By Jennifer Green, B.S.

Jennifer Green, NCHPAD Visiting Information Specialist

When training older adults, there are barriers that fitness professionals must work to address. Self-efficacy, attitude, discomfort (both physical and with environment), fear of injury, ataxia, disability, illness, and cognitive decline are all challenges we must help our clients overcome in order to receive the benefits of a regular exercise program. So how do we get past these barriers? This article focuses on my personal experience working with the aging population and one individual in particular. I'll discuss my experience as well as that of the client's and how we worked to overcome some common obstacles.

When I first moved to the Chicago area to get my master's degree in clinical exercise physiology from Benedictine University, I began working at a place called Villa St. Benedict (VSB). Within this retirement community, Benedictine's Master of Science in Clinical Exercise Physiology program runs the Performance Enhancement Center (PEC). I began working there with other students in my program as exercise specialists, where our job was to create and implement exercise programs for the residents who wished to begin one. Many of the residents had barriers to overcome, which is where creative programming and understanding of exercise physiology came into play.

Margaret was one of the first residents I worked with at VSB. She had previously fallen and done severe damage to her left hip, humerus, and glenohumeral joint. This injury led to several impairments in her left shoulder and arm, including pain during both motion and rest, decreased ROM, decreased arm swing during gait, general muscle weakness, and poor endurance in the glenohumeral muscles. Margaret was unable to reach overhead, behind the head, out to the side, and behind the back with her left arm. She also had difficulty with flexion and abduction of the shoulder joint. Other limitations included difficulty in lifting heavy objects and limited ability to sustain repetitive activities. However, Margaret was able to perform flexion and extension of the elbow joint.

After learning about the condition, it is then important to learn about the client and understand his or her goals and fears about beginning an exercise program. Margaret's fears included fear of further injury, pain associated with movement of the injured area and not being able to regain movement of the joint she had previous to her injury. Our goals for Margaret included maintaining mobility of joints, regaining shoulder mobility, minimizing muscle atrophy, improving strength, endurance and stability of the shoulder girdle, and improving general balance and stability. According to Margaret, her main goal was just to 'get back to normal.' The training program consisted of cardiovascular and strength training as well as exercises to work on balance, stability, and ROM. In order to improve both strength and ROM, we chose activities using a weighted bar, performing exercises such as medial lifts, chest presses, and right-to-left movements while holding on with both hands and in a seated position. Also, to improve range of motion, we used an overhead pulley system for assisted elevation of the arm as well as arm swings with a light dumbbell. Margaret also worked on gait patterns and balance training in order to increase confidence in walking. In addition, she enrolled in a Fallproof! Balance training course offered through the PEC. We used low weights and high reps in order to prevent further soreness and promote endurance. Weighted objects were used to prevent further muscle atrophy and promote increased ROM.

Margaret was very determined and dedicated to her exercise program and attended 6 days per week. While some days were harder than others, the frustration and pain from her injury as well as the encouragement from PEC staff often seemed to motivate her to continue to push herself harder. She has improved tremendously since she started her program, and while not gaining full range of motion in her shoulder, she still continues exercising and working toward her goals.

Margaret's experience is like many in this population. There is fear of further injury, overcoming the discomfort, and working against disability, that all must be overcome. In order to fight these barriers as well as others, as exercise professionals we can do several things:

• Promote the positive personal benefits of exercise and identify enjoyable activities for that individual.
• Come up with creative and specialized exercises that will work with the disability instead of against it.
• Start the program slowly.
• Provide encouragement.
• Vary intensities and range of activities that individuals can match to their varying energy levels.
• Incorporate exercise into a daily routine.

All older individuals benefit from exercise regardless of whether or not an injury is present. Benefits from exercise in older adults have been well documented and include improvements in cardiovascular, metabolic, endocrine, and psychological health. Regular exercise and/or increased aerobic fitness are associated with a decrease in all-cause mortality and morbidity in this population.

Sources:

Kisner, C., & L. A. Colby. (2002). Therapeutic exercise foundations and techniques. Rep. No. 4. Philadelphia: F.A. Davis Co.

Nied, R. J., M.D., & B. Franklin, Ph.D. (2002). Promoting and prescribing exercise for the elderly. American Family Physician, 65(3), 419-26.