How Should We Coach Older Populations?

I love training the older population.

Might sound crazy to some, but hear me out

For a couple of reasons:

1. I can always learn something each session and gain valuable life information

2. The effects on quality of life as a result from resistance training can be dramatic, is more noticeable for them, and likely has more return for their investment than younger individuals.

The latter is why I coach. We all start and use our coaching careers as a vehicle to affect positive change and impact. From a career standpoint there is nothing better than to see the impact on quality of life on my older clientele from evidence based resistance training.

Whether you are a trainer or an individual in this population, the purpose of this blog is to help guide your programming training and where to put your eggs to maximize improvements in function in daily living, overall health, and quality of life. 

Let’s Start Here

Before we get into the x’s and o’s we need to start with how we communicate to our older clients. We need to stop talking to little old Barbra like she’s a fragile, broken human being. 

We need to use language that helps create shifts in our clients’ paradigm that they are strong, resilient, and bad ass individuals who are capable of doing cool shit and getting strong. 

No I do not mean slapping a heavy barbell on her back during your second session and telling Barbra “you’re a badass and you’re strong I know you got this.” We still need to be realistic. It’s about finding the right options, setting them up for success, and then using the right language to instill that confidence and mindset resilience. 

Sprinkle In Some Power and Declaration Work

 

 

As we age one of the first qualities we start to lose is power. Simply put, power is how fast we can generate force. The primary reason I spend time developing this quality with older populations is for fall protection. 

Now hold on, don’t get mad, I understand fall protection is complex and I am not pretending to be an expert on the topic, but power is a critical factor to consider.

That being said, how fast we can generate force with our muscles, rate of force development (RFD), is a crucial quality in fall protection. 

If you live in a place with snow and ice this is an easy example to understand. You are walking to your car early in the morning and you step on some ice you do not see. You feel your feet start to slip from under you and now you have to attempt to quickly get your feet back under your center of mass, and once you do so, resist a lot of eccentric forces acting on you. 

Improving RFD will help with the ability to regain balance during sudden postural perturbations where fast muscle contractions are required (1). If you can’t generate force quickly, you’re going to splat on ground, plain and simple, with some potentially disastrous consequences.

To have success and create amazing adaptations, long term adherence is key (more on this later), so we need to prioritize bang for your buck program selections. This is why I do not start with, nor spend a lot of time with direct balance training with my older clients. I believe we can obtain better/ faster benefit with direct power training and deceleration work.

Some Options

The purpose of this blog is not to give you every option I use in detail, but I would be doing a disservice if I do not clarify and give a few options. There are many safe ways to start increasing power on or close to day 1 of a program. Here are a few to get your brain going:

  • High Tension Isometrics:

    • Duration: 20-45 seconds

    • This can still help with RFD, activating higher threshold muscle fibres, and enhancing declaration/ force absorption capacity.

    • Can be utilized in a number of ways: squats, bridges and lunge variations are among some of my favourites to implement.

  • Bilateral Swipe Downs and Gate Swings 

    • Duration: 5-10 Reps

    • Can improve technique for deceleration/ landing mechanics.

    • Can slow down the speed of each rep to enhance skill development or can increase speed to increase eccentric overload.

    • More transferability to function in real life.

  • Med ball variations

    • Duration: 5-10 reps 

    • Fast explosive movement with a low risk to high reward ratio.

    • Advanced skill is not required for a number of med ball variations

    • Amazing option for upper body specific power development

    • Some great variations are overhead slams, tosses, and press throws.

  • Low level jumps and hops (make sure they physically and mentally ready to handle this demand)

    • Duration  3-6 reps

    • Probably the most effective way to improve lower body power and RFD

    • Requires competence in landing mechanics (start with swipe downs)

    • High level of transferability to function in real life.

Prioritize Resistance Training With Progressive Overload

 

 

The evidence is pretty clear that to best serve this population, this is where we need to spend most of our time. We need to prioritize building strength, it is the foundation that sets the table for most other qualities.

Even if you do not sprinkle in power work as we touched on above, resistance training will give you some of the same benefits for this population, like improved RFD(1). Resistance training is a powerful tool for developing important longevity qualities in this population, and if you need some evidence here you go.

Lean body Mass and Waist Circumference:

After 12 weeks of resistance training Churchward-Venne et al.(3) showed an average increase in lean body mass of 0.9 kg after baseline and after 24 weeks they showed a change of 1.1 kg from baseline. It should be noted that no nutritional changes were required, nor tracked, in this study.

How encouraging is this knowing the participants were an average age of 72 and still were able to pack that much muscle on in a short period of time!

Barbalho et al. (2) conducted a study comparing both low and high volume resistance training. Their study showed that both low and high volume resistance training can significantly decrease waist circumference.

Across the study, over 60% of the participants saw a decrease of at LEAST 4 cm from their waist circumference. This was relatively evenly divided across the two groups.

Why is this important besides your pants fitting better? Waist circumference can be a good indicator of longevity for the masses and in one study(5); 4 cm decrease has been linked to an increased life expectancy of 5 years.

Flexibility/ Mobility:

Life is much more enjoyable having the ability to get in and out of a variety of different positions.

In Barbalho et al (2), a sit and reach test was used to measure flexibility change in pre and post resistance training intervention. Mobility gurus, are you ready for this? In low volume group pre intervention the mean was 18.00, and the high volume group pre intervention was similar at 18.17 cm. Post intervention results were 28.96 and 28.07 respectively. Yup, that’s right, they made a 60% increase in their flexibility!

I know what you’re thinking, but no stretching was not a part of the program! This makes sense when you think about it. 

Lets oversimplify shall we?

I want you to imagine a bridge with no support in the middle. If we make that bridge longer, the weaker the middle will become. If no support is added it might even collapse in the middle.  Well, if we think of a muscle in the same context, if a muscle is weak the best option is to tighten and make itself shorter increasing its mechanical advantage to keep us safe. 

If we get those muscles stronger, your muscle will feel more comfortable resting at  longer lengths which will mean more range of motion.  This is why I opt for strengthening as a better option for gaining more range of motion rather than just static stretching alone.

Improve Absolute Strength and Daily Task Function:

It is jaw dropping to see the strength increases shown in the literature. In Churchward-Venne, et al. (3) after 24 weeks of resistance training, 1RM Legpress and Extension had a 50 kg and 29 kg increase respectively. I don’t know about you……but I consider that a huge deal. 

However, does this translate into daily living, like the ability to get in and out of a chair? Well a notable result in Barbalho, et al. (2) utilized a 30 second chair sit and stand test for max reps. The low volume group went from 9.44 reps pre to 20.74 reps post intervention, and similar results were shown in the high volume group. 

Now It is clear that resistance training is a powerful tool that we should prioritize but it needs to be done in the right way so to finish this blog out here are some….

Keys to Success

Select the Right Variations, Stick to the Basics

When you’re programming, you do not need to get fancy. Stick to the basics and progress/regress/lateralize through many movement patterns. If you focus on enhancing your clients ability to squat, hinge, lunge, push, pull and carry in multiple planes of movement you are going to see market changes fast. Select exercises that will allow your client to move through large degrees of movement in as strong and safe a position as possible. Also, do not be afraid to sprinkle in machine variations. 

Most trainers scoff at the idea of using machines (because they are just so “not functional”). I am for anything that allows my clients to feel safe while adding quality load to the system and move through large ranges of motion, especially for the population we are discussing.

More Doesn’t Always Mean Better

We need to remember that a lot of this population coming to us for help will not have done any type of resistance training for a long time or maybe never in their entire life. Put yourself in their shoes, they might be nervous to start or have false perceptions they are working through about resistance training. Minimal effective dose is all we need. 2 – 3 full body days a week is all that’s required to change lives.

In Barbalho et al. (2) we can see that there are significant changes in the lower volume group as well as the higher volume group and there was not much difference between the two.

These individuals were training only twice a week and saw marked changes across a number of qualities. Long term adherence is the key, and only having to commit 1-2 hours of their week will be a much easier sell. If all a client can commit to is a couple of days a week don’t sweat it, they will improve.

 


 

Lift With Appropriate Intensity

It is crucial in any program, to see hypertrophy and strength gains, appropriate intensity is present each set. This absolutely does not change for this population. It is easy to think we need to train light with a high rep count to “save their joints” but that is not the optimal way to proceed. 

A systematic review by Latham & Liu (4) looked at the benefits of strength training on older populations with osteoarthritis and concluded that strength training improves strength, function as well as a reduction in pain in this population. That being said, here are a few rules that I follow:

  1. Gradually build intensity through the duration of the program. Start with higher volume, low intensity, and low complexity. As they progress through time, start to lower volume, and raise intensity. I typically will try and keep the complexity low with this population but every individual is different, know your client.

  2. Keep RPE around a 7-8 for most working sets.

  3. If your clients pain starts to worsen or develops new pain symptoms as a result from the training, dial back the volume and intensity. If that does not work, refer out to your professional network and make sure you understand your scope of practice.

Don’t Major in the Minors

If you spend most of the time executing what we have discussed above, your client should experience some major benefits to their life. Focus on the big bang for your buck items, stay away from the gimmick unproven BS stuff. There is a place for things like bosu balls, proprioceptive work, direct mobility, etc. but this is later down the line and if time allows. Thank you and good luck!

Thanks! Nathan.

Nathan is a former collegiate basketball player and current strength and conditioning coach based in Kelowna British Columbia.  During his time in post-secondary basketball, he began to realize that his true passion lived in strength and conditioning.  He now strives to provide effective movement and performance coaching to help as many athletes prepare, feel, and perform at their best.


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References

1.Frank, P., et al. “Strength Training Improves Muscle Aerobic Capacity and Glucose Tolerance in Elderly.” Scandinavian Journal of Medicine & Science in Sports, vol. 26, no. 7, 2015, pp. 764–773., doi:10.1111/sms.12537.

2.Barbalho, Matheus De Siqueira Mendes, et al. “There Are No No-Responders to Low or High Resistance Training Volumes among Older Women.” Experimental Gerontology, vol. 99, 2017, pp. 18–26., doi:10.1016/j.exger.2017.09.003.

3.Churchward-Venne, Tyler A., et al. “There Are No Nonresponders to Resistance-Type Exercise Training in Older Men and Women.” Journal of the American Medical Directors Association, vol. 16, no. 5, 2015, pp. 400–411., doi:10.1016/j.jamda.2015.01.071.

4.Latham, Nancy, and Chiung-Ju Liu. “Strength Training in Older Adults: The Benefits for Osteoarthritis.” Clinics in Geriatric Medicine, vol. 26, no. 3, 2010, pp. 445–459., doi:10.1016/j.cger.2010.03.006.

5.Cerhan JR, Moore SC, Jacobs EJ, Kitahara CM, Rosenberg PS, Adami HO, et

al. A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clin

Proc. 2014 Mar;89(3):335-45.

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