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11-14-19 07:10 AM - Post#890318
Ordinary strength training will be powerful.
I have got women off walking frames with the below approach. It requires patience. It took them half a century to become weak, it will take a little while for them to become strong.
Obviously, the below assumes no contraindications. Run the movements by their doctor, emphasising how they are simply formalised versions of movements in everyday life, "a squat is sitting down and standing up, a press putting something overhead", etc.
It's ordinary strength training, but you will find you have to reduce their range of motion, and progress that along with the load. As with anyone, they need some sort of squat, push, pull, hip hinge and loaded carry. Modified.
A person who needs help getting up off the floor WILL NOT be able to do a below-parallel squat on day one, or similar exercises.
ALPS - THE ABLE variation of the LINEAR PROGRESSION TO SWOLE
Two sessions a week, preferably separated by 2 days, as recovery is poor in older deconditioned people.
Day A: squat, press, rack pull
Day B: squat, row/pulldown, rack pull
SQUAT: Goblet squats to a high box; the person will be unable to squat below parallel or hold a bar on their back initially. But a weight held at the front, and a height equivalent to a highish chair (like those found on some walking frames) will be doable.
For example, a gym squat box with a bunch of gym mats stacked up on it. You give them an 8kg KB, have them do 3 sets of 5. Add a rep each time, after 6 sessions they're doing 3 sets of 10. Now drop one of the mats so they'll be squatting an inch lower, and go back to 3 sets of 5. And so on, until they are doing 3 sets of 10 below parallel.
They may need to keep the box indefinitely; deconditioned people who have not been physically active for half a century lack the proprioreception skills and confidence to simply feel when they're below parallel. That's fine, doesn't matter, keep using the box.
PUSH: Presses you will want an 8kg barbell, the "children's" WL bar. Again, 3 sets of 5, with men you can add 0.5kg a session, most women you'll want to work from 5 to 10 reps, add 0.5kg and back to 5, as with the squats.
In deconditioned males over 50, or women over 60, or younger if they're overweight, you will see shoulders rounded forward. In this case, they'll be unable to get the bar directly overhead, and no amount of mobility work will fix this as their joints have calcified; if they put the bar directly overhead, to make up for lack of shoulder mobility they'll hyperextend their lower back, which you do NOT want to see.
In this case, you could have them use a dumbbell, which since they come in big jumps you'll have to progress by finding a weight they can do for 15 easy reps (usually 7.5-10kg for men, 5kg for women), and progress it from 3 sets of 5 to 3x15 as above, then onto the next DB but for 5s.
Alternately you could have them do flat bench, but many will require help getting up and down, and the more hunched-over ones will need a pillow under their head (with upper back rounded forward, when they lie down, to make their head touch the bench would require hyperextending their neck).
PULL: Older deconditioned people will never do a chinup, and the setup for rows will typically be problematic due to lower back strength. You want a lat pulldown or seated horizontal row machine. Find a weight they can do for a comfortable 15 reps, have them start with 3 sets of 8, adding a rep a session until 15, then tick up the weight by the smallest increment and back to 8s. If you have both lat pulldowns and horizontal rows, alternate the two; if you have to do one, do the rows with a long pause at the top of the movement.
HINGE: Use rack pulls. Someone who can't squat below parallel on day one won't be able to pull from the floor without drama, so set up a power rack or blocks so they'll be pulling from just below their knees. Men and women both will be able to start with the 20kg bar for work sets, though the women typically need warmups from an 8kg bar onwards (8, 10, 12.5, 15, 17.5, then 20) to feel confident enough - you'll see them grasp the bar, pull slightly, then say "no, I can't do this" - but after the warmups they're fine. Larger men can add 2.5kg a time, smaller men and most women 1kg. 3 sets of 5 will be sufficient.
If they can pull 60kg from the rack they'll be able to pull 40kg from the floor. But be cautious here: the heart/lung problems that go with age, plus their lack of muscle mass, may mean they get very light-headed pulling from the floor, their system just isn't strong enough to get the blood back to their heads quickly. When in doubt, keep them doing rack pulls.
CARRIES: these are tricky since the person will find it difficult to pick them up from the floor. So you could put some DB on a bench for them, but then the distance must be short since if they put them down on the floor to rest, they mightn't be able to get them back up. Typically a total weight 1/2 that of their rack pulls will be fine for them.
OTHER STUFF
MINDSET is key with older deconditioned people, even more so than younger people. They will be convinced they can't do things they are actually physically capable of doing, and terrified of injuring themselves and losing further capability. This is one reason we start them stupidly easy, to build confidence.
After the first few weeks, two things help develop their confidence. Firstly, keeping their own training journal - giving them a sense of ownership over the process. Secondly, changing their own weight plates etc; if you do it all for them, that encourages a passive mindset, if they do it themselves, it's an active mindset, "I'm in charge of this." Plus, moving plates around is a bunch of small loaded carries, and so a bit of extra work for them.
PROTEIN will be lacking in most older deconditioned people. Common health problems of old age like high blood pressure, arthritis and diabetes, plus slowing digestive systems, tend to push people away from red meat, dairy and so on. As well, as we age we become less good at turning protein into lean mass, we need more for the same effect.
This is where you will need them to consult with their doctor on good ways to increase it. Typically adding a small amount of meat, fish or beans to their normal meals will help - they don't need 200g protein a day, it's not like they're going to be squatting 140kg after all - but they do need a bit more than they're getting. And because of health considerations, this can be a time where protein powder is actually useful. But again this is really something they'll need their doctor's advice for, and it's not a big consideration when they're doing 20kg rack pulls. Let their nutrition progress over time like the weight on the bar.
ENDURANCE work necessarily needs to consider their various injuries and health conditions. Typically they'll be doing 2-3,000 steps a day at most. Call it 14,000 steps a week and have them add 1,000 steps a week, so that in 12 months they're doing 70,000 steps a week.
Failing that, or if you find they simply don't do it on their own, stationary bikes are usually well-tolerated. Have them go at an easy pace for 5 minutes, add 1 minute a time until they hit 30 minutes, and from there progress the speed or resistance by the smallest increment every two weeks.
CONCLUSION
The person training an older deconditioned person has a profound responsibility. You are helping determine not only how many more years they have, but how many quality years. Being able to sit down and stand up unaided means means their dignity - can they go to the toilet unaided? - and the difference between living their daily life without help, and needing a caregiver. And two-thirds of those admitted to nursing homes are dead within 12 months.
As well, you may be the last trainer and the last chance they ever have. If you train a 20 or even 40 year old and injure or discourage them, they'll go to another gym - eventually. But if you injure or discourage a 70 year old, they'll never go to the gym again, and that's it for them.
Done properly, with weights you can change lives. And for deconditioned older people, you are not only changing their life, you are giving them their life back.
But this takes patience and care.
Edited by Kyle Aaron on 11-14-19 07:12 AM. Reason for edit: No reason given.
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