FITNESS TRAINING FOR OLDER PEOPLE COURSE Acknowledgments Writers: Sarina Lococo, Sarah Loh, Rob Aughey, Adele Moses The authors wish to acknowledge the extensive use of material from the following resources: § Council of the Ageing (COTA) § Australian Institute of Education & Training – Canberra Campus § Human Kinetics Text, numerous diagrams and activities have been incorporated from these resources, either unchanged or contextualised into the sport and recreation industry. Fitness Training for Older Adults Course – Student Manual 2005 Edition © 2005 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission. Requests and inquiries concerning other reproduction and rights should be directed in the first instance to: YMCA Australian Institute of Education & Training ­ YMCA Fitness Training – Victorian Campus. The views in this version of the work do not necessarily represent the views of YMCA Australian Institute of Education & Training. Inquiries concerning the manual should be directed to: YMCA Fitness Training Level 1, 152 Plenty Road, PRESTON, VIC 3072 Ph: (03) 9480 1177 Fax: (03) 9480 3699 Email: [email protected] Victorian YMCA working in partnership with COTA.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 1 FITNESS TRAINING FOR OLDER PEOPLE COURSE Contents Page: INTRODUCTION Council of the Ageing (COTA) YMCA Page 4 Page 4 Page 4 COURSE INFORMATION Aim Objectives Course program Fitness Instructor qualification and recognition Page 5 Page 5 Page 5 Page 5 Page 5 IDENTIFYING OUR CLIENTS Older adult Definitions of ageing Venues and facilities Communication and instruction Page 6 Page 6 Page 6 Page 7 Page 8 REVIEW EXERCISE SCIENCE Page 10 Anatomy Page 10 Physiology Page 20 Energy Systems Page 25 Physiological responses to exercise Page 26 Exercise and environmental conditions Page 28 Biomechanics Page 32 Movement analysis Page 32 Age associated physiological and biomechanical changes Page 36 UNDERSTANDING OH & S AND LEGAL AND ETHICAL RESPONSIBILITIES Occupational Health & Safety (OH & S) Legal and ethical limitations of a fitness trainer of older adults Page 39 DEVELOP FITNESS PLANS FOR OLDER ADULTS The importance of physical activity Exercise and older adults Health appraisals Establish regular review sessions Page 42 Page 42 Page 43 Page 46 Page 47 FITNESS TESTING FOR OLDER ADULTS Resting blood pressure Resting heart rate Waist to hip ratio Body Mass Index (BMI) General muscle strength Flexibility Static balance Dynamic Balance Aerobic endurance Page 49 Page 52 Page 53 Page 54 Page 54 Page 55 Page 55 Page 55 Page 55 Page 55 ESTABLISH EXERCISE FREQUENCY, DURATION AND TYPE Endurance exercise Strength training Balance exercise Flexibility exercise Contraindications to exercise Page 56 Page 56 Page 56 Page 57 Page 58 Page 58
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 Page 39 Page 39 2 FITNESS TRAINING FOR OLDER PEOPLE COURSE MODIFYING EXERCISES TO INCORPORATE PHYSICAL CHANGES Page 59 THAT OCCUR WITH AGEING Flexibility Training Page 59 Resistance Training Page 60 Aerobic Endurance Training Page 60 Balance and Mobility Training Page 60 MODIFYING EXERCISES TO INCORPORATE THE SOCIAL AND PSYCHOLOGICAL CHANGES THAT OCCUR WITH AGEING Psychology of ageing The social and psychological benefits of exercise Understanding motivational psychology Modifications to exercise plans and programs Provide positive and effective feedback Page 61 EXERCISE GUIDELINES FOR THE OLDER ADULT Conditions commonly associated with ageing Design and implement an exercise class for a group in consultation with medical advisors and allied health professionals Identify relevant OH & S issues Page 66 Page 66 Page 66 APPENDIX 1 APPENDIX 2 APPENDIX 3 APPENDIX 4 Page 67 Page 68 Page 69 Page 70 REFERENCES Page 70
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 Page 61 Page 62 Page 63 Page 65 Page 65 Page 66 3 FITNESS TRAINING FOR OLDER PEOPLE COURSE Introduction COTA – Council of the Ageing Council of the Ageing (COTA) has a 50 year history of promotion of recreation and sport for people over the age of 50. During the 90’s COTA became increasingly aware and concerned with the lack of strength for older people, and the impact this lack of strength has on their activities and daily living, health and quality of life. This work was further enhanced by research at RMIT on ‘Strength Training Adaptations in Postmenopausal Women’. In 1999 COTA and RMIT entered into a partnership for the purpose of increasing the number and quality of opportunities available for people over the age of 50 to participate in strength training programs. The funding for this project was obtained through Victorian Health Promotion Foundation and the Department of Human Services, under the “Positive Ageing Grants”, as part of the International Year of the Older Person. This partnership then went on to investigate the Fitness Industry regarding; § Activities available to older people § The cost, supervision levels and staff qualifications § Promotion procedures § The level of understanding of the benefits of strength training § The concerns and requirements of older people to take on strength training. The data collected from this investigation of the Fitness Industry and Older People, informed the development of LLLS Endorsement scheme. The Scheme was then taken to the Fitness Industry and Community Health Sectors for implementations in 2002. YMCA In Australia, early settlers founded branches of the London YMCA. The Adelaide branch of the London YMCA opened on the 15th March 1851. In 1853, Melbourne and Sydney appeared, followed by Hobart in 1854. Melbourne was the first Victorian YMCA commencing in 1853, followed rapidly by Geelong, Ballarat and Bendigo. The initial focus of the YMCA was on the physical, intellectual, and spiritual development of young men. The YMCA of 2005 is an organisation which builds strong people, strong families and strong communities. We have now expanded throughout the state, and involve people of all ages and abilities. Our purpose remains focused on the development of individuals and communities in body, mind and spirit. In Victoria we manage over 150 facilities and employing over 4,500 staff. Our work is delivered by our sixteen independent member Associations working in collaboration with the State Council. We do this by: ∙ Promoting the development of strong Associations through improved governance, management and systems ∙ Fostering collaborative programs, projects and services. ∙ Direct delivery of YMCA programs and services through our core service areas: § Community Programming (aquatics, recreation, fitness, sport) § Community Services (children, youth, juvenile justice, families, and disability services) § Student Accommodation § Camping and Outdoor Education ∙ Leveraging the impact of the YMCA through profile raising and community education ∙ Advocacy in State and National forums. The YMCA is also an RTO known as ‘YMCA Australian Institute of Education and Training’ with branches in Victoria, NSW, South Australia and Queensland. In Victoria the YMCA campus is ‘YMCA Fitness Training’ where courses are developed and delivered to the Fitness, Sport and Recreation industry.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 4 FITNESS TRAINING FOR OLDER PEOPLE COURSE Course Information Aim: The aim of this training program is to increase the quantity and quality of strength training available for people over 50 years of age by: § Creating multiple pathways and access for older people to confidently participate in safe, sustainable and inclusive training programs § Addressing ageist myths and attitudes that a re commonly accepted by older people and the community, that include decrepitude and decline is an inevitable part of the ageing process and the negative stereotyping associated with strength training for older people. § Successfully promoting the benefits of strength training to older people, the general community, the health sectors and fitness industry. § Providing training and educational resources to create responsive and skilled Strength Training Instructors. Objectives: § § To provide Fitness Instructors with the knowledge to plan and deliver fitness and strength programs for older people safely and effectively. To train Fitness Instructors in the practical skills of program delivery for people in the community and aged care setting. Course Program: This training course program consists of 2 classroom sessions with 16 contact hours. There is a written exam consisting of 50 multiple choice questions. The final assessment consists of practical hours within a fitness facility, rehabilitation, aged care, allied health or hospital working with older adults. The practical assessment requires you to do the following: § Design a fitness testing protocol for a specific older client § Design an initial fitness plan based on fitness testing results for an older client § Deliver the fitness plan to the client under supervision of a workplace facility The due date of the practical assessment is due no longer than one month from end of course. This course has 15 CEC’s. Fitness Instructor Qualification: Seek advice and direction from COTA about this
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 5 FITNESS TRAINING FOR OLDER PEOPLE COURSE The reference text for this section is Physical Activity Instruction of Older Adults written by C. Jessie Jones and Debra J.Rose, published by Human Kinetics. Identifying Our Clients Older adult:
· Heterogenous group
· Defined as 65+ in most countries
· In Australia 12% of total population­ over 25 % of this group is aged 80 and over
· Majority of older pop 65+ are women (57%) Definitions of ageing: CHRONOLOGICAL AGEING
· definition based on a person’s years from birth
· most common indicator used BIOLOGICAL AGEING
· refers to physical changes that reduce the efficiency of organ systems such as lungs, heart & circulatory system
· there are several theories of biological ageing e.g. genetic, damage & gradual imbalance FUNCTIONAL AGEING
· refers to a person’s ability to function in their activities of daily living USUAL AGEING
· refers to the way most people age and is characterised by a gradual decline in body, leading to physical impairments, disease, functional limitations , disability and eventually death. PATHOLOGICAL AGEING
· refers to the way individuals age who are genetically predisposed to certain diseases or who have high­ risk negative life­styles (e.g., smoking, excessive alcohol abuse, poor eating habits) SUCCESSFUL AGEING
· is a qualitative description of ageing rather than one that refers to longevity or survival
· have better than average physiological and psychological characteristics in later life
· healthy genes
· more satisfied with life in general
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 6 FITNESS TRAINING FOR OLDER PEOPLE COURSE Venues and facilities: The recognized value of physical activity in preserving functional capacity and reducing physical frailty in later years, combined with the support of the medical community, has resulted in numerous senior fitness and physical activity classes springing up in various facilities (e.g., senior centres, hospitals, recreation departments, health and fitness clubs, churches, community centres, retirement communities, long­term care facilities). Because of the varied functional ability levels of older adults, it is important to be aware of the target population (e.g., community –dwelling, able older adults versus homebound or institutionalised frail older adults) and to develop activity programs to meet the specific needs of that population.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 7 FITNESS TRAINING FOR OLDER PEOPLE COURSE Communication and instruction: Types of communication • Intrapersonal communication ­ Communication we have with ourselves • Interpersonal communication ­ Verbal communication between two or more people • Nonverbal communication ­ Physical appearance ­ Posture ­ Gestures ­ Body position ­ Touching ­ Facial expressions ­ Body sounds ­ Voice characteristics – tone, emphasis, tempo, inflection Communication Styles • Telling a client • Advising a client • Manipulating a client • Counselling a client Purpose of communication Although the same process occurs in all communications, the purposes of the communication can vary. You might communicate to: • Persuade a person that they can lose weight by exercising regularly • Evaluate how well a gymnast performs her routine on the balance beam • Inform students on how to perform a new volleyball skill • Motivate your team to psyche up for a tough opponent • Solve problems dealing with a conflict between two of the players on your team Barriers to communication • Preoccupation • Hostility • Charisma • Past experience • Hidden agenda • Physical environment • Stereotyping • Defensiveness What makes a good instructor? A number of factors are related to and predictive of instructor effectiveness. These include client compliance, client satisfaction, and individual and program outcomes. The single most important variable is the leadership skills of the instructor, especially the ability to develop a positive relationship with clients or participants. This can be accomplished by having a genuine desire to help clients by being inspiring, establishing trust and helping to improve clients wellbeing.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 8 FITNESS TRAINING FOR OLDER PEOPLE COURSE RESPONSIBILTY­ A physical activity instructor must fulfil a number of responsibilities when working with older adults:
· · · · · · · · · Following recommended physical activity guidelines
Being on time for appointments and classes
Updating all safety and emergency skills regularly
Knowing each client’s personal health, fitness and mobility status
Conduct periodic assessments and provide client feedback
Be straightforward about what exercise can and cannot do­ i.e., realistic goals
Keep confidential, up­to­date client records
Control emotions by being calm and clearheaded in times of high stress, crisis or emergencies in classes
Manage your own personal stress, and leave negative moods out of the classroom BEING SUPPORTIVE­ Many older adults lack support from family and friends and an instructor can help in a number of ways:
· · · · In every class have at least one verbal exchange with every participant
Emphasize the positive aspects of physical activity­this helps those who have had negative experiences with exercise
Contact participants who have been absent for few classes to see if everything is OK
Utilize the talent and experience of your class participants­as people age they tend to want to give back to the world in some way and accepting their suggestions can help with their self­ esteem and self­efficacy CARE­ One of the most basic human needs is knowing that you are cared about by other people. Try to make everybody feel like “somebody”. Be careful of certain personality types (see Appendix 1) especially hoarders, soloists, sirens and talkers, because they tend to monopolize your time. COMPASSION­ Compassion involves being empathetic or having the ability to appreciate another person’s suffering. You can express compassion in the following ways:
· · · Listen to worries, pains, concerns and losses of your clients but do not encourage long­term self­pity
Allow beginners to be beginners­people learn at different rates and they should not be made to feel less than perfect
Remind participants to listen to their own bodies and not to worry about what anyone else is doing – they need to do what is right and safe for them OTHER CHARACTERISTICS OF A GOOD INSTRUCTOR OR LEADER
· Uses positive reinforcement
· Has a positive attitude
· Awareness
· Is enthusiastic
· Respect
· Is creative
· Is flexible
· Is competent
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 9 FITNESS TRAINING FOR OLDER PEOPLE COURSE Review Exercise Science Musculoskeletal Anatomy: Skeletal anatomy o “Osteo” n Means bone n “Osteology” is the study of bone o Bone n Type of connective tissue o Skeletal system n Includes bone, cartilage, ligaments & other connective tissues o Function of the skeleton: n Support n Mineral / energy storage n Blood cell formation n Protection n Leverage o Responses of bone: n Weight bearing exercise n Low dietary calcium n Age o Bone mineral density (BMD) goes up with weight bearing exercise (at any stage of the lifespan – assuming good supply of calcium) o BMD goers down with low calcium, and age
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 10 FITNESS TRAINING FOR OLDER PEOPLE COURSE Major bones of the body Bony markings: o Tuberosity n A large tubercle or rounded elevation o Crest n A ridge o Trochanter n One of two processes near the head of the femur, the outer being called the great trochanter, and the inner the small trochanter. o Tubercle n A prominence o Epicondyle n A bony projection on the inner side of the distal end of the humerus o Spine n A stiff, sharp­pointed structure o Facet n A smooth circumscribed surface o Condyle n A rounded articular surface at the extremity of a bone o Meatus n A natural passage or canal o Sinus n A notch, depression or cavity o Fossa n A pit, groove, cavity, or depression o Fissure n Any cleft or groove o Foramen n A small opening, perforation, or orifice
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 11 FITNESS TRAINING FOR OLDER PEOPLE COURSE The structure and function of joints o A union between two or more bones n THE BONES of the skeleton are joined to one another at different parts of their surfaces, and such connections are termed Joints or Articulations. n Permit motion n Provide stability o Classification of joints n Structual o Fibrous o The bones are joined by a thin layer of connective tissue or cartilage. o There is no appreciable movement o Cartilaginous o The bones are either connected by broad flattened disks of fibrocartilage, or are united by an interosseous ligament. o Synovial o Fibrous capsule + synovial membrane o Synovial cavity contains a lubricating synovial fluid o Articular cartilage cover the ends of the articulating bones o Menisci are fibrocartilage pads between articulating bones in knee joint. o Ligaments stabilise the joint o Bursae are flattened sacs filled with synovial fluid which cushion friction points of joints o Types of synovial joints n Gliding o In a gliding or plane joint bones slide past each other. n Hinge o A convex projection on one bone fits into a concave depression in another permitting only flexion and extension n Pivot o Where one bone spins around on another bone. n Condyloid o The bones can move about one another in many direction ­ except that they cannot rotate n Saddle
o A saddle joint allows movement back and forth and up and down, bot does not allow for rotation like a ball and socket joint. n Ball­and­Socket o A saddle joint allows movement back and forth and up and down, bot does not allow for rotation like a ball and socket joint.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 12 FITNESS TRAINING FOR OLDER PEOPLE COURSE The vertebral column o o o o o Made up of 26 bones 24 vertebrae: 7 cervical, 12 thoracic, 5 lumbar Sacrum Coccyx Common features of vertebrae
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 13 FITNESS TRAINING FOR OLDER PEOPLE COURSE o Intervertebral discs n A cushion­like pad of FIBROCARTILAGE that surrounds a soft, elastic, semi­fluid center. The discs act as shock absorbers during walking, jumping and running, because they can absorb compressive shock Spinal curvatures o “Normal” o Scoliosis o Kyphosis
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 14 FITNESS TRAINING FOR OLDER PEOPLE COURSE Nervous system o Motor neurons n Neurons, or nerve cells, carry out the functions of the nervous system by conducting nerve impulses n Afferent o Neurons that carry impulses from peripheral sense receptors to the CNS. They usually have long dendrites and relatively short axons. n Efferent o Neurons transmit impulses from the CNS to effector organs such as muscles and glands. Skeletal muscle contraction
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 15 FITNESS TRAINING FOR OLDER PEOPLE COURSE o Nerve message sent from brain n In form of electrical signal – generated through movement of Na + into and K + out of cell o Message reaches neuromuscular junction o Neurotransmitter released o o o o o o o o o n Acetylcholine (Ach) Message crosses into muscle Na + enters muscle cell, K + slowly leaves Called action potential (AP) Changes electrical charge of muscle membrane, AP moves into t­tubule Triggers release of Ca 2+ Ca 2+ binds to certain proteins Enables interaction of myofibrils (actin and myosin) Muscle contracts Types of skeletal muscle contraction o Concentric n Muscle contracts and gets shorter o Eccentric n Muscle contracts and lengthens n Usually under effect of gravity o Isometric n Muscle contracts, but length doesn’t change
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 16 FITNESS TRAINING FOR OLDER PEOPLE COURSE Factors influencing muscle contraction o Length tension relationship n Isometric tension generation in skeletal muscle is a function of the magnitude of overlap between actin and myosin filaments. o Muscle fibre types n Type I or type S (slow) o Slow twitch, fatigue­resistant units with smallest force or twitch tension and slowest contraction; contain oxidative enzymes n Type IIa or type FR (fast, resistant) o Fast twitch, fatigue­resistant units with larger forces and faster contraction times; contain oxidative and glycolytic enzymes n Type IIb or type FF (fast, fatiguable) o Fast twitch, easily fatiguable units with largest force and fastest contraction; contain glycolytic enzymes o Motor unit recruitment n Motor units are recruited in the order of their size, from smallest (Type I) to largest (Type IIb)Motor unit recruitment o Force – velocity curve n Muscle force production is greatest at a slow contraction speed. This is due to the number of cross­bridges interacting. (a) FORCE
FORCE
(b) after after VELOCITY
VELOCITY o Reciprocal inhibition n In order for movement to take place – the antagonist must RELAX whilst the agonist CONTRACTS.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 17 FITNESS TRAINING FOR OLDER PEOPLE COURSE The major muscles of the body: Connective tissue o Ligaments n Connect bone to bone o Tendons n Connect muscle to bone o Refer to handouts for specific joint examples Prime Mover (agonist) Is the muscle or muscle group most responsible for producing a joint action Synergist (agonist) Is the muscle or muscle group that assists the prime mover in producing an action Fixator Muscles Are the muscles and muscle group that fixate the limb and joint around which the work is occurring. Stabilizing Muscles Are the muscle and muscle groups that contract isometrically so as to stabilize the joints away form the point of work Antagonist Muscles Are the muscles that produce the opposing joint action to the prime mover and synergist muscles. The antagonist muscles relax to allow the prime mover and synergist to product the joint action Neutralizing Muscle Are the muscles that contract to neutralize the unrequired movements of the prime mover and synergist muscles.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 18 FITNESS TRAINING FOR OLDER PEOPLE COURSE Physiology: The cardiovascular system The blood o Components of the blood: n Red blood cells n Plasma n White blood cells n Platelets o Red blood cells (Eryhtrocytes): n Large cells, with no nuclei n These cells normally make up 40­50% of the total blood volume (Haematocrit) n Contain haemoglobin (Hb) n Hb binds and carries oxygen o Plasma: n Major component of blood (salty water!) n Transports many items: o Metabolites o CO2 o Hormones o Enzymes o White blood cells (Leukocytes): n ~ 1% of total blood volume n WBC’s form part of immune system and fight infection, scavenge old RBCs or other unwanted matter in the blood o Platelets (Thrombocytes): n Clotting agent in blood
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 19 FITNESS TRAINING FOR OLDER PEOPLE COURSE The heart o A four chamber pump n Two superior atria n Two inferior ventricles n NB: Think about the direction you are looking from! o Major structural components: n Atria n Ventricles n Valves n Conduction system o The atria: n Thin wall, deliver blood to the ventricles n Right atria o filled by deoxygenated blood from 3 sources: o Superior vena cava o Inferior vena cava o Coronary sinus n Right atria o Filled by oxygenated blood from 4 pulmonary veins o The ventricles: n Thick wall, work as two separate pumps n Right ventricle o smaller workload, pumps to lungs o receives blood from rt. atria via tricuspid valve o pumps blood to pulmonary trunk via pulmonary semilunar valve n Left ventricle o larger workload, pumps systemic blood supply o muscle wall is therefore thicker o receives blood from lt. atria via bicuspid valve o pumps blood to aorta via aortic semilunar valve o The valves: n Ensure unidirectional flow of blood
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 20 FITNESS TRAINING FOR OLDER PEOPLE COURSE The cardiac cycle o Blood Circulation Circuits n Pulmonary Circuit ­ lungs n Systemic Circuit ­ whole body o Systole ­ contraction o Diastole ­ relaxation n Atria relax when ventricles contract and vice versa o Steps in a contraction n When atria fill pressure opens AV valves n Atria contraction fills ventricles completely. n Ventricles begin to contract and AV valves snap shut (LUB) n Increased contraction (inc. pressure) forces semilunar valves open n Blood flows into vessels leading away. Pressure increases and forces SL valves shut n Process begins again The conduction system of the heart Sinoatrial node Atrioventricular (AV node) Bundle of His (connects atria to ventricles) ) Left and right bundle branches Purkinje fibres (spread the depol. wave throughout ventricles)
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 21 FITNESS TRAINING FOR OLDER PEOPLE COURSE © Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 22
FITNESS TRAINING FOR OLDER PEOPLE COURSE The blood vessels o Arteries / arterioles n Large blood vessels n Thick walls n Blood transported away from heart n High pressure o Veins / venules n Transport blood towards heart n Contain valves n Action through gravity or muscle rhythmic pumping o Capillaries n Very small n Allow single blood cell through n Easy diffusion to and from tissues The major blood vessels of the body:
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 23 FITNESS TRAINING FOR OLDER PEOPLE COURSE Energy Systems: o Adenosine triphosphate (ATP) n Provides energy to enable cellular work n Energy released via removal of phosphate group ATP ADP + Pi
E
E n
n ee rr gg y n Demand for ATP - 100­fold with exercise n Pathways to resynthesise ATP: o Adenylate kinase reaction (ATP­PC system) o ADP + ADP AMP + ATP o ADP + PCr ATP + Cr o Glycolysis (ANAEROBIC) o ETC (AEROBIC) IMPORTANT: ALL THREE ENERGY SYSTEMS ARE ALWAYS IN USE THE INTENSITY AND DURATION OF EXERCISE DICTATES THE RELATIVE CONTRIBUTION OF EACH ENERGY SYSTEM © Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 24 FITNESS TRAINING FOR OLDER PEOPLE COURSE Fuel pathway Metabolic power Fuel pathway
(mmol.kg ­1 .sec ­1 ) Stores (mmol.kg ­1 ) ATP yield Metabolic (mmol.mmol ­1 ) capacity (mmol.kg ­1 ) CP breakdown 3.0 25 1 25 Total phosphagens 3.0 32 1 32 Anaerobic glycolysis 1.0 80 3 240 Glycogen oxidation 0.5 80 39 3120 Glucose oxidation 0.5 * 38 Fat oxidation 0.24 * v. large >100 © Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 unlimited 25 FITNESS TRAINING FOR OLDER PEOPLE COURSE Physiological responses to exercise Acute responses: o Cardiovascular system n The heart rate goes _______ n Blood volume _________ n Blood pressure _________ n Stroke volume __________ n Cardiac output __________ o The respiratory system n Respiration rate __________ o The immune system o The nervous system n Production of AP’s ________ n Inhibition _________
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 26 FITNESS TRAINING FOR OLDER PEOPLE COURSE Physiological responses to physical activity in various environmental conditions Exercise in Cold Ambient Temperatures Many individuals endeavour to exercise regularly, and some do not have the luxury and/or the desire to exercise indoors. Therefore, they must deal with changes in climatic conditions that can range from very hot to very cold. To safely tolerate these extremes in temperature, it is important to understand the physiological adjustments that occur with temperature. Humans are classified as Homeotherms, or organisms that are able to maintain a constant core (internal) temperature despite wide fluctuations in ambient (environmental) temperatures. Humans maintain a core temperature at approximately 37 oC ( 98.6 oF). At rest, each cell in the body produces metabolic heat that totals approximately one Calorie/min. In essence we can think of the body as a "furnace" that is constantly producing heat. PHYSIOLOGIC METHODS OF HEAT DISSIPATION Exposure to cold or heat stress initiates thermoregulatory mechanisms in the body. In very cold ambient temperatures, the body attempts to prevent excessive heat loss. In very warm ambient temperatures, the body must work at dissipating the heat to the environment, using the following methods:
· Radiation ­ At rest, radiation is the primary method of heat loss. Essentially this involves loss of heat (by electromagnetic waves) to the cooler objects in the environment, such as buildings, walls, trees, etc. The amount of radiative heat loss is influenced by a person's size, mass and body composition (amount of body fat). People who have a high body surface area to mass ratio, such as children and those who are tall and slender, dissipate more heat by radiation.
· Conduction ­ Conduction involves the heat transfer directly from one object to another. Normally this method of heat loss is not significant, unless a person is exercising in cold water (less than 60oF). Water conducts heat from the body approximately 25 times greater than air. At the same temperature, a person in water will lose heat from the body two to four times faster than in air.
· Convection ­ This method involves cooling the body by movement of molecules, such as air or water currents. As air moves, heat loss can occur as convective currents carry the heat away. Air currents at four miles per hour (mph) are about twice as effective for cooling as air currents at one mph. This is the basis of wind chill, where an ambient temperature of 10oF feels like ­29oF with the addition of a 40 km/h (24 mph) wind.
· Evaporation ­ Evaporation of sweat from the body is the major method of heat dissipation, particularly during exercise. Heat is transferred continually to the environment as sweat evaporates from the skin surfaces, producing a cooling effect. THERMOREGULATION IN COLD ENVIRONMENTS When humans are exposed to a cold environment at rest, the body attempts to prevent heat loss as well as to increase heat production. The following physiological adjustments occur: 1. Decrease in peripheral circulation ­ the body reduces blood flow to the extremities as well as the skin surface. This is an attempt to keep heat "insulated" inside the deep body tissues. Subcutaneous fat also aids in this attempt, since fat is a very good insulator. 2. Non­shivering thermogenesis ­ this is an increase in the metabolic rate caused by the release of thyroxine and catecholamines (epinephrine and norepinephrine). A greater metabolic rate generates heat. 3. Shivering ­ the rapid involuntary cycle of contraction and relaxation of skeletal muscles can actually increase metabolic rate four to five times above resting levels.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 27 FITNESS TRAINING FOR OLDER PEOPLE COURSE EXERCISE CONSIDERATIONS IN THE COLD Studies have shown that when people exercise in the cold they generally exercise at an intensity that will maintain sufficient metabolic heat to offset heat loss. Therefore, under most conditions, cold temperatures should not preclude outdoor exercise. Some exceptions exist, so it is important to consider the following before exercising outdoors:
· There is no evidence that cold temperatures adversely affect health. Even the notion that breathing cold air will cause our lungs to "freeze" is not true. Research shows that for exercisers breathing at moderate exercise intensities ­ and inhaling through the nose ­ air temperature is almost completely warmed by the time it reaches the lungs.
· However, at very high pulmonary volumes, which occur during high intensity exercise, assuming mouth inhalation, research shows that extremely cold air can cause irritation to the mouth, pharynx, trachea and even bronchi. This can be alleviated by wearing a scarf over the nose and mouth to trap water in the exhaled air; this subsequently warms and moistens the next breath.
· Although most people are able to exercise at an intensity level to maintain heat production, if fatigue sets in during a long­duration exercise session, the intensity level may drop, thereby reducing the ability to produce heat to offset heat loss. If a person is not dressed appropriately and this occurs, body temperature can drop and hypothermia (low body temperature) may result.
· Some people are more cold­tolerant, such as those who are more muscular, short or those having more body fat.
· Before heading outdoors, consider the wind chill and the effective temperature. Combining the ambient temperature and wind speed, equivalent temperatures of ­22o F or lower begin to pose danger to exercisers. If it is too cold, try to adapt your workout indoors to be safe. Clothing serves as the major barrier between skin surface and the environment. During exercise, people often perspire, and this water must be allowed to evaporate to the ambient air. If this does not occur, clothing may become saturated and accelerate heat loss, by both conduction and evaporation, causing a person to become chilled. Layered clothing is the best choice because it allows a person to add or take off items as necessary. Layers close to the body should be made of fibers such as polypropylene that can transport moisture away from the body's surface to the next clothing layer for evaporation. This second layer should be an insulating layer. On the surface, wear a jacket that acts as a windbreaker and is water repellent. Because blood flow to the extremities is decreased in very cold temperatures, it is important to wear gloves, a scarf and a hat. Thirty to forty percent of body heat can be lost through the head if it is uncovered by clothing (hat, hood, etc.). Early warning signs of cold injury include a tingling and numbness in the fingers and toes or a burning sensation of the nose and ears. Overexposure can lead to frostbite. If you feel these symptoms, move into a warmer environment immediately. With proper precautions, exercise outdoors in cold temperatures can be safe and enjoyable. Exercising in the Heat ­ Understanding Thermal Stress To exercise safely in warm environments, understanding how our bodies regulate internal temperature is very important. Humans are homeotherms, which basically means that we must maintain our internal, or core, temperature independent of the environment. People produce constant internal heat and maintain a core temperature of approximately 98.6 o F or 37o C. This internal heat must be dissipated to the environment. Without effective heat dissipation, heat accumulation can lead to illness and death. At rest, this internal heat production is rather minimal (about one calorie/min). Exercise, however, generates a large amount of body heat. During heavy exercise, heat production may increase to 10 to 20 calories/min, which necessitates a greater need for heat dissipation to prevent becoming overheated. If both the ambient temperature and the humidity are high, it becomes difficult for the body to dissipate heat ­ and body temperature may rise. If body temperature becomes too high, hyperthermia may result, along with concomitant heat related injuries, such as heat exhaustion and heat stroke. Heat exhaustion is characterized by dizziness,
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 28 FITNESS TRAINING FOR OLDER PEOPLE COURSE fainting, rapid pulse and cool skin. Heat stroke is a life­threatening medical emergency, symptomized by a high body temperature (above 106o F or 40 o C) and dry skin because sweating has stopped. In some cases of heat stroke, delirium, convulsions and loss of consciousness can occur. To prevent complications from exercising in the heat, one must understand heat dissipation though radiation and evaporation of perspiration and take precautions during exertion in a hot environment. Radiation At rest, radiation is the primary method of heat loss. Heat loss by radiation occurs by electromagnetic waves when someone is in an environment that is cooler than the body temperature. Therefore, if the ambient temperature is 60o F, and the body temperature is 98.6 o F, the body radiates heat to the environment, including buildings, trees, etc. Factors that affect heat loss by radiation include body size, mass, body composition, peripheral blood flow, clothing and colour of the skin and clothing. A person who is tall and slender has a greater ratio of surface area to mass and thereby can dissipate more heat than a person who is short and stout (even if they are muscular). For outdoor exercise, particularly in bright sunshine, light coloured skin or light clothing fosters radiation because some light waves from the sun are reflected away from light surfaces. Darker colours absorb heat, so wearing dark coloured clothing is not recommended for exercise outdoors on a warm day in bright sunlight. Evaporation of Perspiration Evaporation of perspiration is the major method of heat loss for humans, especially during exercise. People possess millions of sweat glands located just beneath the skin. When body temperature exceeds its "set­point," sweat begins to form in these glands and is secreted to the surface. As the sweat evaporates into the air, heat is dissipated to the environment. One litre of sweat that evaporates can dissipate about 580 calories of heat, producing a cooling effect. For cooling to occur, however, sweat must vaporize, or evaporate. This is hindered by the relative humidity (RH) of the ambient air. If the RH is greater than 80 percent, heat loss by evaporation will be minimal because the great amount of moisture in the air does not allow for additional evaporation of sweat from the skin. When the ambient temperature and humidity approach 90o F and 90 percent relative humidity, exercise sessions should be shortened or include frequent rest periods. Any signs of hyperthermia, such as headache, disorientation, visual distortions and flushed skin, should result in immediate cessation of exercise. Clothing also plays a role in evaporation. If a person wears plastic, rubber or other manmade fibres, sweating is encouraged. But this type of clothing does not allow moisture to penetrate, so evaporation of perspiration is inhibited ­ making heat dissipation minimal and potentially leading to overheating. Thus, when exercising outdoors on a hot day, wearing light coloured, loose­fitting clothing, such as cotton that will allow moisture to penetrate, is the best choice. Dehydration Fluid ingestion is also critical during exercise in the heat, as adequate hydration before and during exercise is one of the best ways to help prevent heat illness. For an average person, sweat loss during exercise may average about one to two litres per hour during moderately heavy exercise on a warm day. To help prevent dehydration, consuming 400 to 600 ml of cold water before exercising in the heat is recommended. During exercise, a person also must drink fluid continuously, especially because voluntary thirst does not keep up with fluid loss. By the time a person feels thirsty, he/she may have a two percent reduction in body weight, which can impair performance and lead to heat illness. The American College of Sports Medicine recommends approximately 250 ml of fluid for every 10 to 15 minutes of activity. The best fluid to offset dehydration is plain water, but any cold fluid (other than diuretics such as alcohol and caffeinated beverages) is beneficial. Taking salt tablets or substitutes generally is not advised, as most people will replenish salt through consumption of a normal diet.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 29 FITNESS TRAINING FOR OLDER PEOPLE COURSE Conclusion Exercise can be safely performed on warm ­ and even hot ­ days. Certain precautions should be taken, however, including wearing proper attire, performing a sufficient warm­up and cool down, ensuring adequate fluid intake and reducing the intensity or duration of workouts on extremely hot and humid days. Effects of Smoking A key ingredient in Cigarettes is Nicotine, amongst others. There have been a number of proven effects associated with Nicotine:
· Whilst Nicotine has been reported to have a calming effect, it is in fact a stimulant.
· It has generally been found to be detrimental and has little value to athletic or fitness performance.
· Generally, smokers demonstrate a lower Vo2 values than non­smokers.
· Carbon monoxide binds with Haemoglobin which reduces oxygen transport capacity There is an increase in heart rate, blood pressure, and autonomic reactivity. Other noted changes include vasoconstriction, decreased secretion of anti­diuretic hormone and catecholamines, and increased blood lipid levels, plasma glucose, glucagons, insulin, and cortisol. (The above information has been obtained from the Life Fitness Resource database)
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 30 FITNESS TRAINING FOR OLDER PEOPLE COURSE Biomechanics and Movement Analysis: Concepts and principles of mechanics Levers o A simple machine n Consists of two forces acting around a supporting force which provides a pivot point n Applied force n Fulcrum or pivot point n Resistance Resistance Applied force Effort arm Resistance arm axis
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 31 FITNESS TRAINING FOR OLDER PEOPLE COURSE o Classes of levers n Class One o Applied force and resistance on opposite sides of pivot point n Class Two o Forces act on one side of the axis (effort is always less than the resistance) n Class Three o Forces act on one side of the axis (effort always greater than the resistance) o Mechanical advantage: n The use of a lever to increase force, change the direction of the force or gain distance
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 32 FITNESS TRAINING FOR OLDER PEOPLE COURSE Movement definitions: n Flexion o Is a bending movement that decreases the angle of the joint and brings the bones closer together o JOINT ANGLE DECREASES n Extension o Involves straightening the joint o JOINT ANGLE INCREASES n Dorsi flexion o Move toes towards the shin n Plantar flexion o Move toes away from shin n Abduction o is the movement of a bone away from the midline of the body n Adduction o is the movement of a bone toward the midline of the body. n Circumduction o a combination of abduction/adduction and flexion/extension n Rotation o left or right rotation of bone on an axis n Supination o turn palm of hand face up n Pronation o turn palm of hand face down n Inversion o inward rotation of the sole of the foot.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 33 FITNESS TRAINING FOR OLDER PEOPLE COURSE n Eversion o outward rotation of the sole of the foot. n Protraction o forward movement away the midline of the body n Retraction o backward movement toward the midline of the body n Elevation o raising n Depression o lowering Mechanical concepts modeling human motion o Gravity n Force acting on an object as a result of the centrifugal force of the earth (gravitational pull) o Centre of mass n the centre of mass of an object is the point located at the object's average position of all the particles of mass that make up that object o Inertia n the tendency of a body to maintain is state of rest or uniform motion unless acted upon by an external force o Force and momentum n the physical influence that produces a change in a physical quantity n the product of a body's mass and its velocity; o Force production by the body n muscular contraction n resisting gravity
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 34 FITNESS TRAINING FOR OLDER PEOPLE COURSE Age associated physiological and biomechanical changes: Although ageing leads to a decline in the function of most body systems, much of this decline is preventable or reversible through participation of physical activity. From the age of about 30 physical activity levels decline and with prolonged inactivity contributes to the progressive decline in body functions. Chronic diseases are also a major cause of physiological deterioration with age. Participating in regular activity has been shown to delay the normal ageing process by 10 to 20 years. Important functional changes associated with ageing in sedentary older adults ▪ A decrease in peak oxygen transport of 5 ml ∙kg‾¹∙min‾¹ per decade between the ages of 25 and 65 years ▪ An increase in body fat ▪ Decreased glucose tolerance ▪ Deterioration of blood lipid profile ▪ A 25% decrease in peak muscle force and lean tissue from age 40 to 65, with an accelerating loss thereafter; atrophy of fast­twitch muscle fibres; less coordination of muscle contractions ▪ A 7% loss of flexibility per decade of adult life ▪ Deterioration of bone matrix and decrease in bone calcium from the age of 25 and accelerating for 5 postmenopausal years in women ▪ Decrease in balance, slowing of reaction of speed and movement time ▪ Deterioration of function in special senses ( vision, hearing, smell and taste), impaired memory, poor sleep patterns, and depression Source: Adapted from Physical Activity Instruction of Older Adults,p38, Human Kinetics. Cardiovascular and Respiratory Function Maximal aerobic capacity decreases with advancing age regardless of physical fitness. An average decline of about 10 percent per decade in VO2max occurs from age 25 to age 65 which then slows at age 80 and older. Because of this decline less physically demanding tasks require more work capacity reserves of healthy older adults. The heart and lungs may function adequately at rest but may be taxed as exercise intensity increases. Regular exercise of sufficient intensity may improve the cardiorespiratory components of fitness substantially, even in the oldest and frailest adults. Maximal cardiac output, the maximal amount of blood leaving the heart per minute of peak exercise is reduced with ageing at an average rate of 1% per year between the ages of 35 and 65. Maximal heart rate and maximal stroke volume also decrease with ageing. In many older adults these changes place enormous strain on the heart and can lead to serious signs and symptoms (e.g., dizziness, muscle cramps, or chest pain) when exercise intensity overtaxes their aerobic capacity. In healthy older adults muscle oxygen consumption may also be limited due to poor muscle blood flow or oxygen delivery in working muscles, especially when exercise is begun without an adequate warm­ up. Common cardiovascular diseases that can result in restrictive blood flow due to atherosclerotic narrowing of arteries include: peripheral arterial disease (PAD), coronary artery disease (CAD) and cerebrovascular disease (CVD).
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 35 FITNESS TRAINING FOR OLDER PEOPLE COURSE Watch out for the following symptoms resulting from these conditions:
· · · CAD may result in Angina Pectoris­ a crushing pain that occurs with exertion
PAD may lead to intense cramping pain in the legs with physical activity
CVD can lead to disorientation or light­headedness with exercise Exercise should be stopped immediately if any of these symptoms occur. In addition the ageing heart is more vulnerable to rhythm disorders, particularly ventricular fibrillation, a dangerously rapid, erratic heart rhythm. An older exercise participant with heart disease may experience symptoms of chest pain, shortness of breath or other signs of exertional intolerance during exercise. A sufficient warm­up before exercise and cool­down after exercise are absolutely essential for older adults to minimise the risk of many serious abnormal cardiac responses to sudden changes in cardiovascular demand. Blood pressure, both resting and exercise, rise progressively with age. Dynamic aerobic training can reduce blood pressure, although the mechanisms responsible for the reduction are not clearly known. The blood pressure response to training appears at training intensities of 40 to 70 % of VO2 max, equivalent to 55 to 80 % of maximal heart rate or an RPE of 12 to 15 (moderate to hard intensity and frequencies of 3 to 5 sessions per week of 30 to 60 minutes duration. Pulmonary efficiency also declines with age. The vital capacity (the maximal volume of air that a person can exhale after maximal inspiration) of the lungs decreases progressively, up to 40 or 50 % by the age of 70. The efficiency of gas exchange within the lungs also declines with age. Much of this functional decline is due to decreased respiratory muscle strength, loss of elasticity in connective tissue and small airway closure. Moderate­ to high­intensity training physical training may prevent the decline in lung function. Exercises that focus on deep diaphragmatic breathing and increasing the elasticity in the thoracic cage, such as yoga, tai­chi and pilates have been shown to improve pulmonary function. Muscle function and mass Age­associated changes in muscle function include:
· · · · · Sarcopenia (decreased muscle mass)
Decreased muscle strength
Decreased muscle power
Decreased muscle endurance
Decreased aerobic enzyme activity in muscle mitochondria Muscular weakness and sarcopenia can lead to a reduction in aerobic capacity, bone density, insulin sensitivity, metabolic rate and increases in body fat, blood pressure and prevalence of cardiovascular disease and diabetes mellitus. Age­related strength reduction in the lower extremities has also been associated with balance and mobility problems leading to physical disability and loss of independence. Aerobic endurance training and resistance training both can minimise and even reverse loss of muscle and muscle function. Joint Mobility Flexibility, the ability to move a joint through its full range of motion, has been found to decline 20 to 50 % between the ages of 30 and 70 years. Reductions in range of motion (ROM) often lead to problems performing essential daily tasks such as climbing stairs, dressing without assistance and getting in or out of a bath or car. Loss of flexibility also increases the possibility of injury to joints or muscles and the likelihood of falls from loss of balance and stability. Flexibility can be maintained in later years by using joints through their full ROM and by stretching the muscles that span joints. Static and dynamic stretching, aerobic exercise and resistance training have
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 36 FITNESS TRAINING FOR OLDER PEOPLE COURSE been shown to increase ROM in older adults. Regular activity also helps reduce pain or disability associated with degenerative joint disease. Bone Mass Both men and women lose bone mass with ageing. At any given age, bone mineral density (BMD), is lower in women than in men. Peak BMD is usually reached by approximately 25 years of age and remains fairly stable until about the age of 50. After this age there is a progressive loss of calcium and deterioration of bone matrix. Women lose calcium particularly quickly in the five years after menopause. BMD is typically measured at the hip and spine using dual­energy X­ray absorptionmetry (DEXA). Low BMD can indicate osteoporosis and women are three times more likely to develop osteoporosis than men. The major consequences of osteoporosis are spine, hip, and wrist fractures. Older adults with smaller bones (e.g., women and Asians) are more susceptible to fractures. Physical activity is essential for preserving bone mass and functional mobility. Weight bearing endurance exercise and resistance exercise have both been found to increase bone mass in older adults particularly that of vigorous or intense type. Neurological Function Some of the most common causes of disability in older adults are disorders of the nervous system. The most important areas of neurological change that accompany normal ageing occur in cognitive abilities and memory, movement speed, posture, balance and gait. There are also changes in the special senses of vision, hearing, smell and taste. Ageing is associated with the following cognitive function changes:
· · · · · Short­term memory loss
Decline in attention
Decline in intelligence
A slow down in speed of information processing
Slower reaction time These declines may make it difficult for an older adult to live independently. A minimum level of cognitive function is necessary for independent living. Cognitive abilities also have a clear relationship to risk of falls. Research has shown that physical activity and fitness have many beneficial effects on memory and other aspects of cognition in elderly persons.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 37 FITNESS TRAINING FOR OLDER PEOPLE COURSE Understanding OH &S and Legal and Ethical Responsibilities Occupational Health & Safety (OH & S): Notes for this section have been adapted from Sport and Recreation Training Australia Ltd Safety and risk management has become a huge issue in community recreation settings. Safe participation in programs is dependent upon the implementation of policies and regulations, which have been adopted by community recreation agencies. The same principle applies to you as an instructor in these settings. It is crucial that instructors are clearly aware of the legal responsibilities and risk management issues involved in this area. Without due consideration of these responsibilities, the threat of litigation is serious. An instructor needs to take into consideration the following issues to ensure the meeting of legal responsibilities: § § § § § § Identify and highlight any risk situations or hazards Determine the cause and act immediately to rectify the situation Establish risk management procedures and action plan for dealing with these issues Document these procedures Implement procedures Monitor the situation constantly Risk Management A risk management plan is a compilation of policies and procedures that are established to manage an organisation’s risks and to assist the organisation in performing more effectively. Policies provide the framework for the organisation to manage its risks and to outline how the risks are to be addressed. Procedures outline how the policies are to be addressed. Procedures outline how the policies are to be implemented in order to be managed. Legal and ethical limitations of a fitness trainer of older adults: Negligence Negligence is unintentional harm to others which is caused by carelessness Negligence occurs when a person either: § does something that a reasonably careful person would not do in a particular situation § fails to do something that a reasonably careful person would have done in a particular situation Put simply, negligence is the failure to use reasonable care. For a charge of negligence to be sustained, you must: § owe a duty of care to the injured person § breach that duty of care § have caused injury through that breach of duty of care
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 38 FITNESS TRAINING FOR OLDER PEOPLE COURSE As an instructor you need to think about your situation and identify what a reasonably careful person would do in the circumstances. To avoid being negligent, instructors should take reasonable care to avoid harming others where the harm can reasonably be foreseen or predicted. For example, avoid: § § § going on a bushwalk when thunderstorms are predicted conducting aerobics classes in an area without drinking facilities using faulty gym equipment Duty of care Duty of care refers to the duty of a person not to endanger another person, where it is reasonably foreseeable that an injury could occur due to the lack of care. For a duty of care to arise, there must exist a relationship of proximity. The duty is breached if the person fails to act in accordance with the required standard of care. The standard is one of reasonable care, taking into account the magnitude of the risk and degree of probability of its occurrence. Also taken into account is the expense, difficulty and the inconvenience of taking alleviating action and any other conflicting responsibilities. Instructors have the responsibility for taking reasonable measures to ensure participants in programs are safe­ that no harm comes to them through the environment, themselves or others. For example, during a weights session in a gym, the instructor needs to be sure the weights are stored safely, participants are adequately warmed up, that they have been properly instructed in technique and that they are adequately supervised. Insurance Insurance­ professional indemnity insurance indemnifies the insured against claims for such things as negligence. For sport or community recreation organisations this type of cover is particularly relevant for instructors, coaches, officials and referees. ETHICAL RESPONSIBILITIES The ethical responsibilities of an instructor refer to the behavioural requirements set down by various peak bodies, which govern the way in which instructors interact with their clients and conduct their instructional sessions. With any instructional session there are potential ethical risks. These risks involve actual or potential harm to the reputation or beliefs of an individual or organisation. As an instructor, you would be expected to adhere to the policies and regulations that relate to the area in which you are instructing. You would be expected to demonstrate integrity, respect and a commitment to fair play. The primary aim of an ethics clause for instructors is: the welfare and protection of the individuals and groups with whom the instructor interacts. Good instructors are caring, intelligent, fair and empathetic people. They also know their clients and treat them according to their level of ability, development and individuality.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 39 FITNESS TRAINING FOR OLDER PEOPLE COURSE Codes of Behaviour are adopted by organisations to assist all those in the organisation to understand what are acceptable practises for the activities conducted by that organisation. Codes ensure that people involved in participating in community recreation and sport activities will have an enjoyable experience, which will encourage long­term involvement in that activity. The Australian Sports Commission has produced AUSSIE SPORT Codes of Behaviour. Contact your local Department of Sport and Recreation for a copy. Here is an example of a possible instructor’s code of ethics § § § § § § § § § § § Instructor’s Code of Ethics Place the safety and welfare of the participants above all else Accept responsibility for all actions taken Be impartial Avoid any situation which may lead to a conflict of interest Be courteous, respectful and open to discussion and interaction Value the individual Seek continual self improvement through study, performance appraisal, and regular upgrading of competencies Encourage inclusivity and access to all Be a positive role model in behaviour and personal appearance Refrain from any form of personal abuse towards participants Refrain from any form of sexual harassment towards participants
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 40 FITNESS TRAINING FOR OLDER PEOPLE COURSE Develop Fitness Plans for Older Adults The importance of physical activity: The elderly population is a growing one. In Australia like other western societies mean life expectancy has increased dramatically and is likely to keep increasing. In 1981 life expectancy was 71.1 years for males and 78.3 years for females. In 1993 this had increased to 74.8 years and 80.8 years for males and females respectively. Thus the elderly population is growing as a proportion of the total population. As more individuals live longer, it is imperative to determine the extent and mechanisms by which exercise and physical activity can improve health, functional capacity, quality of life and independence. According to the American College of Sports Medicine Position Stand on Physical Activity for Older Adults, participation in regular physical activity (both aerobic and strength exercises) elicits a number of favourable responses that contribute to healthy ageing. Physical inactivity is a major risk factor, which can influence prevention of six of Australia’s national health priorities: cardiovascular health, cancer control, injury prevention, mental health, diabetes and musculoskeletal problems. The prevalence of inactivity in Australia is high and increasing. According to research on the physical activity levels of Australians just over half the population do not partake in the levels of physical activity recommended by the National Physical Activity Guidelines (see table). Furthermore only 13% of males aged 60 to 69 years and about 12% of females the same age are vigorously active. Participation in a regular exercise program is an effective intervention to reduce or prevent the above­ mentioned disease states and thus improve health status as well as increase life expectancy. Additional benefits from regular exercise include:
· increased fitness and cardiovascular function (endurance training)
· offsetting the loss of muscle mass and strength associated with ageing (strength training)
· improved bone health (reduced risk of osteoporosis)
· improved postural stability (reduced risk of falls and associated injuries)
· increased flexibility and range of motion There is also some evidence of regular exercise providing a number of psychological benefits in relation to preservation of cognitive function, alleviation of depression and an improved concept of personal control and self­efficacy.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 41 FITNESS TRAINING FOR OLDER PEOPLE COURSE Australian Physical Activity Guidelines The physical activity guidelines for Australians refer to the minimum level of physical activity required for the attainment of good health and healthy body weight. The technology of today has reduced much of the need for human movement. Decreases in activity in society have been associated with an increase in obesity and other health problems. PHYSICAL ACTIVITY GUIDELINES 1. Think of movement as an opportunity, not an inconvenience 2. Be active every day in as many ways as you can 3. Put together at least 30 minutes of moderate­intensity physical activity on most, preferably all, days 4. If you can also enjoy some regular vigorous exercise for extra health and fitness Small increases in daily activity can come from small changes carried out throughout the day. For example walking or cycling instead of using the car; gardening regularly; walking up and down stairs instead of using the lift and doing things by hand instead of using labour saving devices. All these things can contribute to your daily tally of physical activity and remember some activity is better than none, and more is better than a little. Moderate intensity activity includes things such as brisk walking or cycling. Combine short sessions of different activities of around 10­15 minutes each to a total of 30 minutes or more. The 30 minutes does not have to be continuos. A good example of moderate activity is brisk walking at a pace where you are able to comfortably talk but not sing. Research has shown that people can get added health and fitness benefits by carrying out some regular vigorous exercise in addition to daily movement or regular moderate­ intensity activity.” Vigorous” activity means that which makes you “huff and puff”. In technical terms this is exercise at a heart rate of 70­85% of maximum heart rate. Examples include sports such as football, squash, netball and basketball, and activities such as aerobics, circuit­training, speed walking and jogging. For best results this type of activity should be carried out 3 to 4 days per week for at least 30 minutes. Although there is no age barrier for carrying out vigorous activity, medical advice is recommended for those who have been previously inactive, who have heart disease, or close relatives with heart disease, or who have other major health problems. EXERCISE AND OLDER ADULTS For the elderly inactivity may be due to a chronic disorder that has resulted in some functional limitation. The most common disabling conditions suffered by the elderly include arthritis, circulatory conditions and disorders of the ear and mastoid process. The elderly have twice as many disabilities and four times as many physical limitations as people less than 65 years of age. Other factors influencing exercise participation of the elderly include:
· concerns about the appropriateness of physical exercise in old age(i.e. ‘act your age’)
· a lack of knowledge of appropriate exercise
· the belief that exercise may be harmful
· a perceived lack of physical ability
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 42 FITNESS TRAINING FOR OLDER PEOPLE COURSE When designing an exercise program for the older adult one needs to establish the major goals of the client keeping in mind the functional benefits of the activities chosen as well as the client’s physical or medical limitations. For most inactive older adults, a level of fitness needs to be developed in order to:
· enable them to do daily activities without undue fatigue
· have a reserve of energy for pleasure
· help them make a faster and more complete recovery after debilitating disease
· minimise the risks of future ill health
· promote a sense of personal wellbeing and zest for life Data collected from a study conducted in 1999 by the Council on the Ageing (COTA) and RMIT on the “Fitness Industry and Older People” indicated that individuals experienced difficulties in the following tasks: § Lifting § Carrying § Squatting § Bending § Walking long distances § Walking at a moderate to fast pace § Walking with “normal stride length § Climbing stairs § Stretching § Co­ordinating full range of movements § Executing a standing to sitting movement § Executing a sitting to standing movement § Standing erect § Holding their arms up for extended periods of time Older people of different physical conditions have much to gain from exercise and from staying physically active. They also have much to lose if they become physically inactive. Research has shown that exercise isn’t just for older adults in the younger age range, who live independently and are able to exercise regularly. Exercise can benefit even those who are 90 or older, who are frail, or who have the diseases that seem to accompany aging. WHAT KIND OF EXERCISE IS BEST FOR OLDER ADULTS? The National Institute of Aging (NIA), a research institute of the U.S. Department of Health devoted to the mission of improving the health and well being of older Americans recommends four types of exercises for older adults. Endurance exercises: § Increase breathing and heart rate § Improve the health of heart, lungs and circulatory system § Improve fitness and stamina § May delay and prevent many diseases associated with aging such as diabetes, colon cancer, heart disease, stroke and others § May reduce overall death and hospitalisation rates Strength exercises: § Build muscles and strength § May prevent osteoporosis § Increase metabolism, helping to keep weight in check § Decrease resting blood pressure particularly in individuals with elevated blood pressures § Improve blood lipid profiles § Improve glucose tolerance and decrease haemoglobin A1c(hbA1c) in those with diabetes mellitus
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 43 FITNESS TRAINING FOR OLDER PEOPLE COURSE Balance exercises: § Help prevent falls and thus injuries that lead to disability and loss of independence Flexibility exercises: § Help keep the body limber and flexible by stretching muscles and other tissues § Can help prevent injuries § Can help patients recover from injuries § Flexibility may play a role in preventing falls What types of exercise and how much is done depends on every clients unique situation. Physical therapists and other health professionals may need to be consulted on a regular basis in order to give the most appropriate and beneficial exercise prescription or program. However older adults should be encouraged to exercise as often as they can, starting with a level they can manage and building up gradually to include all four types of exercise. It is also important to encourage lifetime leisure activities such as dancing, gardening, hiking, tennis and swimming in addition to structured exercise programs. Establish the acceptability of the exercise plan and program with medical advisers and suitably qualified allied health professionals A very important role of the older adult trainer is to prescribe safe, effective and appropriate exercises. Exercise prescription involves considering the needs and goals of the client and then selecting appropriate exercises to give the desired response. Prescription of exercise for the aged must take into consideration any medical, physical or psychological problems, which may limit the type of exercise possible. The health status of the client will determine the amount and intensity of exercise that should be performed, as well as the rate of progression. Medical advisers and allied health professionals that may need to be consulted could include: § Medical doctors § Dieticians § Counsellors § Psychologists § Exercise scientists § Physiotherapist
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 44 FITNESS TRAINING FOR OLDER PEOPLE COURSE Health appraisals: Notes for the following section have been adapted from information obtained from Council on the Ageing (COTA). Before a client can commence any exercise program a health appraisal or assessment should be conducted in order to prescribe an appropriate individualised program. This initial assessment also gives the trainer the opportunity to establish a relationship with the client and encourage a trust in their ability and knowledge. It is also recommended that assessments be conducted at regular intervals in order to change programs to ensure progression, maintain motivation and to take into account any changes to the individuals circumstances. The type of information that is needed before commencement of an exercise program should include the following: § Medical consent § Medication history § Client goals § Pre­exercise questionnaire § Physical measurements § Personal contact details including emergency contact Medical consent Clients should obtain a medical clearance before commencing an exercise program. The medical clearance form would ideally provide you with the following information about the client: Past or current history of: § Diabetes (either insulin dependent or non­insulin dependent) § Chronic heart disease § Hypertension § Osteoporosis § Osteoarthritis § Rheumatoid arthritis § Chronic fatigue syndrome § Obesity § Fibromyalgia § Respiratory conditions § Joint (hip/shoulder) replacement § Post polio syndrome § Visual impairment § Auditory impairment § Musculoskeletal problems § Neuromuscular problems § Others Note: if the client has to cease exercising due to a medical condition, medical approval must be sought, prior to recommencing the exercise program. Medications It is recommended that all medications being taken by the client be recorded and also any side effects that may impact on a participants capacity to train.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 45 FITNESS TRAINING FOR OLDER PEOPLE COURSE Pre exercise questionnaire The completion of a comprehensive pre­exercise questionnaire assists in providing a complete picture of the client’s health status and medical history, which may be relevant to the exercise prescription. Information that may be important or relevant includes: § Any current or past medical conditions not included in the medical consent form § Results of previous medical tests § Current level and type of physical activity § Previous physical activity history § Current pain status (can be indicated on a pain scale­similar to RPE scale) § Fears and concerns about exercising § Establish main functional problems as perceived by the participant § History of falls § Other lifestyle habits Establish regular review sessions with clients CLIENT GOALS When designing an exercise program it is essential that the clients goals and needs are thoroughly understood. Each program should be individualised and a time frame should be specified. Short­term achievable goals are recommended initially while medium and long­term goals can be established to ensure the program is designed to achieve the aims and objectives of the individual. These goals could include health, fitness, weight loss, leisure pursuits or day­to­day activities­ whatever the goal, all are important for motivation. To check the progress of the client it is important to reassess the client’s goals and objectives at future dates. Reassessment allows the instructor to assess the clients satisfaction with the current program, to retest fitness levels, to set new short term goals and to develop a new program. The timing of review dates will depend on the client, frequency of training and their motivation. However generally a program should be changed every 6­8 weeks. The actual measurements or screening tools that would be suitable for assessing the fitness of an older adult will depend on: § The current health status of the client § The goals of the individual § The current level of physical activity § Any previous injury Tests should be included to determine the health, physical activity and disability status of the older client. This will assist by determining the clients “starting level” to effectively design the program, and a baseline from which to monitor improvement and progression. As a general guide the following measurements have been suggested by COTA: § Resting blood pressure § Resting heart rate § Waist to hip ratio § Body mass index § Posture § General muscle strength § Flexibility § Static balance § Dynamic balance § Function Recommended reading: 1. Senior Fitness Test, Human Kinetics Publishers 2. Rikli and Jones, J.Aging & Phys Act, 6, 127­179
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 46 FITNESS TRAINING FOR OLDER PEOPLE COURSE Biological functional changes between the ages of 30 and 70 BIOLOGICAL FUNCTION CHANGE Work capacity(%) Cardiac output (%) Maximum heart rate (beats/min) Blood pressure (mm Hg) Systolic Diastolic Respiration (%) Vital Capacity Residual volume Basal metabolic rate (%) Musculature (%) Muscle mass Hand grip strength Nerve conduction velocity (%) Flexibility (%) Women Men Renal function (%) ↓25­30 ↓30 ↓24 ↑10­40 ↑ 5­10 ↓40­50 ↑30­50 ↓ 8­12 ↓25­30 ↓25­30 ↓10­15 ↓25­30 ↓15­20 ↓30­50 Note. From “Physical Activity Prescription for the Older Adult” by E.L. Smith and C. Gilligan, 1983, from The Physician and Sportsmedicine, 11, pp. 91­101
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 47 FITNESS TRAINING FOR OLDER PEOPLE COURSE Fitness Testing for Older Adults Fitness testing can be useful as a means of providing a point of reference based on the individual. Whilst there are often reference and comparison tables available, results of an individual that demonstrate their level of improvement or in some cases their decline is usually more appropriate. The main goals of traditional fitness testing are health promotion and the avoidance of lifestyle diseases (heart disease, obesity, diabetes, etc). Older adults generally have established chronic disease, thus the focus for testing shifts from disease prevention to functional mobility­ the ability to continue to do things one wants and needs to stay strong, active and independent. Medical Referrals It is also vital that as fitness professionals we are aware that the results obtained from testing are estimated predictions not diagnosis results. If at any stage of pre testing or testing evidence arises that suggests the individual may suffer a medical condition or present with an injury, it should be suggested to them that seek medical advice from either a doctor or specialist. What is the evaluation process? The whole measurement/evaluation process is a six stage, cyclic affair, involving:
· · · · · · The selection of characteristics to be measured.
The selection of a suitable method of measuring
The collection of that data
The analysis of the collected data
The making of decisions
The implementation of those decisions All of the above stages should be completed with the client ­ especially the analysis and making decision of appropriate corrective action. What are the requirements of a test? In constructing tests it is important to make sure that they really measure the factors required to be tested, and are thus objective rather than subjective. In doing so all tests should therefore be specific (designed to assess the clients fitness for the activity in question), valid (test what they purpose to test), reliable (capable of consistent repetition) and objective (produce a consistent result irrespective of the tester). When conducting tests the following points should be considered:
· · · · Each test should measure ONE factor only.
The test should not require any technical competence on the part of the client (unless it is being used to assess technique).
Care should be taken to make sure that the client understands exactly what is required of him/her, what is being measured and why.
The test procedure should be strictly standardised in terms of administration, organisation and environmental conditions.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 48 FITNESS TRAINING FOR OLDER PEOPLE COURSE In developing a senior fitness test one must first identify the fitness parameters needed for functional mobility. The following are key physiological parameters identified by experts related to functional mobility in older adults:
· · · · · Muscular strength (lower­ and upper­body)
Aerobic endurance
Flexibility(lower­ and upper­body
Agility/dynamic balance
BMI What are the benefits of testing? The results from tests can be used to:
· · · · · · predict future performance
indicate weaknesses
measure improvement
enable the fitness instructor to assess the success of his training program
place the client in appropriate training group
motivate the client What factors may influence test results? The following factors may have an impact on the results of a test (test reliability):
· · · · · · · · · · · · · · The ambient temperature, noise level and humidity
The amount of sleep the client had prior to testing
The clients emotional state
Medication the client may be taking
The time of day
The clients caffeine intake
The time since the clients last meal
The test environment ­ surface (track, grass, road, gym)
The clients prior test knowledge/experience
Accuracy of measurements (times, distances etc)
Is the client actually applying maximum effort in maximal tests
Inappropriate warm up
People present
The personality, knowledge and skill of the tester Pretest Procedure. Although the tests recommended are safe to administer to most community­residing older adults, there are some exceptions. People who should not participate in testing without physician approval are those who:
· Have been advised by their doctors not to exercise because of a medical condition
· Have had congestive heart failure
· Are currently experiencing joint pain, chest pain, dizziness, or have exertional angina
· Have uncontrolled high blood pressure (greater than 160/100) To ensure maximum safety, participants also should be given information prior to test day concerning the best way to prepare for testing. Specifically, participants should be asked to:
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 49 FITNESS TRAINING FOR OLDER PEOPLE COURSE · · · · · · · Avoid strenuous physical activity one or two days prior to assessment
Avoid excess alcohol use 24 hours prior to testing
Eat a light meal one hour prior to testing
Wear clothing and shoes appropriate for participating in physical activity
Bring a hat and sunglasses for walking outside, and reading glasses (if needed) for completing forms
Bring the informed consent and medical clearance form if required
Inform the test administrator of any medical conditions or medications that could affect performance Testing Order After testing resting blood pressure and heart rate it is important to consider which of the aerobic endurance tests you are going to use to minimise fatigue. If you choose to do the 2­minute step test the following order is suggested: chair stand test, arm­curl test, 2­minute step test, chair sit and reach test, back scratch test, and 8­foot up and go test. If the 6­minute walk test is used, it should be administered last after all other tests have been completed. Normally only one aerobic endurance test is administered. BMI and waist­hip ratio can be taken any time.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 50
FITNESS TRAINING FOR OLDER PEOPLE COURSE Resting blood pressure: Auscultatory Method Of Measuring Blood Pressure Auscultation, determined by the sense of hearing, is the most commonly used technique for measuring blood pressure. The equipment used includes a sphygmomanometer and a stethoscope. The sphygmomanometer we use at the Fitness Centres includes an inflation system through which external pressure is applied to an artery, and a calibrated pressure manometer that indicates the pressure at which the blood pressure can be heard. The stethoscope is used to hear the blood pressure sounds. Korotkoff Sounds Korotkoff sounds is the technical term for blood pressure sounds. While the exact cause of these sounds has not yet been confirmed, it is believed that they Sphygmomanometer
are caused either by:
· · The vibratory motion of the arterial wall
Or by motion within the blood as the blood flow is re­established when the pressure in the compression cuff is released There is no sound when the artery is compressed by external pressure greater than the systolic pressure, nor is there any sound when the external pressure is insufficient to collapse the artery. As the pressure applied by the compression cuff is reduced, the sounds from the artery vary in character until they disappear. Action 1 Reduce the client's anxiety level by explaining the procedure. If possible, place the client in a sitting or supine position. Permit the client to rest in this position for five minutes. This is because the side lying position can cause systolic and diastolic readings lower than supine position. Also, measurements taken immediately following activity are elevated above baseline measurements. Position the client's arm at heart level with the palm up. If the arm is above or below the heart level, false low or high readings are obtained respectively. Measure the cuff against the arm to determine the correct width and length. If the cuff is too narrow, it does not compress an adequate length of artery and results in a false high pressure reading. Action 2 Apply the deflated cuff bladder with the centre (either arrow or rubber tubing) over the brachial artery, just above elbow crease. The lower edge of the cuff should be at least 2½ centimetres above the site where the maximum arterial pulse is felt. This way the bladder is in position to compress the artery and space is allowed for the placement of the stethoscope. Wrap the cuff around the arm snugly, avoiding contact with the client's clothing. Support the client's arm with your own, if necessary. If the cuff is too loose or too tight, false high or low readings will be obtained respectively. An unsupported arm can cause false high systolic and diastolic readings. Place yourself a metre or less from the manometer so that you can obtain a clear reading. Action 3 Inflate the cuff rapidly to approximately 180 mmHg. Place the diaphragm of the stethoscope over the pulse site and use your fingers to hold it securely. Be careful not to use excess pressure as this can distort sounds and change the reading. Release the cuff pressure at a speed of two to three mm per heartbeat. Be careful, as too slow a release causes falsely elevated diastolic pressure. Too rapid a release makes it difficult to read points on the scale accurately with the sounds. © Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 51 FITNESS TRAINING FOR OLDER PEOPLE COURSE Action 4 Note the manometer numbers at which the first and last Korotkoff sounds are heard. These numbers are the systolic and diastolic pressures. Rapidly deflate the cuff to zero when the sounds have disappeared to relieve the discomfort caused to the client. If the reading is to be repeated immediately, wait 30 seconds and then elevate the arm above heart level to drain trapped blood from the forearm. Inflate the cuff, lower the arm and repeat steps three and four. If the arm is not elevated, venous congestion can cause false high systolic and low diastolic readings. Heart rate: Heart Rate: The number of beats of the heart per minute. Can be measured at the carotid artery or at the radial artery. By placing the first 2 fingers gently against either artery and counting the amount of beats for 15 seconds and multiplying by 4 e.g. 20 beats counted in 15 seconds and then multiply by 4 = 80 beats per minute. Basal Heart Rate: This is your heart rate taken immediately upon waking after sleep. Resting Heart Rate: This is your heart rate taken during the day whilst at rest. Maximum Heart Rate: This is the maximum heart rate and is calculated for testing purposes as 220 – your age, e.g. 220 – 30 = 190 beats per minute (bpm) Training Heart Rate: There are different heart rate training zones that can be recommended to clients to assist them depending on their goals or fitness levels. For an unfit person you can determine their training heart rate zone from 60% to 70% For the average person the heart rate training zone can range from 70% to 80% For the fit person the heart rate training zone can range from 75% to 85%. One of the best ways for convenience and accuracy is to use a Heart rate monitor which consists of a transmitter (Heart rate strap) and a receiver (heart rate watch). Example calculations for an unfit 65 year olds training heart rate:
· 220 – 65 = 155 beats per minute (bpm)
· 70% of 155 = 108.5 beats per minute
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 52 FITNESS TRAINING FOR OLDER PEOPLE COURSE Waist to hip ratio: Description / procedure: A simple calculation of the measurements of the waist girth divided by the hip girth. Scoring: The table below gives general guidelines for acceptable levels for hip to waist ratio. You can use any units for the measurements (e.g. cm or inches), as it is only the ratio that is important. acceptable unacceptable excellent good average high extreme male < 0.85 0.85 ­ 0.90 0.90 ­ 0.95 0.95 ­ 1.00 > 1.00 female < 0.75 0.75 ­ 0.80 0.80 ­ 0.85 0.85 ­ 0.90 > 0.90
· · · · equipment required: tape measure
target population: This measure is often used to determine the coronary artery disease risk factor associated with obesity.
advantages: A simple measure that can be taken at home by people to monitor their own levels.
other comments: The basis of this measure as a coronary disease risk factor is on the assumption is that fat stored around the waist poses a greater risk to health than fat stored elsewhere. Body Mass Index (BMI): BMI stands for Body Mass Index. It takes a person's weight in kilograms and divides it by their height in meters squared. For instance, if your height is 1.82 meters, the divisor of the calculation will be (1.82 * 1.82) = 3.3124. If your weight is 70.5 kilograms, then your BMI is 21.3 (70.5 / 3.3124) (see calculator links below). The higher the figure the more overweight you are. Like any of these types of measures it is only an indication and other issues such as body type and shape have a bearing as well. Remember, BMI is just a guide. Description / procedure: BMI is calculated from body mass (M) and height (H). BMI = M / (H x H), where M = body mass in kilograms and H = height in metres. The higher the score usually indicating higher levels of body fat Scoring: · · · · underweight <20 healthy range 20­25 overweight 25­30 obese >30
equipment required: scales and stadiometer as for weight and height.
target population: BMI is often used to determine the level of health risk associated with obesity.
advantages: simple calculation from standard measurements
disadvantages: BMI can be inaccurate, for example with large and muscular though lean athletes scoring high BMI levels which incorrectly rates them as obese. Other comments: Although it has not been determined what the optimal BMI range is for older adults, the American College of Sports Medicine suggests values between 19 and 26 are generally considered to be in the healthy range, with BMIs higher or lower than this associated with increased risk for health and mobility problems.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 53 FITNESS TRAINING FOR OLDER PEOPLE COURSE The following tests are a sample of suggested tests, primarily developed by the Ruby Gerontology Centre at California State University , Fullerton ( The Senior Fitness Test, R. Rickli & C. Jones, Human Kinetics). Their aim was to develop or utilise tests that assessed independent­living older adults, aged 60 to 90+. All tests recommended and used have documented reliability and validity. Please find a full explanation of the testing procedures and normal range of scores in Appendix 2.
· · · · · · · Chair stand test (lower­body strength)
Arm curl test (upper­body strength)
6­minute walk test (aerobic endurance)
2­minute step test ( an alternate measure of aerobic endurance)
Chair sit­and­reach test (lower body flexibility)
Back scratch test (upper body flexibility)
8­foot up­and­go test (agility/dynamic balance)
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 54 FITNESS TRAINING FOR OLDER PEOPLE COURSE Establish Exercise Frequency, Duration and Type The following guidelines were modified from recommendations of the American College of Sports Medicine, The National Institute of Ageing (USA) and COTA (see references at end of course notes) Endurance exercise: What and where? § Walking, cycling, rowing are great! § Swimming and stair stepping are also good. § Advise client to get well­made equipment (e.g. walking shoes with good stability) Intensity § Encourage to start each session slowly and warm up (5 min) § They should never be in pain or be unable to speak § Use the rating of Perceived Exertion Scale (*see below)­ encourage client to gradually work their way up to level 13 § Monitor heart rate if possible § Start slowly but encourage client to work a little harder as weeks go by RATING OF PERCEIVED EXERTION (Borg 1982) Least effort 6 7 very very light 8 9 10
11 fairly light 12
13 somewhat hard 14
15 hard 16
17 very hard 18
19 extremely hard 20
Maximum Duration § May be 5 minutes at first but is gradually increased § Progress to at least 20 minutes of continuous exercise each day § 30­45 minutes would be ideal Frequency § 3 to 5 days each week § If done daily alternate weight bearing with non weight bearing (i.e., walk one day, then cycle or swim the next day)
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 55 FITNESS TRAINING FOR OLDER PEOPLE COURSE STRENGTH TRAINING: What and where? § Lift or push weights­ e.g. free weights, resistance bands, cuff weights, machine weights, fitness balls, body weight § Choice of equipment will depend on availability at each facility § Clients should be encouraged to progress through a range of equipment or combinations to promote progression of strength and provide motivation and enjoyment § Within a fitness facility, compound exercises with free weights are recommended to promote functional and natural movement patterns or alternatively if weights are not available “body weight” exercises such as chair sit to stands, push ups, dips lunges etc Intensity § Clients should gradually work their way up to an intensity that is “hard to very hard” or 15 to 17 on the Borg scale § Advise a minimum weight the first week and gradually add weight Duration § Clients should take 3 seconds to lift or push a weight; hold the position for 1 second, and take another 3 seconds to lower the weight § Advise not to drop the weight and that lowering slowly is important Frequency § Strength developing exercises should be performed at least twice per week § Choose 8­10 exercises that use the major muscle groups of the legs, trunk, arms and shoulders for each session § One or two sets of 8­10 repetitions of each exercise § Advise to raise exercise resistance when client can complete 2 sets of 10 repetitions with proper form comfortably § Recommend a rest period between training sessions to allow for recovery and development­ a 48hour rest period is generally recommended § Recovery is also needed when two or more sets of an exercise is executed – 2 minutes recovery between sets is sufficient BALANCE EXERCISE: § § § § Recommend development of core stability by static activation of pelvic floor, transverse abdominus and multifidus (i.e. lying or standing) Once static activation achieved encourage dynamic stability through activities such as standing/ hopping on one leg, throwing and catching a weighted ball, Pilates Balance exercises can be executed while holding on to a table or chair with one hand progressing to one finger tip and eventually without holding on at all In most cases balance exercises can be incorporated into strength exercise sessions particularly standing lower body exercises such as knee flexion, hip flexion, side leg raise and plantar flexion
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 56 FITNESS TRAINING FOR OLDER PEOPLE COURSE FLEXIBILTY EXERCISE: What, where and safety? § Advise client to warm up before stretching or do stretches after endurance or strength exercises § Advise client not to “bounce” during a stretch but make slow, steady movements § Advise client to avoid “locking” joints into place when straightening during stretches § Stretching can be done upright or on the floor­ need to determine clients ability to get up if prescribe floor stretches Intensity § Stretching should not cause pain but a mild discomfort or mild pulling sensation is normal Duration and frequency § Advise holding stretches for 10 to 30 seconds, relax then repeat, trying to stretch farther § Recommend to do each stretching exercise 3 to 5 times at each session § If client cannot do endurance or strength exercises for some reason but is able only to do stretching then recommend to do them at least 3 times a week for at least 20 minutes per session Contraindications to exercise: With any disclosed medical, health or injury condition the client must obtain medical consent or clearance before commencing an exercise program. Absolute Contraindications q Recent significant changes in resting ECG that has not been adequately investigated and managed q Unstable angina pectoris q Uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise q Uncontrolled symptomatic heart failure q Severe symptomatic aortic stenosis q Suspected or known dissecting aneurysm q Acute pulmonary embolus or pulmonary infarction q Untreated high risk proliferative retinopathy q Recent significant retinal haemorrhage q Acute or inadequately controlled renal failure q Acute infections Relative Contraindications (ie can be superseded if benefits outweigh risks of exercise) q Fasting blood glucose > 16.7 mmol/L or >13.9 mmol/L with urinary ketone bodies q Uncontrolled hypertension with resting systolic blood pressure > 200 mmHG or diastolic blood pressure> 110 mmHG q Severe autonomic neuropathy with exertional hypotension q Moderate stenotic valvular heart disease q Hypertrophic cardiomyopathy and other forms of outflow tract obstruction q Tachyarrhythmias or bradyarrhythmias q High­degree atrioventricular block q Ventricular aneurysm q Electrolyte abnormalities (eg. Hypokalemia, hypomagnesemia) q Uncontrolled metabolic disease (eg. Thyrotoxicosis, myxedema) q Chronic infectious disease (eg. Hepatitis, AIDS) q Neuromuscular, musculoskeletal, rheumatoid disorders that are exacerbated by exercise q Complicated pregnancy References: 1. American College of Sports Medicine: ACSM’s guidelines for exercise testing and prescription. Philadelphia, lippincott Williams & Wilkins, 2000 2. Rudeman N, Devlin JT, Schneider SH, Kriska A: Handbook of exercise in diabetes. Alexandria, Virginia, American Diabetes Association, 2000
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 57 FITNESS TRAINING FOR OLDER PEOPLE COURSE Modifying Exercises to Incorporate Physical Changes that Occur with Ageing Flexibility Training Flexibility As we age many factors contribute to a decline in flexibility (e.g., increased joint stiffness, changes in connective tissue, osteoarthritis). In some older adults, the loss in joint mobility can be so severe that the performance of daily functional activities becomes compromised. The good news is that exercises specifically designed to improve flexibility have been shown to be very effective for older adults. Improved flexibility leads to enhanced physical function and helps reduce pain and stiffness. Many different types of stretching techniques can be beneficial if applied correctly and at the right time during an exercise session. These can be divided into two main categories: static and dynamic stretching. STATIC STRETCHING: generally focuses on a particular muscle group and involves moving the joint through a single movement plane until a given end point is reached. The stretch is held anywhere from 10 to 90 seconds. DYNAMIC STRETCHING: moves a joint through a given range of motion but does not hold the joint in an end position for any length of time. Instead the goal is to progressively increase ROM (range of motion) with each subsequent movement repetition. Flexibility training can be incorporated into a training program in many ways. Dynamic stretching should be performed in the warm­up while static stretches are best per formed in the cool down. A standalone flexibility component within a program is also an option. In addition to more traditional flexibility exercises described in Appendix 3 , there are other methods for older adults to improve joint ROM such as tai chi, Pilates, yoga, the Alexander technique, and the Feldenkrais Method. The flexibility exercises you select must be appropriate for your clients and performed correctly. Special precautions should be followed when selecting exercises for certain medical conditions (see section on “Common condition associated with ageing”). It is important that you encourage your older adult clients to move at their own pace to avoid injury. If any exercises selected cause pain, an alternative exercise should be selected that stretch the target muscle or joint without discomfort. A client who has poor balance should perform exercises in a seated position or with the additional support of a chair or wall. FLEXIBILITY EXERCISE GUIDELINES:
· · · · · · · · · Select exercises on the basis of which joints have obvious range limitations and which muscles are stiff
Emphasise good body alignment
Perform dynamic stretches during the warm­up to facilitate warming up the body and muscles
Do not perform static stretches until the body is warm and muscles and joints are receptive to stretch
Move slowly into a static stretch position
Stretch to a point of gentle tension, but not pain
Do not bounce, jerk, or force a stretch, because this could result in injury
Hold a static stretch for 10 to 90 seconds
Inhale before the start of the stretch, exhale during the stretch, and breath evenly while holding the stretch at its end position
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 58 FITNESS TRAINING FOR OLDER PEOPLE COURSE Resistance Training Aerobic Endurance Training Balance and Mobility Training
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 59 FITNESS TRAINING FOR OLDER PEOPLE COURSE Modifying Exercises to Incorporate the Social and Psychological Changes that Occur with Ageing Psychology of ageing: One of the most persistent fallacies about ageing is that it is associated with nothing but losses and declines. Robert Butler , the first director of The National Institute on Ageing(USA), suggested that there is a tendency throughout society to focus on the negative consequences of ageing. Butler referred to this tendency as ageism, which he defined as the practice of discriminating against an individual or group of individuals on the basis of their chronological age. As a result of ageism prejudicial attitudes, discriminatory behaviours and even institutional policies perpetuate stereotypical beliefs about the elderly. The tendency to perceive ageing as a negative condition or a social problem is not consistent with current evidence on the functional capacity of older adults. It is also inconsistent with self­perceptions of most older adult, who do not generally view themselves as disadvantaged or in decline. Physical activity instructors can do a great deal to correct false beliefs about ageing by providing more accurate information about the ageing process and what it means to grow old. Common Myths about Growing Old 1. All aspects of health and physical function deteriorate with advancing age There is strong evidence to suggest that regular physical activity can alter the rate of decline of many physical and psychological variables. For example studies show people who adopt lifelong patterns of physical activity often exhibit little or no decline in cardiovascular function for a long time. 2. All changes in health and functional ability of older people are natural consequences of growing older Not necessarily true! An example of this is loss of muscular strength with advancing age may be due to disuse atrophy resulting from physical inactivity rather than just getting older. We know that strength training has many beneficial outcomes for older adults and a number of professional groups including the American College of Sports Medicine actively endorse resistance training for older adults. 3. You have to be healthy to exercise Many older adults resist exercising because they incorrectly believe that they have to be healthy to exercise. Physical activity can improve quality of life for the vast majority of older adults and may be most effective for people with chronic health conditions. To help with dispelling this myth point out role models in the community who are regularly active despite having health problems. 4. I’m too old to start exercising Physical activity has been shown to benefit people of all ages, including those as old as 90 or 100 years of age. Strategically displaying images of active older adults can help reinforce the notion that age need not be a barrier. 5. You need special clothing and equipment No special clothing or equipment is needed. Exercise can be performed while wearing comfortable street shoes and loose­fitting everyday clothes. Strength training can be achieved with inexpensive equipment like elastic bands and water filled jugs. For many older adults, cultural factors influence clothing and exercise choice.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 60 FITNESS TRAINING FOR OLDER PEOPLE COURSE 6. No pain, no gain Many older adults learned about physical activity at a time when it was thought that exercise had to be strenuous or high intensity to be of benefit. We now recognise that physical activity does not have be strenuous or exhausting to provide health benefits. We need to reinforce the notion that light to moderate activities, such as social dancing, walking, or gardening, are appropriate and effective ways to build more exercise into daily life. 7. Too busy to exercise Older adults may not realise that physical activity does not have to occur at a particular time and place, but it can be built into daily activities such as shopping, gardening and household chores. Older adults may need assistance in identifying opportunities in their busy schedules for increasing physical activity. The social and psychological benefits of exercise: To assist older adults in making the transition from a sedentary to a physically active lifestyle it is important to educate them about the many psychosocial benefits that can be gained from regular physical activity. Many people associate exercise only with changes in physical fitness and have no concept of the impact it can have on their psychological health, overall life satisfaction, and cognitive function, or in other words their overall quality of life. Here is a summary put together by the World Health Organisation of the short­ and long­ term psychological and social benefits of physical activity for older adults. Psychological and cognitive benefits of physical activity for older people Short­term benefits
· Relaxation
· Stress and anxiety reduction
· Enhanced mood state Long­term benefits
· · · · · General well­being
Improved mental health
Cognitive improvements
Motor control and performance benefits (e.g., fine and gross motor skills, balance, risk of falling)
Skill acquisition Adapted from World Health Organisation, 1997, “The Heidelberg Guidelines for promoting physical activity among older persons,” Journal of Aging and Physical Activity 5(1): 2­8.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 61 FITNESS TRAINING FOR OLDER PEOPLE COURSE Social benefits of physical activity for older people Short­term benefits
· Empowerment
· Enhanced short­term social and cultural integration Long­term benefits
· Enhanced long­term social integration
· New friendships
· Widened social and cultural networks
· Role maintenance and new role acquisition (i.e., roles in society)
· Enhanced intergenerational activity Adapted from World Health Organisation, 1997, “The Heidelberg Guidelines for promoting physical activity among older persons,” Journal of Aging and Physical Activity 5(1): 2­8. Understanding motivational psychology: “Motivation can be defined simply as the direction and intensity of one’s effort (Sage, 1977).“ Direction of effort The direction of effort refers to the whether an individual seeks out, approaches, or is attracted to certain situations. For example, a high school student may be motivated to try out for the tennis team, a coach to attend a coaching clinic, a businesswoman to attend an aerobics class, or an injured athlete to seek medical treatment. Intensity of effort Intensity of effort refers to how much effort a person puts forth in a particular situation. For instance, a student may attend a physical education class but not put in much effort. On the other hand, a golfer may want to make a winning putt so badly that he becomes overly motivated, tightens up, and misses. Or, a resistance trainer may work out 4 days per week like her friends but makes much greater progress due to the effort she puts into each workout. Relationship of intensity and effort For most people direction and intensity of effort are closely related. For example, students who seldom miss classes or training and always arrive early, typically expend great effort during participation. Conversely, those who regularly miss training, often exhibit low effort when they do attend. What motivates people? Each of us develops a personal view of how motivation works, or a theory on what motivates people. This is often influenced by what motivates us. Although there are thousands of individual views, most people fit motivation into one of three general orientations: 1. 2. 3. Participant­centred orientation Situation­centred orientation Interactional orientation Situation centred motivation In direct contrast to the trait centred view is the situation centred orientation, which contends that motivation level is determined primarily by the situation. For example, Brittany might be really motivated in her competitive sport situation, but unmotivated in her gym training sessions. Whilst the situation plays a large part in motivation, there are examples of situations where motivation remains despite a negative environment. Participant centred motivation The participant centred view contends that motivated behaviour is primarily a function of individual characteristics. That is, the personality needs, and goals of an individual are primary determinants of motivated behaviour. This is shown in people who have personal attributes that seem to predispose
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 62 FITNESS TRAINING FOR OLDER PEOPLE COURSE then to success and high levels of motivation. However, most of us would agree that we are in part affected by the situations in which we are placed. Interactional view The view of motivation most widely endorsed is the participant­by­situation interactional view. This view contends that motivation does not result solely from participant factors like personality, needs, interests and goals or from only situational factors like a coaches or teachers style or the win­loss record of a team. External and environmental influences on motivation • Indoor – Room set up – Colours – Furnishing – Fittings order • Outdoor – Weather – Location – Presence of onlookers Factors affecting exercise adoption and adherence for older adults Health and medical
· · · Illness
Pain or discomfort
Lack of strength or stamina Knowledge
· Lack of knowledge Motivational or Psychological
· · · · · · · · · Lack of time
Lack of self­motivation
Not a priority
No enjoyment
Fear of injury
Low self­efficacy or confidence
Exercise perceived as inappropriate or unnecessary for older adults
Poor body image
Depression or anxiety Program­related
· · · · Lack of age­appropriate classes
Intensity too high
Inconvenient class times or hours of operation
Program cost Environmental
· · · · Lack of transportation
Unsafe environment
Poor weather
Lack of support from family, friends, health care providers
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 63 FITNESS TRAINING FOR OLDER PEOPLE COURSE Five guidelines to build motivation 1. Both situation and personal factors motivate people 2. People have multiple motives for involvement 3. Change the environment to enhance motivation – Competitiveness or recreation – Provide multiple opportunities – Adjust to individuals with the group 4. Leaders influence motivation 5. Use behaviour modification to change undesirable participant motives Barriers to Physical Activity by Older Adults It is important to understand that despite a wealth of evidence about the benefits of physical activity for older people it has been difficult to convince older Australians to adopt physically active lifestyles. A major goal of health authorities world wide has been to identify some of the societal barriers to physical activity by older adults. Here are some of the barriers found in the United States( The National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older, Journal of Aging and Physical Activity, 9,S5­S13) to have the greatest relevance for both health professionals and physical activity instructors in the local community:
· · · · · · · Poorly planned neighbourhoods and communities that are unsafe and designed in a manner that discourages regular physical activity
Community resources( e.g., senior centres, community centres, apartment blocks) are often disconnected
Health organisations may not collaborate enough with professionals in urban and community planning, transportation, recreation and design to make communities more amenable to physical activity
Many older adults do not know how to start a safe and appropriate home based physical activity program
Many older adults are isolated and lack transportation to community physical activity facilities and programs
Medical professionals do not have the information to make referrals to community resources, and they often lack knowledge about quality programs, materials and resources
Many of the messages and much of the information about physical activity and exercise have been unclear, at times inconsistent, and confusing to older people as well as to the general population, health professionals and policy makers Modifications to exercise plans and programs: Program related factors include the structure, format, complexity, intensity, convenience, and financial and psychological costs associated with the activity. Most older adults prefer moderate­intensity activities instead of more vigorous ones. Physical activities that are convenient, inexpensive, and non­ competitive also tend to be preferred. It is important to understand the psychosocial factors that increase or decrease older adults’ likelihood of adopting and maintaining an exercise program. The barriers to physical activity and the factors affecting either exercise adoption or adherence discussed previously in this section need to be considered when planning or designing a program. Provide positive and effective feedback: Positive reinforcement increases the likelihood that behaviour will be repeated in similar circumstances. Verbal praise for even the smallest improvement in behaviour is associated with enhanced intrinsic motivation. Any effort in exercise or physical activity deserves recognition and positive feedback. Physical reassessments provide another opportunity for providing feedback and motivation. Physical activity instructors often help their clients to set goals but never review their progress towards these goals.
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 64 FITNESS TRAINING FOR OLDER PEOPLE COURSE Exercise Guidelines for the Older Adult Conditions commonly associated with ageing: Design and implement an exercise class for a group in consultation with medical advisors and allied health professionals: Identify relevant OH & S issues:
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 65 FITNESS TRAINING FOR OLDER PEOPLE COURSE APPENDIX 1
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 66 FITNESS TRAINING FOR OLDER PEOPLE COURSE APPENDIX 2
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 67 FITNESS TRAINING FOR OLDER PEOPLE COURSE APPENDIX 3
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 68 FITNESS TRAINING FOR OLDER PEOPLE COURSE APPENDIX 4 REFERENCES • • • • • Psychological dynamics of sport. Human Kinetics. COTA In Service Training Manual YMCA Australian Institute of Education & Training – Canberra campus Physical Activity Instruction of Older Adults. Human Kinetics Senior Fitness Test Manual. Human Kinetics
© Copyright Victorian YMCA Fitness Training Australian Institute of Education and Training (Victorian Campus), 2005 69 

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