Seniors, no matter how old you are, exercise can improve your quality of life and you don’t have to spend a lot of time doing it to see and feel improvements. Like everyone else, seniors need to engage in cardio, strength training, and flexibility exercises to stay healthy and maintain as much strength and functionality as possible.
Aging is an inevitable biological process that gradually changes the body structure and function. There are two components of aging, biological and psychological aging. They are not synchronized and may occur at different rates in different people. Both are dictated by chronological age. A regular exercise program can reverse some of the effects of biological age for seniors and possibly the psychological age, thereby, increasing longevity. Physical inactivity can increase both age components.
The American College of Sports Medicine (ACSM) stresses the importance of strength training for older people. ACSM recommends that seniors begin an exercise program with strength training before they start an aerobic training program.
The purpose of this section is to increase the Fitness Instructor’s understanding of the physiological and as well as the psychological changes that occur during the aging process. This will allow the instructor to develop an effective and safe fitness program specifically for the senior population. Senior classification varies according to who you ask. Generally, seniors are considered to be those that are 55 and older.
As in every population group, senior levels of fitness vary. However, with seniors there is a thin line between fitness training and rehabilitation. Unless you are a licensed exercise physiologist, you should not attempt to rehabilitate clients or exercise the frail. The senior candidate must have a doctor’s physical exam and a doctor’s clearance issued for him or her to participate in an exercise program and to what degree with any limitations noted. As a personal trainer you are responsible for the well-being of your clients. Don’t take chances with their lives.
Some seniors may be willing to endure pain in the expectation that it will be required to get in shape again. Careful observation should be made of the senior client to ensure that they are not overloading themselves. The American College of Sports Medicine (ACSM) has set guidelines for Senior Fitness. You can reach them from our website.
There are essentially two types of senior populations those that are reasonably healthy, and those that are frail and disabled. The personal trainer should not train anyone who is disabled nor has any pathological conditions that requires special training considerations. These situations are the responsibility of the Physical Therapist under the supervision of a doctor and NOT the personal trainer regardless of the client’s age.
Aging can be the result of lifecycle, environment or lifestyle. Exercise and healthy lifestyle have been shown to delay and even reverse some of the effects of aging. Specific systems that undergo changes during the aging process are: Cardiovascular System, Respiratory System, Muscular System, Skeletal System, Digestive System, Endocrine System, Nervous System, Immune System.
This Cardiovascular system includes the heart and the blood vessels. Due to an increase in the size of individual heart muscle cells, the heart tends to enlarge resulting in thicker walls, slightly larger chambers and reduced elasticity of the heart muscle resulting in a reduced cardiac output. Heart valves can thicken and not fully seat (murmur). The heart’s natural pacemaker cells decrease causing arrhythmias or irregular heartbeats.
The older heart functions at a lower heart rate at rest. However, during exertion, it is not able to increase the amount of blood flow as compared to a younger heart. The heart cannot respond as quickly, or as forcefully, to an increased workload. Blood vessels can become brittle and the passages narrow due to arterial plaque (arteriosclerosis) resulting in a decreased blood flow and higher blood pressures (hypertension). An increased risk of aneurysms can be a result of lost elasticity.
A reduction in blood flow results in a decrease in the amount of oxygen that can be delivered to the other systems. This is measured as VO2 MAX and defined as the maximum amount of oxygen that can be utilized per minute. Reduced blood flow can result in shortness of breath, dizziness and in extreme cases Cyanosis characterized by a bluish discoloration of the skin. Many of these effects can be reduced by exercise.
Higher blood pressures are also a result of the heart’s inability to fully relax (diastole) in order to fill with blood before the next contraction (systole). High blood pressure causes the left ventricle to work harder to push blood into narrowed and inflexible pathways. It may enlarge and outgrow its blood supply and thus becomes weaker. Blood pressure is normal during the diastolic phase and high during the systolic phase.
This is common condition in the elderly and is called Isolated Systolic Hypertension. Almost half of all heart failures are due to failure of the heart in the diastolic phase. During diastolic heart failure, heart function appears normal, but the stiffened heart muscle causes excess fluid to build up in the lungs, feet, ankles, and legs. Blood may pool in the veins of the legs because the valves are not able to function correctly. This can also cause swelling of the lower extremities.
Reduction in hematocrit, which is a measure of both the number of red blood cells and the size of red blood cells, which can lead to anemia. Constriction or blockages of peripheral veins can cause the formation of clots, which can then dislodge causing an embolism in the lungs or stopping circulation in extremities. Phlebitis, which is an inflammation of the vein also occurs more often in the elderly. Blood glucose levels increase with age but not because of changes in the blood. Rather, it is the result of age-related insulin changes. Bone marrow decreases with age, causing a decrease in the number of new blood cells. As a result, bleeding will not stop as quickly.
The liver receives a smaller supply of blood due to shrinkage. This reduces the rate of drug detoxification, which can exaggerate the effects of drugs predisposing the elderly to drug overdose. By age 70, the weight of the liver has decreased by roughly 20%.
Specially adapted nerve fibers in the larger blood vessels and heart called beta adrenergic receptors (bAR) become less sensitive and, as a result, cardiovascular adjustments to changes in position are slowed, causing an increase in dizziness and falling. Fluid balance or pH usually remains constant unless there is an incidence of disease or damage to a particular organ.
The Respiratory or Pulmonary system consists of the airway passages, the lungs and the supporting muscles. Due to calcification the airway passages can become less flexible. The muscle fibers, air sacs (alveoli) and connective tissues in the lungs are less able to expand and contract requiring more effort to inhale and exhale. Supporting muscles that assist the expansion and contraction of the lungs including the diaphragm can become hardened and less flexible thereby increasing the breathing effort and reducing Vital Capacity (the maximum amount of air that can be forcibly exhaled after a full inhalation). Generally, Vital Capacity is reduced to sixty-five percent by age 50 and to forty percent of the initial capacity by age 70. Cardiovascular training can reverse the effects of aging by increasing the strength and flexibility of the muscles associated with breathing and strengthens the heart muscle.
Breathing and Vital Capacity is further decreased due to arthritic conditions of the cartilaginous rib joints. A decreased in ciliary action (hair-like fibers that act like cleaning brushes) in the lungs results in an inability to remove mucous in the lungs thereby restricting oxygen intake.
The chronic lack of oxygenation of the alveoli, as is the case in diseases such as emphysema or bronchitis, may lead to pulmonary hypertension. This condition can further result in an overworked right ventricle of the heart. A weakened left ventricle can lead to congestive heart failure (CHF) and pulmonary edema in which excess fluid collects in the alveoli decreasing gas exchange.
Starting at about 40 years of age there is a general atrophy of muscle (Sarcopenia) and an increase in adipose tissue (fat cells). By the age of 80 years old, there is an estimated fifty-percent reduction in muscle mass. The Muscular system includes muscles that are responsible for structure and strength such as the muscles of the shoulders, neck, arms, legs, back and abdomen. As the number and size of the muscle fibers decrease, muscles will reduce in size and strength until they are no longer able to perform their intended function. Tendons become rigid and less elastic and therefore unable to tolerate stress. Muscles continue to atrophy or reduce in size, not so much with age, as with disuse. It just becomes more apparent as one ages. Weight training can increase muscle mass and strength and counter the effects of aging. Skeletal muscle fibers decrease in diameter, particularly in the extensors and flexors, resulting in a curved posture and an abnormal bending of the hips and knees. Muscle growth as a result of exercise (hypertrophy) is slowed by the decrease in blood flow.
Exercise tolerance decreases partly due to fatigue. Thermoregulation is affected, which can lead to rapid overheating. Extreme exercise must be avoided since joints, tendons and ligaments have been compromised. Recovery from injuries will be slower. In the elderly, scar tissue will form faster than tissue repair thereby decreasing mobility. Mitochondrial functionality decreases with age, which reduces the effectiveness of exercise and will therefore slow new muscle tissue growth (hypertrophy). Free weights for the elderly present an additional risk since muscle reflexes have been slowed.
As tendons and ligaments become less flexible, joint range of motion decreases. A thinning of the joint cartilage and calcium deposition contributes to joint stiffness which, if not exercised, will cause permanent immobility.
Age shouldn’t be seen as a barrier where exercising is concerned for seniors, unless of course there’s a serious illness preventing physical activity.
I have personally trained many seniors and helped them live an active life, and a better quality of life. At the present time, a number of my clients are seniors.