Exercise for Frail Elders

336 Pages·2014·22.66 MB·English

by  Elizabeth Best-Martini

ExErcisE
for
Frail EldErs
•
second Edition
Elizabeth Best-Martini, Ms, cTrs
Kim a. Jones-diGenova, Ma
Human Kinetics
Library of Congress Cataloging-in-Publication Data
Best-Martini, Elizabeth, 1948-
Exercise for frail elders / Elizabeth Best-Martini, Kim A. Jones-DiGenova. -- 2nd ed.
p. ; cm.
Includes bibliographical references and index.
I. Botenhagen-DiGenova, Kim A., 1957- II. Title.
[DNLM: 1. Exercise Therapy. 2. Frail Elderly. 3. Aged. WB 541]
RC953.8.E93
613.7'0446--dc23
2013003909
ISBN-10: 1-4504-1609-8
ISBN-13: 978-1-4504-1609-2
Copyright © 2014 by Elizabeth Best-Martini and Kim A. Jones-DiGenova
Copyright © 2003 by Elizabeth Best-Martini and Kim A. Botenhagen-DiGenova
All rights reserved. Except for use in a review, the reproduction or utilization of this work in any form or by any electronic,
mechanical, or other means, now known or hereafter invented, including xerography, photocopying, and recording, and in
any information storage and retrieval system, is forbidden without the written permission of the publisher.
Notice: Permission to reproduce the following material is granted to instructors and agencies who have purchased Exercise
for Frail Elders, Second Edition: pp. 8, 19-31, 41-43, 46, 47, 62, 66, 79, 87, 96, 98-99, 101-104, 139-141, 146, 147, 154, 180-
181, 185, 192, 221, 225, 230, 233, 235-237, 271, 280-286, 288-295. The reproduction of other parts of this book is expressly
forbidden by the above copyright notice. Persons or agencies who have not purchased Exercise for Frail Elders, Second Edition,
may not reproduce any material.
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We thank Long Life Living in San Rafael, California, for assistance in providing the location for the photo shoot for this book.
On the cover: Bill Bromley, age 92, demonstrating balance and core work with a ball.
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To my dearest husband, John A. Martini, whose love for me and
recognition of the importance of my work have been immeasurable
gifts. As a well-known author yourself, you understand this pro-
cess, and you have helped me with editing, photography, graphics,
and most of all, support. Thank you for being you and loving me.
To my mom, Peggy. Every time I look at your smiling face in one
of the exercise photographs, I can hear your laugh and feel your
love and presence.
And a special dedication to all the elderly people who have
touched my life and work. You are at the heart of this book.
Betsy Best-Martini
In honor of John R. Jones, my beloved husband; my father, Alfred;
my mother, Anna; and Auntie Mary, whose unconditional love
and support give me time to follow my heart and passions, such as
writing this book.
To my students of many years, my best teachers, who give joy
and meaning to my life.
And to you, the teachers, who are dedicated to helping our frail
elders and those with special needs.
Kim A. Jones-DiGenova
contents
List of Important Topics vii
Preface ix
Acknowledgments xi
Part i Planning a successful Exercise Program for
Frail Elders and adults With special Needs . . . . . 1
chapter 1 The Participants:
Know Their individual Needs . . . . . . . . . . . . . . . . .3
Frailty and Special Needs in Older Adults . . . . . . . . . . . . . . . . . . . . .4
Common Medical Disorders and Special Needs . . . . . . . . . . . . . . . . .7
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Review Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
chapter 2 The Exercise Program:
Make it Motivating, safe, and Effective . . . . . . . 33
Wellness and the Wellness Model as a Tree. . . . . . . . . . . . . . . . . . .34
Make It Motivating. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Make It Safe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Make It Effective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Review Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
chapter 3 The leader: Tips and strategies for success . . . 59
Creating a Sense of Fun and Community . . . . . . . . . . . . . . . . . . . .59
How to Set Up a Group Exercise Class . . . . . . . . . . . . . . . . . . . . . .61
Opening Your Exercise Class . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Leading Your Exercise Class . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Closing Your Exercise Class. . . . . . . . . . . . . . . . . . . . . . . . . . . . .77
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
Review Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80
iv
Contents v
•
Part ii implementing an Exercise Program for
Frail Elders and adults With special Needs . . . . 81
chapter 4 Warm-Up: Posture, Breathing,
range-of-Motion, and stretching Exercises . . . . 85
Safety Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
Basic Seated Warm-Up Exercises . . . . . . . . . . . . . . . . . . . . . . . . .95
Basic Standing Warm-Up Exercises. . . . . . . . . . . . . . . . . . . . . . . 102
Variations and Progression. . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Review Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Illustrated Instruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
chapter 5 resistance Training . . . . . . . . . . . . . . . . . . . . . 137
Myths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Safety Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Basic Seated Resistance Exercises. . . . . . . . . . . . . . . . . . . . . . . . 152
Basic Standing Resistance and Balance Exercises . . . . . . . . . . . . . . 155
Variations and Progression. . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Review Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Illustrated Instruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
chapter 6 aerobic Training and
dynamic Balance activities . . . . . . . . . . . . . . . 177
Safety Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Basic Seated Aerobic Exercises . . . . . . . . . . . . . . . . . . . . . . . . . 190
Basic Standing Aerobic Exercises . . . . . . . . . . . . . . . . . . . . . . . . 192
Variations and Progression. . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Review Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Illustrated Instruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
vi Contents
•
chapter 7 cool-down:
stretching and relaxation Exercises. . . . . . . . . 219
Safety Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Basic Seated Cool-Down Exercises . . . . . . . . . . . . . . . . . . . . . . . 232
Basic Standing Cool-Down Exercises. . . . . . . . . . . . . . . . . . . . . . 237
Variations and Progression. . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Review Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Illustrated Instruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
chapter 8 Putting Your Exercise Program Together . . . . . 259
Designing Your Exercise Program. . . . . . . . . . . . . . . . . . . . . . . . 259
Scheduling Your Exercise Classes . . . . . . . . . . . . . . . . . . . . . . . . 266
Modifying the Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
Progressing Your Exercise Class . . . . . . . . . . . . . . . . . . . . . . . . . 273
Maintaining Fitness Results . . . . . . . . . . . . . . . . . . . . . . . . . . . 276
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Review Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
appendix a Health and Fitness appraisal. . . . . . . . . . . . . . 279
A1 PAR-Q & You. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
A2 Statement of Medical Clearance for Exercise. . . . . . . . . . . . . . . 281
A3 Cover Letter to Physician . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
A4 Medical History and Risk Factor Questionnaire . . . . . . . . . . . . . 283
A5 Exercise Program Informed Consent. . . . . . . . . . . . . . . . . . . . 285
A6 Fitness Leader’s Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
appendix B Teaching aids and Educational Handouts. . . . . 287
B1 Benefits of Physical Activity for Older Persons . . . . . . . . . . . . . . 288
B2 Muscles of the Human Body . . . . . . . . . . . . . . . . . . . . . . . . . 289
B3 Cueing for Safe and Constructive Biomechanics During Exercise
and Activities of Daily Living (ADL) . . . . . . . . . . . . . . . . . . . . . 291
B4 Exercise Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
B5 Fitness Training Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
appendix c Professional development . . . . . . . . . . . . . . . . 296
C1 Professional Ethics for Group Fitness Trainers . . . . . . . . . . . . . . 297
C2 Answers to Review Questions . . . . . . . . . . . . . . . . . . . . . . . . 299
Bibliography 304 Index 317
Suggested Resources 311 About the Authors 322
list of important Topics
Emergencies p. 43
Balance, core, and agility Training p. 48
Three-step instructional Process p. 71
Good seated Posture p. 96
Three-Part deep-Breathing p. 98
Good standing Posture p. 104
Progressing Your Exercise class p. 273
vii

Preface
T
he concept for this book, Exercise for Frail one who is required to follow federal or state
Elders, originated from our relationships regulations for physical exercise instruction,
with elderly participants in our exercise classes. you will find this book to be of great value as
They mentored and showed us the profound a manual that takes you through every step
effect that physical activity has in each of our of the process in teaching safe and effective
lives—regardless of age or situation. Today’s exercise.
fitness leader needs an understanding of the This book also stands out from other exer-
limitations and special needs of those with cise books for older adults in its thorough and
illnesses, disabilities, chronic disorders, and user-friendly presentation of special needs,
sedentary lifestyles. There is a direct link including Alzheimer’s disease and related
between losing fitness and function and losing dementias, arthritis, cerebrovascular accident,
independence. Some of the simple movements chronic obstructive pulmonary disease, coro-
and tasks that we take for granted can slip away nary artery disease, depression, diabetes, hip
through inactivity. Any person, no matter how fracture or replacement and knee replacement,
out of shape, can improve his or her fitness and hypertension, multiple sclerosis, osteoporosis,
function through proper exercise. The authors Parkinson’s disease, sensory losses, and trau-
of this second-edition text aspire to help you matic head injury. Regular physical activity is
improve your students’ functional fitness (the recommended as a therapeutic intervention
ability to perform activities of daily living for the treatment and management of numer-
such as pushing, pulling, lifting, squatting, ous chronic diseases and conditions, including
balancing, and sitting and standing erect that dementia, depression, pain, and so on (ACSM
enhance well-being and quality of life) through 2009b, USDHHS 2008b). This book will prepare
proper exercise. The terms exercise program, fit- you to meet the challenge of leading exercise
ness program, and functional fitness program are for adults with one or more special needs.
interchangeable in the context of this book. Exercise for Frail Elders gives you the tools to
The need for qualified fitness leaders plan and implement a successful functional fit-
increases with the growing population of older ness program. At the opening of each chapter
adults. This field is an exciting one in which to you’ll find a quotation, an example of one way
work. You can see the benefits of your exercise to open (or even close) a class with a relevant
program in your participants’ increased func- inspirational, motivational, or even humorous
tional fitness and independence. saying. You’ll also find the addition of learning
Exercise for Frail Elders is a training manual objectives at the beginning and review ques-
for beginning as well as experienced fitness tions at the end of each chapter to facilitate
professionals. Professionals in this field include your learning. Answers to the review questions
activity directors, recreation directors, wellness can be found in appendix C2. Part I, “Plan-
directors, recreational therapists, occupational ning a Successful Exercise Program for Frail
therapists, physical therapists, dance therapists, Elders and Adults With Special Needs,” covers
physical education teachers, adaptive physical the participants, the exercise program, and
education specialists, exercise physiologists, the leader. In chapter 1 you will learn about
personal trainers, certified and noncertified participants’ individual and special needs. In
fitness instructors, aerobics instructors, geron- chapter 2 you will learn about the exercise
tologists, adult education instructors, college program and how you can
instructors, and students in specialties related make it motivating, safe,
to older adults. Whether you are an expe- and effective according to
rienced or a beginning fitness instructor, or industry standards. You
ix
x Preface
•
will also learn about the wellness model, which new section on balance, core, and agility train-
includes physical activity. This chapter provides ing, including user-friendly tables for balance
a foundation for integrating balance, core, and and core (a key contributor of balance abil-
agility exercises into your program. Chapter 3 ity) exercises. Many of the exercises included
walks you through steps and strategies needed in part II of this book provide balance ben-
to be a successful leader. Part II, “Implementing efits by increasing joint range of motion with
an Exercise Program for Frail Elders and Adults ROM and stretching exercises (chapters 4),
With Special Needs,” provides warm-up (good by strengthening the muscles with resistance
posture, deep breathing, joint range of motion, training (chapter 5), by increasing flexibility
and light stretching), resistance training, aero- with stretching (chapter 7), and by improv-
bic and dynamic balance (chapter 6, by Janie ing posture (chapter 4). Seated exercises can
Clark), and cool-down exercises (comprehen- give frail and deconditioned participants the
sive stretching and relaxation). Each exercise strength and flexibility to stand to gain further
component in chapters 4 through 7 has an balance benefits. Also, the standing exercises
easy-reference chart and photographs of the that involve a one-legged stand for static bal-
exercises. Each chapter also includes safety ance benefits are now indicated in the variation
precautions, guidelines, seated and stand- and progression sections in chapters 4 through
ing exercises, and variations and progression 7. Lastly, in chapter 6, you will find additional
options for the exercises to meet the diverse fun and functional dynamic balance exercises.
needs of this population through the years. The exercises in part II that provide more
Although part II of the book is geared toward significant balance benefits are indicated
class or group instruction, the information with a balance symbol.
is also applicable when working one on one In chapter 8 you will learn about putting it
with this population. Thus, the terms student, all together to implement an exercise session
resident, client, and patient can be used inter- or program that incorporates one or more
changeably with participant, and session and components—warm-up, resistance, aerobic
appointment can be used interchangeably with and dynamic balance, and cool-down exer-
class, which is used throughout part II. cises—from chapters 4 through 7. You will
Start with the basic seated exercises in chap- also learn how to design, schedule, modify,
ters 4 through 7, which are intended to help progress, maintain, and monitor a functional
frail elders and those with special needs have fitness program for frail elders and adults with
a successful experience in your class. Through- special needs. Chapter 8 also has a new sec-
out chapters 4 through 7 you’ll learn tools for tion on the balance component to aid you in
adapting the exercises for your participants’ designing an exercise class that includes or
individual needs, particularly in the sections focuses on balance.
“Specific Safety Precautions for Those With In the back of the book are appendices that
Special Needs” and “Illustrated Instruction,” provide you with necessary and useful forms,
which includes exercise and safety tips and educational handouts, answers to the review
variations and progression options (VPOs) for questions, and other information to help make
each exercise. Carefully progress to the basic your role as fitness leader easier. In “Suggested
standing exercises with participants who are Resources” you will find a new section, “Bal-
able to stand safely. The seated and stand- ance,” that lists books and supplies for devel-
ing exercises are designed to be taught at the oping a class that includes or concentrates on
same time, which allows you to accommodate balance. We encourage you to use “Suggested
people with a wide variety of special needs. Resources” to enhance your knowledge base
The second edition of Exercise for Frail Elders and embrace life-long learning.
provides a broader focus on balance, a critical It is our sincere hope that this book will
component of a functional fitness program for enhance your competence and confidence in
reducing risk of falling and improving quality meeting the special needs of people in your
of life for older adults. Chapter 2 includes a exercise classes.