SFA Certified Professionals note: SFA is pleased to accept studies and reports like the following as an alternative method for earning continuing education and is proud to include such information on our website.
The following case study, by SFA certified Senior Personal Trainer, Bev Mickelson, M.A., is a fine example of the importance of being adaptable, patient and persistent when working with elderly populations.
Bev Mickelson, M.S.
Senior Personal Trainer
Bev Mickelson, MS is a certified Senior Personal Trainer who currently lives and works in Portland, OR. Her graduate work was at the University of Wisconsin at LaCrosse with a major in adult fitness and cardiac rehabilitation. Having worked in the field of health and fitness for 25 years, Bev is well known in the industry for prescriptive geriatric fitness program design. Currently she works with residents in senior living environments that provide a range of programs from independent retirement living to assisted living and memory care. She also provides Wellness Education lectures and workshops and is available as a consultant. Ms. Mickelson can be reached at (503) 299-0101.
Table of Contents
An 82-year old, male Alzheimer's patient, in relatively good health, has been referred for an exercise program. This resident lives in an assisted living facility where he receives additional care as needed. He has a set appointment on Tuesdays and Thursdays for a thirty minute exercise session, and is met at his room by the senior personal trainer (SPT). The resident's family and physician are very supportive of a regular exercise program.
Baseline fitness tests were attempted, but the resident could not grasp the concept of "speed" used in a "30-second trial," so the results were given little merit.
Exercise sessions consist of:
Also included are various other warm-up exercises, coordination exercises and some outdoor walking. The resident possesses fairly good physical ability, but very poor communication skills. He can understand most verbal communication, but cannot verbalize very well. Hence, much of the communication is done by the SPT asking questions that require only a "yes" or "no" answer, and by the SPT demonstrating a movement that the resident mimics. Exercise sessions were recorded over a 16 week period.
Six balance exercises were attempted (Appendix A). Each exercise was demonstrated by the SPT, and then the resident was asked to follow along. The exercises were repeated many times as demonstrations. It was a very slow learning process but, with time, the resident was able to successfully perform all six exercises. Due to the Alzheimer's disease, there seemed to be no retention of the tasks performed. Therefore, each session was approached as if it was the first time the resident had done the exercises. One set of 8 repetitions, gradually increasing to 15 repetitions, was completed by the resident for each exercise during a session.
Five strength exercises also were attempted (Appendix B). First, each exercise was demonstrated by the SPT using a four pound weight. Next, the exercise was done by the resident, without the weight, with guidance from the SPT. Finally, the exercise was done by the resident using the weight. Patience and persistence produced satisfactory results. Due to the resident's lack of retention, each session was a new experience. At times, a completely different exercise would emerge after doing a few arm curls. The resident completed one set of 8 repetitions, gradually increasing to 15 repetitions, for each exercise during a session.
The Shoulder Raise (Appendix B, pg. 14) had to be omitted because the resident could not perform the task. During the fifteenth week, the SPT attempted to use a five pound weight instead of a four pound weight. However, the resident was unable to lift this amount of weight. The change in weight also caused great confusion for the resident, so the decision was made to continue using a four pound weight.
An exercise called Knees, Shoulders, Clap, done in the sitting position, was used as a warm-up and coordination exercise. In this exercise, the resident touches the top of his knees with both hands, the top of his shoulders with both hands, and then raises his arms above his head and claps with both hands. This proved to be a challenging exercise for the resident, yet enough success was experienced for it to be fun. Also, many different variations on the road to success were presented by the resident, which made each session interesting. Eight to twelve repetitions were attempted during each exercise session.
Other coordination exercises were added, during various sessions as time permitted, so each exercise was not done on a regular basis. These exercises consisted of a follow-the-leader activity. The SPT tapped out a pattern with hands or feet, and then the resident tapped the pattern with his hands or feet along with the SPT, changing the pattern as it was changed by the SPT or remained constant. The resident appeared to really enjoy these exercises and, with practice, became fairly good at following some simple patterns.
After twelve weeks, a more advanced balance movement, Step-Together, was attempted (Appendix C). This exercise was done holding onto the long rail in a hallway so that several could be done in a row. Here again, the resident mimicked the SPT doing a Step-Together to get the feet moving correctly. The hard part was adding the hands and getting the resident to slide them along the rail at the same time that he moved his feet, because this involved doing two things at once. By the end of the month, the resident was able to do 10-12 Step-Togethers in a row in both directions, sliding his hands along the rail as he moved his feet. This activity was always demonstrated several times by the SPT, and then the resident followed the SPT down the rail as the exercise was done. Usually, the foot movement was started first, and then the hands were added.
Of the first eight sessions, four were not attended tor various reasons. It was decided to call the resident's son and have him attend an exercise session to encourage and support his father. This proved to be a very effective strategy, because the resident attended all of the sessions during the next month. Over the next two months, only four sessions were missed. Once a regular routine was established for this resident, compliance was very good. Overall, compliance was seventy-five percent for the sixteen week period.
It was important to find a quiet place without distractions in which to exercise. The resident needed to have his complete attention on the SPT. A side hall with a handrail worked very well to start the exercise sessions. This was where the balance exercises were done. The strength exercises were then done sitting in a chair in the SPT's office. This routine of using the same non-distracting locations for each exercise session was very beneficial to the resident. It also helped with compliance as the resident became comfortable with the routine.
The goal of exercising 2 days a week for a 30 minute exercise session was met at a 75% compliance rate. The initial goal of 8-12 weeks was extended to 16 weeks. The 11 initial exercises were reduced to 10 because the resident was unable to perform one of the exercises.
Pre- and post-fitness tests were not reliable because the resident had trouble understanding the concept of "speed" due to the Alzheimer's disease. Subjectively, the SPT felt the resident's activities of daily living were enhanced. He was able to function better in activities of balance, strength, coordination, and walking. The resident also seemed to enjoy the new routine as he became familiar with the exercise sessions. The resident was able to gradually increase his repetitions for each exercise he was able to perform. The family was pleased that the resident was exercising on a regular basis and felt that the exercise was a positive experience for their father.
Even though this was only one person with Alzheimer's disease, this case study demonstrates a successful exercise program. Persistence and patience are a great help. Establishing a routine in an environment without distractions contributed to the resident's success. It was a very rewarding experience working with this resident.
The photographs in Appendix D represent some of the resident's successes.