Working with the older client: Part 1 by Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, AMS

Introduction According to the 2012 Census, people over the age of 65 make up almost 14% of the US population. That means there are over 43 million seniors (adults 65 or older) today, with the numbers continuing to grow, reaching 70 million by 2030. This aging population creates a unique opportunity for the fitness professional to work with. In this article, we will review the effects of aging on the musculoskeletal system, learn simple functional assessments and understand benefits of strength strengthening. In part 2, strength training guidelines and programming for common aging conditions will be discussed. Effects of Aging on the Musculoskeletal System The aging process is accompanied by both structural and functional changes of numerous systems of the body. Research has shown that skeletal muscles with age, specifically type II, there is a loss in these fibers, they atrophy over time, and decrease in size (Brunner et al. 2007). Research has consistently shown that muscle strength decreases with age(Lindle RS, Metter E. 1997). Physiologically it has been studied that maximal strength capacity reaches a peak sometime around the second or third decade of life, and by the fifth decade, begins a gradual decline(Peterson et al. 2010). The strength of people in their 80s is about 40% less than that of people in their 20s(Chiung-Ju Liu, 2011). The decline in muscle strength is associated with an increased risk of falls and physical disability in older adults. Functional assessments of older client Balance tests Assessing an older client’s balance needs to be objective and not guesswork. There are many tests available, but few are objective, measureable, and supported with research as the timed up and go test and the sit to stand test. 1)Timed Up and Go Test Use a standard armchair. Place the line ten feet from the chair. The score is the time taken in seconds to complete the task. The subject is encouraged to wear regular footwear and to use any customary walking aid. No physical assistance is given. Have the subject walk through the test once before being timed, to become familiar with the test. To test the subject, give the following instructions: • Rise from the chair • Walk to the line on the floor (10 feet) • Turn, return to the chair • Sit down again Scoring: Persons who take 10 seconds or less to complete this sequence of maneuvers are at low risk of falling. Persons who take >20 seconds to complete this sequence are at high risk of falling. 2)Sit to stand test Have the client sit with their back against the back of the chair. Ask the client to stand from the seated positing, counting each stand aloud so that the client remains oriented. Stop the test when the patient achieves the standing position on the 5th repetition. Age Time(seconds) 60-69 11.4 70-79 12.6 80-89 14.8 Scoring-Age Norms: Benefits of Strength Training For Older Adults for function There are numerous benefits of strength training for the older adult client. Because large muscle groups, including shoulders, arms, trunk, hips and legs, are important to perform activities of daily living(ADLs) and are susceptible to the aging process, training should targets these muscle groups. The latissimus dorsi muscle (assists with sit to stand). Glute maximus is a primary hip extensor muscle involved in walking and climbing stairs. The hamstring muscles are important in flexing the knee and extending the hip, which are involved in everyday activities such as walking, sit to stand, and negotiating stairs. Glute medius and minimus muscles are lateral stabilizers that are important for getting in and out of bed or car or stepping into a bathtub. Strength training physiologically improves strength of bones and connective tissue, size of fast and slow-twitch fibers, reduces blood pressure, improves blood flow with many more benefits. Research has shown specifically that strength training improves gait mechanics(Persch et al. 2009), reduces the risk for falls in the elderly (Karlson, MK et al. 2013, Trombetti, A et al. 2011, Sherrington et al. 2008 & Zhen-Bo, Cao, et al 2006). Summary Aging is inevitable. Falls can be prevented. Arming yourself with more knowledge about the body will enable you to help your clients’ age gracefully reaching optimal health.