With Independence Day just behind us, I got to thinking about what independence means. As Americans we are fiercely independent. And for our seniors I think that is even more true. More and more people are choosing to age in place instead of going to assisted living facilities or nursing homes. What does “Aging in Place” mean? Well just how it sounds, to grow old in your own home, and more and more people are choosing to do just that.
When you Google “Aging in Place” or talk to people about it you predominately find two things. First is home modifications. Making your home easier and safer to live in allows you to stay there longer. The other subject I found a lot of information about was assistance in the home such as home care and caregivers to help with shopping, dressing, bathing and other tasks. But what is so disappointing in my profession, is there was very little about actually keeping the person safer and more independent by improving their health and mobility!
The need for home modifications and home care assistance all stem from one of two things, cognitive deficits and physical deficits. You might ask what could I possibly do to improve my cognitive and physical abilities? Well, EXERCISE!!!! Regular progressive exercise programs have been shown to guard against dementia, and improve strength and balance. One of the most important words in that statement is “progressive”. This means that your exercise program should progress, get progressively more challenging.
There are several options for older adults to stay physically active. Senior centers and interest groups are providing virtual classes. YouTube has a huge variety or balance and strengthening classes for older adults. But what you must be sure of, is to find a class that is both safe and challenging. What doesn’t challenge you doesn’t change you.
At Agewell Senior Fitness we bring fitness right to your home. Our trainers are experienced with all older adults and all kinds of heath conditions. Personally I feel the fitness world needs to step up to the plate and help this population. Not all older adults are active but most all of them can benefit from a regular progressive exercise program.
So when you are looking at ways to age in place, or if you are concerned about a loved one remaining safe and independent in their own home, home modifications and home care are excellent ways to reach that goal. But don’t forget about improving the mobility and strength of the person living at home. Improving strength and balance through a regular progressive exercise program is another key to maintaining independence at home, and maybe the most important one.
With the prevalence of the Covid 19 virus, how we exercise has dramatically changed. Gyms and Senior Centers have closed and group exercise classes have gone online. With Spring arriving with warmer temperatures and with people’s fatiguing of being indoors, more and more people will be going outside for activity. Recently the CDC recommended wearing face covering in public where social distancing is hard to maintain or in areas with significant community based transmission. In addition, many states have mandated wearing and face coverings while in public places. But what about exercise? Should you wear a mask when you are out for a walk or jog?
First let’s talk about how the virus is transmitted.
What we know now about The COVID-19 virus is that it is most often transmitted from person to person through water droplets expelled during, coughing, sneezing and even talking. We also know that people can be infected with the virus and not have any symptoms. So the use of face coverings is mostly to prevent the spray of droplets from person to person especially from people who may not know they are infected. My mask protects you, your mask protects me, has been the mantra.
So the answer to “should I wear a mask while exercising?” is “it depends”.
If you are able to go outdoors and take a walk or jog and not come within 6-10 feet of another person, then no you do not need to wear one. I happen to live in a rural area. My family and I walk regularly and always have, and we do not wear a mask, because we do not get close to other people. But what if you live in a city or heavily populated area? First I can not find any scientific information showing harm from wearing a mask while exercising, only anecdotal reports on the internet, which is unreliable. But here are some strategies you can put in place if you live in a heavily populated area.
Change your route or the time of day you go outdoors. Try to find a time and area where there are less people outdoors
Wear a mask around your neck and if you are unable to distance you can pull it up over your face.
However there is the social aspect of wearing a mask. In some heavily hit areas such as New York City, wearing a mask is a sign of respect for the health of others and it’s frowned upon to go about the city without one.
Of course if you have a breathing problem such as COPD, or asthma you should check with your pulmonologist to see if wearing a mask is safe for you.
In the end you have to make the decision for yourself on what you feel comfortable with.
If you are not comfortable wearing a mask while exercising outdoors then try to find an area or time of day when there are less people around and social distancing is more feasible. Social distancing is our best tool against the spread of Covid-19. Also keep in mind that this virus is new, hence the name Novel Coronavirus, and experts are learning new things about how the virus spreads, how it affects people and how it behaves on a daily basis. What we knew in February or March may not be accurate today. So stay updated on your information and check the dates on articles you read to educate yourself.
It’s February which makes us think of Valentine’s Day and many of us turn to the thoughts of hearts, chocolate, red wine and love. Did you also know that February is Heart Month? As a result, this is a good time to make a commitment to getting heart healthy. According to WebMD, new research shows that chocolate and red wine, in moderation, can help keep the blood flowing throughout the body.1 Although, these findings are still somewhat controversial, one thing that is not controversial and can decrease our risk for cardiovascular disease (CVD), is EXERCISE.
Exercise has been shown to significantly decrease our risk for CVD. CVD is the leading cause for mortality and morbidity worldwide, and is the leading cause of death in both men and women in the United States.2 Among the multiple risk factors that predispose one to the development of CVD, there is one in particular that has been proven to be a major risk factor that leads to poor cardiovascular health and that is a sedentary lifestyle. A sedentary lifestyle has been defined as consistently low levels of physical activity. In contrast, regular exercise and physical activity are associated with considerable widespread health benefits and notably decrease the risk for CVD.
So what if you already have heart disease? Is it still safe to exercise? It is never too late to get started and YES regular exercise is very important when you have heart disease. Getting regular exercise when have heart disease can strengthen your heart muscle and can help you manage your blood pressure and cholesterol levels. The muscles we use become stronger and the muscles we don’t become weaker and atrophy. The heart is just like any other muscle in the body and needs to be exercised. When you exercise your heart, it can pump more blood throughout the body and with less strain. Regular exercise also can improve blood flow through the other blood vessels of the body helping normalize your blood pressure. Heart disease can also be associated with other co-morbidities that can also benefit from physical activity, such as Diabetes Mellitus (DM). If you have DM, exercise can help lower your blood sugar along with the benefits of improving the efficiency of your heart.
The American Heart Association (AHA) and the American College of Sports Medicine (ACSM) recommend that all Americans should try to participate in at least 30 minutes of moderate-intensity aerobic activity at least 5 days a week or vigorous-intensity activity for 20 minutes on 3 days a week. Multiple sessions of exercise lasting 10 minutes can be performed throughout the day to satisfy the 30-minute recommendation. For those with cardiac disease, the ACSM recommends you perform physical activity 5-7 days a week at an intensity of 40%-80% of your heart rate reserve for 20-60 minutes depending on your previous activity levels or per your MD recommendations. ACSM also recommend resistance training involving the major muscle groups. You should perform 8-10 different exercises, for 8-12 repetitions of each exercise, 2-3 times a week on non-consecutive days.2 This will improve muscular strength and endurance. As always, you should talk to your doctor before beginning any exercise program! In addition, you can consult with a physical therapist or personal trainer to assist you to begin and develop a safe exercise program.
So please join in this month to take the steps to protect your heart and start exercising. Evidence shows that the benefits of exercise in primary and secondary prevention of CVD needs the promotion of physical activity in our population. It is well known that a sedentary lifestyle is one of the major risk factors for CVD so take the steps literally to reduce your risk of heart disease.
1 WebMD; Food and recipes/featured stories. Valentine’s Day: Good for the heart.
2 Agarwal, S. (2012). Cardiovascular Benefits of Exercise. International Journal of General Medicine, 5: 541-545.
Bernadette Schwai is an ACSM certified personal trainer with Agewell Senior Fitness and a holds a Doctorate in Physical Therapy
As the population of adults over the age of 65 continues to grow, understanding the link between exercise and mobility is paramount.
Falls and Other Effects of Mobility Loss
Maintaining mobility is important for both the physical and mental health of older adults. As people age and their ability to participate in activities they enjoy decreases, a number of health risks become more prominent.
The study also found that injurious falls appeared to increase with age for adults over the age of 70. However, mid-life women — aged 35 to 65 — reported the highest prevalence of injurious falls.27%of adults aged 45-79 reported at least one fall in the past 12 months, according to a 2014 study.11%reported an injurious fall, meaning it resulted in activity limitation or healthcare utilization.25,180people aged 75 or older died from a fall in 2016, compared with 8,613 in 2000, a 192% increase.
When an individual becomes less mobile, he or she may start to avoid activities and social events, leading to the feeling of isolation. This can take a serious toll on one’s mental health.
Additionally, a person can experience isolation as mobility decreases, not just at the point of reaching disability. A 2013 study on social engagement among older adults External link found that both lower life-space mobility and disability were associated with lower levels of social engagement. The measure of social engagement included both activities outside the home, such as participation in organizations, and social interactions at home, such as talking on the phone or using the internet.
High Healthcare Costs
Not only does mobility loss affect people’s physical and mental health, but it also affects them financially.
According to the CDC’s resource on home and recreational safety, External link fall injuries are among the 20 most expensive medical conditions, with the average hospital cost for an injurious fall being more than $30,000. Additionally, as people age, the cost for treatment for fall-related incidents increases.
One challenge of navigating these health risks in relation to mobility loss is that they can be cyclical. For example, low physical activity puts an individual at higher risk for obesity and type 2 diabetes. In turn, having a pre-existing condition such as obesity can lead an individual to engage in less physical activity due to impaired mobility.
“We know that physical activity has immense benefits for cardiovascular health and mobility, but about one-third of adults in the United States are inactive,” Ylitalo said. “So, this physical inactivity is a huge health problem, but it’s directly related to physical functioning and aging well throughout the life course.”
How Can Exercise Help Maintain Mobility?
When addressing the issues of increased fall risk and mobility loss, exercise and physical activity are critical for preventive care.
“The biggest myth we have to bust is that falling is expected with age,” said Ashlee Britting, a clinical specialist in geriatric physical therapy. “You should not just assume that weakness or debility is expected as you get older.”
Britting said the four areas of focus for maintaining mobility are:
Depending on a person’s health status, physical activity can be attainable in many ways, from regular walks to enrolling in exercise classes tailored for older adults. People who require specialized attention may also work one-on-one with a physical therapist.
Mobility Exercises for Older Adults
To help maintain mobility, older adults should focus on physical activities that help build strength, balance, flexibility, and endurance. The following exercises require no equipment and can easily be done at home or outdoors.
Purpose: To build strength
Sit at the edge of a sturdy, armless chair with your knees bent and your feet shoulder-width apart and flat on the floor.
Cross your hands over your chest and lean back, keeping your shoulders and back straight.
Bring your upper body forward until you are in your original position.
Extend your arms parallel to the floor and stand up from your seated position.
Slowly sit back down.
This can be repeated 10–15 times, with a rest in between each set.
Purpose: To improve balance
Use a sturdy chair or supporting item to hold onto for stability.
Keep your shoulders, back, and head straight.
Stand on one leg and stretch the other leg forward for 10–15 seconds.
Repeat this five times and switch to balancing on your other leg.
Back of Leg Stretch
Purpose: To maintain flexibility
Find a sturdy bench or other surface of similar size.
Sit sideways on the bench and stretch one leg out on the bench with your toes pointing up. Keep your other foot on the floor and make sure to keep your back straight.
Hold the position for 10–30 seconds. If you don’t feel a stretch, lean forward from your hips.
Repeat 3–5 times.
Switch to the other leg and repeat 3–5 times.
Purpose: To build endurance
In addition to your normal walking routine, try these strategies to optimize your physical activity.
Reverse your route: After walking a distance, turn around and walk back to your starting point. Changing direction allows you to hit different hills and curves to change up your routine.
Time yourself: When doing a daily walking routine, use a timer each day and try to gradually reduce the time it takes for you to complete your route.
Explore different terrain: With consideration for your level of ability, try to find places to walk with different surfaces. This can include soft surfaces such as grass, accessible sidewalks and other paved walkways, and hiking trails.
Invest in the right shoes: As people age, the shape of their feet changes — tendons, muscles, and ligaments stretch to make the foot wider, and the natural padding of the foot can become thinner. Look for a walking or running shoe that fits the widest part of your foot, has a ridged sole, and leaves enough room for you to wiggle your toes while standing.
What Can Be Done to Age Healthily and Maintain Mobility?
In an ideal world, physical activity would be a normal part of every person’s routine throughout their lifetime. In practice, health professionals know this is not always the case. As people age, it is important to be self-aware and take action when signs of mobility impairment become noticeable.
Self-Assessment for Mobility
If an older adult is wondering whether they should talk to a clinician about mobility and fall-risk concerns, Britting recommends asking the following questions. If the answer is “yes” to any of these prompts, a clinician visit may be necessary.
Have you had a fall or incidents of nearly falling?
Do you feel dependent on your spouse or family member for assistance?
Do you feel comfortable being home alone?
Do you have difficulty standing up from a seated position?
Have you noticed yourself avoiding certain activities?
Our team recently set up at the Frederick County Elder Expo to promote fitness for seniors and active aging. The Frederick Elder Expo gets hundreds of visitors each year and there are booths for all types of resources. It’s a great event and resource to the Frederick County senior community.
There were several things that surprised me as the people filed past our booth. I was shocked at how many people commented “I don’t need you yet” or some negative comment about exercise in general. Bernie and I just shook our heads. You see we both had extensive experience in home health physical therapy and all we could think was “see you in a few years in PT” Its unfortunate that people have not yet embraced the PREVENTIVE benefits of regular exercise! Why would you wait until you were falling apart before starting an exercise program? Of course we were there to promote the business and the one on one personal training service we provide. However, we also had educational materials on exercise guidelines and the benefits for adults over 55. We realize personal training is not for everyone and we are more than happy to point people in the direction of the YMCA, the local senior center or the local hospitals medically supervised exercise program if that better meets their needs, as long as they do something. Its never too early to start being more active! Don’t wait until moving becomes difficult before making it an important part of your life.
We also had the pleasure to chat with a lovely lady who exercises regularly at the local rec center. She was from Cuba and when she would say my team mate’s name, Bernadette, it rolled off her tongue like the name a of a sexy bombshell from the 1920s. She was delightful. After speaking with her for a bit about her home and her exercise program, she mentioned her husband, whom has dementia. She said, several times a day she would get him up and have him walk 2-3 laps to the door and back with his walker. Then she would have him sit, out of fear of him falling. Then she said “But you couldn’t work with him….” Um YES!!!! Yes, that is exactly who we specialize in! Unless the doctor says no exercising we can work with most anyone. In fact that is our super power, our zone of genius! Working with older adults with medical issues or who are becoming frail…walkers, wheelchair, bed bound, we can work with them! Frail, home bound, Parkinson’s Disease, Stroke, we can work with them!! These are the clients we love to serve. Its not too late! Can we work miracles and make them 25 again? No, of course not. Can we improve their strength and balance? Can we be a bright spot in their day? Can we reduce their stiffness from immobility? Most likely YES!
So the lesson here is, its never too early to start. Don’t wait until you fall to work on balance. Don’t wait until you have trouble getting out of a chair to work on your strength. And….its never too late! Even if you or your loved one may have a health condition, may use a walker or wheel chair, exercise is for you! Its especially for you.
As the the baby boomers age the number of adults over 55 is growing rapidly. They call it “The Silver Tsunami” I’ve worked with aging adults over the last 22 years and there is definitely a shift in mind set in the baby boomer generation. For one, they are more proactive about their health and more likely to participate in exercise and physical activity. This is wonderful but is this age group getting the right kind of physical activity.
Drive by any senior living community or suburban neighborhood on a nice day and you will see people out walking. Walking is great exercise, it burns calories, improves aerobic conditioning and its functional….but walking is not enough. The ACSM recommends 150 minutes of moderate cardiovascular activity a day, that’s 30 min 5 times a week. They also recommend strength training a minimum of 2 days a week and to also incorporate balance training as well.
Benefits of Strength Training for Older Adults
We begin to lose muscle mass in our 30s and the process only speeds up as we age and more exponentially for those who are sedentary. Strength training has shown to not only help older adults live longer but improve their quality of life as well. With benefits such as:
improved muscle mass
improved physical function
Improved management or risk of developing chronic health conditions such as diabetes, and osteoporosis
Manage conditions such as low back pain and obesity
However some surveys report only 9% of older adults participate in some sort of strength training. And these recommendations are not just for healthy active aging adults, the same hold true for frail adults as well. There is even evidence that improved diet along with strength training can reverse frailty in older adults.
What types of Strength Training?
The ACSM recommends 8-10 strength training exercise with 10-15 reps per exercise. These exercises should address all the muscle groups. Also to reap the long term benefit for strength training, the program should be progressive. This means you need to make it harder. The last 2-3 reps of each exercise should be somewhat difficult, it you are completing 15 reps easily you need to increase your weight. That means put those 2lb pink weights away!! Strength training can include:
free weights or weight machines
body weight exercises (good ole counter push ups!!)
Is Strength Training OK for Everyone?
With a few unusual exceptions, I would say YES!!! Always check with your doctor before starting any kind of new exercise program, and if you have any health conditions, such as arthritis or cardiac conditions, check with your doctor to see if you have any lifting restrictions. However I am here to tell you strength training is beneficial at most any age. I have been working with a client for the past year. She is 95 years old, about 4’11” and maybe 90 pounds. When we started she could lift a 1 pound weight and needed frequent rest breaks. Today we are using 3 pound weights, she’s moved up 3 levels in resistance bands, takes only 2 breaks and her family is even considering traveling with her cross country to visit family because she is functioning so much better. The focus of her program has been strength and balance training. And I don’t feel she is an exception, many seniors out there have the same potential given the right guidance.
Where to Start?
Start with a medical clearance from your doctor to be sure exercise is safe for you. There are actually very few instances where exercise in contraindicated. Once cleared there are several avenues you can take.
Check out your local senior center, they often have low cost exercise programs, but make sure you are advancing your weight or resistance to get the most benefit
Youtube has tons and tons of videos of exercise programs and yes, they have videos geared to seniors
Check out your local gym. Most gyms offer a few free sessions with a personal trainer to get you started and make sure you are using proper form.
Community and Apartment gyms. The community you live in may have a great fitness facility and maybe even classes.
Personal Training. Now as a personal trainer I am biased here. But I do believe its a good investment to make sure you are getting a program that’s right for you and that your are progressing appropriately to get the most benefit. Make sure you research the trainer you are considering. Are they Certified by a reputable organization? ACSM, NASM, and ACE are some of your most reputable. Are they experienced in working with adults over 55? Look for certified Senior Fitness Specialist or someone with a proven track record working with seniors. Ask for references specifically from other seniors or family.
Strength training should be a corner stone of any fitness program but it is especially important for adults over 55 in order to remain strong and independent as they age.
In preparation my blog posts, I always do research, specific scientific studies, on the subject and then link to the studies I use. When I searched for studies on strength training intensity and seniors, the information was overwhelming. There have been so many studies on strength training and aging. Basically…..its good. What I found supported that a progressive strength training program helped increase muscle mass, and maintain quality of life as we age. I also found that most seniors are not getting the recommend amount of strength training. (2 days a week according to the ACSM)
One of my biggest pet peeves when I was practicing physical therapy was when I would get a patient that told me the only thing they did in rehab was sit in a chair doing upper body exercises, and march and kick their legs along with a walk to and from the therapy room. I really hope with all my heart my fellow therapy professionals were doing more than that, and my patients memories were cloudy.
In 2014 the APTA and ABIM launched their Choose Wisely campaign, of which they advocate “Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals.” And since have been advocating strength training for seniors to their abilities and not below. Working in the field of Home Health I can say that this recommendation has been slow to trickle down.
Seeing this in the physical therapy field brings me to the fitness field. Now granted I have seen some videos of some fantastic strength training programs for active seniors. I’ve seen seniors in cross fit, body building and gyms. This….is fantastic. But…I believe the fitness industry will be tasked with serving a population of frail and deconditioned seniors not just active seniors. As insurance benefits decline, and medical cost increase, people are going to look to fitness professionals to guide them with an exercise program after their insurance reimbursed physical therapy has ended. The active baby boomer market is already a growing demographic for fitness professionals. Baby boomers are more likely to advocate for their health and to spend money to maintain it. But guess what? These people have parents and they are more likely to advocate for them as well. Many of my clients are over 80 and their training programs have been facilitated by their children.
So what does this mean for the fitness professional? I think most fitness professional are comfortable with exercise prescription for active agers but what about your not so active agers? This is my advice to you:
Get a medical release, even if they pass the PAR-Q. Also contact their physical therapist if they have recently been discharged. They have already done a thorough assessment and can give you insight into the clients needs and any contraindications before you even start. (this can also lead to a great relationship where the therapist may send you future clients)
Do a thorough fitness assessment. Be sure to use testing appropriate for your client. Don’t do a 1RM on a 85 yo with rheumatoid arthritis. You could use 30 sec chair rise test or the 30 sec arm curl test. And be sure to look at balance as well. Look into a senior fitness specialist certification to expand your knowledge.
Progress your strength training program. For your frail individuals this may take longer. Progress the clients weights and repetitions just like any other clients. I think this is especially important for group fitness instructors working at senior centers. Its easy to fall into a rut. Its easy for your clients to fall into a rut or to be fearful of increasing the resistance band or hand weights. It falls on the instructor to educate, encourage, and guide the participants to increase their resistance when what they are doing has become too easy. (remember back to a progressive strength training program is beneficial)
GET OUT OF THE CHAIR!!!! For Gods sake get your client out of the chair! (as they are able of course) Upper body exercises can be done in standing to promote balance and improved endurance. I don’t know about you but most of my clients are excellent sitters, its in standing they have the issues. Of course this varies by client. I have some clients with spinal stenosis that we have to alternate standing and sitting exercises to prevent onset of back pain but I still get them ON THEIR FEET!
Strength training should be a vital component of everyone’s fitness program but it can be argued that its even more important as we grow older. Strength training prevents the natural loss of muscle mass that happens with age starting in our 30s. Improved muscle mass can translate to better balance, and better overall function. Historically we have treated seniors carefully, using only light weights and resistance and doing the same simple exercises over and over again. But a growing body of research supports that progressive strength training programs tailored to the individuals capability (don’t give the entire class 2 pound weights, some may need heavier) is our best path to improve function as we age.
And for God’s sake, GET THEM OUT OF THE CHAIR!
Katrina Wolf is and ACSM certified personal trainer and ACE certified senior fitness specialist. She brings her 20+ years as a physical therapy assistant working with seniors and frail elderly to the fitness profession. Her passion is to improve seniors quality of life through exercise and education. She also strives to educate other fitness professionals regarding seniors and exercise. Her special interest include Stoke survivors and those living with Parkinson’s Disease and other neurological disorders.
Click here to get more information about working with Katrina