good to great: training baby boomer clientexhibition+ser… · good to great: training baby boomer...
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Engage.. Ignite.. Empower..©
Developed by: Fabio Comana, MA., MS. NASM CPT, CES & PES; NSCA CSCS; ACSM EP-C; ACE CPT & HC; CISSN
Good to Great: Training Baby Boomer Client
Building Blocks for the Active Aging
Who are Baby Boomers … ?
Born between 1946-1964 (early 50’s to early 70’s)
What do they Seek (Physically) What do they Seek (Other)
Respect and Acceptance: • Still productive, experienced and
willing to work harder (committing time and resources).
• Although more resistant to change or learn new skills, they can.
• Treated equally. Value choice and freedom.
Functional independence: • Live like they were 40 – preserve health and
function. Overall health and wellness: • Reduce risks of morbidity / mortality. • Enhance overall quality of life – dimensions.
What Does this Mean?
Greater propensity for disease + accelerated changes within physiological systems that includes:
Physical Changes Musculoskeletal
Cardiopulmonary Cognitive
Emotional
Balance/Gait
Nutritional
General Health Concerns …
You NEED to conduct a more robust Health Risks Assessment (HRA) – risk v. pro (especially if program contains moderate-to-vigorous intensity activity)
Health Risk Assessment
PAR-Q (valid to 69 years)
ACSM / AHA Screening tool for CAD + Musculoskeletal Screening Offices in BBK, KL, India,
Singapore, Manilla, China.
Cognitive Changes • Decreased mental efficiency and memory decline = #1 cognitive complaint in
older adults
By mid-late 20’s = 1% loss of hippocampus mass / year (learning, memory)
10% of adults > age 65 have some form of cognitive impairment.
50 % of adults > age 80 have some form of cognitive impairment.
Age
Cog
nitiv
e Pe
rfor
man
ce
Cognitive Decline with Age
20 40 60 80 100
Generally attributed to:
Physiological losses within cells, tissues, organs and systems. Disease (e.g. Alzheimer’s). Lack of use (repetition or practice) Lack of physical activity. Depression and medications.
Some Changes …
Postural Control Strategies • Maintaining postural balance relies on 3 distinct / sequential processes
utilized consciously or subconsciously: o Located at ankle, knee (step) and hip. o Strategies function along a continuum depending upon the magnitude
and speed of the balance disturbance.
Some Changes …
Balance and Movement Changes
Central nervous system is key to successful balance: • 3 peripheral sensory systems provide information regarding position in space
relative to gravity and environment: o Visual (75% of sensory input), vestibular and somatosensory. o All suffer losses with aging.
Some Changes …
Balance Changes
Psychological Fear of Falling
Physiological Losses + Reduced
Mobility
Heightened Fear of Falling
Fall Risk Factors Muscle weakness
Lower extremity, physical inactivity, frailty
Gait and balance deficits.
Sensory. Vision, vestibular, touch, feel and cognitive deficits
Arthritis. Side effects of medications. Prior history of falls. Environmental hazards. Medications
American Academy of Orthopedic Surgeons: • Over 30% of adults > 65 experience falls ≥ 1 time / year. • Over 50% of adults > 75 experience falls ≥ 1 time / year. • Falling = NOT part of aging process – attributed to multiple risk factors.
Some Changes …
Balance Changes
Types of Falls Percentage Slipping, tripping or stumbling 57.0% Loss of balance, dizziness, fainting, seizure 26.7% Other (collision, pushing, shoving; jumping, etc.,) 16.3%
Location of Falls Inside the house 49.9% Outside the house (but in close proximity - yard, etc.) 23.7% Street, highway, or parking lot (away from home) 6.3% Residential institution, health care facility, or public building 10.1%
Other (playground; park or recreation area, etc.) 10.0%
Programming
What language do you use? • Exercise v. movement training or ability training? • Diet v. eating patterns or eating habits?
Be more than just a trainer – don’t limit your programs to just activity. • Cognitive training – mental games (digital or analog – Elevate) • Social and Recreational activities.
New Experiences • Learn something new – a new
skill, using non-dominant hand, new tasks, new trips, new tastes or new smells.
Mental Exercises
Participate in frequent digital or analog games, tasks and challenges to stimulate neurogenesis and synaptogenesis.
Digital Analog
Computer / Smartphone applications: • Luminosity • Elevate • Sudoku • Crosswords
Traditional Games: • Scrabble,
Scategories, Risk
Non-Traditional Games: • Backward Digit
Span, Word Spell (backwards).
• Sequenced Information (names)
• Brain Tasking (mental/physical)
Cross-lateral Patterns
Mental Activities …
• Connectivity between left and right hemispheres.
• High 5’s and 10’s with leg movement (balance training).
Brain under Tasking Stress: • Do each activity until instructed to change to another activity
Drill #1 Drill #2 Clap your hands
Count out loud to 10 Tap the back of your head with your right hand
Cluck like a chicken Do arm circles with your left arm
Count backwards from 10 Wave hands above your head
Moo like a cow Snap your fingers
Recite the alphabet backwards Stomp your feet
Ask participants – 3rd / 4th task?
Mental Activities …
Assessments
Stop – pause! Who do the assessments really serve? • Can they be disguised?
Other Population-specific Assessments • Functional Reach Test • Multidirectional Reach Test (MDRT) • Modified Clinical Test for Sensory
Interaction in Balance (M-CTSIB) • Berg Balance Test • Fullerton Advance Balance Test • Fullerton Functional Fitness Tests
(Senior Fit Tests) – 7 functional assessments..
• Tinetti Balance and Gait Evaluation • AAHPERD Functional Fitness Tests
Timed Up-and-Go Test (Rickli & Jones)
Consider Key Assessments • Rhomberg Balance Test • Sharpened Rhomberg Balance Test • Any relevant balance screen (e.g.,
stepping, navigating obstacles) • Postural Observation • Sit-to-stand Movement Screen • Overhead Reach Movement Screen • Get-up-and-Go Test
Programming …
References: • Katzmarzyk, P.T., et al., (2009). Sitting time and mortality from all causes, cardiovascular disease and cancer. Medicine and Science in
Sports and Exercise, 41(5): 998-1005. • Levine, J.A. (2009). Move a little, lose a lot. Three Rivers Press, Pittsburgh, PA. • Ekelund U, et al. (2015). Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men
and women: The European Prospective Investigation into cancer and nutrition study. American Journal of Clinical Nutrition, 2015: as doi: 10:3945/ajen.114.100065.
What does research tell us? • Study: 17,013 individuals over a 12-year period.
o In all individuals – strong correlation between sitting and mortality risk.
o Physical activity does not cancel all ill effects of being sedentary: § Reduced HDL levels = increased CVD risk. § Decreased muscle LPL activity = elevated blood TG = increased CVD. § Increased insulin resistance.
• Study: Non-exercisers (low BMI v. high BMI) o Low BMI group averaged ~150 min more movement per day.
§ Averaged 352 kcal more per day = 36.7 lbs. per year.
• Study: 334,000 adults over 12 year period.
o 100 kcal per day (e.g., brisk 20-min walk) reduced mortality by 16-30%.
Programming …
Unloaded (bw) Loaded Explode (movement) (strength) (strength x speed)
Overload
Multi-Directional
Specificity Sagittal – Frontal –
Transverse
Linear
Foundational Training
Functional Training Ability –
Performance
Fundamental Preparation Corrective exercise
Isolated muscle training Self-efficacy
Specialized Movement
Generalized Movement
Programming Model
Programming …
Why isolated muscle training? Why self-efficacy? Internal barriers and social norms.
Within the Upper Extremity Mobility
• Promote lumbar stability 1st !! • Then target thoracic spine mobility next!!
o Why is this so important? o Think balance and perspective of their world. o What does thoracic extension provide?
Never compromise lumbar stability !! – demonstration
Programming …
Balance Training
You manipulate variables to challenge postural control (stability). • 1st – reeducate neural pathways or reinforce core engagement.
Programming …
Variables Duration
Line of gravity Points of contact
Base of support Sensory alteration Sensory removal
Center of mass Additional unstable surfaces
External perturbances
Seated Exercises • Supported v. unsupported • Stable v. unstable
Standing • Supported v. unsupported • Stable v. unstable
Systematically introduce / progress variables
• Positional Isometrics: 2-4 reps x 5-10 seconds to start.
Considerations: • Vestibular issues = dizziness / loss of balance in transverse plane / head
rotations (e.g., in-step marching).
• Caution (sagittal plane – loss of peripheral vision).
Static and Dynamic Balance
Hip-width Stance Neutral stance Narrow Stance
Staggered Stance Split-stand Stance
Tandem (heel-to-toe)
Single-leg Stance
Programming …
Weight Transference
In-step Marching
Stepping: • ½ step • Full step
Step ups; Stepping to Single-
leg end ROM Gait-
specific
Obstacles – walking variations (e.g., alternating width, tandem, high-knee, crossovers).
Dynamic, Standing:
Static, Standing:
Option One: Talk-Test:
• Level 1-4: Caloric quality (fat), but little caloric quantity (kcal) • Level 5-6½: Caloric quality (fat) + good caloric quantity (kcal) = optimal • Level 7-10: Little caloric quality (fat), good caloric quantity (kcal), but higher risks.
Programming …
Option Two: Simple Cardio Solution
Consider ignoring HR monitoring – may be uncomfortable and inaccurately measured:
Volume-Intensity-Progression (VIP) Model
Total Training Volume x RPE frequency x duration (volume) x RPE (intensity)
• Simple and easy. • Requires no HR monitoring.
Programming …
Steps to using VIP Model: Example: Joe’s goal – improve his cardiorespiratory health and commits to 3x/week for ~ 20 minutes @ 5-out-of-10 effort + 10% weekly progression.
1. Training Volume: Frequency x duration = 3 x 20 minutes = 60 minutes. 2. Training Intensity: RPE of 5 3. Training Model: V x I = 60 min x 5 = 300 points.
Frequency Duration Intensity Total Time 3 Sessions x 20 x 5 … 300
Variations 4 Sessions ü x 15 x 5 … 300
2 Sessions 1 Session
x 22 ü x 16 ü
x 5 x 5
… 220 … 80
2 Sessions 1 session
x 19 x 15
x 5.5 ü x 6 ü
… 209 … 90
10% weekly progression: • Week 1 = 300 points (x 10%); week 2 = 330 points (x 10%); week 3 = 365 points.
Programming …
Considerations: • Although load (intensity) is the most adaptable variable, what about frequency
v. duration (i.e., 1x30-min bout v. 4x7½-min) – training each fitness parameter frequently?
• Outcomes = comparable if not better adaptions, but improved psycho-emotional impact of bouts (i.e., experiences).
Variable Modality Training (VMT)
Warm-up Conditioning Phase – cardio and/or resistance Cool-down Traditional:
5-10 min 5-10 min 45 min
1 2 Integrated: 3 4 5 6 7
Series of mini or micro-bouts (each can be uniquely different or repeat at fixed or odd intervals. 5-10 min
Programming …
Microsession 1 Microsession 2 Microsession 3 Microsession 4 Microsession 5 Microsession 6 Microsession 7 Microsession 8 Microsession 9
Inte
nsity
Warm-up / balance
Skill Drills – light agility
SS cardio
UE Endurance
Core stabilization
Power-reaction drills
SS Cardio
LE Strength
Cooldown / Flexibility
Programming …
Goals: Smaller, more manageable exercise bouts + greater transitions from (anaerobic) to type I (aerobic). • Enables and facilitates appropriate anaerobic recoveries. • Active recovery modalities include:
o Light cardio o Stabilization / mobilization exercises. o Balance and postural control.
Avoid excessive body-position changes (i.e., lying-to-standing): • Hypotensive responses • Difficulty in movement
For individuals > 50 years of age (after 12 weeks of training)
Exercise (Resistance) Guidelines for Older Adults – FITT-VPP ACSM (2014)
Frequency (F): • Target major muscle groups ≥ 2 days / week
Intensity (I): Light • 40-50% 1RM for older adults beginning a
program or for more frail individuals. • 3-5 out-of-10 effort (0-10 Scale)
Intensity (I): Moderate • 60-70% of 1 RM (one repetition max) • 7-8 out-of-10 RPE effort (0-10 Scale)
Type (T): • Progressive weight-training program or weight-bearing calisthenics. • 8-10 exercises involving major muscle groups. • ≥ 1 set x 10-15 repetitions each exercise (2-3 sets optimal for muscle hypertrophy /
strength).
Strength Gains
1x 2x 3x Training Frequency / week
Programming …
Why are we not training them like us, but like china dolls??
Name: Fabio Comana, MA., MS.
Credentials: NASM CPT, CES & PES; ACE CPT & HC; NSCA CSCS; ACSM EP-C; CISSN.
Email: [email protected]
Thank You..!! For Your Commitment to Excellence
Questions .. ??