Turning Back Time: Personal Training and the Older Adult

My introduction to training older adults was awesome. Len, my first ‘older’ client taught me a lot.

Sharp as a tack, and full of life, Len was a former soldier in the NZ Army. In his late 60’s, he was enjoying his retirement, grandkids, and moseying on down to the shops when he could. I’d see him clanging weights most days. He’d come to see me for a couple of sessions a week, and ‘train’ on his own the other days.

I put ‘train’ in quotation marks, because whilst Len was a regular gym goer, ‘training’ was not his main objective. I could have given him anything to do – he’d happily push through the sets very eager to continue our conversation during the breaks.

He didn’t want to be thrashed from one exercise to the next. But he didn’t want to be mollycoddled either.

He’d do the work, have a yarn, and have me in stitches with (Grand)Dad jokes 101. 🤣

‘Leg presses? I haven’t done those since my disco days in the 70s!’

One time Len called me over just so I could listen to the crunching in his knees and to see the look on my face when he told me – ‘you’ll get knees like these too one day!’ 😜

Nearly 20 years later, all I can say is – Boy, was he right!

Len was a joker.

He was my first older client, and it was great fun working with him.

For Personal Trainers just starting their career, the thought of training older clients can be somewhat nerve-wracking though. You can almost sense their apprehension.

‘What if I break them?’

The good news is – most older clients don’t conform to the ‘frail and fragile’ stereotype. Far from it in fact. Heck, if I ever implied that Len was fragile, I’d have received a well-deserved clip round the ears!

It is good to be concerned about safety though.

So, in this article we’ll endeavor to alleviate concerns PT’s might have about training older adults by:

• Discussing the physiological changes associated with aging.
• Examining how physical activity resists and minimizes the effects of aging.
• Providing five key tips for training the ‘older adult’.

What happens when we get older?

First up, I need to define what I mean by ‘older adult’, because it’s a very subjective term. Te Ara (The Encyclopedia of NZ) defines older people as those aged 65 years or more. This is a simple measure of chronological age or ‘years on the clock’.

However, chronological age isn’t always the same as biological age (how old our cells are).

Len is a great example. Chronologically he was 69yrs old. However, by virtue of living a physically active life his biological age was likely much lower.

As trainers, we’re mindful of chronological age, but when we consider the person in front of us, training should be tailored to their biological age.

You see, Len was able to do more in his training sessions than sedentary clients who were chronologically much younger.

With that caveat in mind, our physiology does change as we age.

From as young as 25, our bodies start letting us know that we’re getting older. After age 25 our maximum heart rate declines by about one beat per minute, every year. Also, our capacity to pump blood drifts down by about 5-10% every decade.

As we age, this reduction in capacity can start to produce fatigue and breathlessness, even with modest daily activities.

Our blood vessels gradually lose their elasticity, and our blood becomes thicker and stickier making it harder to push around the body. These factors contribute to our blood pressure gradually increasing with age.

As we get older, our muscle mass and strength tend to decrease, and we tend to gain body fat. Our ‘good’ cholesterol drops whilst the ‘bad’ type increases. The risk of diabetes, osteoporosis, arthritis, broken bones, and forgetting important birthdays all increases. And our coordination, reflexes, and libido generally deteriorate. Perhaps unsurprisingly, our sense of humour often takes a hit as well! [ref 1].

The somewhat ‘sobering’ physiological effects of aging are summarised in the following table:

However, before you think that aging is all bad, there’s another crucial caveat that needs to be understood:

The sands of time are no match for the rejuvenating power of exercise.

How does exercise ‘turn back time’?

In our Personal Training programme we introduce students to the ‘Health – Disease Continuum’. The continuum takes a more biological view of aging. It helps us to understand that the development of diseases often associated with aging, are heavily influenced by modifiable lifestyle factors.

For example, in my youth, I was fit, active and had very limited access to fast food and takeaways. Despite incessant pleas from me and my siblings for a Maccas Dinner, my parents rarely gave in to our demands.

Most evenings we were served up a wholesome ‘meat and 3 vege’ meal with the ultimatum of ‘eat it or go hungry’.

We ate it.

As I got older, I was afforded more control of my own lifestyle choices and unfortunately, proved to my parents why I couldn’t be trusted with this responsibility as a child!

Poor nutrition, physical inactivity, stress, and the odd overindulgence with alcohol were pushing me along the continuum, more so than age.  My cells were becoming more diseased and my likelihood of bumping prematurely into the grim reaper was increasing.

It’s a similar picture for many of us as we get older. Various demands compete for our attention. We get into the habit of sacrificing healthy meals for takeaways or flagging exercise for nights in front of the telly.

A typical scamper along the health-disease continuum could look like the diagram below.

Generally, we start life in good health. Inevitably, as we age, we move along the continuum towards disease and death. What’s important to understand is that the speed with which we move along the continuum depends largely on our lifestyle. And as the arrows above suggest, movement along the continuum isn’t restricted to being one-way.

Don’t fear the reaper!

The good news is that many of the negative consequences associated with aging are, at least in part, the result of modifiable risk factors.  This means we can change them. And when we do, we put the brakes on the aging process. To a degree, we’re capable of ‘turning back time’ and regaining lost vitality.

Arguably, the most important modification we can make is to (re)establish and maintain a regular exercise habit. A 2019 meta-analysis [ref 2] examined the impact of physical activity on health outcomes in adults aged 60 and above.

The study concluded that physically active (as opposed to inactive) older adults had:

• Lower risks of mortality, cancer, fractures, falls, disabilities, and cognitive decline, and
• Improved cognitive functioning.

Another fascinating, although somewhat dated study from 1966 investigated the detrimental impact of physical inactivity. Known as The Dallas Bed Rest and Training Study [ref 3], five healthy young men were confined to three weeks of bed rest. After just three weeks, the young men’s:

• Resting heart rates increased,
• Blood pressure increased,
• Heart pumping capacity reduced,
• Body fat increased and
• Muscle strength decreased.

After the bed rest, an 8-week exercise program was introduced. The detrimental effects of bed rest were reversed. And on some measures, the young men recorded better results than when they started the study (i.e., prior to the bed rest).

Here’s that same table from earlier with the effects of exercise added for comparison. It’s quite telling isn’t it?

Not only does ‘an apple a day keep the doctor away’, ‘daily exercise keeps the reaper at bay’!

Five Top Tips for Training Older Clients

Now that the importance of physical activity is clear, here are some key pointers for working effectively with older clients.

1. Conduct a thorough consultation

A core part of our Personal Trainer programme focuses on the consultation process. With older clients, a thorough consultation enables you to:

• Build rapport and alleviate any concerns the client may have regarding exercise.
• Find out about the client’s history of illness and injury. This makes it easier to identify safe exercises to start with.
• Identify whether the client is taking any medication. If they are, find out whether the medication may influence the client’s ability to exercise. Often, the client will be able to tell you themselves.
• Develop an understanding of the client’s objective(s) and set goals leading to the achievement of those objectives.
• Learn about the client’s exercise history and preferences so that your prescription can be tailored to these.
• Develop a plan of action which includes support activities to ensure the client builds a safe, enjoyable exercise habit.

As part of a thorough consultation process, you’ll gain insights into any mobility issues, balance problems, or muscle weakness your clients may have.

Len had developed arthritis and had some of the creakiest knees I’ve ever heard – He’d often joke about how we’d always hear his knees arriving before he did! Insights gained through the consultation made it easier to identify and plan safe and effective exercise for him.

2a. Start slow…

Some older clients may have limited mobility, flexibility, and balance. Therefore, low-impact exercises are often a good place to start. This might include exercises such as walking, cycling, or rowing for cardio. Use light loads initially with resistance training and increase them as the client is able.

Assuming you’ve completed a thorough consultation (tip no.1) you’ll be aware of any underlying health conditions that may affect the client’s ability to exercise. Use this knowledge to guide your exercise selection accordingly.

For example, with Len’s mild arthritis in mind, he benefited from low-impact exercises that didn’t put undue stress on his joints. He preferred leg press over a standing squat and the cross trainer instead of a treadmill.

Ultimately, anything the client enjoys and can comfortably tolerate is likely to be a good option.

2b. … but be prepared to go!

There’s an old adage that…

‘You’re only as old as you feel’.

Always remember that older clients are not necessarily fragile or unable to handle intensity in their workouts. If a client is capable and willing, a trainer can incorporate higher-intensity exercise or intervals into their workouts.

This can be beneficial not only for the client’s physical health, but also for their psychological well-being. Many older clients want to feel challenged and empowered in their workouts, and incorporating intensity can help them achieve a sense of accomplishment and pride in their abilities.

Of course, it’s important to monitor intensity carefully (more on this point shortly). If there’s any sign that a client might be overdoing it or struggling with an exercise make modifications or adjustments to make it easier. But overall, incorporating intensity into workouts can be a positive experience for older clients just as it is for younger ones.

3. Encourage bending, balancing and mobility

As people age, maintaining flexibility and mobility becomes paramount. These factors directly influence an individual’s ability to perform daily activities, prevent injuries, and enjoy an active and independent lifestyle as they navigate their golden years.

By emphasising balance and flexibility in training sessions, you can help improve mobility, reduce risk of falls, and enhance the overall quality of life for older clients.

The below table summarises some workout options you might consider in this area:

As part of our PT courses, students can develop specialisations in Assisted Stretching and improving Mobility and Stability. This is a useful starting point for familiarising with a selection of specific activities focused on improving both the flexibility of tight muscles and the mobility of joints.

Well worth checking out if you intend to work with older adults (or any clients for that matter)!

4. Monitor Heart Rate/Intensity

Unfortunately, the risk of heart disease does increase as we age. Therefore, it’s crucial to monitor the heart rate of older clients during exercise. A simple way to do this is to use a heart rate monitor or manually check the client’s pulse.

Nowadays, fitness and activity trackers are widely used and available. You will likely have one on your wrist right now! Many older clients are also embracing wearable fitness technologies, so this part of a PT’s job has become much easier.

A quick note on medications that affect the heart:

It’s reasonably common for older clients to be taking medications (or substances) that either increase or decrease their heart rate. For example, beta-blockers are medications that lower heart rate by blocking the effects of certain hormones, while stimulants such as caffeine can increase heart rate.

If a client is taking medication that affects their heart rate, you’ll need to be aware of what the medication does and adjust the exercise program accordingly. You may need to monitor such clients more closely and avoid certain types of exercise altogether. Heavy, overhead weights are never a good option in such cases!

If a client’s heart rate is affected by medications, using the RPE scale to determine workout intensity can be more useful than monitoring heart rate. This is because the client’s observable heart rate may be quite low due to their medication. So, avoid cranking up the tension on the cycle in response to what appears to be a low heart rate. They may actually be working at a 7, 8 or 9 intensity already.

Don’t assume they are cruising!

Furthermore, if your client is returning to activity after a serious cardiac event, then work closely with their allied healthcare team to fully understand the client’s capabilities. Allow those experts to dictate suitable intensities. Follow their guidance and focus on supporting and monitoring the client. Once the client is given a full bill of good health – then you can start adjusting target intensities again.

5. Think functional

As a Personal Trainer, incorporating functional movements that will help improve a client’s quality of life is always a good option.

Functional movements are exercises that mimic the movements people use in their daily lives. For example, squatting to pick up an object from the ground, walking up and down the stairs to the front door, or maintaining balance and posture whilst carrying groceries in from the car.

Unless your client is also a ninja warrior – muscle ups, rope climbs and walking handstands are probably not functional in this case. Keep it to common everyday movements.

Prescribe exercises that target specific functional movements that the client may be struggling with.

For example, I had another older client who had difficulty getting in and out of her chair. So we incorporated exercises that focused on improving leg strength and flexibility. I particularly like exercises such as the seated leg press or chair squats for this purpose.

These exercises keep the client in a stable position allowing them to work within a range of motion that suits their capabilities. No need to throw a loaded barbell up on their shoulders.

Another example would be to focus on exercises that improve balance, such as single-leg stance or standing on a slightly softer surface or mat which can help with proprioceptive awareness.

Such exercises help to improve people’s quality of life by making daily tasks easier and more manageable.

The last word

Staying fit in older adulthood is like safeguarding a fountain of youth within. With its beneficial effects on physical and mental health, exercise is a cornerstone of long-term health and well-being.

As Personal Trainers, it’s important to remember that advancing age is not an indication that people need to ‘take it easy’. Within reason, many older clients, like Len, are more than willing to be put through their paces.

Yes, like with any client, we must always account for medical history, illness, injury, and previous exercise experience. Safety is always a paramount concern for any client. In the case of the older client though it’s important to leave any preconceived and limiting notions of what they could or should do at the door.

If they are already fit and active – you are helping them prolong their vitality.

If they are somewhat new to physical activity – you’re helping to move them back down the health-disease continuum.

Start slowly. Consider any underlying health conditions and build a suitable programme from there. But be prepared for leaps in ability as you would any client as big gains are often on the horizon! 💪

Finally, to train older clients successfully, you should remember that older adults are seldom ‘fragile’. Many will seek out and thrive on a good challenge. So, identify opportunities to incorporate appropriate intensity into their workouts. Make sure you monitor progress carefully. Like with any client, it’s all about keeping them safe and progressing. Hopefully while also having a bit of a laugh, as I found out from Len, the great kiwi joker.

 

References

1. Harvard Health Publishing. (2014, March 9). Exercise and aging: Can you walk away from Father Time – Harvard Health. Harvard Health; Harvard Health. https://www.health.harvard.edu/staying-healthy/exercise-and-aging-can-you-walk-away-from-father-time 
2.  Cunningham, C., O’ Sullivan, R., Caserotti, P., & Tully, M. A. (2020). Consequences of physical inactivity in older adults: A systematic review of reviews and meta‐analyses. Scandinavian Journal of Medicine & Science in Sports, 30(5), 816–827. https://doi.org/10.1111/sms.13616
3. Mitchell, J. H., Levine, B. D., & McGuire, D. K. (2019). The Dallas Bed Rest and Training Study. Circulation, 140(16), 1293–1295. https://doi.org/10.1161/circulationaha.119.041046