Misty Seidenburg, DPT, OCS, cert MDT, providing postural cues to patient during Kettlebell Turkish Get Up.

Misty Seidenburg, DPT, OCS, cert MDT, providing postural cues to patient during Kettlebell Turkish Get Up.

By Misty Seidenburg, DPT, OCS, cert MDT

With today’s rise of the Baby Boomers, fitness and staying young has become a prevailing concept. Though it seems these days that increasing numbers of older people are staying in shape and pushing the envelope for athleticism further, the aging process ultimately brings a decline in physical capability. After the age of 35 years, physiologic changes begin to occur that affect the body. By the age of 50 years, it typically becomes evident that an athlete is experiencing several performance-altering changes. These changes include reduced muscle mass, particularly of Type II muscle fibers that provide power and strength; loss of bone leading to possible osteopenia and osteoporosis; metabolism changes, leading to a propensity for weight gain; soft tissue changes, such as decreased elasticity increasing the risk of injury; and reduced enzyme and hormone activity, slowing the body’s rate of recovery.1

These changes create an aura of fighting an uphill battle for one to maintain or improve fitness. The reality, however, is often simply a failure to change lifestyles and exercise regimens with age. With the right knowledge and commitment, staying healthy and ultimately increasing longevity can be a reality.

Don’t Train Like You’re 20

Exercise, as with medication, needs to be dose dependent. Research that has investigated endurance athletes shows that more is not always better, and that exercise and recovery have a dose response curve similar to medication. It is important as humans age to train smarter, not harder. As a person ages, he or she has less room for error, so exercise must be precise. Things to consider when planning an exercise program include strength and power, muscle hypertrophy, kinesthetic awareness, flexibility, overall aerobic fitness, and variability.

In order to maintain or even gain muscle mass, exercises including strength, power, and muscle hypertrophy must be incorporated into an exercise program. Strengthening programs should follow a periodization program that follows a cyclic organization. These cycles of intense lifts followed by light lifts allow for recovery periods between bouts of higher-intensity exercise. Placing a focus on muscle hypertrophy also assists in building lean muscle mass, which increases overall metabolism and decreases the risk of comorbidities.2 Particular focus should be placed on the legs, as they are the largest muscles in the body. Varying a program frequently also can reduce the risk of overuse injuries.

Often overlooked, kinesthetic awareness is a critical component to address in the aging athlete. While it may not apply to a 35-year-old, balance is something lost with age that increases the risk of falls and subsequent injury. Dynamic and static balance should be utilized both to strengthen and stabilize the joints, and to significantly reduce the risk of injury.

Overall aerobic fitness is also imperative to maintain cardiovascular health. Two options to aerobic fitness include high load, short duration or low load, long duration with a tendency toward the latter among older individuals. Research has shown that the opposite is more effective in delaying the effects of aging and maintaining or even improving athletic performance.3 Athletes who train with high intensity interval training (HIIT) find their aerobic capacity only drops .5% per year until their age reaches the mid-70s, compared to athletes who train long distance and see a decline at 1% to 1.5%.4 HIIT training incorporates intervals in which the athlete exercises just below the anaerobic threshold at predetermined levels of intensity and recovery. Completing this workout variation a few times per week results in shorter overall sessions, but higher average intensity with longer recovery periods. Varying HIIT training along with endurance activities can provide optimal aerobic capacity.

Lastly, flexibility is also critical for optimal movement and function. All joints are meant to move through their full available range of motion. As we age, connective tissue gets stiffer and injuries to this tissue take longer to heal. Static stretches are helpful to regain flexibility as well as ensure that any muscle imbalances are addressed.

Product Resources

The following companies offer fitness products for physical therapy practices:

Alter-G
www.alterg.com

Aretech
www.aretechllc.com

BTE
www.btetech.com

Bioness
www.bioness.com

Exertools
www.exertools.com

Fitter International Inc
www.fitter1.com

Gorbel Inc-Medical Division
www.safegait.com

Magister Corporation
www.magistercorp.com

NZ Manufacturing
https://nzcordz.com

OPTP
www.optp.com

Primal 7
http://primal7.com

Railyard Fitness
www.railyardfitness.com

Solo-Step
www.solostep.com

Spirit Medical Systems Group
www.spiritmedicalsystems.com

SPRI Products
www.spri.com

Stretchwell
www.stretchwell.com

The Hygienic Corporation
www.hygeniccorp.com

Workout Adaptations

Sometimes, despite an athlete’s best efforts, injuries occur. With aging bodies it is critical to stay active during these times to prevent deconditioning or suffer the effects of other comorbidities such as heart conditions, diabetes, and arthritic changes. For this reason, low-level workouts options and adaptations must be considered to keep the aging athlete moving.

There are many options for individuals looking to begin an exercise plan or to provide adaptations. One popular program is Silver Sneakers, a national fitness program designed to keep seniors active. This program’s membership fee is covered by many insurance companies. Another lower-level option are chair exercise programs offered by many senior centers for those individuals just getting started on the road to fitness later in life. These are group fitness classes that incorporate light stretching and strengthening in a seated position.

Adaptations should also be considered. Body weight supported treadmill training (BWSTT) is an adaptive system typically thought of for individuals recovering from neurological conditions, but these devices can also be used for individuals with orthopedic issues or for injury prevention. A traditional BWSTT device is the ZeroG treadmill by Aretech (Ashburn, Va) that consists of a dynamic suspension system that maintains a consistent off-load of the joints and accommodates for vertical changes in center of gravity to allow individuals to work on functional activities. Some features of this system include a computer system that saves individual parameters and also “fall protection” that detects a loss of balance stopping the treadmill immediately and “catching” the user.

Other manufacturers that offer treadmills for fitness applications include Spirit Medical (Jonesboro, Ark), which manufactures the MT200 Gait Trainer Treadmill with optional parallel bars and removable step-up. GlideTrak, Ashland, Ore, also offers a treadmill equipped with a pelvic support system designed to provide unweighting.

Another device tailored to orthopedics is the Anti-Gravity Treadmill by AlterG (Fremont, Calif). This treadmill utilizes positive pressure technology to apply uniform air pressure to the lower body, reducing joint stress while allowing normal mechanics during walking and running. It can be utilized for the following: reduce joint loading after an orthopedic injury while allowing the athlete to continue to be active and recover quicker; strengthen in a fall-safe environment for patients affected by balance issues; encourage weight loss by allowing longer-duration exercise; and to prevent injury during sport-specific conditioning.

This device is used frequently in our physical therapy clinic for various injuries. It can be used to maintain endurance or build endurance after many injuries. After an ACL repair before the patient is allowed to initiate a full running program, patients can complete interval training and distance training that is sport specific in conjunction with strengthening and proprioceptive exercises. The AlterG is also useful in older patients who have knee injuries to reduce compensatory strategies while allowing them to continue to walk or run.

For student athletes recovering from ankle sprains, the AlterG allows for an opportunity to resume running with less pain and restore normalized mechanics to get back to sports quickly. All programs are tailored to the specific individual to ensure specificity of training. The amount of loading can be altered to allow the maximum amount of weight bearing that the patient can tolerate. After patients are discharged from therapy, they can continue on a wellness basis and pay per use to continue to use the AlterG and enhance their training even further.

For cardiovascular exercise from a seated position on a pedal-equipped device, the Eccentron BTE (Hanover, Md) is an eccentric resistance trainer that offers a lower perceived exertion by comfortably producing more force output than concentric exercise. It can also visually display each session’s performance so that users can track improvement over a complete course of treatment.

Therapist providing tactile cues to patient during squat on Primal 7.

Therapist providing tactile cues to patient during squat on Primal 7.

Simple Technology for Performance and Value

As people age, life situations can limit gym time. Some affordable, user-friendly home options include Kettlebells, elastic bands, the Primal 7, and foam rollers. Kettlebells have been around a long time, but are only recently making their way into general fitness training and even rehabilitation. Kettlebell workouts are designed for strength and power—both necessary components to the aging athlete’s workout program and can also incorporate balance and global strength due to the asymmetrical forces and core activation placed on the body. Another product offered to the physical therapy market for building core power as well as strengthening knees and ankles is the Fitterfirst Extreme Balance Board Pro from Fitter International (Calgary, Alberta, Canada).

Elastic bands provide another choice for tools that are simple yet effective. The most popular brand in our clinic are those manufactured by TheraBand (Akron, Ohio) and are color coded in different resistance levels. These can help assist with carry-over from a rehab program to a wellness program. Due to their flexibility and varying levels of resistance, bands can be used for low to high level strengthening, postural stabilization, and balance. Other manufacturers who make similar products for the PT marketplace include Stretchwell (Warminster, Pa) and OPTP (Minneapolis).

Another piece of adaptive equipment is the Primal 7. Aptly named, this device allows the seven core patterns of movement to be completed: push, pull, squat, lunge, gait, twist, and hinge. It is comprised of a set of suspension straps connected by an elastic band wherein the resistance band can be altered to provide support or increase resistance. It provides dynamic bodyweight support while relieving joint stress and allowing compound movements to optimize neuromuscular activation, all while allowing biomechanically correct movement.

Lastly, foam rollers by OPTP are also an excellent tool to assist in maintaining flexibility and overall recovery when used in combination with traditional stretching. As discussed, flexibility is critical for optimal joint health and function. Used correctly, foam rolling can increase muscle length, and massage the fascia which may help muscles function better, decrease muscle fatigue and reduce soreness.

Among older patients, the AlterG is useful in treating knee injuries to reduce compensatory strategies while allowing patients to continue to walk or run.

Among older patients, the AlterG is useful in treating knee injuries to reduce
compensatory strategies while allowing patients to continue to walk or run.

Lifestyle Considerations

In addition to creating a tailored exercise program, certain aspects of overall lifestyle can also help with overall fitness. Recovery is the often-missed component for an aging athlete. Regularity, quantity, and quality of sleep are necessary to allow the body to deal with the daily stress of exercise. In addition, nutrition is also important. The appropriate levels of macro- and micro-nutrients and avoiding processed foods allows for optimal nutrition. Lastly, listening to the body and adapting an exercise routine day by day is essential to avoid overuse and injury.

Seeking the advice of a healthcare professional, such as a physical therapist, can help establish the correct volume and intensity of an exercise program. A physical therapist can screen and treat an individual for any underlying orthopedic issues and provide education on injury prevention as well as changes that occur with age.

Understanding the changes that take place as the body ages and making simple modifications can allow the aging athlete to continue to perform at a high level. PTP

Misty Seidenburg, DPT, OCS, cert MDT, is the Drayer Physical Therapy Institute Orthopedic Residency Manager. She is a graduate of the DPTI Orthopedic Residency and Spine Fellowship and board-certified in orthopedics. Her areas of expertise include orthopedic manual physical therapy as well as the McKenzie technique of assessment and treatment. For more information, contact PTPEditor@allied360.com.

References
1. Siparsky P, Kirkendall D, Garrett W. Muscle changes in aging. Understanding sarcopenia. Sports Health. 2014;6:36-40.

2. Candow DG, Chilibeck PD, Abeysekara S, Zello GA. Short-term heavy resistance training eliminates age-related deficits in muscle mass and strength in healthy older males. J Strength Cond Res. 2011(2):326-33.

3. O’Keefe JH, Patil HR, Lavie CJ, et al. Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin Proc. 2012;6:587-595.

4. Pollock ML, Foster C, Knapp D, Rod JL, Schmidt DH. Effect of age and training on aerobic capacity and body composition of master athletes. J Apple Physiol. 1987;62(2):725-31.