The future will see an increased proportion of elderly people throughout all modern societies. It is estimated by the WHO (World Health Organization) that in the year 2050 there will be equally as many elderly people in the world as there are children (1). Not only will there be more elderly people but the perception of being old will also continue to change. Previously, age was seen as a natural weakness process and reduction in lifestyle options.
Can you accept insurance for medical fitness/exercise therapy? Can your clients use their FSA & HSA (medical savings account) for your services? The answer to both questions is yes, however, it’s not an easy yes. The only way for your clients to do these two things is if you are billing for qualified medical expenses.
What are qualified medical expenses? Qualified medical expenses are expenses that mitigate, treat, or prevent disease per IRS.gov Publication 502. The IRS narrows the expenses that are deductible even more by limiting the qualified expenses to supplies (example: KT Tape) or an action being billed that will alleviate or prevent disability or illness. The catch for medical fitness/exercise therapy is that general health and well-being are not qualified medical expenses.
So, how can your client use their insurance or medical savings accounts for your services? The client needs their doctor to provide them with a prescription that identifies your services as medically necessary. The doctor saying you really need to lose weight is not a prescription.
What expenses or activities are covered per the IRS Publication 502? One example is a weight loss program for a client with a medical need for weight-loss. The weight-loss program becomes medically necessary when the doctor has diagnosed the client with obesity, heart disease, or some other disease and has determined that your weight-loss program or something similar will help the client improve or alleviate the disease or condition. What isn’t covered as a qualified medical expense are the dues for your club, the weight-loss program for a client without the prescription from the doctor, or the sessions to maintain good health after you fixed the problem your client had a prescription. The key is that a doctor or medical professional has diagnosed a disease and given the client a prescription for your services.
Accepting FSA & HSA is as simple as contacting your credit card processor and making sure you are set up correctly in their system. Most of the time this is as easy as answering a few questions about what you do. Making the decision to accept medical insurance at your facility is a much more extensive process, one that will require you to have a NPI (National Provider Identifier) number and a lot of extra time for the processing, filing, and record-keeping that goes along with dealing with medical insurance companies.
In short, if your client has a medical necessity for your services and their doctor has given them a prescription, then your client can use their FSA or HSA for their sessions. They also may be able to submit their receipts back to their insurance company for reimbursement. If your client doesn’t have a medical savings account or an insurance company that will reimburse them for their expenses, they can collect the receipts for the services, that qualify as medically necessary, and submit them with their taxes to their tax preparer. There are minimum limits that clients must reach before they can start using their medical expenses as itemized deductions. Their tax professional can help them with this.
To learn more about exactly what is and isn’t considered a qualified medical expense refer to the IRS Publication 502: irs.gov/pub/irs-pdf/p502.pdf
Heather Nusbaum is a Certified Management Accountant, Exercise Physiologist, Licensed Massage Therapist, MELT Instructor, and Master Trainer with NASM & ISSA. In 2013, Heather created Paws for Fitness a program to incorporate canines in the workout process. Over the years, this program has become a therapeutic modality within the training protocols of her business Nutree Fitness.
How did Heather go from Accounting and Business to Exercise Physiology? At a young age Heather was diagnosed with ‘Dysfunctional Knees’, this was a label that was attached to describe being in pain 24/7. This pain continued for the next 15+ years. After gaining weight due to age and inactivity, she realized that something had to give in her early 30’s. On her own she picked up and modified a box program and within 1 year had completely removed all the knee pain she’d suffered for the last 15+ years. Over the next few years it became apparent that she could help other people do what she had accomplished by accident, improving their quality of life and moving toward a pain free existence.
I was recently told that a very high percentage of people with Multiple Sclerosis (MS) DO NOT exercise. As a fitness professional with MS, that blew me away. I wish I could find the actual percentage but I don’t think that’s a statistic high on the priority list for any studies! But with all the time I spend in the MS community educating about fitness, I tend to believe that this is a fact, as I hear so many say they don’t exercise because they don’t know how. This is where I have found my niche to fill the gap.
According to Multiple Sclerosis News Today, “The first study on the benefits that exercise can provide to people with MS was published by University of Utah researchers in 1996. The participants improved their cardiovascular, bladder and bowel function, increased their strength, experienced less fatigue, developed a more positive attitude, and suffered fewer bouts of depression”.
With information and proof like this, why don’t more people with MS get into the gym, exercise at home or do some form of fitness program? My answer is lack of knowledge and fear. When you don’t know where to start, don’t understand how to find an exercise program that fits you, or you are not educated on the benefits of exercise for MS, you become immobilized and therefore do nothing. I believe this is the main reason why the percentage of MSers who aren’t exercising is so high.
This is where becoming a MS Fitness Specialist makes a ton of sense. Providing a proper workout plan for those with MS is not just a great thing to do, but a much-needed service.
There is a very good selection of workouts that can benefit people with MS, and one of these programs is circuit training. This type of workout gets your heart rate up and strengthens your muscles at the same time. You will never get bored in a circuit training program.
With little rest between each exercise, you rapidly go from one exercise machine to another to work different muscle groups. Depending on the intensity of the workout, you may use 8 or 12 different machines performing a different exercise and muscle group each stop.
I have my clients do 10-12 reps at each machine, using a time under tension (TUT) pace, lasting between 120–144 seconds, before moving on to the next stop.
To keep things exciting and motivating, you can change it up a bit by switching the exercises you do for each body part. A circuit training workout can be done at the gym with equipment, at home with dumbbells and resistance bands, or on an outdoor fitness trail by alternating push-ups and squats with fast-paced walking, jogging or biking.
You will need 20-30 minutes to take a MS client through the workout. The great thing about circuit training is it is easy to adjust the level of intensity by the rest time spent, the pace you perform each movement (TUT), and the speed in which you go through the circuit. A program like this works all areas of your body so you get an effective full-body workout in a short amount of time, as long as you select an exercise for each muscle group: core, arms, chest, back, shoulders and legs. The cardiovascular aspect of the program is taken care of in the time spent at rest. The less rest between sets and exercises, the more your heart rate will be elevated and the more heart-healthy cardio benefits you will receive.
There are many benefits in a circuit training routine as it is aerobic, low-impact and strength training all wrapped up in one program. You get the benefits of muscle building and toning along with a cardio workout. So, if you’re looking for a full-body workout for a MS client that can be don in 30 minutes or less, circuit training checks off all the boxes. The exercise options are endless as well with the variety of machines, resistance bands, free weights and bodyweight movements that can be incorporated into this style of program. Circuit training is an excellent workout choice for MS once you completely understand how to do it at a level that is safe yet challenging for the client you put through this program.
I want to see the percentage of people exercising with MS to overshadow the percentage that do not. You have a tremendous opportunity to be a solution to avoid in the fitness industry by becoming a MS FitnessSpecialist and working with a community that needs you.
David Lyons, BS, CPT, is the founder of the MS Bodybuilding Challenge and co-founder of the MS Fitness Challenge with wife Kendra. He has dedicated his life to helping people with MS understand and be educated on the importance of fitness in their lives. He is an author and sought after motivational speaker, dedicated to helping others by sharing the lessons gained from his life experience. His most recent book, Everyday Health & Fitness with Multiple Sclerosis was a #1 New Release on Amazon at its release. He is the 2013 recipient of the Health Advocate of the Year Award; in 2015, he received the first ever Health Advocate Lifetime Achievement Award, and the Lifetime Fitness Inspiration Award in Feb 2016. In 2017, David received the Special Recognition Award from the National Fitness Hall of Fame.
One aspect of training and conditioning the human body the right way, that I find particularly fascinating, is the anabolic effect that occurs, and the healing response that it creates. Anabolic, or anabolism, refers to the metabolic process of building up tissue structure in the body. You can easily remember that anabolism refers to building up when you think about anabolic steroids – the performance-enhancing drugs that bodybuilders, baseball players, and others have used to gain bulk. However, we are not talking about artificial anabolism through taking anabolic steroids here; we are talking about the body’s natural and healthy anabolism. Many times, this anabolic effect gets discussed among athletes and strength coaches in terms of getting bigger, faster, and stronger, or amongst fitness enthusiasts in terms of shedding fat, looking lean and ripped, and feeling great. However, when we think about anabolic response from an injury standpoint, one of the best parts of an elevated anabolic effect is the tissue growth and healing response it stimulates.
To further discuss anabolism in the body, we must understand that metabolic processes are controlled by our body’s hormones. Hormones regulate many of the major physiologic processes in our bodies. These processes include metabolism, appetite, strength, lean muscle mass, body fat percentage, body composition, tissue integrity, heart rate, blood pressure, energy and fatigue, mood, sex drive, emotions, and stress. Many factors affect hormone levels, including nutrition, sleep, physical activity, and physical, emotional, and mental stress. We cannot control all of these factors, but we are able to control some of them.
One major factor influencing hormone regulation that we as humans are (for the most part) in control of is physical activity, aka exercise. The type of exercise is important. The intensity and the duration of exercise are the two main factors to consider when thinking about how hormones will be influenced by exercise. This is why I say training the body the “right way” will produce an anabolic effect. We will get back to exactly what the “right way” is in terms of hormone regulation in the next section. For now, let’s finish discussing how these hormones are promoting a healing effect in the body.
Basically, exercise is really a form of trauma to the body. Correct exercise training is a controlled, mild form of trauma done in a very specific way to produce a very specific result. So one main, and very cool, thing that happens when you consistently train your body the right way is that you are actually teaching your body how to recover from damage. You are training your body to recover from trauma. You are literally teaching your body how to heal in a more efficient manner. The way I see it, healing is a skill. You can train yourself to be better at that skill!
Dr. Donnie Richardson, DC, CCSP, DACBSP, CSCS, is a Sports Medicine Specialist and Strength and Conditioning Specialist. Dr. Donnie has worked for the Many United States National Teams since 2008, serving as both a team doctor and sports performance coach, traveling both nationally and traveling internationally all over the world with our countries top athletes. Dr. Donnie also owns and operates his own private practice in Los Angeles, Universal Sports Performance, offering services ranging from sports medicine, injury diagnosis, physical rehabilitation, physiotherapy, injury prevention, sports performance training, personal fitness training, nutrition and diet programming, among other health care services.
“Many people trying online routines during the coronavirus pandemic are finding it’s not so easy to do them right.” A recent article in the Wall Street Journal, titled “New Home Workouts Come With New Aches and Pains”, has pointed out an unfortunate side effect of folks exercising at home during the pandemic shelter-in-place order.
They are getting injured.
Social media has been saturated with home-based exercise programs as the fitness industry works hard to get, and keep, individuals exercising during this intense, but temporary, period of partial social isolation and staying at home.
We wish we could tell you that under any and all conditions you should always be pursuing exercise because it is always good for you…
It’s not!
“This is chess, not checkers” —Alonzo Harris: Denzel Washington’s Character in the movie, Training Day
Of course, we commend everyone who has made the wise choice to begin and sustain a regular routine of physical exercise.
Exercise is simple, right?
It looks so easy when the trainer and therapists are doing it on the video.
There is a name for the exercise, there is a way it is supposed to be done, you do it, and it helps you!
Right?
Apparently not.
Physical exercise is certainly presented like checkers: a relatively simple and easy game that doesn’t require a lot of skill and deep thinking… some quick fun for the family.
But physical exercise is really more like chess. Chess is a complex game that requires deeper thinking, patience, and skill. So is physical exercise.
Why?
Because the human body is really complicated!
Because exercise places stress on your body.
There are hundreds of muscles, joints, tendons, ligaments, nerves, bones, and on and on.
These structures and tissues have varying properties and tolerances for handling stress.
Some are better at it than others. If you haven’t exposed some of them to the demands of the physical stress of exercise in awhile, or you have had surgeries, previous injuries, or diseases that negatively affect some of your body’s tissues then they just might not be ready.
Instead of being a great thing to do to promote health and wellness, physical exercise becomes a process that degrades it.
But there is a solution.
1 Take honest stock of your own body. Ask yourself some questions:
2. Put the ego aside. Expediency is the wrong mindset for exercise. Physical exercise is a long game.
3. Start slowly and do not assume that because an exercise looks easy it will be.
4. Pay attention to body signals. You’re the expert on your bodily experience. Trust that. If it doesn’t feel right to you stop or modify.
5. Take on the perspective of what is the least amount of exercise I need to do to reach my goal, not the most. Overdosing exercise is the problem.
6. Seek professional guidance and support from a qualified healthcare professional and trainer.
7. Take Dr. Nicholas DiNubile’s Advice: “The managed dose of exercise that will do the most for you – without harming you – needs to be measured out for you alone.” (1)
If you have been injured while exercising, see your physician to make sure nothing really serious has happened that will require medical attention. When the doctor gets done, and there is no serious problem, seek out an Exercise Professional from the MedFit Network to discuss how we can help measure out the right dose of exercise – just for you – so you can exercise safely and effectively for life.
Co-written by Charlie Rowe and Greg Mack.
Charlie Rowe, CMSS joined Physicians Fitness in the fall of 2007 after spending 9 years as the Senior Personal Trainer at Oak Hill Country Club in Rochester, New York. He has also worked within an outpatient Physical Therapy Clinic coordinating care with the Physical Therapist since joining Physicians Fitness. Charlie has earned the Cooper Clinic’s Certified Personal Trainer, the NSCA’s Certified Strength and Conditioning Specialist, the American College of Sports Medicine Certified Health Fitness Specialist, Resistance Training Specialist Master Level, and American Council on Exercise Certified Orthopedic Exercise Specialist Certifications.
Greg Mack is a gold-certified ACE Medical Exercise Specialist and an ACE Certified Personal Trainer. He is the founder and CEO of the corporation Fitness Opportunities. Inc. dba as Physicians Fitness and Exercise Professional Education. He is also a founding partner in the Muscle System Consortia. Greg has operated out of chiropractic clinics, outpatient physical therapy clinics, a community hospital, large gyms, and health clubs, as well operating private studios. His experience in working in such diverse venues enhanced his awareness of the wide gulf that exists between the medical community and fitness facilities, particularly for those individuals trying to recover from, and manage, a diagnosed disease.
References
(1) DiNubile, MD, Nicholas A. Framework: Your 7-Step program for healthy muscles, bones, and joints, 2005, Page xix.
“So every few weeks you change things up, right?”
A common question asked by parents when I begin working with a new athlete in my program.
“I change the exercises once we see independent mastery. Variety is just variety without pre-requisite skills being developed. So yes, I’ll add some new exercises…when it makes sense.”
If there’s one thing I can’t do it might be avoiding long-winded sentences.
For the autism and other neuroadaptive populations, developing strength and enhancing motor skills does not come easily. Pre-existing deficits in motor control and stability can present a challenge for engaging in a variety of physical activities. Many individuals with ASD often find physical activity aversive due to myriad factors. Among these are;
The pathology behind movement limitations is a combination, mostly a feedback loop, of muscular and neurological impediments. Differentiation in neuronal firing for those with autism causes a delay in neuromuscular performance, often resulting in movement that can be described as “clunky,” “inhibited,” and compensatory patterns are often observed.
Given the importance of fitness, particularly the development of strength and stability for neuroadaptive populations, it is critical to implement programming that addresses strength deficits and contraindicated movement patterns. An effective approach progresses or regresses exercises based on current level of ability.
Criteria for Baseline Mastery (CfBM) is a protocol borrowed from the practice of Applied Behavior Analysis (ABA). CfBM provides us a clear description of when a skill is mastered and what the requirements are for that goal. Mastery, in this definition, means that the skill can be performed to a particular level independently.
In our Autism Fitness™ programs, we use CfBM to set goals, track progress, and provide appropriate progressions and regressions for each athlete with every exercise. With squats, we very often reduce range of motion (ROM) by having the athlete squat to a box or similar stable platform. Depending on trunk stability, an upper body support may also be required. Having the athlete hold onto a band (held lengthwise by the coach), provides additional support. What we’re after is the athlete’s best performance of the squat with a complete reduction of compensatory movement.
Establishing a standard for performance enables us to set both general and specific goals for each athlete. For squats, as with most of our strength-focused exercises, we use 3 sets of 10 reps as our goal. Within those sets and repetitions, we are looking for stability and control throughout the entire range of motion (hips below parallel). While 3 x 10 may initially read like a standard-issue hypertrophy protocol (not necessarily bad, either), there is further reason to embrace this scheme. Three sets provides enough stimulus for the athlete and enough observational opportunity for the coach for integrity or technical breakdown of the movement. If and when the athlete is able to maintain technical control of the squat for 3 sets of 10 reps, it will be abundantly clear that they have mastered the skill, at least to the current level of challenge.
We use 10 repetitions because it takes us far enough away from maximal loading to be safe (especially for detrained athletes) and an excellent range for improving general strength and muscular development. If an athlete can perform 10 consecutive squats below parallel maintaining rooted foot position and spinal integrity, we have valid claim to progressing the exercise.
For those with neurodevelopmental challenges, it may take months to improve on a particular exercise. Strength and stability aside, proprioception (the real-world “mind/body” relationship) often presents as a particular obstacle. Our athlete may confuse squatting with bouncing or sitting, intentionally or unintentionally rushing through the exercise.
We have to be careful in assessing the underlying reason for the bounce and/or sit squat. When we consider through the lens of the PAC Profile™, we ask whether this is a physical, adaptive, and/or cognitive concern. For each possibility, we can apply particular questions.
Physical: Is the squat progressed beyond the current capability of the athlete and are they compensating as a result?
Adaptive: Is the athlete sufficiently motivated to complete the exercise at their current level of ability?
Cognitive: Does the athlete understand the expectation for performance of the squat? Are we certain it is clear for them?
Our goal for each athlete, strictly from the physical perspective, is safe and effective performance of each exercise or movement pattern before adding variety. Building a foundation of strength, stability, and motor planning can have restorative and preventative benefits and enhance quality of life at any age.
Eric Chessen, M.S. is the Founder of Autism Fitness. An Exercise Physiologist with an extensive background in Applied Behavior Analysis (ABA), Eric has coached successful fitness and adapted PE programs for the neurodiverse population over 18 years. Eric is the creator of the Autism Fitness™ Certification and PAC Profile™ Method. He is also Director of Neuroadaptive Programming for Inclusive Fitness. He resides in Charlotte, NC. Go to AutismFitness.com for more information.
I recently thought about why we exercise and what we choose to do first – and it isn’t generally strength training. Why is that? I believe it’s because we feel we CAN’T do something about becoming stronger unless we join a gym – and then we always seem to gravitate to cardio exclusively as if that is all we can do. We want to lose weight, feel better about ourselves, burn stored fat or just increase our energy level, but what if there was a better way?
Fitness trackers are some of the hottest tech gadgets on the market. They can measure your daily steps count, monitor your heart rate, log how many calories you’ve eaten, and even analyze your sleep quality. Some models can read your blood oxygen levels and use GPS technology to keep track of your running, walking, or biking route. Many people swear by making this type of “wearable” technology a part of their daily routines.
But is there any merit to all this hype?
Are fitness trackers a passing trend or a worthy addition to your health and exercise routine?
We all know that it’s important to exercise regularly, especially as we age. Studies have shown that physical activity can extend longevity, prevent cardiovascular disease and stroke, and combat the onset of dementia. Having a regular exercise routine is an important part of keeping your body feeling young and in shape. The trouble is that many people struggle with keeping up a consistent workout routine. This is where fitness trackers come in.
Fitness trackers are wearable health devices designed to monitor your activity level. They come in all shapes and sizes, from simple models that are little more than glorified pedometers to advanced smartwatches that can track your body’s vital signs in micro detail.
Tracking your fitness activity also can be an important step to taking charge of your health because it makes people more conscious of their health. Having a log of your activity level and vital signs can also be a valuable tool to share with your doctor or personal trainer. Seeing hard data makes it easier to create a sustainable routine you can stick to.
Helps build routine
For many people, blindly exercising without any way to track their progress can be frustrating. It can be hard to find the motivation to get moving when you have no way of knowing if your efforts are working. Wearing a fitness tracker allows you to see your progress in real-time and make adjustments. If you track 5,000 steps a day, you can make it a goal to gradually increase to the recommended 10,000 steps per day. It can be motivating to see your numbers improve, which makes it easier to stick to your routine.
Motivates you to move more
Most of us spend far more time than we’d like to on the couch. Sitting too much can be deadly. It’s a good rule of thumb to get up and move for 15 minutes for every hour that you spend sitting down. Many fitness trackers come with built-in reminders for this exact reason, helping you remember to get up and move throughout the day.
Keeps track of your dietary choices
Many fitness trackers offer ways to input your daily food and water intake via the connected apps. Keeping track helps make sure that you’re getting adequate nutrition. Studies have shown that tracking your food intake can lead to weight loss, even without following a specific diet plan. The information can also help a dietitian or a personal trainer get an idea of your daily meal plan. They can use this data to help you formulate a healthy diet, and logging your choices regularly can help you stick to it.
Can be overwhelming
Some people may find the amount of data to be overwhelming. Many devices offer far more options than the average person needs, and the high cost of some premium models means they may not be an ideal investment. Those who are less technically savvy may also find the device’s smartphone app frustrating to use, or simply not worth the trouble.
Ask yourself what’s most important to you to keep track of — such as your heart rate, number of steps and estimated number of calories burned — then look for models that only track those features. You’ll save money and save your brain from information overload.
May lead to obsessive behavior
The detailed stats that a fitness tracker provides can be a tremendous motivation for some people. But for others, this may open a gateway to obsessive behavior. Many people can’t help but fixate on obtaining perfect stats, and may push themselves too hard to achieve them. The number on the screen is only a best estimation of your daily activity, not a measure of your self-worth! It’s also worth noting that fitness trackers are not medically accurate with their stats, and there can be vast discrepancies between different models.
Not as useful in the long-run
While a fitness tracker can be a valuable tool to motivate you in the early stages of your fitness journey, they’re not as useful for keeping the weight off in the long-run. Surveys have shown that around ⅓ of people who buy fitness trackers stop wearing their devices after six months. Other studies have found that they’re not as helpful for losing weight as most people would believe. A randomized trial by the Journal of American Medicine found that people who didn’t wear a fitness tracker actually lost around 8 pounds more on average compared to their device-wearing counterparts.
Does that mean that wearing a fitness tracking device will inhibit your progress? Not necessarily. Those in the study who wore the trackers still saw improvements to their body composition and physical fitness thanks to their new diet and exercise routines. That’s because the trick to living a healthy lifestyle is finding a routine that works and sticking to it. If the fitness tracker helps you do this, excellent! If not, another method of motivation might be better for you.
It’s worth noting that shelling out hundreds of dollars for a fitness tracker isn’t the only way to monitor your health. If you want to get an idea of what your heart rate is like while exercising, try this simple experiment: go for a brisk 30-minute walk around your neighborhood. When you get to the halfway point, try singing one of your favorite songs. If you can sing it perfectly without any hesitation, up the pace.
You can also set “stand up and move” reminders on your watch or smartphone. For tracking your food intake, there are a number of apps available to let you log your daily meals. Some people enjoy keeping a physical food journal rather than going with a purely digital route. You can always experiment until you find the right method.
When used correctly, a fitness tracker can be a helpful tool that offers detailed feedback on your body’s activity level and other aspects of your health. If you need an extra boost to get moving or want to keep a close eye on your progress, they can be a worthwhile investment. However, if you have a tendency to obsess over small details or don’t need the extensive data that a fitness tracker provides, another option might be better to track your progress. Ultimately, how you choose to track your activity is your choice. Whatever option you choose, the important thing is that you keep moving and stay active at a healthy level.
Originally printed on aviv-clinics.com. Reprinted with permission.
Aviv Clinics delivers a highly effective, science-based treatment protocol to enhance brain performance and improve the cognitive and physical symptoms of conditions such as traumatic brain injuries, fibromyalgia, Lyme, and dementia.
Our intensive treatment protocol uses Hyperbaric Oxygen Therapy and cognitive and physical training as well as nutrition management for better brain health. The medical program closely tracks clients’ progress before, during, and after the treatment protocol, using customized tablets and other technology. Based on over a decade of research and development, the Aviv Medical Program is holistic and customized to your needs.
Aaron Tribby, M.Ed is Head of Physiology for Aviv Clinics where he is responsible for managing a team of physiologists, physical therapists, dietitians, and stress technicians at Aviv Clinics – the first hyperbaric medical treatment center of its kind in North America dedicated to improving brain performance. He also oversees the cardiopulmonary exercise tests and CPET in the clinic, responsible for analyzing each test. Leading to Aviv Clinics, his clinical experience is focused on health and wellness, strength and conditioning and nutrition within both the non-profits and private sectors including Mercy Hospital and MusclePharm, respectively.
References
Beginning in the seventh grade, I became fascinated with age—specifically how our bodies’ functional capacities decrease with the passage of time. When I once shared this perception with my 98-year-old grandmother, she said, “Just wait until you’re 80.” I’m still far from 80, so I can only imagine how difficult it will be then to stand up from a chair or run around the neighborhood.
The biggest factor in the decline in physical capacity with age is level of physical activity. When your clients remain active throughout adulthood, they can retard the aging process and continue to live a life worth living. I know 70-year-olds who are fitter than 30-year-olds.
After age 30, most physiological functions decline at a rate of approximately 0.75 to 1 percent per year. Perhaps the biggest functionally-related physiological change with age is a decrease in muscle mass, called sarcopenia, which is due to a loss of motor units (a motor neuron and all the muscle fibres it connects to) and atrophy of fast-twitch muscle fibres. With the loss of motor units comes denervation of muscle fibres (a lost connection between the motor neuron and the fibres within the motor unit). This denervation causes the muscle fibres to deteriorate, resulting in a decrease in muscle mass, which significantly decreases the older adult’s muscle strength and power, making certain activities of daily living difficult.
Men and women generally attain their highest strength levels between ages 20 and 40, after which the strength of most muscle groups declines, slowly at first and then more rapidly after age 50. Muscle strength decreases approximately eight percent per decade after age 45, with greater strength losses occurring in women compared to men. In both men and women, lower body strength declines more rapidly than upper body strength.
With the loss of muscle mass also comes a loss in mitochondria, which decreases muscular and aerobic endurance. Mitochondria are unique in that they have their own specific DNA, so when older adults lose mitochondria, they also lose mitochondrial DNA. If your clients want healthy functioning muscles as they age, they need lots of healthy mitochondria.
Cardiovascular fitness also declines with age, in part due to a decrease in maximum heart rate and stroke volume (the volume of blood the heart pumps per beat). With a lower maximum heart rate and stroke volume comes a lower maximum cardiac output (the volume of blood the heart pumps per minute), a decreased ability to deliver oxygen to the muscles, and thus a lower VO2max (the maximum volume of oxygen the muscles can consume). VO2max decreases by 8 to 10 percent every 10 years after the age of 30 in healthy, sedentary adults. When maximum cardiovascular functioning declines, so does the workload that can be tolerated at a given percentage of the (lower) maximum. Decreases in VO2max with aging can be variable, particularly if your clients remain active. But if not attended to, a youthful run becomes an aged walk.
Although many physiological factors decline with age, up to 50 percent of this decline is due to deconditioning rather than aging. With proper training, your clients can lessen the physiological effects of aging and remain fit and functional.
Arguably, cardiovascular exercise will always be more important than strength training throughout your client’s life because heart disease is the most common cause of death for both men and women. No one has ever died of a weak biceps muscle. But people die of weak hearts every day. One cannot live very well or very long without a strong heart. Since the risk of heart disease increases as people age, older adults need cardiovascular exercise just as much or even more than do younger adults. Like younger adults, older adults should do at least 30 minutes of cardiovascular exercise on most, if not all, days of the week. The more physically fit one remains, the slower the rate of cardiovascular decline. Maintaining exercise intensity, rather than a higher volume of training, is the key to minimizing the loss of aerobic fitness as your clients age.
Strength training also becomes more important as people age. Given that aging is accompanied by a decrease in muscular endurance, strength, and power, resistance training should take on greater weight (pun intended) when training an older client. I’d even go as far to say that every person over the age of fifty should strength train because that’s about the age at which people start to lose a significant amount of muscle mass. And that loss in muscle mass with age affects your client’s ability to function. If you’ve ever seen a senior citizen try to stand up from sitting in a chair or witnessed how catastrophic a fall can be to a senior, you know how much benefit strength training can have. The positive effects of strength training on bone density, muscular strength and endurance, balance and coordination (which reduces the risk of falling and fractures), functional mobility, physical aesthetics, and self-esteem cannot be denied.
Train older clients with heavier weights and fewer reps per set to target improvements in muscular strength, or with lighter weights lifted quickly to target the fast-twitch muscle fibres and improvements in muscular power. Greater strength gains occur at intensities of 80 to 90 percent of the one-rep max (the maximum weight that can be lifted just once). Although we tend to think of power training as something done to improve athletic performance, it has big implications for older adults, whose muscles lack strength and power. Research has shown power training to be very effective for strength and power development in seniors. Since it takes longer to recover from workouts as people age, give your clients more time between intense resistance and cardio workouts.
If you train older adults with higher intensity, less volume, and more recovery between workouts, not only will they be fitter and stronger, they may even be able to keep up with my 98-year-old grandmother.
From CanFitPro magazine. Sept./Oct. 2017. Reprinted with permission from Jason R. Karp, PhD
Jason Karp, PhD, is the 2011 IDEA Personal Trainer of the Year, 2014 recipient of the President’s Council on Fitness, Sports & Nutrition Community Leadership award, and creator of the REVO₂LUTION RUNNING™ certification. He has more than 400 published articles in international running, coaching, and fitness magazines, is the author of eight books, including Run Your Fat Off and The Inner Runner, and speaks at fitness conferences and coaching clinics around the world. Get training programs and autographed copies of his books at run-fit.com.