How to Train The Senior Personal Training Client by Greg Mikolap
You don’t need to be an egghead to figure out that we age, but did you know that in 2017, for the first time in history, the number of people aged 65 years and older will outnumber children younger than 5 years? This trend doesn’t show any signs of slowing down as society ages and we live for longer.
One of the biggest advancements of 20th and 21st century is longevity. In most developing countries life expectancy has risen by 3 months a year since 1840 without showing any signs of stopping.
According to data, even if our health conditions around the world don’t improve, now ¾ of babies will survive until 75 years of age. 
How do we, as trainers, help in adding more life to the added years? And more importantly, can we influence the health of our clients?
I will explore these questions below and post practical tips on adherence, communication and training for the older population.
The great news is that we can assist in the healthy ageing of our clients and it is never too late for people to improve their health.
- A study done on over fifteen thousand people, published in American Journal of Medicine showed that people aged 45 to 64 reduced their risk of cardiovascular disease and mortality by 35% within 4 years of adopting healthy habits like increasing fruit and veg consumption and taking regular exercise. 
- Another study showed that individuals who were in the weakest group amongst their peers were 50% more likely to die of all-cause mortality than individuals in the upper third for strength. 
- Lastly, 80-year-old trained individuals had similar muscle power to 60-year-old untrained individuals suggesting that we can slow down muscle and power decline by 20 years. 
All of the above looks very promising but sadly, when you look at the data, the reality isn’t that great. Only about 20% of people do the required amount of aerobic activity and only about 10% of older adults train twice a week in the gym. [5,6,7,8,9]
This also has importance for the number of preventable deaths. According to WHO (World Health Organization), insufficient physical activity is 1 of the 10 leading risk factors for death worldwide. 
The Current Realities of Exercise And The Senior Market
Even if people do start to exercise, 50% of people stop between first 6 and 18 months.  People with mild cognitive impairment (self-reported memory complaints in the absence of dementia) have even lower adherence and participation in exercise programs with only 25% continuing exercise longer than one year.  Philips et al. in 2010 pilot trial noted that “This suggests the first 6 months is a particularly important stage in attendance.” 
Can we help increase retention and therefore improve the health of our ageing nation? Big fat YES! Not only is it possible but we are EXPECTED to do so.
Trainers are at the forefront of that education and support. In a questionnaire completed by 320 people aged 74-85 years old, almost 85% ticked ‘important’ or ‘very important’ in response to the question “how important is quality of the instructor in starting exercise programme”.
In response to the question about the importance of evaluation of health and demonstration of proper exercise technique 70% said ‘important’ or ‘very important’. 
Several studies on Self Determination Theory (SDT) and Social-Cognitive Theory model showed that education, addressing barriers and increasing enjoyment of the sessions can increase retention by up to 20%.  More information on adherence and SDT can be found on the LTB members site and is included in my course on older adults.
So what are the specific aspects of communication, training and nutrition that are different in older groups in comparison to our younger clients?
One of the things that really stands out from studies is that people don’t understand the benefits of exercise and how much they actually need to be doing.
In one study older adults surveyed said that they get enough exercise in their activities of daily living.  Unfortunately, this is definitely not the case, and it supports other studies that say a lot of people don’t start or maintain physical activity due to vague ideas of what is enough and its benefits.
The recommended amount of activity for the benefits previously mentioned according to guidance from the Chief Medical Office (CMO) is 150 minutes of light to moderate-intensity aerobic activity or 75 minutes vigorous-intensity aerobic activity or combination of both and 2 strength training sessions a week. 
A great quote from the paper published in Controlled Clinical Trials:
Physical activity is often perceived as a recreational or competitive activity rather than a therapeutic or prophylactic regimen. Pharmacological and dietary interventions, on the other hand, are often viewed as both necessary and effective means to improving health. In fact, only recently have health professionals given much attention to prescribing physical activity for older adults. Indeed, standardized recommendations regarding the appropriate “dose” of exercise (frequency, intensity, duration) to elicit the desired “response” (amelioration or prevention of a specific condition or disease state) are currently in the formative stages.
Also, health professionals must continually examine the quality and clarity of their recommendations to older adults. For instance, older adults are often given vague directions regarding physical activity; they may simply be told to “be more physically active.” These recommendations are in marked contrast to drug and diet recommendations, which can be rather precise. 
In respect of the form of communication it is worth noting that an estimated 50% of people over 75 suffer from hearing loss. Some people may have an unclear articulation of speech, usually caused by Parkinson’s, this is called dysarthria.
Very common with the post-stroke patients is stringing the words together incorrectly or using the wrong words in a sentence, both in speaking as well as listening and reading.
Due to the above and to the fact that with the normal ageing process, speech, voice, volume, pitch and fluency may change, you should consider doing a consultation in a clean and quiet environment. Some other things to consider are:
- It helps if you know your clients’ strength and weaknesses in communication, e.g. To know which ear is ‘good’ and trying to speak on that side.
- Make people feel involved, ask open-ended questions and wait patiently for the answer.
- Speak at the face level and communicate clearly.
- Have a joke, make people feel welcome and comfortable.
- Give options. Outside of treatment there are rarely any form of exercises that a person MUST do, so ask which one they enjoy more and choose it more often.
- Be honest.
- Provide materials to take home and read or study, in a format that is preferred by the client and using language that client can understand.
Loss of Strength
According to different sources we lose strength every year from the age of 30,  it isn’t linear and highly depends on individual training history. After the age of 70, this number can go to 3% per year.  So conservatively you can estimate that your 60-year-old clients have lost 35% strength compared to their younger selves and at 70 years around 45-50%.
Because of the above when testing an individual’s strength level take into consideration that most 1RM calculators fail to predict accurately levels of strength. The most practical method is to record what weight client lifted for 6 to 12 repetitions with good technique and rated as 7-8 in modified CR-10 RPE scale and then retest it every 6 to 8 weeks.
Due to sarcopenic changes to the muscle, tempo is more important at this age group than at any other one! Changing tempo for slower, more controlled eccentric (2-3 seconds) is a good solution for maximum gains. Also lower bone mass determines use of lower mechanical loads in favour of more tension.
Some studies point towards 5-20% aerobic decrease per decade, however, it is not a linear decrease and ranges from 3% to 6% in your 30’s and 40’s to over 20% per decade after the age of 70. [19,20]
When prescribing aerobic activity with the guidelines from Medical Chief take into account what aerobic activities outside of the gym your client is already doing.
Light to moderate aerobic activities (ones that are recommended to do for 150 min a week) include:
- Golfing – walking and pulling clubs
- Mowing Lawn
- Walking the dog
- Weeding the garden
Vigorous aerobic activities (ones that are recommended to do for 70 min a week) include:
- Cycling at around 12.5mph
- Running 5mph
- Cross-Country Skiing
- Chopping wood
As I mentioned earlier about vague instructions, people need to be taught to recognise normal signs of physical activity and differentiate them from warning signs.
Normal Signs of Activity
Warning Signs of Activity
– Blushed skin
– Mild muscle ache
– Slight shortness of breath
– Increased heart rate
– Cool, clammy skin
– Acute joint pain
– Shortness of breath lasting over 30 minutes after the exercise is complete
– Chest pain
I hope all of the above will help in adjusting your consultations and sessions with people 55 years of age +
Find Out More About The Author
Greg is a Personal Trainer based in Maidenhead, England where he owns a gym called Icon. Greg holds a BSc in Physiotherapy and various qualifications within the fitness industry. With almost 10 years of experience in the industry, Greg is also a course director for Progress, Polish investment bureau. You can learn more about Greg’s course, Strong Ageing, by clicking here.
Find Out More About LTB
If you would like to learn more about what we offer at LTB, head here to check out our membership benefits and to learn about our 14-day free trial. You’ll be able to take courses on the senior market, programme design, lead generation, business practicalities and download sample meal plans and marketing checklists the minute you sign up!
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