Consideration for Designing an Exercise Class for Older Adults

How to Design your Classes General Guidance

Provide an environment of inclusivity.

• Use principles of group dynamics to facilitate relationships.
• Offer positive feedback
• Start will accessible movements and allow everyone to grow at their individual pace

There is a spectrum from frail to hearty in the population of aging adults.

• Accept all movers in their current health and ability.
• Start low, slow and small and move up in increments
• Allow everyone to find their appropriate level of challenge

Warm up joints and muscles.

• Stay within range of motion. Remind participants that everyone’s range of motion is individual.
• Cue movement with little to no weight on joints
• Wrists, elbows, shoulders, spine, hips, knees, and ankles all benefit from warm-ups. Warm-ups may include drills or getting blood pumping to a certain area

Always start low, slow, and small.

• Begin with the most accessible movements, weights, and balance requirements
• Begin with decreased range of motion options and build

Provide frequent feedback.

• Watch for signs of challenge such as shaking, instability facial grimacing.
• Cue the class to take a step back
• Use if-then statements to guide into appropriate challenge

Find range of motion.

• Show actions most accessible to individuals
• Use muscles to find range of motion preventing use of momentum for movement

Repeat movements.

• Avoid facilitated stretching
• Develop muscle memory - train the muscles
• Develop muscle and cognitive strength through repetition
• Simplify physical activity without complicated sequences

Cool down with slower movements and gentle stretches.

• Offer stretches that match the activities completed
• Ease into and out of a workout

Respect potential sensory degradation.

• Respect hearing limitations by offering visual demonstrations
• Respect sight limitations by offering encouragement and guidance verbally
• Only demonstrate and say what you want people to do. Offering an example like “what-not-to-to” may be misinterpreted

Step-by-Step Class

1. Establish safety protocol
2. Start by marching in place
3. Reintroduce yourself and any assistants
4. Ensure participants are in position (have enough space, supports needed [chair, wall, walker], shoes are tied, water bottles under the chair or out otherwise of the way)
5. Remind participants to listen to their own body, modify as needed, amplify as needed, use breath as a guide, stay in natural range of motion 
6. Begin cardio
   
   • Incorporate stretches after the first warm-up song; remember to complement folks on their form and use your body or words to provide corrections rather than calling someone out for “improper” form.
7. 2-3 more cardio songs
8. Cardio and stretching ~ 20 minutes total (~4 songs)
9. Water break (5 minutes)
10. Standing weights (10 minutes ~2 songs)
11. Mat work (15 minutes ~3 songs)
12. Stretches (10 minutes ~2 songs)

Consider specific responsibilities when leading aging adults individually or within a group.

Know your limitations.

• Do not diagnose participants or provide any medical advice.
• Suggest consulting a medical provider if specific/individual health questions arise.
• Become comfortable with saying, “I don’t know.”
• “If it hurts, don’t do it.” is a safe response for everyone.

Know your role.

• Guide movement with confidence
• Encourage without pressure.
• Suggest alternatives provided by your training and programming.
• Demonstrate range of motion appropriate for your group, not YOUR greatest range of motion

It is a challenge to honor the individual while leading a group.

Using if - then statements can help. If - then statements establish safety and next steps for challenge.

IF states the safety and knowledge of what is needed to support the movement.

THEN states what the next step is in taking on a challenge.

This process keeps everyone moving from low, slow and small towards challenge. “If this is easy, then get a heavier weight.”

“If your core is holding tight and you can still breath, then reach a little further”

“If you can balance with one finger on the chair, then try and slowly let go all together.” “If your front foot is steady on the ground, then lift the back foot.”

Safety suggestions specific to LIFT

• Watch the floor for tripping hazards, including tied shoelaces and placement of water bottles/personal items.
• Keep participants using their muscles, rather than momentum.
• Allow an individual to choose their weights daily, recognizing ups and downs occur with health.

Safety suggestions specific to mindfulness or yoga informed movement

• Follow the class plans start to finish. Follow program plan from class to class.
• Use English over Sanskrit when discussing yoga poses and philosophy.
• Music is optional and discouraged if it challenges a participant’s ability to hear the instructor. Demonstrate the “Do’s” showing participants only what to do.

Tips for Modification

Arthritis

• Try to exercise your larger body parts and muscles (such as your forearms and elbows) instead of smaller ones (such as your wrist, fingers, and hands).
• Don't exercise to the point of discomfort. You want to feel a nice stretching sensation, not pain.
• Pay attention to the signals your body sends you.
• Decrease the intensity of your workouts if you feel joint pain or soreness.

Osteoporosis

• Exercises to avoid:
  • Exercises that involve loaded forward flexion of the spine such as abdominal sit-ups.
  • Exercises that increase the risk of falling
  • Exercises that require sudden, forceful movement, unless introduced gradually as part of a progressive program.
  • Exercise that requires a forceful twisting motion, such as a golf swing, unless the person is accustomed to such movements.

Joint replacement

• Ask participants to talk to you before or after class about their joint replacement.
• Ask participants to speak with their care provider about modifications.
• Warning signs of blood clots. The warning signs of possible blood clot in your leg include:
  • Pain in your calf and leg unrelated to incision
  • Tenderness or redness of your calf
  • Swelling of your thigh, calf, ankle, or foot
• Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:
  • Sudden shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing

Balance issues

• Ask participants if they need a chair to hold onto during exercises.
• Modify all balance exercises by not lifting foot off the floor.

Vision or hearing limitations

• Ask participants if they need a chair to hold onto during exercises.
• Modify all balance exercises by not lifting foot off the floor.

Cognitive impairments

• Please direct participants to the website for audio, visual and written exercise instructions.
• If a participant does not have access to the internet but would like written instructions, the research team can print this for participants.

Loneliness or isolation

• Encourage participants to exchange phone numbers.
• As an instructor try to engage with all participants equally.
• If a participant confides in you regarding isolation, please direct them to a health care professional.

Socio-economic considerations

• Ask participants to volunteer to bring homemade snacks or bring fruit.
• Encourage participants to carpool, walk, and use public transit for commuting to classes.

Resources

Additional Resources

Adaptive Exercise Videos from the International Council on Active Aging: http://www.icaa.cc/category.asp?categoryID=63&type=3

American Academy of Orthopedic Surgeons

https://www.aaos.org/

Arthritis: https://www.everydayhealth.com/

Balance Issues: http://goal.kin.educ.ubc.ca/glossary/leg-swap

Fall Prevention:

http://www.ideafit.com/fitness-library/addressing-the-fear-of-falling-in...

Exercise Recommendations

CSEP Recommendations (CA) [PDF link]: http://www.google.com/urlsa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ve...

Centers for Disease Control and Prevention (USA): http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html