Friday, March 15, 2013

Thoughts On Training The Elderly

Several hundred studies have been done on what to do when training the elderly (don't hurt them, beware of balance, blood pressure medications, don't get up too fast, etc etc) so I'm not going to go over that stuff. It's pretty easy to find via a Google search, and most of it is common sense anyway.

I'm going to talk about some things that I've been doing recently with one of my elderly clients (she is 86 year old Holocaust survivor). This client is an extremely active woman who still takes public transportation around town and does some guest lectures at various schools. As a result, I want to make things as applicable and specific to hear as possible.

What are some considerations you need to take with older folks? Balance, coordination, range of motion, strength and bone density. I make sure that each session involves something to address all of the above.

My clients mobility isn't great, so there are some things that I just won't do with her. Her posture isn't great and she has a poor overhead position. As such, we don't do anything overhead. "But its a valuable movement pattern" you'll say; true, but it's not a risk I need to take with a woman of her age. We do some mobility drills to help with that pattern, but I've decided that the amount of time we'd need to spend on mobility to see any significant results isn't exactly worth it. Simply put, there's other things that will be better for her.

I think that balance and strength, especially in older people, are directly related. The inability of an 80 year old to hold themselves on one leg is most highly correlated to the fact that the muscles involved in that action aren't strong enough to complete it. Sure, there is a neurological reason that is beyond my ability to explain, but I truly believe that it's strength related. As a result, I want to get her stronger.

Just like any other client, I believe it's worthwhile to focus on the basic human movements in whatever ROM is possible. This client has a knee with very little cartilage left, but no pain during movement. As such, I ask her to squat (de-loading her body with a TRX) nearly every time I see her because she needs to be comfortable in that pattern. We recently started doing a dumbbell deadlift to help strengthen her posterior chain and to get her comfortable when hinging. We also done a fuckshit ton of pulling/scap-retraction work to help with her upper-back, and some uni-lateral cable pressing as a double core/press exercise. A 6th basic human movement that Dan John has talked about also comes into play often with this client: getting up off the floor. Every session involves an exercise that requires her to get up and down off the floor. Even a simple plank will require this action of her, which means that in the horrible situation (knock on wood) that she does fall, she will be able to get herself up off of the floor.

The most important aspect of training an elderly client, in my opinion, is the improvement to bone density that you can hopefully help to incur. Anytime you can help to strengthen the long bones of an older client, you're doing them an amazing service. The best way to achieve this is with weight bearing exercise, and the best way to do that is axially (from the top down). My favorite way to do this is with loaded carries. You don't have to go crazy with the loading, but every little bit helps. I believe that this is the single most important exercise you can do with a person of this age. With this one exercise (and its multiple variations) you load them axially, you challenge their core stability and teach them to brace, force them to stabilize their pelvis and allow them to improve one of their activities of daily living.

In short, it's a hell of an exercise. If you train or work with an older population, I feel very strongly that this is an exercise that must be in your programming.

I hope this was a helpful post! Thanks for reading; have a great day and go lift some heavy shit!

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