is perhaps the most common condition impacting movement in older adults. A condition known as orthostatic hypotension also impacts movement. Clients with orthostatic hypotension experience a drop in blood pressure when they change body position. For example, standing too fast from a seated position. A client may complain of the following symptoms: dizziness, disorientation, and light-headedness. This drop in blood pressure temporarily impacts balance and orientation, which can be scary and perceived as a barrier to exercise.
However, most research points to multiple underlying causes of movement issues.
Things to Consider When Designing a Corrective Exercise Program for Seniors
Before beginning any training, it is important to evaluate older adults. Gather all relevant medical history, information on current medical conditions, and a PAR-Q. Conduct a face-to-face interview.
Harvard Health suggests asking these two questions:
- “For health or physical reasons, do you have difficulty climbing up ten steps or walking one-quarter of a mile?”
- “Because of underlying health or physical reasons, have you modified the way you climb ten steps or walk a quarter of a mile?”
Answers to these questions may indicate that the client has a gait problem. If so, corrective exercise will help prevent falls before the risk increases.
Additionally, ask clients about their history of falls and any concerns they may have about falling.
- Have you fallen in the last week? What about the last month?
- In the last year, have you been to the doctor because of a fall?
- Are you concerned about falling?
The ISSA Senior Fitness course includes the following assessments. These have been clinically researched and proven safe and effective for assessing the fitness level of older adults.
- Chair Stand
- Arm Curl
- Two-minute Step Test
- Chair Sit and Reach
- Up and Go
What Corrective Exercises are Appropriate for Seniors?
After collecting objective and subjective data on your client, you can begin to design a corrective exercise program.
Depending upon your findings, the following exercises are generally safe and appropriate to include for seniors as corrective exercises program. Modify each to suit the fitness level of the client by using supports—walker, chair, wall, etc.—or performing the movement in water.
- Alternating lunges
- Single-leg stands
- Triceps kick-back
- Chair leg raises
Clients with weight issues may prefer to start with swimming for initial weight-loss. Swimming reduces impact on the joints and is an effective cardiovascular workout. Many aquatic facilities have Senior group water aerobics classes. These are a great option for motivating clients and holding them accountable for their fitness program.
The following are exercises recommended for reducing pain:
Strength training targeting muscles of the lower body will help reduce knee pain. Exercises include:
- Straight-leg raise
- Seated hip adduction
- Seated toe taps
- Hip raise (bridge)
- Chair squat
- Calf raise
Statistically, 20% of clients with previous hip fractures will die from complications within the first year after surgery. If a client has had a hip repair or replacement and is experiencing hip pain, refer them back to their physical therapist or surgeon for consultation. If a client has not had a hip surgery or suffered a fall, then the following exercises will help strengthen the joints to reduce pain:
- Leg swings
- Lateral squat
- Standing hip abduction
- Side-step jacks
Lower Back Pain
Low back pain is a common issue, not just for seniors, but most clients. Use the following exercises in the corrective exercise program to help clients:
- Seated knee lifts
- Leg extensions
- Pelvic tilt
- Hip flexion
Read more about the causes of low back pain and exercises to help reduce pain in our article, Exercises for Low Back Pain—Help Your Clients Get Relief.
Shoulder pain impacts activities of daily living including dressing, cooking, and driving. Help clients with the following corrective exercises:
- Chest press
- Shoulder rolls
- Shoulder press
- Lateral raise
- Arm circles
Remember to collect data on your client at every meeting. Ask whether they have experienced pain in their joints—knees, shoulders, elbows, low back—since the last session. Ask about muscle pain—legs, arms, core, shoulders, etc. Inquire whether symptoms of underlying conditions seem to be improving or worsening. If symptoms seem to be getting worse, refer them to their primary care physician.
How Long Should the Corrective Exercise Program Be?
When it comes to corrective exercise programs for seniors, the goal is always to get them back to a pain-free, functional status. Activities of daily living should be easier to complete as the program progresses. This may take longer for some clients than for others depending upon how many issues are present and need to be corrected.
The main goal of a fitness program for older adults should be improving quality of life and longevity. Teach clients basic concepts of fitness, help them develop autonomy, and establish healthy habits. This way they can integrate fitness into their lifestyle and improve their quality of life for years to come.
Feeling led to work with older adults? Click here to find out more about becoming an ISSA Corrective Exercise Specialist.
Click HERE to download this handout and share with your clients!