"We first must think "I can," then behave

appropriately along that line of thought."

- Marsha Sinetar

Fitness Focus On Frail Elderly

By Wayne L. Westcott, Ph.D.

I recently experienced a busy travel week that really opened my eyes to the fast emerging field of fitness for frail elderly and senior living center residents. The first part of the week I shared our strength training studies with Beverly Enterprises in Los Angeles, a group responsible for health services in more than 700 senior living centers throughout the country. The latter part of the week, I presented our strength training research at the American Association for Homes and Services for the Aging National Conference in Miami. On my return flight to Boston, it hit me that there is presently a great interest in and enthusiasm for older adult fitness programs. This awareness was reinforced by an article in U.S. News and World Report that featured our senior strength training study, and an article in Athletic Business that detailed our strength research with frail elderly nursing home residents.

This awareness is very exciting because no one has more to gain from strength training than older adults. Lifting weights is no longer limited to young athletes who want greater performance power. Strength training is for every person who needs more muscle and functional ability, and no one fits that description better than our senior population.

Consider a 20-year old woman who has 50 pounds of muscle and a relatively high level of physical strength. If she does not perform regular strength exercise, she will lose about five pounds of muscle tissue every decade of her adult life. By age 70 she will have only half of her original muscle mass and a life-changing low level of physical strength. Data from the famous Framingham Disability Study shows that more than half the women over age 70 cannot lift a 10-pound weight, let alone a grocery bag or a grandchild.

Consider also that muscle loss inevitably results in bone loss, leading to osteoporosis. A weak musculoskeletol system is associated with poor balance, ambulatory problems, a variety of degenerative diseases and a devastating lack of independence.

Can strength training help? Absolutely. Numerous studies have demonstrated that strength training is beneficial for (1) increasing bone mineral density (reducing the risk of osteoporosis); (2) increasing glucose utilization (decreasing the risk of type II diabetes); (3) quickening gastrointestinal transit speed (reducing the risk of colon cancer); (4) lowering resting blood pressure and total cholesterol (decreasing the risk of heart disease); (5) increasing low back strength (reducing the risk of low back pain); (6) easing arthritic discomfort; and (7) increasing self-confidence and decreasing depression.

But let's not put the cart in front of the horse. The most important outcome of senior strength training is replacing muscle lost during the aging process. Our studies have consistently shown that older adults regain more than a pound of muscle every month of strength exercise. Outside of the fabled fountain of youth, that's about as good as it gets for regaining lost ground.

Consider the results of our senior study in which men and women between 60 and 80 years old performed one set each of 12 Nautilus exercises, three days a week, for a period of eight weeks. They added 2.5 pounds of muscle and lost 4.0 pounds of fat for significant improvements in their body composition and physical strength. Ninety-five percent of the participants were so pleased with their results that they committed to continue the strength-training program.

Our research with debilitated elderly nursing home residents was just as encouraging as our work with healthy older adults. We conducted a landmark study at the John Knox Village Assisted Living Center in Orange City, Florida, where the average age of the patients was 89 years. Due to their low level of muscular strength (most of the participants were pushed in wheelchairs to the exercise room), they performed only six Nautilus exercises per session. The participants performed one set of each exercise, twice a week, for a period of 14 weeks. They replaced 4.0 pounds of muscle and reduced 3.0 pounds of fat. Their strength increased so much (80 percent in the legs and 40 percent in the upper body) that almost all of the patients could function without their wheelchairs. One woman's physical capacity improved to the point where she actually left the nursing facility and went home to live with her husband.

This study showed us that a brief program of strength exercise can be effective for even the most frail members of our society. The assisted living patients increased their personal independence (functional independence measure) by one percent per week, enabling them to perform many daily tasks that they couldn't previously do without assistance.

The results of this and similar studies have prompted numerous assisted living centers to initiate strength training programs to improve the quality of life for their most needy residents. In addition, many senior living facility administrators now realize that strength training may be the best means for extending the time people spend on their independent living campuses which, of course, benefits everyone. For this reason more and more senior living centers are making well-equipped and well-staffed exercise rooms available to all residents.

Think of it this way. If you are planning to move into a senior living facility, would you choose one that expects you to go from walking independently to walking with a cane to walking with a walker to using a wheelchair? Or would you prefer a facility that helps people move from wheelchairs to walkers to canes to walking independently through supervised strength training programs? If you are like me, you appreciate the pro-active approach that focuses on improved fitness and function.

Sometimes we have the mistaken notion that keeping elderly individuals comfortable means all rest and no physical effort. I am convinced that most older adults enjoy a more comfortable and satisfying life when they have a balance between quality rest and purposeful physical activity. And make no mistake, strength training is far and away the most important physical activity for older adults. The muscles are the engines of the body, and most senior men and women really appreciate the more powerful engines they develop through sensible strength training.

If you have frail elderly family or friends, encourage those responsible for their care and well-being to provide supervised strength training opportunities that can improve their physical fitness and functional capacity. Everyone benefits when frail elderly become strong older adults.

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Wayne L. Westcott, Ph.D., is fitness director at the South Shore YMCA in Quincy, Massachusetts, and strength training consultant for IDEA, the American Council on Exercise, the International Fitness Institute, and the YMCA of the USA. Dr. Westcott is the author of the college textbook Strength Fitness, and the professional textbook Be Strong.