copyright © 2010 delmar, cengage learning. all rights reserved. chapter 3 resistance-training...

Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Chapter 3

Resistance-Training Strategies for Older Adults


Advantages of Resistance Training

• Helps modify aging patterns

• Helps stabilize health profiles– Mitigates frailty

• Helps preserve and (possibly) enhance functional capacity, vitality, and quality of life


Obstacles to Resistance Training

• Multiple chronic medical conditions

• Limited access to appropriate programs or qualified instruction

• Fear of injury

• Logistical obstacles

• Economic barriers


Prevalence of Aging

• More than 35 million Americans over age 65– Approximately 12 percent of total population

• By 2030, 70.3 million adults over age 65– More than 20 percent of population

• Older adults susceptible to frailty, disease, and dependency


Frail Older Adults Constitute

• 50 percent of all hospital care

• 80 percent of home care services

• 90 percent of all nursing home beds

• US spent approximately 66 percent of $585 billion on health care in 2000 on older adults


Physiology of Aging

• Pervasive loss of fat-free mass– Skeletal muscle

• Increases in body fat

• Cardiovascular changes


Sarcopenia

• Age-related loss of skeletal muscle mass and strength

• Progressive atrophy of skeletal tissue

• Rate of loss accelerates after age 50

• Results in functional limitations– Impaired activities of daily living


Risks of Increased Body Fat

• Predisposition to metabolic-based morbidities

• Predictor of disability, physical limitation, declining mobility/quality, and higher mortality

• Combined with sarcopenia, increases overall morbidity and mortality


Cardiovascular Changes

• Stiffening of large central arteries

• Heart exerts more effort– Pushing blood downstream

• Increased cardiac workload causes:– Exercise intolerance

– Increased susceptibility to instability


Inflammation

• Caused by many non-cardiac diseases– E.g., chronic obstructive pulmonary (COPD),

infections, arthritis

• Detriment to functional capacity in elderly

• Visceral fat common source of systemic inflammatory peptides


Benefits of Resistance Training

• Allays muscle weakening/atrophy– Can stimulate muscle growth

• Reduces body fat, inflammation, and catabolism

• Increases function


Benefits of Resistance Training

• Diminishes frailty

• Preserves and/or restores more youthful, generally healthier physical profile


Positive Impact on Aerobic Power

• Facilitates increases in overall physical activity

• Enables safe initiation of physical activity

• Increases posture, joint stability, balance, flexibility, and bone strength

• Improves capacity for activities of daily living


Positive Impact on Sarcopenia

• Increases fiber size

• Increases muscle mass and intrinsic strength

• Mitigates oxidative stress

• Increases protective heat shock proteins

• Contributes to pattern of increased overall activity that reduces ambient inflammation


Positive Impact on Body Fat

• Fat reduction

• Increased muscle mass leads to higher levels of physical activity

• Reduced visceral fat mitigates associated risks for insulin resistance and hypertension


Positive Impact on Body Fat

• Enhanced insulin sensitivity in skeletal muscle decreases inflammation and helps weight loss


Other Positive Impacts of Resistance Training

• Bone mineral density– Increased muscle strength stimulates bone homeostasis

• Helps mitigate osteopenia

• Vasculature– Beneficial to vascular health


Training Goals for Frail Adults

• Slow progression of weakening/disability

• Regain capacity for activities of daily living

• Emphasize safety and behaviors conducive to long-term progression



• Begin with basic, simple movements– Warm-up and stretching

– Instruction on balance and breathing

– Low-intensity resistance using body weight

– Short sets• One to two sessions per week



• Advanced– Add resistance tubing, ankle weights, and other weights

over time

– Increase repetition number before resistance


Training Goals for More Robust Adults

• Include strategies to achieve maximum increases in muscle mass, muscle strength, and function

• High-intensity regimens achieve beneficial muscle and metabolic changes

• Benefits among men and women similar


Exercise Prescription Strategies for Older Adults

• ACSM guidelines use Borg scale of perceived exertion

• Intensity ranges from 12 to 19, two to three days per week, up to one hour

• Older adults can maintain these goals with key refinements– Particularly when frail



• Robust older adults can begin at lower intensities of 12 to 13 and then advance to 15 to 16

• Frail adults may advance to intensities of 12 to 13



• Emphasize muscles in lower and upper extremities that facilitate standing, walking, lifting, and reaching


Exercise Choices

• Exercise machines– Provide greater safety

– Make it easier to control ROM


Exercise Choices

• Free weights– Offer greater accessibility

– Provide cost advantages

– Require thorough teaching and monitoring

– May be difficult for frail older adults


Factors Influencing Exercise Prescription

• Time of day

• Proper clothing and footwear

• Appropriate warm-up and cooldown

• Static stretching for each muscle group

• Proper breathing– Avoiding/Minimizing Valsalva maneuver



• Rhythmic movements performed at moderate-to-slow, controlled speed through full ROM

• Supervised training of proper technique

• Length of sessions– Begin with short sessions

– Only advance as stamina/comfort increase



• Use of unilateral movements to increase balance and decrease total amount of work

• Allowance for rest, as needed

• Use of Borg scale to gauge exercise intensity


Effects of Cardiovascular Diseases on Exercise Prescription• Program must include:

– Clinical assessment

– Coordinated care with primary physician

– Monitoring

• Does not preclude participation in program


Effects of Cardiovascular Diseases on Exercise Prescription• Typically safer than aerobic training due to

slower heart rate

• Contraindications– Signs/Symptoms of unstable cardiac conditions


Barriers to Resistance Training

• Fear of precipitating cardiac event or causing injury

• Embarrassment over incontinence or lack of skill

• Apprehension caused by hearing/visual impairments, cognitive slowing, and economic constraints


Barriers to Resistance Training

• Lack of transportation

• Poor nutrition

• Lack of sleep

• Muscle soreness– Causing fear or apprehension


Overcoming Barriers

• Requires stepwise, individual approach

• Apprehension– Education to prevent injuries

– Seated exercises to help prevent falls


Overcoming Barriers

• Sensory impairment– Visual aids and signs with large fonts

– Consistent room organization

– Proper lighting

– Loud and clear manner of speaking


Overcoming Barriers

• Economic– Most challenging barrier to overcome

– Classes offered in senior centers• Help with transportation issues

• Low-cost transportation options often unavailable to older adults


Home-Based Exercise

• Unsupervised

• “Exercise & Physical Activity: Your Everyday Guide from the National Institute on Aging”


Home-Based Exercise

• Barriers to success:– Frail adults require personal instruction

– Periodic reassessment necessary

– Lack of emergency care


Community-Based Exercise

• Occurs in health or fitness center

• Supervised

• Social


Advantages of Community-Based Exercise

• Incorporates components of assessment, monitoring, and safety

• Social reinforcement means higher adherence to routine

• Achieves significant increases in lean mass and muscle strength

• Better suited for frail older adults


Successful Resistance Training

• For older adults, requires:– Social support and positive reinforcement from friends,

family, and physician

– Comprehensive management strategy to maximize recruitment, increase teaching and safety, increase motivation, and minimize attrition

• Review sample 24-Week Program

copyright © 2010 delmar, cengage learning. all rights reserved. chapter 3 resistance-training...

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