Personal Training 13c: Training elderly clients

This post is part of an ongoing series about my learning process as I train to become a personal trainer.

In this part of the series, I’m going to consider how to put together a personal training programme, which is essentially a large part of the deliverable that a client is actually paying for, unless you are a fantastic cheerleader and your client has zero will-power without you there to cheer them on.

And in this particular post, I’m focussing on what happens to that training programme when the client is an elderly person, which is a great follow-on from my book review of Blue Zones, yesterday, which was about longevity.

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My course notes

My course notes have the following observations about what happens as we age:

• Bone density – bone density reduces, which increases the potential for osteoporosis.
• Cardiovascular function – cardiovascular function and aerobic power decreases by approximately 5ml/kg ml per decade.
• Muscle – ageing brings about a loss of lean muscle tissue and an associated reduction in muscular strength.  This is largely as a result of the reduction in the body’s production of anabolic hormones.
• Metabolism – the metabolic rate begins to decline by 1% per year and this alters body composition.
• Flexibility – muscles become less flexible as a result of the process of fibrosis.  Fibrosis results in a greater quantity of fibrous tissue forming within the muscle.  This reduces its elastic properties.
• Height – the cartilage in joints is unable to retain the same amount of water and this causes the length of the spine and limbs to shorten.
• Stored water – the body’s stored water is reduced.  The loss of water from the brain and skeletal muscles impairs motor skills as water is used to ensure conductivity of the neural impulses.
• Sweat glands – the atrophy of sweat glands reduces the ability of older adults to regulate body temperature.
• Blood pressure – blood pressure rises in older adults, which is usually caused by a hardening and a narrowing of the arteries.
• Neurotransmission – a reduction in the production of neurotransmitters impairs motor skill function, particularly balance and reaction time.

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So how do we take these factors into consideration?

Well, I will spare you the commentary in my course notes and cut to the chase.  Here are my thoughts about what I will do…

• Bone density – as Jason Nunn at Elite FTS notes in his article about training females, which also discusses osteoporosis, the key here must be to progress safely towards heavy compound exercises that focus on spinal loading, such as front and back squats and deadlifts (sumo, conventional and trap bar).  I had not considered plyometrics, as he does, and I expect I would have to be feeling very brave before I did…
• Cardiovascular function – clearly, impaired cardiovascular function is not to be desired and we need to take it into account before we start increasing workload with elderly clients, but I don’t see it being a significant factor that needs addressing from the outset.  I would hope that it would come with increased workload over the course of time.
• Muscle – I am a complete convert to the message of Biomarkers.  I believe that increasing the muscle mass of elderly trainees will produce a significant improvement in their quality of life and ability to lead a life that is normally associated the behaviours of younger people.  Indeed, such a belief is supported by research, as in this discussion paper, which notes that: “the loss of muscle mass and strength may not be an inevitable part of the ageing process but may, in fact, be more related to changes in activity patterns which accompany advancing age.”  However, as with all trainees unaccustomed to resistance training, a little goes a long way in the beginning.
• Metabolism – both aerobic exercise and resistance training have been shown to improve metabolic levels.
• Flexibility – Both a consideration for other training modalities and an issue in itself, flexibility training is always going to be an important part of any programme for an elderly client.  To address this issue, I can see my prehab/warm up section of my programme being a lot longer and slower than with other populations.
• Height - there’s not a lot I can do about height, I have discovered.  If there were something I can do, I would have done it to myself already… Seriously, though, it seems that adequate hydration may be a concern for the elderly.  Perhaps, a recommendation for drinking more water might be appropriate.
• Stored water – this is an interesting point and I wonder whether anyone has addressed it in the field.  Clearly, as above, a recommendation for drinking more water  might be useful.  However, I also wonder whether timing of carbohydrates around workouts might also be a interesting protocol for experimentation, as carbohydrates are stored in the muscles with water.  I also wonder whether creatine would help or hinder this issue.
• Sweat glands – a risk factor for training elderly clients is therefore that they cannot regulate body temperature as effectively.  Keeping them hydrated is therefore important, as is making sure that they have plenty of layers of sweat clothing so that they can aclimatise to the temperature in the gym, which will likely be slightly too cold for them if it is a proper gym.
• Blood pressure – I am a little unhappy about this in the way that it is worded but I accept that most people of a certain age will probably have abused their bodies to the point that they have narrow and hard arteries so it is most likely valid.  I would imagine that common sense probably prevails here and that doing tabata intervals is probably not a good idea…
• Neurotransmission - I found this interesting as I thought that the main reason elderly people fell was the reduction in muscular mass and strength.  Obviously, if you do stumble, however, being stronger and more stable is going to help you recover more easily.  However, I wonder whether specific stability drills and standing on one leg type skills might be worth incorporating to help mitigate against this issue.

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Just in case you missed it: the message of Biomarkers

As I mentioned above, I am a convert to the message of Biomarkers.  Biomarkers came to my attention when I spent some time reading through Clarence Bass’s articles in preparation for my top 10 posts from the desk of Clarence Bass.

Biomarkers makes the bold assertion that (disease notwithstanding), there is no reason to become frail and weak as you get old.  Biomarkers makes the claim that there is no reason to lose strength and muscle while gaining fat and that strength training is the key to achieving this.

Essentially, if you strength train, then they assert that you should be able to maintain the appearance and abilities of youth practially indefinitely.

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Interesting links

I could probably do a whole post on longevity and ageing links but I thought these two links were worth pointing out here:

1. Here’s Mark Sisson on the importance of phyiscal activity and muscle mass for ageing populations.  Mark draws our attention to some recent studies and reviews that suggest that physical activity levels are a good predictor of mortality.  Mark also notes the importance of muscle mass and discusses the best ways to build this muscle.  Whether you agree with him or not on the best ways to build muscle, he’s making some good points.
2. Here’s Dan John on the way he has adapted his training as he’s got older.  Dan John makes it clear that muscular hypertrophy is be a big concern for people as they age, as is a consideration of the tonic and phasic muscles (see my post on flexibility and Janda for more details).  Dan also emphasises the importance of sleep, fibre and water.

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Can you help?

If you already train elderly populations or maybe you are an elderly population yourself (!) then please let me know if you have any thoughts.