December 3, 2007
Table of Contents
How Senior Fitness Trainers Work their Magic
Today Experience! readers are privy to a rare insider's look into the inner workings of the senior fitness industry. By permission of those involved, we're presenting an edited version of an amazing email dialogue between SFA-certified trainer Steve Wood and his advisor SFA Mid-Atlantic Regional Coordinator Jerry Hart, M.S.
Below, lay-readers will get a glimpse into how much thought and care a diligent personal trainer puts into serving his or her client. In this example, the trainer consults a trusted mentor to make certain his participant receives the very best in fitness programming.
Professionals are sure to be spellbound by these awesome email exchanges -- and may pick up some practical tips and ideas while poring over them!
Training the Client with Multiple Health Concerns
Consider the steps involved in conducting an exercise program for a 78-year-old female participant with this combination of physical issues:
Please give me more details about your client and maybe I can provide some strategies I've used successfully with multiple issue fitness participants. Are you training your client in a facility or at home?
My client has OA (osteoarthritis) in her wrists, hips, and knees; osteoporosis, though not severe; fused vertebrae at L3-5; elevated right hip; minimal scoliosis; right knee replacement 10 years ago, with the other knee scheduled for replacement next year; prior plantar fasciitis surgery involving the left ankle, with her Achilles tendon cut during that surgery; hypermobile joints -- she is double jointed; mild hypertension; and for good measure dyspnea (shortness of breath). She had colon surgery recently and has acid reflux. Takes some NSAID (nonsteroidal anti-inflammatory drugs) for pain and inflammation, and Protinex for the reflux. Other than that she is in fine shape!
Seriously, she is five feet tall and weighs 140 pounds. She's very vibrant and active. She wants to resume her former swimming and water aerobics activities as soon as possible. She has a new dog and walks him every day, although it leads to OA knee pain. She has been a severe pronator for years, probably the source of many of her joint problems.
She was a ballet dancer long ago. Her "dream goal" is to square dance again. My first recommendation was to see a podiatrist about the possibility of rigid orthotics. This afternoon I'll have the results of that visit. I hope he can help with her gait, alignment, and pain levels. Her short-term goal is to establish an exercise routine at least 3 to 5 days a week. Her long-term goals are to improve her overall strength and balance and to lose 10 pounds during the upcoming months.
I have started her out on very basic upper body strengthening exercises and balance training with Swiss Balls. Everything very safe and conservative. I plan no load-bearing lower body work until we see about the orthotics and receive your advice. Any lower body loading would have to be very gradual. I train her in my studio. I have a Body Solid machine with the basic multi-stations and high, low, and mid cables. I have Swiss Balls -- I'm an instructor -- along with tubing, hand weights from 3 to 50 pounds, and assorted medicine balls from 1 to 7 pounds. My client is willing to try gentle yoga and Tai Chi later on after working with me. Not all at the same time obviously.
I will let you know what the podiatrist recommends. Thank you very much for any suggestions.
Your client seems to have a great attitude. Does her arthritis flare up often? Is she on hypertension medications? How is her thyroid function? As you noted, weight loss will be beneficial. Has she had a bone density scan as well as a full DECCA scan (for osteoarthritis)?
I think your training approach is sound given all her concerns. Orthotics are clearly indicated, although they will need to be redone after her next knee replacement.
If she wants to be more active, has she considered sports orthotics? They are more flexible and comfortable. Five other medical types can make orthotics: PTs, DCs, DOs, physiatrists, and orthitists, who make both orthotics and prosthetics. I have had hard orthotics that did address my plantar faciitis, but when I switched to the full-foot flexible ones I was able to compete in power lifting again -- in my mid-fifties -- and any other activity I wanted without the condition becoming chronic as it did with your client, necessitating surgery.
Does she have any other joint problems? Here I am thinking RC (rotator cuff). I've learned that when one joint has issues it calls on the nearest joint(s) for help and sometimes the resulting compensations cause problems even several joints removed from the one initially affected. Her hip issues may be a result of her foot problems. What postural assessments do you use?
You have probably gotten medical clearances from more health providers than just her primary doctor. If not, I would encourage doing so to obtain more information on what has been effective and what to avoid. Safety is the first consideration for this (and actually any) client. This measure will show concern for your client and is also prudent from a liability standpoint.
There could be a problem regarding her ballet background if she did a lot of point work (toe dancing). It seems to offset the postural, balance, and strength benefits of classical dance. If so, Pilates on the Reformer may be a great help for this client. Joseph Pilates fine-tuned his system for dancers when he immigrated to New York.
I admire her dream of square dancing. Sounds like the left knee needs fixing first maybe? Have you done any balance work with her on an Airex pad or a BOSU? (Both are balance training products.) Do you do any half foam roll activity for adductors and abductors? (For an overview on the use of foam and half foam rollers, visit www.jasonpt.com/FoamRollers.pdf .)The training you're doing with balls should be excellent fall prevention and core work -- good stuff.
Sounds like you have a nice setup. I suggest adding any balance devices you don't already have: those mentioned above, balance boards, small inflated disks, etc.
You may wish to consult a NASM-OPT (an Optimum Performance Trainer, who will have specialized expertise on injury-prone participants) for hints on the first phase ("Corrective Exercise Training") of their "Stabilization" system. In addition, purchasing the book Fallproof! by Debra Rose would be a good investment for you.
Strength and balance actually are not separable. Your functional approach to training will provide both for her. Her ball work will condition the core, allowing her arms and legs to become even stronger (within her capabilities). Minimal scoliosis probably is not a serious issue at her age. If she is relatively straight up and down -- not curling in to the side and down -- then I think your training is only going to help.
With all that is going on, I would be careful of overtraining -- not because of her training sessions with you, but because she sounds like a person who is going to do as much as she can in terms of physical activity. Help her monitor her total volume of activity, not just what she does with you.
The electronic communications reproduced above are part of a longer conversation between Steve Wood and Jerry Hart. These excerpts demonstrate both the dedication of a responsible trainer and the valuable guidance that can be obtained from a seasoned expert. Steve has followed up on all of Jerry's recommendations and continues to keep Jerry apprised of his client's progress.
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