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Easy Exercises and Stretches: How seniors can improve stability and core strength and prevent falls

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By Diane Muhlfeld • December 10, 2015

Easy Exercises and Stretches:
How seniors can improve stability and core strength and prevent falls

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INTRODUCTION

As the U.S. population ages, the importance of balance and mobility has received more attention as a component of fitness. Maintaining the ability to move around easily and lowering the risk of falls is one of the goals—and challenges—of aging.

Yet one in five older adults reports balance problems and/or dizziness. Are these problems related to physical issues? A review of studies conducted at the University of Alabama Birmingham found that even with comprehensive diagnostic testing, the real cause of geriatric dizziness is still elusive.

Among the findings:

• Almost 20 percent of people 65 and older reported dizziness or balance problems during the previous year.
• Symptoms occur more often in women than in men.
• Less than 5 percent of patients report having continuous symptoms.
• Frequency of symptoms ranges widely, but one study found that 35 percent of geriatric dizziness patients had symptoms daily, 14 percent weekly, and 51 percent monthly.
• Approximately half of patients with vestibular disease—that is, the part of the inner ear and brain involved with controlling balance and eye movements—receive some type of medication after an initial visit to the doctor.

The good news: Balance can be improved at any age with a simple and easy exercise routine. Besides improving balance, mobility, and—through resistance exercise—strength, participating in a regular exercise program has other benefits as well. Exercise can also reduce stress by relieving tension and anxiety, serving as a diversion from daily routines, increasing energy levels, elevating mood, and improving overall emotional well-being.

Even though exercise doesn’t change the causes of stress, it can change our perception of stress and how we respond to it. Exercise seems to force the body’s systems to communicate more efficiently, according to the American Psychological Association (APA), and this is necessary to deal with physiological and psychological stress. The more sedentary our lifestyles become, the less efficient our bodies are at responding to stress.

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I. WHAT IS PHYSICAL FITNESS?
AND HOW DOES IT PREVENT FALLING?

Balance and mobility are based on a certain degree of strength in both the upper and lower body. Difficulty in getting up, or pushing upward with your arms, from a chair or sofa might be an indication of upper body weakness. Lower body weakness or unsteadiness is a warning sign for potential falls and decreased mobility.

People who don’t view themselves as particularly athletic still need to engage in exercise to maintain their independence. When you ask, “What is physical fitness?” the answer is anything that aids strength, flexibility, and mobility.

Falling: How Does It Happen?

Falls can happen to anyone, but the common denominator in most falls is age. Many of the people at high risk for falls are the same ones who have lost some of their mobility. One in every three adults 65 years and older will fall this year, according to the Centers for Disease Control and Prevention. Falls are the leading cause of fatal and nonfatal injuries.

An injury that begins with a fall can develop into restricted mobility that negatively affects the way you live. At first it’s a “hard to get around” situation, but it can end with a smaller world in which a person can’t walk very far, can’t drive, can’t travel, and can’t enjoy normal activities that once were taken for granted.

There are as many myths about falls as there are about potential loss of mobility. Here are a few you may have heard—or even repeated.

Myth: Falls happen to other people, not to me.
Fact: Remember that statistic about one out of three older adults falling each year? If you are 65 or older, you have a 33 percent chance of falling this year. If it doesn’t happen this year, you face increased odds next year and every year after that.

Myth: Taking medication doesn’t increase my risk of falling.
Fact: Medications may increase your risk of falling by making you sleepy or dizzy, says the National Council on Aging. Talk to your health care provider about potential side effects, and be especially careful when starting a new medication.

Myth: There is no need to get my vision checked every year.
Fact: Vision is a key risk factor for falls. People with vision problems are twice as likely to fall as those without an impairment. Get your eyes checked every year, and update your glasses as necessary.

Myth: Falls are not as serious as cancer or heart disease, so I don’t need to talk to family members or my doctor(s) if I’m concerned about my risk of falling.
Fact: Preventing falls is a team effort and something that should be discussed with your doctor, family, and others in a position to help.

Myth: I don’t need to talk to a parent, spouse, or other adult if I’m concerned about his or her risk of falling.
Fact: Yes, you do. Without being threatening, let the person know about your concerns and offer support to help him or her maintain the highest degree of independence possible.

How to Prevent Falls

So what is physical fitness to aging people? It’s one of several factors that can help prevent falls. The keys to making sure you’re safe include the following:

• Improve your balance
• Maintain or increase your mobility
• Increase your strength and flexibility
• Make your home safer
• Identify medications that may contribute to falls
• Explain why hearing and vision are related to a surprising number of falls

Researchers at the University of Sydney found that strength and flexibility tasks embedded in the daily activities of a group of men and women over the age of 70 reduced the rate of falls by 31 percent.

The participants in the University of Sydney studies were assigned to a program consisting of walking, stepping over objects, and moving from a sitting to standing position reported significantly fewer falls than participants who engaged in a traditional lower-body exercise program and those who were assigned to a sham exercise group. They also displayed better balance, increased ankle strength, and improved function and participation in daily life.

The study emphasizes the importance of staying active and fit. In the chapters ahead, we’ll be supplying you with mobility and balance exercises, aerobic exercise, and resistance exercise. Whichever one or ones you decide to follow, you’ll be helping yourself stay active and fit while reducing your chances of falling.

First, though, let’s get into a preliminary discussion on how to warm up, why nutrition is important, and the need for hydration.

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II. SENIOR EXERCISE BASICS: WARM-UP, DIET, AND HYDRATION

Regardless of any exercise activities in which you engage—whether they’re low-impact exercises for seniors (brisk walking, bicycling, light aerobics, swimming) or more strenuous (tennis, racquetball, running the treadmill)—you should begin with a dynamic warm-up. The more prepared your body is, the less likely it is to get injured. So make sure you devote five to 10 minutes to a proper warm-up.

Warm-Up Tips

The best warm-up routine will vary from person to person, but the goal is the same: Break a sweat, gradually elevate the heart rate, and increase circulation. Light calisthenics, slow-paced swimming or cycling, moderate-paced walking, and jogging can be effective warm-ups. Another method is to move the body through a range of motion that mimics the exercise you will be doing.

Besides allotting yourself proper warm-up time, make sure you’re giving your body the right nutrition and hydration. Those factors are keys to preparing your body to deal with the stress placed on it during a workout, even if you’re engaging in low-impact exercises. For seniors and young people alike, the proper nutrition and hydration will make injuries and such conditions as cramping less likely to happen.

What and when you eat have an effect on how you feel during exercise. Here are some hydration and diet suggestions.

Hydration Tips

(Adapted from the American College of Sports Medicine)

• Drink 2 to 3 cups of water in the two to three hours before a strenuous exercise session.
• Drink approximately 1/2 to 1 cup of water every 15–20 minutes during a workout, but adjust amounts according to your body, the weather, and the intensity of your exercise.
• Drink 2 to 4 cups of water after your workout for every pound of weight lost during your workout (weigh yourself immediately afterwards).

What to Eat and Drink Before You Exercise

• Whole-grain cereals, bread
• Juice
• Fat-free yogurt
• Pancakes, waffles
• Fruits (apple or banana)

What to Eat and Drink Following Strenuous Exercise

Concentrate on fluids, carbohydrates, and protein via these types of selections:

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III. BALANCE AND MOBILITY EXERCISES FOR SENIORS

It’s important to keep physically fit enough to maintain balance, keep from falling, and stay active and mobile—and independent. There are things you can do to put yourself in a lower risk group for falls and improve your mobility. One of those measures is regular exercise. How to get started?

The U.S. Department of Health and Human Services highly recommends balance exercises for elderly people. It’s smart to schedule balance training at least three days a week, for 10 to 15 minutes per session, using exercises included in studies and programs that have been proven to reduce falls. Include lower-body strength exercises (side leg raises and back leg raises, for example) as part of your routine exercises.

There are things you can do to put yourself in a lower risk group for falls and improve your mobility. One of those measures is exercise. Here are some you can do on your own.

BALANCE WALK
This most basic exercise is one that you can turn into a daily routine in your own living space.

• Raise your arms out to your sides near shoulder height.
• Select a spot or an object across the room (at least 10 steps away) and focus on it as you walk toward it, stepping with one foot directly in front of the other.
• Repeat 8 to 12 times.
• Variation: As you walk, lift your back leg and pause one second before stepping forward.

SEMI-SITS
Keep your abdominal muscles strong with this easy-to-practice exercise requiring only a chair and several minutes.

• Stand in front of a sturdy chair, feet hip-width apart.
• Engage your abdominal muscles by gently pulling them in and up.
• Slowly lower your buttocks and bend your legs as though you are going to sit down in the chair. Instead, just touch the chair seat lightly with your buttocks, then return to a standing position.
• Repeat 8 to 12 times, rest, and complete another set.

More on Mobility

There is almost as much misinformation about fall-related mobility as there is solid, evidence-based data. Here are some common myths, followed by the facts.

Myth: If I limit my activity, I won’t fall.
Fact: Physical activity will make you more independent, increase your strength and range of motion, and benefit your overall health, according to the National Council on Aging.

Myth: As long as I stay at home, I can avoid falling.
Fact: More than half of all falls happen at home, so staying at home is not exactly being free of risk, the National Council on Aging warns. Many of the things at home that contribute to falls can be changed, added, moved, or removed to prevent falls.

Myth: Using a cane or walker will make me more dependent.
Fact: Walking aids help older adults become more independent, not less. They help people maintain and/or improve mobility and stability, American Family Physician notes. With improved mobility comes greater independence.

Myth: I’m too old to do anything about it.
Fact: You’re never too old to start exercising. In fact, not exercising increases the risk of multiple health problems, including falls, according to NIH Senior Health at the National Institutes of Health. Exercise helps people with high blood pressure, balance problems, and difficulty walking.

Myth: Mobility cannot be improved.
Fact: Mobility can be improved. A study published in the British Medical Journal found that strength and flexibility tasks embedded into routine activities improved balance, strength, function, and participation in daily life among people age 70 and over. The quadriceps muscles, located on the front of your thighs, are particularly important for walking and for maintaining independence. They play an essential role in walking because they’re responsible for swinging the leg forward as you take a step. The quads also play a primary role in movements, such as getting up from a chair, getting out of the bathtub, and climbing stairs. Strong quadriceps also help with balance and stability. You’re less likely to stumble if your quadriceps are strong. Strong quads not only help you maintain equilibrium and prevent falls, but they protect your back when you bend down to pick up an object.

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IV. FLEXIBILITY

As you may have noticed, flexibility decreases with age. The exact age varies from person to person, but 50 represents the age at which people noticeably begin to lose flexibility. It may happen sooner, maybe later, but it’s going to happen unless you do something about it.

Heart attacks and strokes can be deadly and dramatic events that often motivate people to make drastic lifestyle changes. Loss of flexibility is insidious, even sneaky—we take it for granted because loss of flexibility comes on gradually.

Many older adults just let it happen by being sedentary and not being proactive about their bone, muscle, and joint health. But by taking some steps now, such as flexibility exercises and activities, you can ensure that lack of flexibility doesn’t cause your world to get smaller as you age.

Flexibility is the range of motion through which a joint moves—the ability to move a joint. But the degree of flexibility varies widely with the person and the joint. Evidence shows that stretching and other range-of-motion activities increase flexibility.

The loss of flexibility can be prevented and at least partially restored by stretching. There is compelling evidence that a long-term stretching program can result in sustained increase in range of motion.

Benefits of Stretching Exercises

Stretching as part of an overall warm-up for a specific sport-related activity is effective if it mimics the movement needed for that sport. But perhaps one of the most practical benefits of stretching is that it makes movement easier, which enhances coordination needed to participate in sports such as golf and tennis.

Stretching through a full range of motion helps maintain balance. As people age, coordination and balance enhances mobility and reduces the risk of falls.

Flexibility-related activities increase the amount of blood that flows to the muscles. The blood flow brings nutrients and gets rid of waste products that have accumulated in muscle tissue. Improved circulation can help reduce the amount of time it takes to recover after an injury to a muscle.

There are ways to maintain or regain a full range of motion in some or all of your joints. A 2014 statement from the American Academy of Orthopaedic Surgeons says that much of the decline associated with aging is due to inactivity, not aging.

Flexibility Self-Tests

Here are a few flexibility self-tests you can do at home: informal, do-it-yourself measurements that will give you a general idea of your current flexibility. Be careful, do them slowly, don’t hurt yourself, and don’t do them at all if there’s the slightest risk of injury.

LOWER BODY: SIT-AND-REACH
The sit-and-reach test is a general measure of lower-body flexibility.

• Sit on the floor with your legs stretched outward.
• Keeping your back flat and not rounded, bend forward at the hips.
• Reach toward your toes. Do not bounce or stretch to the point of pain.
• Note the distance from the tips of the middle fingers to the top of your toes.
• If you can reach past your toes, you have above average lower body flexibility.
• If you can touch your toes, you have average lower-body flexibility.
• If you cannot touch your toes, or need to bend your knees to touch them, you have below-average lower body flexibility.

LYING KNEE-TO-CHEST
This test can help to measure hip flexibility.

• Lie on your back and draw your knees to your chest.
• Continue holding the left knee in that position while you extend the right leg until it lies flat on the floor.
• Repeat the movement with the other leg.
• If you cannot completely extend one leg while bringing the opposite knee to within a few inches of your chest, your hip flexors and buttocks may be too tight.

Easy Flexibility Program

Ready to try some flexibility exercises? Try these, with a 5-minute warm-up period and some stretching before beginning (see sidebar above).

DEAD BUG
• Reps: 8 to 10
• Sets: 2 to 3

LUMBAR ROTATION
• Reps: 2 to 4
• Sets: 2 to 3

LUNGES
• Reps: 8 to 10
• Sets: 2 to 3

STANDING BACK EXTENSION
• Reps: 8 to 10
• Sets: 2 to 3
Cool-down: 5 minutes

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V. STRENGTH AND POWER EXERCISES FOR SENIORS

Why train for strength and power? At some point—probably in our mid-30s—we begin to lose muscle mass, muscle strength, and muscle function if we don’t engage in a program of strength training that involves all of the body’s major muscle groups. Fortunately, it is never too late to begin and benefit from a strength (resistance) training program.

Those two facts mean we must make a decision regarding one of the oldest clichés in medical history: “Use it or lose it.” If we take the “use it” option, we will begin to see results in a matter of weeks. With continued strength and power-based activities, the benefits will last a lifetime.

Benefits of Strength Training

Total fitness includes aerobic capacity, balance, mobility, flexibility, and strength. Without strength as a foundation, the other fitness advantages are difficult to achieve.

Strong muscles and muscle groups affect almost every system of the body, every physical activity of daily living, and help combat many common health conditions, such as arthritis, back pain, blood pressure, body composition, diabetes, loss of muscle mass, digestion, functional fitness, and physical and emotional health.

Demands of Resistance Training

If “sticking with it”—motivation—is the No. 1 challenge of a successful resistance training program, challenge No. 1-A might be to make a commitment to begin one. The most effective peer pressure for changing exercise habits may come from the person sitting across the table from you at breakfast—your spouse.

Husbands were 70 percent more likely to reach recommended fitness levels after their wives had been advised by a doctor to engage in a more demanding exercise program. Wives were 40 percent more likely to follow their husbands’ leads in picking up the pace.

Cost is a factor, but it is understandably a consideration. The cost of an exercise program can come in three forms: 1) apparel; 2) equipment, if you choose to conduct your program at home; and 3) supervised instruction.

Time commitment is another factor, and comes in three levels:
1. A single resistance training session, which can easily be completed in an hour and in some cases in only 30 minutes. The exact length will depend on the number of exercises per session, the number of repetitions, the number of sets, and the time between exercises.
2. The number of sessions per week. With resistance training, every other day is the typical frequency, meaning three or four workouts per week.
3. The long-term commitment, which is often the most difficult—one-half of all people who begin exercise programs drop out within six months. But if you can make it past six months, you have a good chance to be a regular resistance-training exerciser for life.

Nutrient Needs for Resistance Training

Maintaining and building muscle and bone strength requires a combination of strength training plus three specific nutritional factors—protein, vitamin D, and intake of fruits and vegetables.

• Protein is a building block for muscle and bone health and helps support the growth and recovery of body tissue after exercise.
• Vitamin D helps fuel muscle growth and is necessary for calcium absorption in order to keep bones strong and healthy.
• Low intake of fruits and vegetables combined with excess intake of acid-producing foods, may have a negative effect on muscle and bone health.

How Resistance Training Works

• Effort: Resistance training is work. The concept of progressive resistance implies that you keep challenging muscles and muscle groups to get stronger by exerting muscle force against resistance. From an exercise science perspective, resistance training is about overload, progression, and specificity.
• Overload: The stress placed on your body when physical activity is greater than usual. The body adapts to muscle- and bone-strengthening activities by making them stronger to meet the new challenges.
• Progression: Small, progressive changes in overload that help the body adapt to additional stress while minimizing the risk of injury.
• Specificity: The benefits of strength training are specific to the areas of the body doing the work. For example, running is not going to increase upper body strength. Instead, you need resistance training exercises like arm curls, shoulder shrugs, and push-ups.

Programs and Equipment

Community centers, wellness facilities, and your local YMCA can help you find organized resistance training programs and personal trainers. As for equipment, consider the alternatives and options for strength and power training:

• Stability balls
• Resistance bands
• Medicine balls
• Cuff weights
• Chairs (for chair-based exercises)
• Weight machines

Where to start? Simple: You’ll only need two very light dumbbells (the kind held with one hand) or a barbell (held with two hands). And how much should the dumbbells weigh? An amount that you can lift 8-12 times with good form; for beginners, it means one, three, five, or eight pounds. Begin with a light weight and gradually progress to something heavier.

Here are some other frequently asked questions about how to start strength training.

Q: How many repetitions for each exercise?
A: Eight to 12 reps is good for most exercises, but adjust the number to your initial strength level.

Q: How many sets (lifts before resting)?
A: One set at the beginning; 2 to 3 sets later.

Q: How often?
A: Typically, 2 to 3 times a week, but not on consecutive days.

Q: How many exercises each day?
A: Select 8 to 10 exercises for each session. For example, do four strength and flexibility exercises combined for the upper body and four for the lower body, or four strength exercises and four for balance. To avoid boredom and to engage different muscle groups, vary the exercises from session to session or from week to week.

Q: When should I increase the amount of resistance?
A: If you can perform 12 repetitions in two consecutive sets with good form, add two-and-a-half pounds. Some exercise scientists recommend that you not increase the amount of weight or the number of repetitions by more than 10 percent each week.

Q: What if I miss a day?
A: As long as the exercise intensity level remains the same, missing a day or a session occasionally will not result in a loss of strength, flexibility, or endurance.

Strength and Power Exercises

If you’re ready to get going on becoming healthier, here’s a group of exercises to help you on your way:

DUMBBELL ARM CURLS
Target: Biceps

• Standing or seated, hold a 3- to 5-pound dumbbell in each hand, arms down, palms out, and feet comfortably spread.
• Contract your abdominals and move the weights upward (together or alternately) by bending your elbows.
• Slowly lower the weights, stop, and repeat the movement.
• Do 2-3 sets of 8 to 10 repetitions.

DUMBBELL HALF-KNEELING
Target: Shoulders, back

• Place your right knee on the floor, with a cushion or pillow under it, left leg bent.
• Left hand on left hip, hold a 1 to 5 pound dumbbell with your right hand, elbow bent so the dumbbell is at shoulder height.
• Extend your arm upward (without locking your elbow) and press the weight toward the ceiling.
• Hold for 1 to 2 seconds, then lower.
• Work up to 8 to 10 reps, 2 to 3 sets for each side.

MODIFIED SUPERMAN
Target: Back, core

• Lie face down on a floor or mat, arms and legs extended forward.
• Tighten your buttocks and lift your legs, shoulders, and arms off the floor simultaneously.
• Flutter your hands and feet in an up and down motion for 2 to 3 seconds and slowly return to the starting position.
• Work up to 8-10 repetitions, 2 to 3 sets.

WINDSHIELD WIPERS
Target: Core

• Lie on your back, legs together and stretched out, arms extended at your sides.
• Contract the muscles of your abdomen and buttocks, lift your legs 6-12 inches off the ground and swing them to the left as far as they will go. Push your arms into the floor for support.
• Hold for a second and swing your legs to the right.
• Work up to 8 to 10 repetitions, 2 to 3 sets.

SIDE LEG LIFTS
Target: Thighs, hips, buttocks

• Lie on left your side, right leg extended and on top of your left leg.
• Place your head on your left arm or on a cushion and place your right hand on the floor for balance.
• Slowly lift your right leg 12-18 inches off the floor and hold for 2-3 seconds.
• Slowly return to the starting position. Work up 8-10 repetitions and 2-3 sets.
• Change positions and perform the same exercise for the left leg.
• Add weight cuff around your ankles to increase the load.

MEDICINE BALL SQUAT
Target: Buttocks, quads, hamstrings

• Stand and hold a 3- to 5-pound medicine ball in front of you at chest level.
• Slowly bend your knees to assume a modified squat position—not to a point at which your upper legs are parallel to the floor.
• Hold for 1 to 2 seconds and slowly return to the starting position.
• Start with 1 to 5 repetitions and work up to 8 to 10 reps, 2 to 3 sets.

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VI. CORE EXERCISES FOR THE ELDERLY: STAYING IN CHARGE

Everything begins with the core. Core muscles stabilize segments of the body, act as a shock absorber for the whole body, maintain functional (working) posture, and allow for motions such as flexion and rotation. Improving your core through regular resistance exercises, experts pledge, can improve overall mobility.

What is “core fitness”? We define the core as the muscles of the hips, pelvis, abdomen, and trunk. Whether you’re sitting or standing as you read this, you’re using core muscles to maintain good posture. If you’re slumping or slouching as you sit or stand, a weak or unbalanced core is probably the problem.

When you rise to a standing position, the core gets you started. When you stand, turn, bend, reach, twist, stoop, carry something, maintain your balance, walk, jog, swim, or participate in any physical activity, the action begins from the center of your body and moves out to your arms and legs.

Core fitness is at the center, literally and figuratively, of strength and power. The most important muscles are those in the hips, trunk, shoulders, and neck— the core. They’re involved in every aspect of daily living. Whether you’re sitting or standing, you’re using core muscles to maintain good posture. Core muscles are necessary for flexibility, strength, and injury prevention. A well-planned program of balance and mobility fits in perfectly with a routine that includes core exercises for elderly as well as young people.

Within the core muscle group, trunk muscle strength is associated with improved balance, daily functions, and prevention of falls. A review of 20 studies investigated the associations between trunk muscle composition and balance, functional performance, and falls in older adults as well as the effects of core strength training and Pilates exercises on those variables. Small to medium correlations existed in both.

The study’s authors concluded that core strength training and/or Pilates exercises can be used as an adjunct or even alternative to traditional balance and/or resistance programs for older adults. Both types are easy to administer in a group setting or in individual programs because little equipment and space are needed to perform the exercises.

The Core and Flexibility

Beyond simply allowing or supporting certain movements, the core is necessary for flexibility (see Chapter 5), strength (see Chapter 7), and injury prevention. Flexibility is the ability to move joints through a range of motion. Weak or tight muscles limit flexibility; strong muscles enhance it.

In middle-aged and older adults, tight (less flexible) hamstrings and hip flexor muscles often affect muscles of the core, including those in the buttocks, pelvis, and lower back.

Some sample programs to strengthen core muscles follow.

Core Muscles Sample Program

Warm-up: 5 minutes

MODIFIED PUSH-UPS

• Lie on your stomach, palms near your shoulders.
• Slowly move your head, neck, shoulders, and upper core upward, keeping your head up, and looking ahead.
• Lift upward until your arms are fully extended.
• Avoid arching your neck.
• Work up to 8 to 10 repetitions, 2 to 3 sets.

SIDE LEG LIFTS

• Lie on your left side, right leg extended and on top of your left leg.
• Place your head on your left arm or on a cushion and place your right hand on the floor in front of you for balance.
• Slowly lift your right leg 12 to 18 inches and hold for 2 to 3 seconds.
• Slowly return to the starting position.
• Work up 8 to 10 repetitions and 2 to 3 sets.
• Change positions and perform the same exercise for the left leg.

Variation for beginners or older adults:
Instead of lifting your entire leg, engage your abdominal muscles, squeeze your buttocks, and lift only your knee while keeping your heels together.
Reps: 8 to 10
Sets: 2 to 3

Cool-down: 5 minutes

Core Flexibility Sample Program

Warm up: 5 minutes

DEAD BUG

• Lie flat on your back with feet and knees off the floor and bent at 90 degrees.
• Tighten your abdominal muscles and extend your arms upward.
• Hold for 2-3 seconds, then slowly lower your right arm and left leg to the floor.
• Bring them back up, then lower your left arm and right leg to the floor to complete 1 repetition.
• Work up to 8 to 10 repetitions, 2 to 3 sets, but don’t overdo it.

Variation for beginners and older adults: Begin with 4 to 5 repetitions.
Reps: 8 to 10
Sets: 2 to 3
Cool-down: 5 minutes

LUMBAR ROTATION

• Lie on your back, legs bent, knees together and on the floor at your left side, and arms extended outward.
• Try to keep your shoulders grounded.
• Engage your abs (in and up), keep your upper body still, and slowly roll your knees from the left to the right until they touch the floor, or come as close to the floor as possible without lifting your shoulders. Hold for a few seconds; breathe easily, then roll your legs to the opposite side to complete one repetition.
• Repeat 2 to 4 times to each side. Rest and complete 2 to 3 sets.

Variation for beginners and older adults:
Reduce the number of reps to each side and/or the number of sets. Take 3 to 4 deep breaths after each rep. Hold for a few seconds, breathe.
Reps: 2 to 4
Sets: 2 to 3
Cool-down: 5 minutes

Core Balance Sample Program

Warm-up: 5 minutes
Tandem Walking

• Stand at one side of a long room.
• Contract your abs and place one foot in front of the other so that the heel of the forward foot touches the toes of the rear foot.
• Take 20 steps as if walking a tightrope.
• Turn and take 20 steps back to the starting point.
• Repeat 2 to 3 times, rest, and complete 2 to 3 sets.

Variation for beginners and older adults:
Take 10 steps in each direction instead of 20, or complete 1 to 2 sets until you’re comfortable doing the exercise.
Reps: 2 to 3
Sets: 2 to 3

Single Leg Stand

• Stand with your feet slightly apart, head up, left hand on your hip, right hand holding onto to a chair for balance.
• Tighten your stomach muscles and lift your left leg off the floor until your knee is parallel with your hip.
• Hold for 5 seconds, and slowly return to the starting position to complete 1 repetition.
• Work up to 8 to 10 repetitions and 2 to 3 sets.
• Change positions and repeat movement with the right leg.
• Gradually try to stand on the leg without holding onto the chair.

Variation for beginners and older adults: Limit the time balancing to 2 to 3 seconds,
or complete 4 to 5 repetitions, 1 to 2 sets.
Reps: 8 to 10
Sets: 2 to 3

Cool-down: 5 minutes

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VII. SENIOR AEROBIC FITNESS

Aerobic fitness is a life-changing gift you can give yourself—one that affects every system of your body. The word “aerobic” means needing oxygen for activity, and aerobic exercise provides that oxygen. If you’re already exercising at a steady pace but ready to pick it up, aerobic exercises and activities may be your next step. They’re proven to better the quality of your life and may even add extra years.

The great thing about an aerobic fitness program is that you’ll have total control of your own program. You can begin today, exercise alone, or get involved with a group at little or no cost, and go at your own pace. You’ll be able to choose from a wide variety of activities that includes walking, jogging, swimming, cycling, dancing, water exercises, aerobic classes, DVD workouts, or simply working out at home. In fact, you can incorporate many aerobic activities into your daily routine.

Aerobic Benefits

Why is physical fitness important? The benefits of aerobics as part of your weekly exercise plan go far beyond cardiovascular health; they help you in terms of weight control, mobility, blood sugar levels, emotional health, and prevention or control of diseases.

Aerobic fitness is also called cardiovascular fitness, which is measured by two things:
1. The amount of oxygen in blood that is pumped by the heart to the body.
2. How efficient the body is in using that oxygen.

The way to improve aerobic fitness is through large-muscle physical activities that are demanding enough, last long enough, and are performed often enough to strengthen the heart, improve the vascular system, and increase lung capacity.

No other component of fitness, whether it’s strength, power, flexibility, balance, or mobility, brings with it so many added benefits. Exercising to become more aerobically fit makes the heart stronger, allowing it to pump more blood with each beat. The more blood pumped, the better the supply of oxygen to the rest of the body, including the heart. As a bonus, fewer beats are needed. Over time, the chamber of the heart doing the pumping (the left ventricle) adapts, gets bigger, holds more blood, and ejects more blood per beat.

A stronger heart is like having a stronger engine that can deliver oxygen with greater ease. And like any other machine, the easier the workload on the heart, the longer it lasts.

Aerobic exercise also stimulates the growth of new blood vessels that supply oxygen to muscles. The result is more efficient circulation. While cardiovascular exercise increases the number of blood vessels, strength training, also called resistance training, makes them bigger.

Physical Activity: How Much?

People vary in how much physical activity they need, so some have to be more active to maintain a healthy weight. That’s where aerobic fitness comes in. The CDC says to work your way up to 150 minutes of moderate-intensity aerobic activity, or 75 minutes of vigorous-intensity, or an equivalent mix of the two each week. More about what constitutes moderate- and vigorous-intensity exercise later in this chapter.

To lose weight, you might need a greater amount or intensity of physical activity unless you also adjust your diet to reduce the intake of calories.

Multiple studies have shown that aerobic exercise results in a greater increase in lean body weight, which means more muscle tissue and a lower percentage of fat tissue.

Several studies have linked aerobic exercise and aerobic fitness to improved mobility. The association is as much common sense as science. People who are motivated and able to follow through on a long-term exercise program are more mobile and independent than more sedentary individuals.

Exercise and Disease Control/Prevention

Exercise also appears to help the body’s immune system deal with bacterial and viral infections, according to the National Institutes of Health (NIH). The mechanism isn’t clear, but there are at least four theories:
1. Physical activities may flush bacteria from the lungs and carcinogens from the body by increased output of waste through urine and perspiration.
2. Exercise pushes antibodies and white blood cells through the body at an accelerated rate, which may allow for earlier detection of illnesses.
3. The body’s elevated temperature during exercise may prevent the growth of bacteria.
4. Exercise slows the release of stress-related hormones that normally increase the risk of illness.

Exercise, particularly aerobic exercise, can reduce stress by relieving tension and anxiety, serving as a diversion from daily routines, increasing energy levels, elevating mood, and improving overall emotional well-being.

A relationship exists between moderate-intensity physical activity and longevity. Archives of Internal Medicine published an article a decade ago concluding that moderate levels of physical activity expanded total life expectancy, and the gains were twice as long at higher activity levels.

When Does Exercise Become Aerobic?

Whatever the type of exercise, experts use terms like intensity, frequency, and duration to describe what we have to do to become or stay fit. The basic concept of aerobic exercise (and aerobic fitness) is to exercise hard enough, long enough, and often enough to get the heart rate into a target heart zone and keep it there for a specified length of time.

Here are two ways to find your heart’s target zone:
1. Multiply your age by .93 (93 percent of your age). Subtract that number from 216. For example, the maximum heart for a 60-year-old person would be 160 (60 x .93 = 55.8; 216—55.8 = 160.2.) For a 70-year-old, the maximum heart rate would be 151 (70 x .93 = 65.1; 216—65.1 = 150.9).
2. Multiply your age by 0.7. Subtract that number from 208. For example, the maximum heart rate for a 60-year-old person would be 166 (60 x 0.7 = 42; 208—42 = 166). For a 70-year-old, the maximum would be 159 (70 x 0.7 = 49; 208 — 49 = 159).

Typically, older adults need moderate-intensity exercise in order to make a significant change in aerobic fitness. The chart below, for example, shows that the target heart rate zone for a 60 year-old person is between 80 and 136, so the target rate should be somewhere in the middle of those two numbers.

Two frequently asked questions about aerobic exercise:

How long should I exercise?
The American College of Sports Medicine recommends 20 to 60 minutes of continuous aerobic activity, but time restraints make it difficult for some people to exercise that long at one time. Now experts agree that the exercise periods can be broken down into 10-, 20-, or 30-minute sessions throughout the day. Typical moderate-intensity sessions last 20-30 minutes, not including warm-up and cool-down time.

How often should I exercise?
The CDC recommends 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous activity, or an equivalent mix of the two types of activity, spread throughout the week (at least three times for those who exercise vigorously; five times or more for moderate-intensity workouts). An easy routine for many is at least 30 minutes a day, at least five days per week.

If You’re Just Getting Started…

Low-intensity exercise might be the place to start for beginners and some older adults. Something is better than nothing. These types of exercises can get you into an exercise routine, make you more flexible, and begin to prepare your body for more demanding exercise.

Begin with low-intensity exercise and gradually build up to a moderate-intensity level and perhaps to a high-intensity exercise program later. Examples of each:

Low-Intensity Exercises

• Walking leisurely
• Stretching
• Lifting hand weights (dumbbells)
• Housework, yard work
• Wall push-ups or modified push-ups

Moderate Intensity

• Walking fast
• Water aerobics
• Riding a bicycle slower than 10 mph
• Playing tennis (doubles)
• Mowing a lawn
• Light gardening

Vigorous Intensity

• Race walking
• Jogging
• Running
• Swimming laps
• Riding a bike 10 mph or faster
• Rope jumping
• Playing tennis (singles)
• Aerobic exercise or dance classes
• Heavy gardening (digging, hoeing)

The type of exercise doesn’t matter, as long as you get your heart rate into the target zone and keep it there for 10 minutes or longer.

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VIII. AEROBIC FITNESS: CHOOSING THE RIGHT PROGRAM

There is no “one-size-fits-all” program of aerobic fitness. Instead, dozens of methods and combinations of methods have been proven to be effective.

The key is to find a program that works for you, one that takes into consideration your age, health status, physical condition, personality, fitness goals, and living circumstances.

Sample Aerobic Program for Beginners

To view a worthy sample program created by MOVE, a U.S. Department of Veterans Affairs suggested work, visit this page: Sample Aerobic Plan for Beginners. It’s a 12-week, 30-minutes-per-session plan based on the “Borg Rating of Perceived Exertion,” and can be used for any exercise that reaches or exceeds the aerobic training zone (as defined by Borg). The best types of activities for using the Borg rating are the ones that use arms, legs, and trunk, as in walking, jogging, cycling, swimming, or dancing. You can gauge your intensity with the Borg ratings.

“Perceived exertion” is how hard you feel like your body is working, based on the physical sensations—including increased heart rate, increased respiration or breathing rate, increased sweating, and muscle fatigue—you experience during physical activity. It’s a subjective measure, but experts believe your Berg exertion rating can provide a reasonable estimate of actual heart rate during physical activity.

“Practitioners generally agree,” according to the CDC, “that perceived exertion ratings between 12 to 14 on the Borg Scale suggest that physical activity is being performed at a moderate level of intensity. During activity, use the Borg Scale to assign numbers to how you feel. Self-monitoring how hard your body is working can help you adjust the intensity of the activity by speeding up or slowing down your movements.

“Through experience of monitoring how your body feels,” the CDC continues, “it will become easier to know when to adjust your intensity. For example, a walker who wants to engage in moderate-intensity activity would aim for a Borg Scale level of ‘somewhat hard’ (12-14). If he describes his muscle fatigue and breathing as ‘very light’ (9 on the Borg Scale) he would want to increase his intensity. On the other hand, if he felt his exertion was ‘extremely hard’ (19 on the Borg Scale) he would need to slow down his movements to achieve the moderate-intensity range.”

The Borg rating scale ranging from least to maximum effort appears in Box 1. The aerobic training zone is from 11 to 13 and above. For strength activities such as lifting weights and performing pushups, aerobic training is in the 15 to 17 zone.

Apart from the Borg rating, you can use common sense to know whether your fitness activity is the right pace for you. Gasping for breath? You’re exercising too hard. On the other hand, there’s the “talk test”: If you can easily carry on a full conversation and perform an activity at the same time, you probably aren’t exercising aerobically, says the American Heart Association.

Take Your Pick

Finding aerobic programs beyond MOVE shouldn’t be a problem. Many can be done at home or in your neighborhood and are available in almost every format, including print, television, websites, videos, DVDs, and smartphone apps.

Commercial programs include Jazzercise, Zumba, Silver Sneakers, and CardioTennis, among others. Non-profit organizations like the Arthritis Foundation and American Heart Association offer programs, as do various government agencies (including the National Institutes of Health as well as the Veterans Administration and the Centers for Disease Control and Prevention).

If you prefer exercising with others and with the supervision of a trained exercise instructor, here are some places where you might find them.

• Local/regional hospitals
• YMCAs/YWCAs
• Churches/Synagogues
• Fitness/wellness centers, gyms
• Neighborhood tennis/swim club/golf clubs
• Physical therapy clinics/facilities
• Municipal recreation centers
• Senior/community centers
• Colleges/Universities
• Workplace wellness centers
• Personal trainers (in-home)

Warming Up for Aerobic Exercise

As part of your warm-up for aerobic activities, focus on overall static and dynamic exercises, with special attention to the shins, calves, quadriceps, and hamstrings. Heel Raises, Semi-Sits, and Quadriceps Stretches are good starting points:

HEEL RAISES

• Stand with your toes on a secure surface (such as the edge of a stair step). Hold onto a handrail or chair back for stability, if needed.
• Rise slowly on your toes while keeping your body erect, with knees straight.
• Return to the starting position, then slowly let your heels drop below the standing surface, feeling the stretch in your calves. Hold for 3 seconds, then repeat the motion.
• Do 2 to 3 sets of 8 to 10 repetitions, resting between sets.
• To further challenge yourself, and if you feel stable enough, hold light dumbbells or weights (2-5 pounds for each hand) during heel raises.

SEMI-SITS

• Stand in front of a chair, feet at hip width.
• Slowly lower your buttocks and bend your knees as if going to sit.
• Instead, touch the chair seat lightly and return to a standing position.
• Do 2 to 3 sets of 8 to 10 repetitions, resting between sets.

QUADRICEPS STRETCH

• Stand holding the back of a chair or other surface for balance.
• Bend one knee by bringing your heel toward your buttocks, keeping knees together.
• Hold that foot with your hand 3 seconds, until you feel the stretch on the front of your thigh.
• Do 2 to 3 sets, 5 repetitions each side.

To warm up the upper body, try these:

OVERHEAD REACH

• Standing, with your arms down, interlock your fingers in front of your lower abdomen.
• Lift your hands over your head and rotate your wrists so your palms are facing the sky.
• Extend your arms as far upward as possible and hold for 10 seconds, then return to the starting position.
• You should feel a stretch in the upper part of your back and in your shoulders.
• Repeat 2–3 times.

BACK EXTENSIONS

• Start from a hand and knees position on the floor.
• Slowly lift and extend your left arm and right leg, holding the position for 2 to 3 seconds, then return to the starting position. (If it’s too challenging to lift your arm and leg together, you may lift and hold them one at a time, holding each for 2-3 seconds.)
• Now slowly extend your right arm and left leg, holding for 2 to 3 seconds to complete 1 rep.
• Work up to 8-10 repetitions, 2 to 3 sets.

Walking

Of all aerobic activities, walking is the most natural, convenient, inexpensive, and probably the safest type. If you decide to start walking for exercise, you won’t be alone. Exercise-walking is the No. 1 form of physical activity in the U.S., with more than 93 million people reporting that they walk for exercise at least once a year—not exactly a commitment to aerobic fitness, but it’s a start.

Turning an occasional activity into an aerobic exercise is simply a matter of walking more often, walking faster, and walking for periods of time that eventually add up to 30 minutes or more a day, at least five days a week.

Walking is also the easiest way for a previously sedentary individual to get started on an aerobic exercise program.

Jogging/Running

These two activities offer all of the benefits of walking, but at a higher intensity level. Their benefits are well-documented, and for many it takes as little as 10 minutes a day, running at a speed of less than six miles per hour to get positive health results. Like walking, all you need is time, a place to jog or run, and a good pair of running shoes.

Jogging gives you two advantages over walking. The first is that it allows you to expend energy in a shorter period of time. Obviously, it takes longer to walk a mile than to run one. The second has to do with heart rate. Running for 20-30 minutes is the equivalent to walking 40-50 minutes. Note: For younger adults, brisk walking may not raise the heart rate into an optimal training zone. That’s not usually a problem with middle-aged and older adults.

Furthermore, jogging helps older adults walk more efficiently. A November 2014 study conducted by researchers at the University of Colorado and Humboldt State University found that seniors who jog regularly walk as efficiently as young adults. The study involved 30 volunteers, average age 69, who had either walked or jogged 30 minutes a day, at least three days a week, for at least six months. Testing for walking efficiency showed that those in the jogging group were seven to 10 percent more efficient at walking than older, sedentary adults, as well as older adults who walked regularly as their primary form of exercise.

Decline in walking ability is a predictor of morbidity in seniors. Not only did jogging improve walking efficiency, but joggers’ metabolic cost of walking (the amount of energy consumed) was similar to that of young adults in their 20s, and they were less likely to experience age-related physical decline in walking efficiency.

Jogging and running are high-impact exercises, as opposed to low-impact (one foot always on the ground) activities, and they require a higher degree of dedication. One study showed that 50 percent of people who begin a jogging program drop out, compared to 20 percent of those in a walking program.

One of the most compelling arguments for jogging came in the Copenhagen City Heart Study, which found that joggers had a five to six-year longer life expectancy than the average population.

Swimming

Swimming is the fourth-most-popular sports activity in the U.S. and a good way to get regular aerobic activity, according to the Centers for Disease Control and Prevention.

Some other Centers for Disease Control & Prevention facts about swimming:

• Just two and a half hours per week can reduce the risk of chronic illness.
• Swimmers have about half the risk of death compared to inactive people.
• People report getting more enjoyment out of water-based exercise than exercising on land.
• People can exercise longer in water than on land without increased effort or pain in joints or muscles.

Finally, although swimming is an aerobic activity, it is not a weight-bearing exercise and doesn’t promote bone health.

Water Aerobics

If you’re comfortable in the water but want a more varied exercise routine than swimming laps, water aerobics might be the right choice. This activity offers the benefits of building muscle tone, expending calories, and increasing aerobic capacity.

Water aerobics are particularly helpful for people with medical conditions such as arthritis because they place less stress on the joints. Water provides resistance (and thus, strength training) in every direction, and water exercises can be designed to fit individual needs.

However, it’s possible to improve strength, flexibility, balance, and cardiovascular fitness by doing the same exercises. Here are some sample exercises:

SIDE STEPS

• Feet together, arms at your sides in waist-high or chest-deep water.
• Brace your spine and take a big step to the side with your right leg.
• At the same time, move your hands upward and out to your sides.
• Bring your left leg to meet your right leg with hands moving back to your sides.
• Repeat the sequence and move across the width of the pool.
• Next, complete the same exercise, starting with the left leg to cross the pool in the opposite direction.

WATER MARCHING

• Stand straight up.
• Make continuous strides, as if marching in place.
• Extend your arms as much as possible with each step.
• One 2-minute march, rest one minute, and repeat 2 to 3 times.

Weekly Workout Plan

Looking for the ideal starting-out plan? Here’s one worth trying out, as adapted from the President’s Council on Physical Fitness and Sports.

SAMPLE WALKING PROGRAM
In each segment, stop or slow down if you become uncomfortably tired or sore. Begin walking every other day, but try to work up to at least five days per week.

Week 1/Activity/Time

• Warm-up, slow-moderate pace: 5 minutes
• Walk at brisk pace: 5 minutes or less
• Walk slowly or rest: 3 minutes
• Walk at a brisk pace: 5 minutes
• Cool-down, moderate-slow pace: 5 minutes

Week 2

• Same as Week 1, but increase the pace as soon as you can walk 5 minutes without soreness or fatigue.

Week 3

• Warm-up, slow-moderate pace: 5 minutes
• Walk at a brisk pace: 8 to 10 minutes
• Walk slowly or rest: 3 minutes
• Walk at a brisk pace: 8 to 10 minutes
• Cool-down, moderate-slow pace: 5 minutes

Week 4

• Same as week 3, but increase the pace as soon as you can walk 10 minutes without soreness or fatigue.

Week 5

• Warm-up, slow-moderate pace: 5 minutes
• Walk at a brisk pace: 10 to 15 minutes
• Walk slowly or rest: 3 minutes
• Walk at a brisk pace: 10 to 15 minutes
• Cool-down, moderate-slow pace: 5 minutes

SAMPLE SWIMMING PROGRAM
This program is recommended by UCLA physical therapists for beginning swimmers or those who have been away from the activity for an extended period of time. Increase the intensity and duration each week only if you are having no pain and minimal-to-no fatigue. Schedule your swims 3 to 4 times per week on nonconsecutive days to get adequate rest between sessions.

Week 1/Activity: Time

• Warm-up (jogging, calisthenics, dynamic [swimming-related] stretches): 5 to 10 minutes
• Freestyle, breaststroke, or backstroke: 10 minutes
• Kicking with kickboard on back or stomach: 5 minutes
• Cool-down (walking, dynamic stretches, slow-pace lap swimming): 5 to 10 minutes

Note: Designed for 3-4 nonconsecutive days per week.

Weeks 2 to 5

• Add 5 to 10 minutes of swimming and kicking segments per week as tolerated to reach the 150-minute minimum of total swimming/aerobic exercise per week.

SAMPLE WATER AEROBICS PROGRAM
Try a variety of exercises that engage the upper and lower body, and use only the ones that seem like a good match. It’s okay to change the routine from day-to-day or week-to-week, as long as you hit your target heart rate zone and are using all the major muscle groups. However, the advantage of repeating some exercises is to be able to measure your progress.

Activity: Time

• Warm-up (jogging, calisthenics, dynamic [swimming-related] stretches): 5 to 10 minutes
• Water Marching: 5 minutes
• Side Steps: 5 minutes
• Karate Punch: 5 minutes
• Jumping Jacks: 5 minutes
• Cool-down (walking, dynamic stretches, slow-pace lap swimming): 5 minutes

Note: Designed for 3-4 nonconsecutive days per week.