August 2017 Issue

Older Adult Fitness Programs
By Jennifer Van Pelt, MA
Today's Dietitian
Vol. 19, No. 8, P. 26

As the senior population increases, exercise options for boomers and beyond are growing in number and variety.

Due to the aging baby boomer generation, the number of Americans aged 65 and older is rapidly growing; by 2050, this group will comprise about 25% of the US population. The benefits of exercise for older adults go beyond improving and maintaining cardiovascular fitness, strength, and flexibility. Exercise helps to lessen or even prevent age-related physical and cognitive decline as well as maintain functional independence. However, a majority of adults aged 65 and older don't meet recommended guidelines for weekly physical activity; a data analysis from the Centers for Disease Control and Prevention found that only 16% met guideline recommendations for muscular strengthening and aerobic activity.1 Encouraging older adults to engage in physical activity and maintain a regular exercise schedule is essential for the healthy aging of one-quarter of America's future population.

Available Programs
Older adult fitness programs have been available for decades, but more options are now emerging due to the fast-growing senior population. The American College of Sports Medicine (ACSM) ranked fitness programs for older adults at number 11 on its list of the Top 20 Trends in Fitness for 2017. According to the ACSM, the health and fitness industry is evolving to appeal more to this expanding market.2 This evolution is indeed noticeable in programs like Silver Sneakers and Silver & Fit, which have been in operation for many years. Both programs have offered traditional senior fitness workout formats that focus on strengthening, balance, flexibility, and aerobic fitness for frail to fit seniors. Recently, they've added more intense formats to appeal to more active, athletic participants.

The ACSM recommends that fitness facilities and professionals offer age-appropriate and safe exercise programs that meet the varying needs of this age group.2 Most fitness facilities offer Silver Sneakers and/or Silver & Fit, both of which are linked to health insurance companies; memberships to facilities nationwide are low cost or even free. In addition to specialized senior memberships, these two organizations offer older adult fitness classes. The group fitness class setting is ideal for seniors to not only exercise regularly but also socialize with their peers and make lasting friendships that help motivate them to attend classes regularly. Class formats range from very basic chair-based strength and balance appropriate for any fitness level to more advanced classes that include low-impact aerobics, strength training with heavier weights, and floor exercises for core strength. Basic chair-based classes accommodate frail older adults and those with movement limitations, since exercises can be performed seated or standing. Instructors offer more advanced options for more fit participants, too, so these classes are appropriate for any older adult. Even those in wheelchairs can perform most of the exercises. Silver Sneakers and Silver & Fit offer chair yoga (appropriate for all fitness levels and those with movement limitations) and standing balance/stability formats to address flexibility, fall prevention, and mind-body wellness.

More advanced classes are designed for more mobile older adults who don't require a chair for support and who are capable of moderate to vigorous exercise. Exercises generally are low impact on the joints but provide a good aerobic and strength workout using weights, resistance bands, and small inflatable resistance balls. Circuit workouts and modified boot camp-style classes also are available for more active older adults.

Silver Sneakers and Silver & Fit classes are named and described clearly on their websites and on schedules at facilities where they're offered so participants know which classes match their fitness capabilities. Both organizations provide training to qualified fitness instructors to maintain consistency in safety and appropriateness of exercises offered in each class format.

Many facilities also offer other older adult fitness classes, such as gentle yoga, tai chi/qigong, senior strength and stretch, aqua workouts, and dance-based workouts. The Zumba franchise offers an older adult format called Zumba Gold, which includes the same motivating dance music as the Zumba program but choreographed with slower, low-impact movements. Zumba Gold is appropriate for older adults who enjoy dancing and don't require a chair for support during exercise. Aqua Zumba classes move the dancing into the pool for those who enjoy water workouts and/or have arthritis or other movement limitations that require the supportive and gentle setting of water.

Group fitness classes aren't the only option for older adults, but generally they've been the most popular because they offer the opportunity for socializing and provide motivation that many exercisers need. Active older adults who prefer exercising on their own, or those who want variety in their routines, can use gym cardiovascular and strength equipment, the pool for lap swimming and water walking, local neighborhoods for walking, or exercise DVDs/online workouts at home. Safety and injury prevention are the primary issues for older adults working out without supervision. For clients who want to use gym equipment, advise that they receive instruction from gym staff on appropriate equipment and exercises for their age and fitness level. Exercise DVDs/online workouts also should be age-appropriate and offer exercise modifications for different fitness levels.

Fitness Activities for the Very Fit and Frail
All of the above classes and activities are appropriate for previously active older adults and those who have been sedentary but don't have movement limitations; most older adult fitness programs are designed with this demographic in mind because it represents the majority of older adults who will participate in classes. But what about those clients outside the average—those who are highly active (possibly former competitive athletes, who the ACSM calls "the athletic old")2 and those on the other end of the fitness spectrum, who are frail and/or have movement limitations?

Very fit older adults likely won't require much guidance on exercise options; they're more likely to require guidance on safety and variety. For example, a dedicated older runner may neglect upper body strength exercises and stretching, which can help prevent injuries and improve posture, while overdoing high-impact exercise and risk overuse injuries. Encouraging the addition of nonimpact but intense exercise, such as water running, swimming, and indoor cycling, as well as one or two strength and flexibility sessions per week can help them reduce risk and improve overall fitness. For the highly active older exerciser looking for new activities, the ACSM suggests more rigorous exercise programs, like strength training, team sports, and even high-intensity interval training (HIIT) geared toward older exercisers.2 HIIT, which involves short bursts of high-intensity aerobic exercise with longer periods of lower-intensity training (generally strength with weights or body-weight exercises), does require close supervision by an instructor with training and experience in senior fitness. Since the publication of a study finding that HIIT in older adults actually reversed cellular-level signs of aging, interest in HIIT for older exercisers has been high. If exercises in HIIT workouts are modified for older exercisers, HIIT can be safe. Many exercisers confuse "high-intensity" and "high-impact." HIIT workouts can be done with low- and nonimpact activities, such as walking, cycling, and swimming, which minimize risk of joint injuries in older exercisers. Aerobic intensity can be achieved without impact, making HIIT workouts an option for many older adults. HIIT may even be beneficial for very frail older adults. A modified HIIT walking workout recently was found to be effective in improving function in frail older adults in an assisted living facility.3

Frail adults have balance and functional impairments that can be addressed by appropriate exercise, thereby improving performance of activities of daily living (ADLs). The ACSM ranked functional fitness as the number 12 top trend in fitness for 2017. Functional fitness involves the use of strength training and other exercises to increase balance, coordination, strength, and endurance to improve performance of ADLs. Exercises often mimic the actual movements in ADLs, like lifting objects up to a shelf, sitting down and standing up from a chair, turning around when walking, and carrying groceries.2 Functional fitness is a key component of physical therapy programs and fitness programs for older adults who are frail or have movement limitations. Functional fitness also helps prevent falls; one in three adults aged 65 and older and nearly one-half of those over age 80 fall at least once annually; falls are a major cause of fracture and mortality for this age group.4

The chair-based group fitness workouts offered by Silver Sneakers and Silver & Fit all have functional fitness exercises incorporated into the format to address balance and fall prevention for older adults. For frail clients who aren't yet comfortable in a class setting, supervised exercise based on functional fitness principles can help them improve daily activity. Even a small increase in strength can allow a frail client to perform ADLs, such as making a bed and doing laundry, and increase their daily functioning and quality of life. Once they're stronger and able to move more confidently, they'll be motivated to increase their activity level even more and participate in different exercise activities. Good first activities for exercise for these frail clients are chair yoga and tai chi/qigong (in a chair or standing). These mind-body exercises have been shown to improve strength, balance, coordination, and flexibility in older adults.4

The above are only a few of the many options for older clients who want to become or remain active as they age. Team activities are increasing in popularity for baby boomers who played team sports when younger. Local gyms and community centers may offer tennis, racewalking, swimming, pickleball (a combination of tennis, ping pong, and badminton), and basketball for adults over 50 who enjoy competition. Cultivating relationships with local fitness facilities and professionals can provide resources for dietitians and their older clients.

For more information on functional fitness and older adult exercise, see the sidebar.

Putting It Into Practice
When counseling older adults on their fitness possibilities, a good first step is to assess their fitness level and interests as well as any medical issues. Although a comprehensive assessment requires a physical examination and testing, a client's fitness can be quickly evaluated with some questions, such as the following, about their past and current exercise history and medical conditions:

• When you were younger, did you participate in sports or dance?
• Do you enjoy competing and/or playing games?
• Do you prefer exercising outdoors, indoors, or both?
• What physical activities do you currently do regularly for exercise?
• Do you have any medical conditions that limit certain exercises?
• Do you have any movement limitations?
• Do you have trouble performing daily tasks, such as carrying groceries, going up stairs, or getting up out of a chair?
• If you don't exercise regularly, what types of activities do you think would motivate you to start and keep exercising?
• If you don't exercise regularly, what's preventing you from exercising?

Answers to these questions, in combination with knowledge about the client's local community, can then be applied in determining some safe and effective exercise options. For example, what would be a good weekly exercise program for JoAnn, a 70-year-old female client who enjoyed dancing when younger, prefers exercising indoors, currently walks once or twice weekly as exercise, has recently been diagnosed with early osteoporosis, and thinks gyms are for young people? JoAnn lives five miles from a large gym that offers Silver Sneakers and Zumba Gold classes. Her enjoyment of dancing makes her a good candidate for Zumba Gold once or twice weekly. Adding two Silver Sneakers strength-oriented classes will help combat the osteoporosis. Introducing JoAnn to the gym's Silver Sneakers coordinator or the older adult fitness class instructor would help motivate her to go to her first classes.

Once the client's physical capabilities and interests are determined, dietitians can make suggestions for appropriate exercise activities. For the older exerciser, ensuring the activity is safe, effective, accessible, and fun are most important for keeping them exercising regularly.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Reading, Pennsylvania, area. She has specialized training and 20-plus years experience in older adult fitness instruction.

References
1. Centers for Disease Control and Prevention. Adult participation in aerobic and muscle-strengthening physical activities — United States, 2011. MMWR Morb Mortal Wkly Rep. 2013;62(17):326-330.

2. Thompson WR. Worldwide survey of fitness trends for 2017. ACSMs Health Fit J. 2016;20(6):8-17.

3. Danilovich M, Conroy D, Hornby TG. Feasibility and impact of high intensity walking training in frail older adults [published online January 25, 2017]. J Aging Phys Act. doi: 10.1123/japa.2016-0305.

4. Forman DE, Arena R, Boxer R, et al. Prioritizing functional capacity as a principal end point for therapies oriented to older adults with cardiovascular disease: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2017;135(16):e894-e918.