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Most of us in the fitness/wellness/healthcare field understand that when planning a strength training program, it’s important to incorporate principles like specificity, overload, progression, etc.
Unfortunately, it seems as though those same principles are either not used or misused in the older adult population.
Let’s take pretend client Sally for example. Sally is 75 years old and enjoys crocheting, cooking, and playing with her grandkids. She owns a small Beagle named Hoover who she walks daily. She recently fell while out on a walk with Hoover and is coming to you to improve her strength.
Where do you start with Sally? Do you assume that she just wants to get back to sitting and crocheting so you focus on light hand weight exercises? Or do you do a 1RM strength assessment? Do you think maybe she just needs to walk more regularly and maybe navigate curbs and uneven sidewalks better? Do you introduce her to kettlebells and pushups? Or, do you start her with “strength” training by handing her (the dreaded) yellow resistance band?
While I understand each client is unique and it’s hard to say exactly what you would do with Sally, if you thought you would work low weight, high rep, or just do a walking program, or cut her a yellow resistance band, I kindly ask you to reconsider.
As we age, we all lose muscle mass (aka sarcopenia). It’s been found that every decade after 30 we are losing muscle mass and function. For those who are less active, there’s about a 3-5% loss of muscle mass every 10 years.¹ Sarcopenia impacts our fast twitch, or type II muscle fibers more than our slow twitch, or type I muscle fibers.
While research debates the exact cause, it’s known that a loss of power (speed + strength) also occurs with aging. Studies have found that we lose power at a higher rate than strength.²
Due to a decrease in not only muscle mass, but proper muscle function, seniors can experience difficulties with balance and gait. This can lead to an increased risk for falls.³
So, what does this mean for fitness professionals working with older adults?
Underdosing older adults is actually hurting them!
To combat the deleterious effects of aging, older adults need to do resistance training that incorporates the training principles we use with all of our other clients- especially proper overload and progression.
Studies have found that older adults need to work at 60-85% of max voluntary strength and train at 85% of that to increase force development.4
Here’s my recommendation for ensuring proper dosage for your older adult clients:
1. Do a 1RM test. You don’t have to put them on the squat rack or bench press and load them to max capacity day one. Instead, I use an app called One Rep Max. You can use a variety of exercises or weights and then it calculates 1RM and gives you weight suggests for 70-98% 1RM.
2. Use an RPE scale. This will also be needed for the One Rep Max app. RPE stands for “Rating of Perceived Exertion”. It’s a scale (usually from 0-10) for clients to identify how hard they feel they’re working throughout the session (feel free to download this one). For training, we want them at a 6-7 at least. This gives you a good idea if you’re providing enough challenge. While using things like heart rate to determine intensity is okay, some older adults may have heart conditions that will give you misinformation.
3. Throw out your yellow resistance band. Seriously, do it now, please! Think about what you’re trying to accomplish with that hardly resistant band and ask yourself is there a more functional way you could achieve that. Even if they need lighter resistance, could they do standing push-ups against the wall? Could they use the Lebert HIIT system to do standing squats?
4. Focus on function. Even if your client is like Sally and sits to crochet all day, remember she still needs to be able to stand from her chair and get to the bathroom- that requires a lot of leg strength and power! Lifting a laundry basket off the floor is a deadlift- make sure your client knows how to do those! Use specificity in order for your training to carryover to activities of daily living to help promote independence and boost your client’s safety.
5. Don’t overutilize rest. Just because your client is older, doesn’t mean they need more rest. I have my clients tell me when they need to rest, and they do! Too much rest won’t help them get stronger.
6. Be cautious, like you would with any other client. When your 30 year-old client tells you they have a stress fracture, you don’t dive into the same workout routine, right? Make sure you do the same for your older adult clients. If they have osteoporosis or another condition or injury, make sure you’re taking into account the proper safety measures and referring to a medical professional as needed.
7. Check your bias. None of us want to admit that we have them, but we do. It’s important to know if you have a subconscious bias about older adults in order to help address it. I recommend taking this quick implicit bias test from Harvard University. There’s actually a number of them you can take which is highly beneficial for all of your clients too!
Aging comes with loss of strength, however, that doesn’t mean we need to be weak, or experience falls, or struggle with chronic conditions!
Exercise that is properly dosed and progressed is key to enabling older adults to live highly functional, independent lives!
By Dr. Katie Landier, PT, DPT
Board Certified Specialist in Geriatric Physical Therapy