Helping Older Adults Conquer Everyday Activities

Picture yourself getting into the driver's seat of a car or out of an armchair. How about walking down a flight of stairs or simply holding your head up off your chest? For most individuals, visualizing these simple tasks requires more conscious thought than actually completing them. But for others, namely many older adults, such everyday functions are only dreamed about.

As the senior population in the United States continues to explode right along with the country's fascination with fitness, an abundance of research conducted within the past few years has shown that people of advanced ages and those with chronic ailments can benefit greatly from a regular regimen seemingly reserved for the young and the buff: strength training. In fact, strength training has allowed many older Americans to regain use of muscles left atrophied by years, even decades, of neglect. The result is fuller lifestyles, and perhaps years of extended life.

"We're on the right track," says Wayne Westcott, director of fitness research for South Shore YMCA in Quincy, Mass., who has studied the positive effects of strength training on wheelchair-using nursing home residents in Florida. "I don't think there's anything else that comes close to strength training. The average doctor says people should walk. I'm not against walking, but these people couldn't walk. That's why they were in wheelchairs. What they needed was basic, functional muscle strength." And that can come from any number of exercises using a broad range of equipment-or no equipment at all. Older adults can work out in the privacy of their own homes or under close supervision in health-club settings. The key is convincing them that it's never too late to start strength training, even if they've never exercised before.

"The biggest thing is getting them to do it," says Tom Laviano, director of the New Hyde Park, N.Y.-based Oxygym, a 2,200-square-foot fitness center that caters exclusively to seniors, particularly those with chronic conditions such as emphysema, asthma, cardiovascular disease and diabetes. "You can't let them say, 'I can't do it,' or, 'I don't want to do that exercise.' I respond with, 'Well, you are going to try.' You've got to give them that little push, but at the same time, you have to gain their respect so that they trust you. Once they trust you, they'll try just about anything."

Oxygym opened in January with the goal of providing an independent facility where seniors-removed from the intimidating atmosphere of a health club or the sterile surroundings of a hospital - could work out more comfortably.

Membership has grown from only a few at the outset to nearly 50, all of whom pay $500 for three months of access to two 10-piece circuits of strength-training machines, as well as cardiovascular equipment. A dozen members at a time complete both strength training and cardiovascular circuits during hour-long classes, guided from one exercise to the next by an instructional CD. "They all start together. They all stop together. They all move to the next machine together," says Laviano, one of two exercise physiologists on the Oxygym staff. "There's a certain period of time when they're on each machine, and they do as many repetitions in a slow, controlled manner that they can do in that time, and then they move on to the next piece of equipment." All the while, Laviano is adjusting the machines, correcting technique and closely monitoring members' blood pressure and bloodoxygen levels. "We're always there with the group," he says.

Oxygym appears to be tapping into a niche market at an ideal time. According to 1999 figures compiled by the U.S. Census Bureau, roughly one in eight Americans, or 34.6 million people, are age 65 or older. Projections indicate that by 2020 the number of individuals age 65 to 74 will have grown 74 percent over the previous three decades. An estimated 72,000 people who have lived at least 100 years currently reside in the United States, and by 2050, the number of centenarians is expected to hit 834,000.

So what? People that old can't strength-train, right? Tell that to Westcott, who targeted extreme examples of sedentary seniors when he introduced a strength-training program to residents of John Knox Village, a retirement community in Orange City, Fla. When the 14-week study began in November 1998, many of the 19 participants (average age: 89) exhibited such poor posture due to muscle atrophy that their ribs were touching their hips, according to Westcott. "Most of these women and men were in their wheelchairs only because they were too weak to get out of their wheelchairs," he says. "We felt that if we could do a very basic strength-training program for them that we had a fighting chance to improve their lifestyle."

The program included six exercises, two of which focused on the functional muscle strength required of a person rising from a seated position. The quadriceps and hamstring muscles, which both facilitiate standing upright, were strengthened using a leg-press machine. The triceps press worked the arms, chest, front shoulders and upper back, with the goal to provide enough strength for the seniors to push themselves up from the arms of their chairs. The remaining four exercises were incorporated to enhance muscle balance and improve posture.

They included a seated row (shoulders), trunk extension (lower back), and two exercises using the type of fourway neck machine common in football training rooms. "We did it each way for muscle balance, but the important way was the neck extension, lifting their chin off their chest, where it was almost permanently embedded because they had no neck strength. They couldn't hold up their 12- or 14-pound heads anymore," Westcott says, adding that no exercise proved more functional. "They can't breathe very well in that position. They can't speak well. They can't look up to see. So even if they were able to walk, they couldn't see where they're going. It certainly makes it very difficult to swallow, to drink water or other fluids, or to eat their food. So, to me, for these people in a nursing home, that was the most important exercise-to get them to hold their head up."

Excluding the time it took to transport the participants out of their wheelchairs and into the various exercise machines, the semiweekly six-minute workouts totaled less than three hours of actual targeted muscle exertion over the course of the study. And the gains made in that short time were staggering. The participants' leg strength increased by an average of 80 percent; upper-body strength, 40 percent. "Their flexibility increased 30 percent just from doing the strength training, just from getting those muscles active and using them once again," Westcott says.

By the study's conclusion in mid-February 1999, participants had gained an average of four pounds of muscle and lost an average of three pounds of fat. "That's typical of people who start strength training, but it's not typical when you're doing 12 minutes a week," says Westcott. "It was because they had so little muscle left that they were able to add it fairly quickly-and I don't want to say easily, because they put in the effort."

Strength training can also be worth the effort for facilities like John Knox Village. The study there took into account participants' functional independence measure (FIM), a seven-point scale used to quantify a person's ability to handle tasks in each of 18 different categories. A person's ability to brush his or her own teeth, for example, would help boost that individual's FIM score in the grooming category toward a 7. Someone who needs to have the toothpaste put on the brush and the brush maneuvered in his or her mouth would pull the score down toward 1. The cumulative FIM score for study participants improved by an average of 11 points, translating to potential annual cost-of-care savings for John Knox Village of $40,000.

The bottom line for participants, meanwhile, was a renewed sense of function. All but one participant (a double amputee) spent less time in their wheelchairs. One resident hung a "For Sale" sign on her wheelchair after she discovered she no longer needed it. Others discarded their back braces. One woman rejoined her husband in an independentliving setting elsewhere on the John Knox campus.

Westcott's only regret is that, in his mind, the study concluded prematurely. "If we had gone just two to four more weeks, I think all of them, except for the double amputee, would have been able to get out of their wheelchairs. They might still need their wheelchairs once in a while, because they still tire out. We didn't get a great cardiovascular effect on 12 minutes a week. What they needed was strength, and strength training certainly improved that in every category we tested."

People's understanding of the aging process has come a long way since the 16th century, when Spanish explorer Ponce de Leon searched for the Fountain of Youth and its age-restorative waters. But not enough people living today realize the role muscle plays in how we grow old, or stay young, according to Miriam Nelson, director of the Center for Physical Fitness at the School of Nutrition, Science and Policy at Tufts University in Medford, Mass.

"Muscle is a very important tissue within our bodies, and most of us don't understand how important it is," Nelson says. "Around our mid-30s, we start to lose up to a half pound of muscle each year, and we gain that much body fat, if not more. This body composition shift has a profound effect on our metabolic rate and our health. It makes us more resistant to insulin. We assume a greater risk for type-2 diabetes. Lipid profiles are not as good. We become weaker, frailer, the sort of things we think of as typical aging."

While cardiovascular health is important, and attainable through aerobic exercise, it does little to preserve muscle, according to Nelson. "Strength training does that," she says. "Our research at Tufts involves progressive-resistance exercise on people ages 45 to 98, and what it has shown is that at any age you can gain back muscle. You can get stronger. Biologically, in terms of age, you can become 20 to 25 years younger than you are now. We've seen people in their 60s become as strong as people in their mid-30s. We see people in their 90s getting as strong as people in their 60s."

These individuals don't turn into Jack LaLanne clones overnight, of course-if at all. The strength-training goals of most are more about overcoming fears of falling down than they are about pumping up. The older the individual, the more the focus turns to the lower body and the leg muscles essential in maintaining balance. At Tufts, training begins with squats using the back of a chair and the exerciser's own body weight to work the quadriceps, hamstrings and gluteals. Another exercise might entail repeatedly stepping on and off of a single stair to target those same muscles. "I've designed programs that one can do easily at home," Nelson says.

Consider the case of Bernice, a 92-year-old Medford resident. Five years ago, she suffered a bone fracture resulting from a fall in her home. Consequently, Bernice became so overcome A feeling of vulnerability that she was afraid to go outside. "We went into her home and showed her how to do some simple strength-training exercises," Nelson says. "She got so strong that she started bowling again and caring for her great-grandchildren. She helps out at the church on Sundays now. It's just totally changed her life, and being physically strong is what did it."

Eventually, elders under Nelson's watch may graduate to progressive-resistance exercises using strength-training machines, but the machines aren't for everybody. They're not even the first choice of Michael Rogers, director of the Center for Physical Activity and Aging at Wichita State University. While the center offers traditional means of strength training with weights, Rogers prefers the versatility and safety offered by elastic bands, and he's adapted 25 different exercises to them. "Those who are trying to regain functional capacity can do every exercise in a chair. Then the goal is to have them eventually be able to stand up and perform those same exercises," says Rogers, who works with 200 adults at the center, ages 60 to 94, from the physically fit to the frail. He also takes the bands out into the community, where his oldest program participant is 101.

According to Rogers, balance is the most important factor in helping seniors regain functionality. "It's something the young take for granted, but come 70 or 75, all of a sudden it becomes one of the most limiting factors-not just loss of balance, but a fear of falling," he says. "So those individuals tend to sit in a chair more and their fitness declines, and it becomes this downward cycle."

The Center for Physical Activity and Aging offers two classes that specifically address balance training, and participants fill out a 16-point questionnaire called The Activities-Specific Balance Confidence Scale. It asks class members to rank on a scale of zero to 10 their level of confidence when performing activities such as bending over to pick up a slipper from the floor, standing on a chair to reach a can on a shelf or walking through a crowded shopping mall.

One class is for relatively fit older adults and involves such balanceenhancing techniques as sitting on exercise balls while engaging in upper-body workouts using the elastic bands. The other class is for people ages 85 to 97 and involves a basic but effective approach to improving balance-standing and walking on 2- and 4-inch-thick sheets of foam rubber purchased from an upholstery dealer. "You can imagine that it's not easy to remain perfectly still while trying to stand on your couch," Rogers says. "What we do is measure their ability to remain as still as possible. And we also look at their dynamic balance - their ability to walk on the foam and the amount of time it takes to walk through an obstacle course."

Though a departure from the use of strength-training machines to improve functional mobility, the foam works. "It's been successful," says Rogers. "In the first two months of this class, we've had two people who have been able to discontinue use of their walking aids. It could be a function both of improved balance and certainly the effects of improved confidence for these people."

Whether helping transform fear into confidence or simply weak muscles into strong ones, strength training has proved to be a fountain of youth of sorts for a growing number of older Americans - individuals who are again conquering the life functions they once took for granted.

A statistic indicating just how many U.S. seniors regularly strength-train is hard to come by, but it's a safe bet the number is not large. But as life expectancies in this country rise and the population of older adults continues to exponentially increase, fitness professionals will have to do their part to keep the booming elderly population active and functionally able.

"The ones who have come to our program on campus have already overcome the biggest hurdle, and that's to initiate some type of action," says Rogers. "But there are about 500,000 people total in the metropolitan Wichita area, and we have only 200 in our program. Given that 14 percent of those 500,000-about 70,000 people-are older adults, there are obviously a lot of people we haven't convinced to join our program. That doesn't mean they're not exercising somewhere else, but certainly nowhere near enough of them are participating in programs in the city."

To date, Oxygym has done little in the way of marketing or member recruitment, relying instead on an increasing number of referrals from area physicians, according to Laviano. Often, curious individuals come through the door and are turned away for being too young. "We don't want to bring that regular-gym atmosphere in here," he says. "We want to keep this a monitored program." For nearly a year now, Laviano has been monitoring changes in both body and spirit. "You see people's attitudes changing," he says. "I have people coming in who, in the beginning, are very anxious and nervous. They look at all this equipment and they feel overwhelmed.

Then we get them believing that they can do this, and the next thing you know they're a different person. They're happy-go-lucky." Tufts University's Nelson is confident that the concept of senior strength training is coming of age.

"A lot of older people have gotten over dwelling on things they should have done 20 or 30 years ago," she says. "Once they are shown how easy it is and that it's safe and fun, they love it, because they feel themselves getting stronger so fast." Which is a strong argument for getting seniors started on strength training at any age. "The question I get asked a lot of times is, 'What age is the best age to start?' " Nelson says, before providing the answer. "Whatever age you're at."