Exercise for older adults
Updated: Sep 11, 2020
Did you know it is common for aged care facilities to have a gym?
Stories of "grandma lifting" are becoming much more common and as an exercise professional it makes me so happy to see people moving pain-free and challenging themselves, despite many others in their age bracket failing to do the same.
Exercise for older adults is a major area of study in the realm of exercise science, and for good reason. As people go through the aging process, many preventable diseases become more prevalent in the population (including sarcopenia, osteopenia and cardiovascular diseases). Additionally, many of the things we lose with age, such as muscle strength, muscle function, balance, bone density and cognitive function, can either be delayed or even reversed with training!
Risk of falls is a term you'll hear thrown around when talking about this topic.
Basically, as you age it gets easier to lose your balance, misjudge distance, fail to adjust your feet in time and break a hip from a fall. Obviously, this is a big deal because it means hospital visits, limited mobility, lasting pain and feeling like a fool. In the research this has been directly linked to all-cause mortality, meaning the more likely you are to fall over, the more likely you are to die.
That's where I swoop in to save the day! (or at least someone in my field)
With appropriate exercise you can minimise your risk of falls, risk of heart, muscle and bone diseases and improve your brainpower. All it takes is a little bit of well-placed effort and sustaining good habits.
This graph shows what to expect in terms of muscle strength as we age. Exercise professionals in the aged care setting aim to keep everyone above the threshold of disability, so they can maintain mobility and independence in their older life. As you can see, the stronger we get now, the easier it is to maintain that strength as we age.
Did you know 50% of adults older than 80 years experience a fall each year?
Now I know what you're thinking... "that's only for super fit people, I tried that for a week and even that injured me" but let me tell you: resistance training is completely safe for older adults given proper supervision, technique and weights.
In fact, resistance training will reduce your injuries by reducing your rate of falling by about 20%!
Let's summarise the first question undoubtedly on your mind:
Why should I bother?
On top of the already exhaustive list of benefits everyone receives from exercise (seriously that list is written in a tiny font and still takes up a long page!), older adults have a few areas that are of extra importance.
As you get older, keeping your independence can become a barrier for happy aging.
Regular exercise will improve your mobility, physical functioning, performance in activities of daily living, and preserve the independence of older adults. In other words, you can move pain-free and live your life without the need for assistance.
You will improve your resistance to injuries and reduce risk of catastrophic events such as falls. In other words, you'll spend less time with a sore hip in a hospital bed and more time with your grandkids.
It will help improve your psychosocial well-being. In other words, your brain will function better, you will feel better and it will help you to socialise with others.
Resistance exercise also combats common age-related diseases:
Sarcopenia (the loss of muscle mass) - is slowed by resistance training and in some cases can even be reversed.
Osteopenia (the loss of bone mass) - is slowed by resistance training and in some cases can even be reversed.
Cognitive impairment or Dementia - resistance training will improve cognitive function, neuromuscular function and functional capacity losses.
Okay, so you want to start exercising and gain all these benefits? Let me tell you the best way to do it.
There was a 108 year old woman from Adelaide in the news recently for going to gym on her birthday! She claims her longevity is due to her fitness. She could probably teach me a couple of new moves. Credit
What should I do?
I've written up an entire list of recommendations below but the main take away from this is - go see an exercise physiologist. These people are highly qualified experts (4+ years of study) who will help set you up with an individualised plan to approach your fitness goals given your current situation. If you get a referral from your GP, Medicare will even cover a number of sessions for you!
Go put your trust in a knowledgeable professional and let them do the work for you rather than relying on your understanding of my article, which is only my understanding of the topic.
P.S. that's going to be me in a few more years of study.
Also remember: I am only giving general advice here, please go get medical clearance before beginning a new exercise routine!
Here are the official recommendations:
Older people should be active every day in as many ways as possible, doing a range of physical activities including a mix of endurance, strengthening, balance and flexibility work.
Older adults should aim to accumulate 30 minutes of low-moderate intensity exercise on most, if not all, days.
These are often continuous movements that work your cardiovascular system (your lungs and heart). The safest endurance activities have a low impact on the joints such as walking and swimming. Other popular endurance activities include jogging, cycling, hiking and sports.
Follow a progressive balance program such as this simple to follow flyer by the Western Australian Government. Challenge your balance on most, if not all, days. Other exercises where you are leaning forwards, left, right or backwards can also help with balance such as tennis, golf, yoga or gardening.
Stretch out tight muscles to improve and maintain joint range of motion. This is often done as static stretches, holding a stretch for fifteen or more seconds, twice, on two or three days per week. These can be completed as part of a warmup or cooldown on either side of a workout.
Older adults should aim to perform resistance training on 2-3 days per week (with rest days in between).
Resistance training programs for older adults should follow the principles of individualisation, periodisation, and progression.
Individualisation is altering the intensity, the type and the methods of the workout to fit in with the person trying to train. For example, finding the correct weight for you, adjusting movements to account for injuries and finding a routine that is enjoyable and sustainable for you. Finding a workout routine on the internet is a good start, but it won't be specific to what you need, making it less effective.
Periodisation is creating specific, manageable blocks of training to work on all aspects of fitness over time. For example, you might focus on building your muscular endurance for one four-week block, balance on another and power in another to ensure the body has a well-rounded fitness.
Progression is increasing the stimulus on the body to keep eliciting positive adaptations. Think about increasing the reps, sets, distance, exercise progressions or weight to keep things challenging and interesting. Only increase one of these variables at a time and by no more than 10% each week.
Reps: 8-12 (beginner) or 10-15 (advanced)
Intensity: 70-85% of 1 rep maximum (1RM)
Type: Machine-based or free weight exercises
Include: power training at 40-60% 1RM and functional movements (exercises that mimic daily life)
Overall, the recommendations are very similar to the recommendations for healthy adults, with a few tweaks such as a lower maximum intensity.
With it comes the usual considerations: start low and build up your exercise tolerance, drink plenty of water, eat plenty of protein, keep strict technique, ensure you get adequate sleep and allow time for your body to recover.
However, there are some additional things you should be aware of.
Extra considerations to stay injury-free:
"Start light and earn your right to do certain exercises" is my advice for everyone but it is extra important here. Keep track of your numbers so you have an objective measure of how much is too much or not enough and when to progress on to a harder challenge.
It is not recommended by authorities to push yourself to do vigorous exercise (exercise causing you to feel out of breath and struggle to speak between breaths). However, it is also considered OK to do so if you are used to regular vigorous exercise, meaning you can keep up your old healthy habits in a manner that has been adjusted to suit you.
Take a little bit longer to warm up before exercise and cooldown afterwards to ensure your muscles and joints are ready to perform. Ten minutes on either side of the work out should be sufficient. Want to know what an effective warm up looks like? Check out my article on it from earlier in the year HERE.
Power - producing force quickly - is lost the fastest as we age and plays a role in falls prevention, so should be a large focus for older adults. You probably won't be doing squat jumps like young athletes, but there are other plyometric (explosive) exercises which are safer to do, like throwing a medicine ball or drop squats.
Arthritis, osteo-arthritis, back pain and joint pain can hold back plenty of older adults from doing exercise but, when performed correctly, exercise is proven to help reduce pain whereas inactivity will only make this pain worse! Exercises should be altered to be performed in a pain-free range of motion. This links back to making sure each program is individualised for the specific person rather than just their age group.
Osteopenia, sarcopenia and frailty all suffer the same fate, creating inactive patients, yet they can be treated with exercise! Supervised exercise programs are the way to go - see an exercise physiologist for how best to approach your situation.
If you have a heart condition, holding your breath, as well as standing up quickly from lying down can drastically and rapidly alter your blood pressure. Avoid these circumstances to avoid unwanted complications.
And finally: anything is better than nothing! You don't have to be hitting all of these recommendations perfectly. Do what you can and you will still see the benefits to your life.
So, things to remember for older adults:
Exercise is important now more than ever, you have more to lose but that also means you have more to gain from exercising!
Seek medical clearance before starting a new program.
You should perform a mix of cardio, strength, flexibility and balance exercises throughout the week.
Avoid injury by following an individualised, periodised, progressive program, and reminding yourself of the extra considerations to take.
Don't let pain stop you, you can stop pain through exercise!
Use the knowledge and experience of exercise physiologists. They will know what to do and how to do it to get the best results possible for you.
As you can see there is plenty to think about when starting any exercise routine, especially for older adults who have been through a lot of what life has thrown at them.
However, just starting a new habit is always the hardest part and the benefits of regular exercise are more than worth it.
Now go out there, find yourself an exercise physiologist to guide you and get moving!
In the future I hope to be coaching as an accredited exercise physiologist in gyms filled with healthy grannys and gramps.
Make it happen by starting now!
The information for this post was gathered from the NSCA's position stand on resistance training for older adults (2019), as well as my time working in an aged care home as a physiotherapist assistant.
There are plenty of helpful resources for older adults to keep fit (since it saves lots of $$$ for the government if their population is super fit!) so, here are some cool, easy to read resources to check out if you're interested in learning more:
Sports Medicine Australia's "Choose Health" brochure on healthy aging. Lots of useful, easy to digest information in this brochure. My favourite part is the list of common excuses with answers for each one.
The Australian Government's Recommendations on physical activity for health for older Australians.
Subsidised exercise classes for Australians over 65 years old.
or check out these free at home workouts for older adults.
Find an ESSA accredited exercise physiologist near you (Australia wide)
If you enjoyed this article please consider subscribing by entering your email address below or check out some of my other articles. I don't earn any money from this blog, I am sustained purely by the positive feedback from you, the reader.