One of the most significant challenges older adults have to deal with as they continue to age is the alarming loss of strength that accompanies getting older. This decline in strength (especially in the lower extremities) is associated with loss of physical function, increased levels of disability, and dependence on others in later years. Therefore, restoring strength and function in senior clients’ lower extremities should be a large exercise programming focus for this clientele.
Ideally, exercise selection should focus on the most functional of movement patterns, such as deadlifts, squats, and lunges (in the ACE Integrated Fitness Training Model, this phase is called Phase 2: Movement Training). The exercises should be selected to help the client learn and improve movement patterns
with respect to his or her muscular fitness and strength-training experience. Clients with
less strength-training experience should begin with basic exercises performed with light resistance and relatively stable conditions. For example, have your client stand behind a sturdy chair or countertop and hold on with both hands while performing body-weight squats to a depth that is comfortable. In some cases, especially for lower-functioning older adults, exercise selection can begin with selectorized weight machines (such as the leg press), which utilize the basic movement patterns of exercise but provide stability and control the path of motion.
Once a client demonstrates progress with motor control and muscular strength, he or she can begin performing ground-based standing exercises that emphasize muscle integration. Traditional selectorized machines are good for isolating a working muscle, but do not promote functional movement. Therefore, the goal is to move clients away from seated and supported machines to more functional strength activities. Such exercises include a variety of deadlifts, squats, and lunges (at first with only bodyweight and then eventually with added load, such as dumbbells). As strength increases, emphasis may be placed on multiplanar movements that require higher levels of muscle integration.
The basic programming guideline in the movement-training phase is to give clients exercises to help them develop proper control and adequate range of motion while performing basic movements. The timeframe for movement training could be two weeks to several months, depending on each client’s initial level of movement ability and his or her rate of progression.
Two to three days per week is adequate for the beginning stages of a movement-training program. Considering that many older clients who are deconditioned will also be engaging in regular cardiorespiratory training, a frequency of two days per week may be a more appropriate recommendation.
Initially, the goal in this phase is to focus on coordination and muscular conditioning for
the basic movement patterns. Thus, clients should not use any external load while learning
to perform the movement-pattern exercises properly. After the client has shown appropriate control along the kinetic chain during movement-pattern training, the intensity can be progressed to include added resistance. The rate at which an older client will progress is dependent on each individual’s current level of fitness and ability to learn new motor skills (e.g., one client might be ready to add resistance to movement-pattern training after two exercise sessions, whereas another client might need two weeks of consistent exercise training before he or she is ready to increase the intensity by adding load). When adding load to movement-pattern training, start with a light resistance that allows clients to learn proper movement techniques and then over time progress to as high as 60 to 70% of maximum resistance.
Initially, when a client is learning a new movement pattern and using only body weight
as the training load, an appropriate repetition range is 12 to 20 repetitions. The number
of repetitions performed varies inversely with the intensity of the exercise set. That is,
fewer repetitions can be performed with a higher resistance and more repetitions can be completed with a lower resistance.