Aging and Exercise: How to Adapt Your Own Gym Workouts for Patients

By Kaitlyn Baran, PT, DPT

Physical Therapist

As individuals age, many abandon activities that used to bring so much joy. Tennis requires balance and coordination for a quick change in direction while distance running or walking requires increased endurance and demand on the cardiovascular system. When working with the geriatric population, we often hear “Oh, I used to do that when I was younger” in reference to physical activity or a workout routine.

The more I heard this response, the more I began to question why these individuals seemed to have abandoned exercises they once enjoyed. Could it be fear of getting injured? Or maybe just an overall decline in strength? I wanted to understand what keeps this population from performing quality functional movements, particularly those that I am performing in the gym myself.

What Happens to Muscle as we Age?

Research from Harvard Medical School reports that men begin to lose muscle mass after forty. Women also experience a loss in muscle mass and bone density, better known as osteoporosis, as they enter menopause. Bone calcium declines over time in both men and women leading to a higher risk for fractures. Musculature also continues to decline by becoming tighter and stiffer. If people are not staying active and maintaining strength on a regular basis, weakness and disability quickly follow behind.

Targeting the Deficit

A common deficit we see while working with the geriatric population is difficulty with a sit-to-stand transfer. My clinical reasoning as a PT would lead me to believe there is either a deficit in strength or power of the hip extensors. I am always working my posterior chain in the gym. That is exactly what these folks also need. While I often perform a deadlift variation, the traditional exercise may be challenging at the initial introduction for my geriatric patients. How can I modify this exercise to suit their abilities while monitoring safety? If your patient is lacking the available range to perform the deadlift from the floor, place a chair in front of them. The individual is now in a position to perform a hip hinge. This will assist in protecting the spine when bending forward to pick up an object or performing household tasks.

When the form is on point and the patient feels comfortable, you can then introduce a weighted object, either a dumbbell or weighted household item. This exercise can even be taken into the seated position for modification. The upper extremities are extended between the knees as an emphasis on the hip hinge remains a top priority. Although the exercise has been modified, the patient is still performing a deadlift variation – just like me.

More Functional Exercise For Geriatric Patients:

• Deadlift – This is a great compound exercise to target multiple muscle groups required for standing from a seated position and picking up a heavy object from the floor.
• Bent over row – A great stabilization exercise that recruits back and leg muscles when performed while standing.
• Overhead press – Targeted for shoulder and core strength and stabilization.
• Burpees – Awesome, full-body movement relying on strength and cardio.

Many patients report being formerly involved in group exercise, but stopping because they were lost in the classes or felt the movements were too difficult. Any movement can be modified to fit the safety and comfort of the performer. Deadlifts, bent-over rows, and the overhead press can all be performed from a standing or seated position. The burpee can be performed utilizing a ballet barre or even the kitchen counter while replacing the “jump” at the end with a heel raise.

Equipment

People often think actual gym equipment is required in order to achieve any gains. Before reaching for your Theraband or two-pound pink dumbbell, I encourage you to utilize what the patient has readily available in his or her own home. Using common household items translates into the performance of daily tasks and activities. For example, you can add or remove weight to a reusable shopping bag with woven handles based on your patient’s progression or regression.

Substitutes for dumbbells/kettlebells:

• Cans of soup/vegetables
• Gallon of milk
• Carton of juice
• Laundry detergent container (This one typically has a handle!)

Since incorporating these interventions into each treatment session, I have noticed an increase in both strength and confidence when completing daily tasks. Individuals are able to generate the power needed without compensating to rise or lift heavy objects. I have also noticed a decline in reported pain, specifically in the low back. These functional movements translate into everyday actions while teaching proper mechanics for the long haul.

Enough of the long arc quads and glute squeezes. Those types of interventions certainly have their place where it is necessary and appropriate, however, we as clinicians are often providing a great disservice to our patients. We need to challenge our patients into the functional positions they are performing each and every day. Those positions are no different than what you and I perform, so why should their exercises differ?

I challenge you to change up your treatment session and introduce an exercise you perform at the gym to your patient. Modify it as needed. I promise you will be surprised at what they can do!