Holly Benson, BS, Author at MedFitNetwork

Break It Down – KISS Principle (Keep it Simple for Seniors)

Holly Benson, BS/21 March 2024/ All MFN blog/

Teaching proper and biomechanically safe movement patterns takes a keen understanding of each pattern. What muscles and joints are involved? What skills are required for good execution? What deficiencies does the client have based on your preliminary movement assessments? Begin with the simplest version of each fundamental movement pattern and build on the complexity and intensity slowly.

Adjust accordingly, and encourage the client to give honest and precise feedback as they are learning. Find out if there is discomfort physically and/or psychologically. Adjust again. You want your client to feel successful and excited about their accomplishments during the exercise session and overall. They need to feel confidence in their ability to learn and improve, and enjoy the learning experience while they get stronger and more functional. Learning to exercise properly and safely is hard work for our clients. We must progress them gradually and with well thought out, logical, and achievable progressions. Knowing when they need to rest and reset is essential to building trust with the client, and creating a positive learning experience for them.

Fatigue and the Body/Brain Duo

It is critical that researchers consider the brain as well as the body when examining fatigue development and its impact on the body. By looking at brain and muscle function simultaneously, they will see that when participating in highly cognitive tasks, brain resources are divided which may speed up the development of physical fatigue. Processing and executing detailed and complex exercise instructions can accelerate the onset of body fatigue.

A study conducted by Ranjana Mehta, PhD., assistant professor at the Texas A&M Health and Science Center School of Public Health, evaluated the interaction between physical and mental fatigue and brain behavior. The study showed that when we attempt mental tasks and physical tasks at the same time, we activate the prefrontal cortex of our brain. This can cause our bodies to become fatigued much sooner than if we were only participating in a physical task. (Study published online as: Human Factors: The Journal of the Human Factors and Ergonomics Society This study was co-authored by Raja Parasuraman, Ph.D., professor of psychology at George Mason University in Virginia)

When we are working with geriatric clients, and one of our objectives is educating them, we must be cognizant that the lesson material must be “dosed-out” in absorbable amounts. Keeping the instructions simple and concise for maximum understandability is advised. When combining actual physical movement with the processing and following the instructional cues, the client is working extra hard and fatigue can set in sooner than you had planned. You may notice them starting to lose attentiveness or move slower. They may abruptly stop what you have them doing. They may look a bit frustrated or flustered. They have detached from the workout experience. The brain is full. The body feels tired. They need a break.

Taking pause to re-assess and re-set allows time for the client to recover mentally and physically. It is also a good time for the trainer and client to decide how to adjust and move forward in the session. Switching to less physically demanding, easy-to-do exercises feels like a relief to the client. They experience ease and a sense of control as their body and mind restore.

You can resume the previous exercise if the client wants to. If they are done with that hard thing, they are done. Save it for the next session to practice or learn again, and celebrate the effort and attention that the client gave the exercise that day. Educate them on the facts surrounding fatigue levels after learning and practicing complex physical movement. Tell them the cognitive benefits of combining cognition with physical effort!

Fit Pros: Guide Older Clients as a Geriatric Fitness and Lifestyle Specialist

Millions of people over age 65 looking for guidance from fitness professionals who are knowledgeable in exercise, nutrition and lifestyle principles that can help them improve functional mobility, while also preventing and managing chronic conditions to live their highest quality of life. The Geriatric Fitness and Lifestyle Specialist online certificate course will give you insights, strategies and tools to be a successful professional in this rapidly growing market. Learn how to be a valued part of clients’ continuum of care, working with the medical team to improve functional outcomes and positively impact people’s lives.

Holly H. Benson, BS, is a veteran in the Recreation and Fitness industries with over 35 years of administrative and technical experience. She holds two bachelor’s degrees, Corporate & Community Fitness and Recreation Administration, and numerous fitness certifications. She has developed thriving fitness programs for special populations and has passionately focused her career on the much older adult. She currently owns and operates Moving Strong Medical Exercise, LLC in Lakewood, Colorado and provides in-home and virtual fitness training to older adults and persons with chronic medical and orthopedic conditions.

female-trainer-senior-client-exercise-ball

Become a Movement Detective!

Holly Benson, BS/17 November 2023/ All MFN blog/

Often clients have nagging pains and aches that do not seem to go away. Pain inhibits seniors from doing more. And they WANT to do more. You need to find out what is causing pain. You might need a team of referral partners. You might figure it out yourself. You start by becoming a Movement Detective !

Analyzing your clients’ daily patterns and repetitive activities as well as how they spend their “down” time will give you many CLUES into what might be causing the aches and pains of daily living. A careful detective asks the best probing questions in a conversational manner. There once was a 70’s TV detective named Columbo. He was always asking questions to get to the bottom of the crime. You need to get to the bottom of the crimes of poor movement and poor sedentary postures.

Once you discover a few clues, then you can incorporate alternative patterns and postures that may be less irritating to the joints and safer for the client. Just because they are still climbing stairs and ladders does not mean they are doing it well. Sewing all day in a hunched over position is doing nothing to improve that chronic neck and shoulder pain. Plopping into car seat and grabbing the seat belt with too much force and rotation is not helping with their back pain. See where this is going?

A. WHAT to look for

Ask your client to answer these questions. Give them a day or two to think about it. Write them down on an index card for them to carry around and be prompted to pay attention to their personal patterns.

Things you do the most often…

Where do you sit?
Where do you stand and what do you do there?
Where do you move around? What areas of the home?
What tools do you use? Home. Garden. Hobbies.
What do you pick up and put down? Pets. People. Stuff.
What shoes do you wear? Home. Outdoors. Exercise.
What kind of car do you drive? SUV. Sedan. Low/High.
In what position do you like to sleep? Side. Back. Tummy.

B. HOW to set up the crime scene for examination. Clues are in the moves.

Have your client demonstrate how they maneuver through their day inside and outside the house.
Have them demonstrate a few ADLS like picking up and putting things down.
How they work at a counter and desk.
How do they talk on the phone and work on their devices.
How and what do the like to keep clean?
Have them sit in their favorite chair and get cozy.

C. WHO to refer to if you spot a problem that you are not qualified to address.

Having a strong network of allied health professionals for your client to consider is a level of service most trainers are unable to provide.

Sometimes we notice things that are troublesome like seeing the client wince in pain when doing daily movement. This is when you ask about it and see if they would consider going to the doctor or physical therapist to determine if there is pathology to the pain or other discomforts such GI issues, headaches, etc. (Take detailed notes here. This will help the allied health professional if your client goes to them for diagnosis and treatment).

Important things to remember:

Refer not Defer!
When in doubt… Refer Out!
Stay in Your Scope of Practice!

D. WHEN and WHERE to begin teaching the client new ways to do these everyday things.
BETTER and PAIN FREE.

Fit Pros: Guide Older Clients as a Geriatric Fitness and Lifestyle Specialist

Balance, Falls and Resilience

Holly Benson, BS/15 September 2023/ All MFN blog/

Falls can happen in an instant. They are one of the top fears for older adults. The statistics are frightening. Between the years 2000-2016 the rate of mortality from falls for those over age 75 more than doubled.⁽¹⁾
Weakness when standing, insecure balance, and falling are leading cause of fatal and non-fatal injuries for older Americans.⁽²⁾ Standing and walking balance is taken for granted for a large portion of our lives. When adults start talking about balance, it is usually when they begin to notice their balance declining. By then, they may have already reduced activity, and may have even resigned themselves to being forever unbalanced and at a risk of a fall. Most older adults know that if they fall and become injured, the outcome could have dire circumstances. Who wants to live like that?

With all the negative information out there, no wonder there is so much fear around loss of balance and falling. National surveys show that only 1 in 3 people get advice on physical fitness or exercise from their medical doctor. Racial, ethnic minorities and the elderly get this advice even less. Most advice surrounding exercise given by doctors has historically been centered around cardiovascular health and aerobic exercise. “Get out and walk!” they are told. Not always is this a practical solution for those who are unsteady and feel fearful being out of the home at risk of a fall. The risk outweighs the reward.

Physicians and physical therapists need more resources and avenues for senior adults to access when they need to improve their balance and reduce their fall risk. Evidence-based fall prevention programs are fortunately on the rise in retirement communities, senior centers, and general recreation and fitness facilities. These programs are valuable but do not begin to serve the needs of the expanding geriatric demographic. More qualified fitness professionals as well as more accessible and affordable programs are needed to help serve this growing need to keep our aging seniors upright and steady on their feet! Fall resistance and resilience training will change these statistics.

It is safe and realistic to say that there are 2 categories of older human beings in relation to balance: the “fallen” and the “not-yet fallen”

Often a trainer will acquire a client that has already fallen and is fearful. The client must first work to overcome this intense fear and the hesitancy of movement that this fear creates. The importance of using E3 (Educate, encourage, and empower) cannot be underestimated here. It is important that geriatric fitness trainers have a deep understanding of the basic principles surrounding the science of balance as well as training methods that are best for reducing fall risk for both categories. Getting the “already fallen” to rise up and move with confidence again will require systematic and progressive programming combined with patient and compassionate instruction.

Fall Resiliency for the “Already Fallen”

Each year millions of older adults suffer falls. Many of these result in serious physical injuries that can reduce their mobility and functioning, cause pain and discomfort, and even increase the likelihood of death in the near future. It is not only the physical effects of the fall that you should consider. Once the injuries have healed and general function is restored, they may be experiencing serious emotional consequences in the form of fearfulness which can diminish their quality of life as they age in place. Helping them to handle this type of impact can help them to move forward after their fall and preserve their lifestyle.

A 2012 university study found that loss of mobility might be due, in part, to “balance confidence”, an issue closely related to a fear of falling. The study concluded that among people who have had a fall-related hip fracture, an independent relationship exists between balance confidence and mobility and balance performance – as well as perceived mobility function.

The study tracked 130 adults over the age of 60 who had suffered hip fractures between six weeks and 7.4 years prior to observation. To test balance confidence, researchers used a simple but comprehensive measure called the Activities-specific Balance Confidence Scale (ABC Scale).(4) The ABC scale can be self-administered, and is comprised of a series of questions that gauge an adult’s confidence in various walking scenarios, such as walking up steps or on an icy path. Adults who rated a higher balance confidence tended to do better in balance and mobility tests.

Use these tips to help someone recover from the emotional impact of a fall:

Acknowledge it. An older adult may feel as though their emotional response to their fall is overly dramatic or not a big deal, and cause them to not discuss it, which can worsen the negative impact. Acknowledge that they have gone through something frightening and humbling. Show them that you can offer support and encouragement as they overcome the fear and movement hesitancy the often comes after a fall.

Recognize the risk. Suffering from one fall does increase the chances that your senior will suffer from another fall. Recognizing this risk and acknowledging this fact is important because it both validates the fear they may now have, and it may foster difficult decisions surrounding their safety in the future. Keeping open communication surrounding this serious issue will allow for prudent decisions regarding their living situation.

Encourage them. The emotional impact of falling can range from simple embarrassment to worry and distress about the changes in their physical functioning, which creates the fear that they will fall again. It does not mean that they should just stop engaging in activity which could actually further diminish their quality of life and increase the possibility of another fall. Introducing movement and exercise in incremental steps and stages will rebuild their confidence, but must be done at their pace. Praise all progress.

Imbalance is not entirely a result of muscle weakness. Strengthening muscles alone will not improve balance. Balance will improve when it is practiced in everyday activities and keen body awareness. Imbalance begets inactivity and inactivity accelerates the aging process.

Balance cannot be willed by the mind. We are not born with balance. We learn balance developmentally as we grow from babies to adults. The body learns how to stay erect in the face of gravity and the forces that are put upon it. It retains balance by staying active. Inactivity erodes balance which in turn inhibits people from being active. A vicious cycle that needs intervention and solutions.

Retraining balance and fall resistance requires knowledge of the anatomy and physiology involved in balance. The muscle systems of the body belong to one of two categories. The Phasic muscles are the mobilizing and movement/action muscles. The mind tells these the body to move in a certain way and the joints move from the contracting and elongation of these mostly fast-twitch muscles. The second type are the Postural or balance muscles and are not subject to conscious direction. These are slow-twitch stabilizing muscles and they engage automatically to hold a person erect against gravity’s pull. They do not shorten or lengthen, but supply isometric tension. With underuse, these postural muscles can “forget” how to maintain balance even on steady and level surfaces. Falling and hesitant walking is the sign that a lifetime of balance muscle memory is declining or lost. Without retraining our postural muscles, imbalance will take over. The solution is to re-educate and activate these essential postural/balance muscles in concert with the Phasic (movement/action) muscles (3) Trainers must encourage daily balance practices and educate their clients on how to manage their posture and center of gravity through drills and skills that align with their functional and independence needs.

Fit Pros: Work with Older Clients on Fall Prevention (and MORE!) as a Geriatric Fitness and Lifestyle Specialist

References

Are You Asking the Right Questions of Your Geriatric Clients?

Holly Benson, BS/10 January 2022/ All MFN blog/

In the world of medical and mainstream fitness, assessment methods and tools abound. We like to pre-test and post-test and record our findings to show positive change toward the betterment of our clients’ general health. But what about their well-being? Are we asking them how they are really doing on that day and in general? Should we probe further or would that be invasive and make our older client feel uncomfortable and possibly interrogated?