2003
Volunteer Leader Training Guide
Healthy Exercise for a Healthy Mind and Body
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Handouts & Visuals
Introduction
For the most part, when older people lose their ability to do things on their
own, it doesn’t happen just because they have aged. More likely, it is because
they have become inactive. Older, inactive adults lose ground in four areas that
are important for staying healthy and independent: endurance, strength, balance
and flexibility.
Fortunately, research suggests that you can maintain or at least partly
restore these four areas through exercise – or through everyday physical
activities (walking briskly or gardening, for example) that accomplish some of
the same goals as exercise. What may seem like very small changes resulting from
exercise and physical activity can have a big impact.
Regular physical activity can help the human body maintain, repair and
improve itself to an amazing degree. And most older people – even those with
illnesses or disabilities – can take part in moderate exercise programs.
People who exercise regularly may also be less apt to suffer fractures or other
accidents. Exercise must become one of those things that you do without
question, like bathing and brushing your teeth. Unless you are convinced of the
benefits of exercise and the risks of unfitness, you will not succeed. Patience
is essential. Don’t try too much too soon, and don’t quit before you have a
chance to experience the rewards of improved fitness. You can’t gain in a few
days or weeks what you have lost in years of sedentary living, but you can get
it back if you persevere. And the prize is worth the price.
Target Audience
• EHC members
• Adult audiences
Objectives
• Participants will learn the importance of exercise for
staying healthy and independent.
• Participants will learn the four types of exercises
necessary for staying healthy and independent.
• Participants will learn how to safely perform exercises that
contribute to health and independence.
Main Teaching Points
• Importance of exercise for staying healthy and independent.
• Types of exercise for staying healthy and independent
• Safe and correct execution of exercises
Handouts
Handout 1 – How Much Exercise Should I Get Each Week?
Handout 2 – Borg Category Rating Scale
Handout 3 – Target Heart Rate
Handout 4 – How to Improve Your Endurance
Handout 5 – How to Improve Your Strength
Handout 6 – How to Improve Your Balance
Handout 7 – How to Improve Your Flexibility
Suggestions for Teaching the Lesson
• Obtain enough copies of handouts for each participant.
• Review the information in the lesson guide and on the
handouts.
Leader says:
Who Can Exercise?
Studies show that, in the long term, older adults in all age groups hurt
their health far more by not exercising than by exercising. As a rule, older
people should stay as physically active as they can.
CHECK YOUR HEALTH – Anyone who has been inactive for many years should
never try to do too much too soon. Start by seeing a doctor, especially if
you are over 50, if you have a disease or disability or if you are taking
medication. Your doctor can evaluate your physical condition, help you
decide which activity will suit you best and check your progress after the
exercise program is underway. Other conditions that indicate a need for medical
clearance are:
• high blood pressure
• heart trouble
• family history of early stroke or heart attack
• frequent dizzy spells
• extreme breathlessness after mild exertion
• arthritis or other bone problems
• severe muscular, ligament or tendon problems
• osteoporosis
• other known or suspected diseases
Those with medical problems may have to avoid some kinds of exercise or
adjust their level of activity. Vigorous exercise involves minimum health risks
for persons in good health or those following doctor’s advice. Far greater risks
are presented by habitual inactivity and obesity.
Getting Past the Barriers
You may be reluctant to start exercising, even though you’ve heard that it is
one of the healthiest things you can do. You may be afraid that physical
activity will harm you, or you might think you have to join a gym or buy
expensive equipment in order to exercise. Or, you may feel embarrassed to
exercise because you think it’s for younger people or for people who look great
in gym clothes. You may think exercise is only for people who are able to do
things like jogging.
In fact, just about every older adult can safely do some form of physical
activity at little or no cost. And you don’t have to exercise in a public place
or use expensive equipment, if you don’t want to.
Even household chores can improve your health. The key is to increase your
physical activity, by exercising and by using your own muscle power.
Begin by exercising slowly, especially if you have been inactive. Start with
short periods of about 5 to 10 minutes twice a week. Then build up slowly,
adding no more than a few minutes each week. If all goes well, as it probably
will, slowly increase your exercise periods to 15 to 30 minutes, three or four
times a week. Your doctor may advise stretching as well as warm-up and cool-down
periods of 5 to 15 minutes to tune up your body before exercise and to help you
wind down afterward.
Always pay attention to what your body tells you. If you feel much
discomfort, you are trying to do too much. Ease up a bit, or take a break and
start again at another time. Although most people will have no problems if they
start exercising slowly, be alert to unusual symptoms such as chest pain,
breathlessness, joint discomfort or muscle cramps. Call your doctor if any of
these occur.
There are four types of exercises that can help older adults gain
health benefits.
Endurance or aerobic exercises increase your breathing and heart rate.
They improve the health of your heart, lungs and circulatory system. Having more
endurance not only helps keep you healthier, it can also improve your stamina
for the tasks you need to do to live and do things on your own – climbing stairs
and grocery shopping, for example. Endurance exercises may also delay or prevent
many diseases associated with aging, such as diabetes, colon cancer, heart
disease, stroke and others, and reduce overall death and hospitalization rates.
Strength exercises build your muscles, but they do more than just make
you stronger. They give you more strength to do things on your own. Even very
small increases in muscle can make a big difference in ability, especially for
frail people. Strength exercises also increase your metabolism, helping to keep
your weight and blood sugar in check. That’s important because obesity and
diabetes are major health problems for older adults. Studies suggest that
strength exercises may also help prevent osteoporosis.
Balance exercises help prevent a common problem in older adults:
falls. Falling is a major cause of broken hips and other injuries that often
lead to disability and loss of independence. Some balance exercises build up
your leg muscles; others require you to do simple activities like briefly
standing on one leg.
Flexibility exercises help keep your body limber by stretching your
muscles and the tissues that hold your body’s structures in place. Physical
therapists and other health professionals recommend certain stretching exercises
to help patients recover from injuries and to prevent injuries from happening in
the first place. Flexibility may also play a part in preventing falls.
Which Ones Should I Do, and How Much Should I Do?
Some types of exercise improve just one area of health or ability. More
often, though, an exercise has many different benefits.
In other words, exercise as much as you can. It’s best to increase both the
types and amounts of exercises and physical activities you do. Gradually build
up to include endurance, strength, balance and flexibility exercises.
Now that you have heard about all the benefits of exercise, I hope you are
enthusiastic about getting started. However, it’s important to start at a level
you can manage and work your way up gradually.
For one thing, if you do too much too quickly, you can damage your muscles
and tissues, and that can keep you on the sidelines. For another, your
enthusiasm needs to last a lifetime. The benefits of exercise and physical
activity come from making them a permanent habit. Start with one or two types of
exercises that you can manage and that you really can fit into your schedule,
and then add more as you adjust to ensure that you will stick with it.
How much you exercise depends on you and on your unique situation. For some,
muscle-building exercise might mean pushing more than a hundred pounds of weight
at the local gym to keep your legs in shape for hiking or jogging. For others,
it might mean lifting 1-pound weights to strengthen your arm muscles enough to
use a washcloth. That might mean the dignity that comes from being able to wash
yourself, instead of having someone else do it for you. The goal is to improve
from wherever you are right now.
Some people are reluctant to start exercising because they are afraid it will
be too strenuous. Researchers have found that you don’t have to do strenuous
exercises to gain health benefits; moderate exercises are effective, too.
Sticking With It: What Works
When you need extra motivation, try the following:
• Ask someone to be your exercise buddy. Many older adults
agree that having someone to exercise with helps keep them going.
• Listen to recorded books or music while you do endurance
activities.
• Set a goal, and decide on a reward you will get when you
reach it.
• Give yourself physical activity homework assignments for the
next day or the next week.
• Think of your exercise sessions as appointments, and mark
them on your calendar.
• Keep a record of what you do and of your progress.
Understand that there will be times that you don’t show rapid progress and that
you are still benefiting from your activities during those times.
• Plan ahead for travel, bad weather and houseguests. For
example, an exercise video can help you exercise indoors when the weather is
bad.
According to the U.S. Surgeon General’s report, you are more likely to keep
doing physical activities if you:
• think that, overall, you will benefit from them.
• include activities you enjoy.
• feel you can do the activities correctly and safely.
• have regular access to the activities.
• can fit the activities into your daily schedule.
• feel that the activities don’t impose financial or social
costs you aren’t willing to take on.
• have few negative consequences from doing your activities
(such as injury, lost time or negative peer pressure).
In other words, set yourself up to succeed right from the start. Choose
realistic goals, learn to do the exercises correctly and safely and chart your
progress to see your improvement.
Most older people can exercise just fine on their own, without advice from a
fitness instructor. Some have special needs and may want to consult a
professional. If you decide to seek advice, how can you tell whom to trust?
Anyone can call himself or herself a fitness professional, and many people do –
but that doesn’t always mean they have the training to help older people
exercise safely and effectively.
Instructors who aren’t trained to work with older adults, specifically, might
not be aware of their needs. For example, they might not know that certain
conditions or medications can change older people’s heart rates or that people
with osteoporosis risk spine fractures if they do some types of forward-bending
exercises incorrectly.
A number of professionals are familiar with the special physical needs of
older people. Doctors who specialize in sports medicine are highly qualified to
help you exercise the right way. So are professionals who have a college degree
in exercise physiology. They can help you start an exercise program tailored to
your needs, build it up to your best possible level, then show you how to
continue safely on your own.
Physical therapists are qualified to design exercise plans for older people,
especially those who have conditions affecting their muscles, skeletal systems
or nervous system conditions that affect their muscles. Some physical therapists
take special training for a certification in geriatrics.
Cardiologists can advise you on how to improve your cardiovascular system
through endurance exercise. Orthopedic doctors can help you understand how to
prevent injuries to your muscles, bones and other structures.
Many hospitals and health plans now have wellness centers that offer exercise
programs. Some colleges and universities hold special exercise classes for older
adults or conduct studies on exercise for older people. It’s likely that the
fitness instructors hired by these organizations are carefully screened and are
qualified to teach you how to exercise correctly. Try calling them to find a
fitness professional in your area.
If you do consult a fitness instructor, ask for his or her credentials. Any
instructor who is qualified to work with older people is likely to be proud of
his or her credentials and will be happy to share them with you. Also ask about
expenses. Costs vary, and insurance plans differ as to what kinds of services
they will cover.
How Much Exercise Should I Get Each Week?
When you first start out, you might have trouble keeping up with even the
minimum amount of exercise suggested in
Handout 1. Start out with a schedule that your body can tolerate and that
you think you really can manage, and build up from there.
Note that the schedules are arranged so that you are never doing strength
exercises of the same muscle groups on any two days in a row. If you want to do
strength exercises every day, alternate muscle groups. For example, do strength
exercises of your upper-body muscles on Monday, Wednesday and Friday and of your
lower-body muscles on Tuesday, Thursday and Saturday. Or you can do strength
exercises of all of your muscle groups up to every other day.
Many different physical activities can improve your health and independence.
Whether you choose to do the exercises shown in Handouts 4-7 or other activities
that accomplish the same goals, gradually work your way up to include endurance,
strength, balance and stretching exercises.
Here are some points to keep in mind as you begin increasing your activity:
• If you stop exercising for several weeks and then return,
start out at about half the effort you were putting into it when you stopped,
then gradually build back up. Some of the effects of endurance and
muscle-building exercises deteriorate within two weeks if these activities are
cut back substantially, and benefits may disappear altogether if they aren’t
done for 2 to 8 months.
• When an exercise calls for you to bend forward, bend from
the hips, not the waist. If you keep your entire back and shoulders straight as
you bend forward, that will help ensure that you are bending the right way, from
the hips. If you find your back or shoulders humping in any spot as you bend
forward, that’s a sign that you are bending incorrectly, from the waist. Bending
from the waist may cause spine fractures in some people with osteoporosis.
• It’s possible to combine exercises. For example, regular
stair-climbing sessions improve endurance and strengthen leg muscles at the same
time.
How Hard Should I Exercise?
I can’t tell you exactly how many pounds to lift or how steep a hill you
should climb to reach a moderate or vigorous level of exercise, because what is
easy for one person might be strenuous for another. It’s different for different
people.
I can, however, provide some advice based on scientific research: Listen to
your body. The level of effort you feel you are putting into an activity is
likely to agree with actual physical measurements. In other words, if your body
tells you that the exercise you are doing is moderate, measurements of how hard
your heart is working would probably show that it really is working at a
moderate level. During moderate activity, for instance, you can sense that you
are challenging yourself but that you aren’t near your limit.
One way you can estimate how hard to work is by using the Borg Category
Rating Scale, shown in
Handout 2. It was named after Gunnar Borg, the scientist who developed it.
Another way to estimate how hard you are working is by measuring your target
heart rate as shown in
Handout 3.
Am I Making Progress?
There are ways to tell when it’s time to move ahead in your activities. For
example, when you can lift a weight more than 15 times, you know it’s time to
add more weight in your strength exercises. And when endurance activities no
longer feel somewhat hard to you, it’s time to exercise a little longer, then to
add a little more difficulty, like walking up steeper hills.
As you progress, you can do some simple tests that will tell you just how far
you have come. These tests also can help you assess how fit you are before you
start exercising. After that, try them again every month. Record your scores
each time, so you can see your improvement the next time you test yourself.
You might be interested in doing these tests for a couple of reasons. For
one, most people make rapid progress soon after they start exercising, and you
might find the improvement you see in your scores after just a month
encouraging.
For another, these tests are a good way of letting you know if you really are
progressing. Although it’s normal for your improvement to slow down at times,
your test scores should get better overall (unless you have reached your goal
and are maintaining your current level).
If you are not in condition to do these tests right now, keep working on your
current exercises and activities until you are. Whether you are testing or
actually exercising, your pace should never make you feel dizzy, lightheaded or
nauseated, and you shouldn’t feel pain. If you have a chronic medical condition,
check with your physician before doing these tests.
1. Endurance
See how far you can walk in exactly 6 minutes. Write down how
far you walked (in feet, blocks, laps, miles, number of times you walked up and
down a long hallway or whatever is convenient for you). Do this test every
month. As your endurance improves, you should find that you can walk farther in
6 minutes.
2. Lower-Body Power
Time yourself as you walk up a flight of stairs (at least 10
steps) as fast as you safely can. Record your score. Repeat the test, using the
same stairs, one month later. It should take you less time.
3. Strength
Each time you do your strength exercises record how much
weight you lift and how many times you lift that weight. Make another chart to
show how much more weight you can lift, and how many more times you can lift it,
compared to the month before.
4. Balance
Time yourself as you stand on one foot, without support, for
as long as possible (stand near something sturdy to hold onto, in case you lose
your balance). Record your score. Repeat the test while standing on the other
foot. Test yourself again in one month. The amount of time you can stand on one
foot should increase.
CLOTHING – All exercise clothing should be loose-fitting to permit
freedom of movement, and should make you feel comfortable and self-assured. As a
general rule, you should wear lighter clothes than temperatures might indicate.
Exercise generates great amounts of body heat. Light-colored clothing that
reflects the sun’s rays is cooler in the summer, and dark clothes are warmer in
the winter. When the weather is very cold, it’s better to wear several layers of
light clothing than one or two heavy layers. The extra layers help trap heat,
and it’s easier to shed one of them if you become too warm. In cold weather and
in hot, sunny weather, it’s a good idea to wear something on your head. Wool ski
caps are recommended for winter wear, and some form of tennis or summer hat that
provides shade and can be soaked in water is good for summer. Never wear
rubberized or plastic clothing. Such garments interfere with the evaporation of
perspiration and can cause body temperature to rise to dangerous levels.
Refer to Handouts 4-7
Select several of the exercises to demonstrate.
Leader Says:
It’s time to get started! Let’s try a few of the exercises illustrated in the
handouts.
Remember, be safe and listen to your body. If you experience any of the
discomforts that we talked about earlier, stop the exercise immediately.
Adapted from Exercise: A Guide from the National Institute
on Aging, National Institutes of Health
Dr. Russ Kennedy, Extension Health Education Specialist
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