6 Core Exercises for Older Adults
By Alex Germano, PT, DPT, GCS
Physical Therapist, Maryland
Vestibular Rehabilitation Specialist (AIB-VR)
Older adults who are increasingly sedentary will experience a decline in muscle mass and a related increase in muscle weakness. With increased time in supported sitting (i.e. the dreaded recliner!), core musculature can weaken significantly. This can have a profound impact on a variety of household and community-level skills that a patient would need to perform to have meaningful participation in daily life.
To combat this, clinicians may reach to core-specific exercises to improve a patient’s proximal stability in order to improve distal mobility. For example, a patient with poor trunk control in a sitting position will have great difficulty reaching for objects of various weights in forward or lateral positions. In standing, a patient with reduced trunk strength can have difficulty with dynamic balance, such as using a stepping strategy to avoid a fall. It is important to address core strength and coordination in order to improve balance, functional mobility and use of the extremities.
Don’t Stop at Transverse Abdominis Activation Exercises
The “core” or “trunk” musculature can be defined anteriorly as the rectus abdominis, transverse abdominis, and external and internal obliques. Posteriorly, the multifidus, latissimus dorsi, and erector spinae are present. The diaphragm, psoas major and minor as well as the pelvic floor musculature should also be considered.
The transverse abdominis activation exercise in hooklying is a very common exercise thought of for “core” strengthening or for low back pain management. However, this exercise leaves a lot to be desired as it only targets one of the many core muscles and is not performed in a functional position that may be meaningful to patients. When considering the urgency to get older adults strong, clinicians should not be reaching to the transverse abdominis activation or at least should not be performing this activity for multiple sessions in a row without progression.
6 Exercises to Help Strengthen Your Older Adult Patients’ Core
This article will help address more functional positions for core strengthening and more effective exercises that target many muscles at once. This article will also provide scaling options in sitting and standing positions as well as video examples of the exercises.
You can use this video to visualize some of my patients demonstrating the exercises.
1. Pallof Press
This is an anti-rotation activity, meaning the trunk is going to resist rotation. The patient attempts to maintain a neutral trunk position while extending the hands away from the chest resisting a lateral rotational force. The patient can be seated, standing, standing in a mini-squat, or in a half-kneeling or tall kneeling position.
Pallof Press Upgrades:
- Increase the band resistance
- Add isometric hold
- Perform in single-leg position
- Add “chaos” variety by placing a 2-5 lbs. change plate on the band and performing a fast pushing phase of movement followed by an isometric hold
Example Videos:
2. Front Raise
With the patient seated or standing, lift weight or band with arms straight up to shoulder level. Try to perform this movement, especially lowering the arms, slowly. Moving the arms away from the body while trying to maintain a neutral trunk position is surprisingly difficult and not only targets the arms but gets at the core.
Front Raise Upgrades:
- Increase weight
- Vary stance
Example Video:
3. Deadlift
With the patient in a standing or sitting position, while maintaining a neutral trunk, hinge at hips, and lower weight to the floor. The patient may slightly bend their knees after the weight passes their knees.
This exercise focuses more on the posterior chain, including the posterior muscles of the core. They should be held isometrically throughout the lift. This is an incredibly functional movement with the ability to provide full body strengthening.
Deadlift Upgrades:
- Vary stance (stride stance, single leg)
- Increase weight
- Perform with weight in one upper extremity only
- Add bent over row to each repetition
Example Videos:
4. Russian Twists
With the patient sitting in bed or on the floor and holding a weight, lift the feet off the floor. Then perform a rotational movement, tapping weight on either side of the hip in an alternating fashion.
To reduce the difficulty of the movement, you can place one or both feet on the floor. This movement may not be appropriate for someone with a fragility fracture history. For a patient with osteoporosis, monitor symptoms and start with low weights in a more proximal position to build up strength safely.
Russian Twist Upgrades:
- Increase weight or repetitions
- Both feet in the air
Video:
5. Planks
The patient should place hands on a surface (floor/counter/table) and keep their body straight from head to toe. They will hold this position for a certain length of time.
Patients can perform this movement on their knees to reduce the challenge. Another way to decrease the difficulty would be to increase the height of the hands.
Plank Upgrades:
- Hands on the floor, knees off of the floor
- Perform alternating shoulder taps
- Perform side plank variations
- Perform alternating twists to the side
- Add a weight on the patient’s back
Video:
6. Turkish Sit-Ups
This movement starts with the patient lying flat on their back with their arms above their head at 90 degrees. The patient then begins a sit-up while keeping their legs straight and hands above the head. The movement ends in a long sitting position with the hands above the head.
There is another option to hold weights while performing this movement. This movement can be scaled back to a hospital bed. Start the patient in a large amount of incline and have them perform the sit-up. Progress them closer to flat as they improve this movement.
Turkish Sit-Up Upgrades:
- Add/increase weights
- Perform with less incline
Video:
Add Core Exercises to Your Existing Routines
Working on core strength is incredibly important for sedentary older adults in order to establish a strong body in which to move limbs. The beauty of the core exercises listed above is that they can be performed in sitting or standing positions, which means they should be accessible to most patients. They can easily be added to existing routines and home exercise programs for added strengthening.