Mind your P’s and Cues

2 years ago, I spent a month at Kripalu Center for Yoga and Health in western MA and earned a 200-hour yoga teacher certificate. While I don’t teach much yoga these days, I find that many of the principles I learned at Kripalu apply to personal training, particularly the training of seniors and frail seniors. One such principle is the principle of cueing.

What is cueing?

If you are someone who enjoys group fitness classes or if you ever worked with a personal trainer, you are already familiar with cues: it’s whenever the instructor or trainer tells you what to do with your body.

Take a look at this picture: that’s me demonstrating an exercise I do with many of my clients: the Standing Thera-Band Row. The main purpose of this exercise is to develop balance, upper body strength, and improve posture.

Oh my! My body’s changed a bit since I took this picture at the beginning of August! It looks like it’s time to update my exercise photos :-/

This exercise is not only a multi-function exercise, but it also is a fairly complex series.

This is the basic cue list for the exercise:

1) Hold one end of a theraband in each hand

2) Stand with your feet hip-width apart and slightly bend your knees

3) Tighten up your tummy, relax the tops of your shoulders, chin straight ahead.

4) Bend your elbows and pull back on the band, squeezing your shoulder blades together.

5) straighten your elbows.

6) Repeat 10-15 times.

(Notice that before I even cue the movement, I cue the correct form to minimize injury and to maximize muscle engagement.)

This is a fairly simple list of cues that seems fairly straight forward, right?

Imagine for a minute that you are a senior who has never participated in an organized fitness program or maybe you’re someone who is new to fitness. Do you know what I mean when I say “tighten up your tummy?” Many people think that I mean, “suck in your gut,” or they laugh in a self-deprecating manner and say, “there is NO WAY I could tighten this up.” I could try to say, “focus on your core…” many 80-100 year-olds don’t know what the “core” is. I initially took for granted that everyone knows what the core is since it is a fitness term bantered about so much these days that you could live in a fitness vacuum and still know where it is in the body.

So, does this cue work?

The short answer is no. Much of senior fitness is teaching (or re-teaching) a person how to move their body; it is teaching them proper anatomical terms; it is teaching them not to be afraid but to be confident; it is breaking down barriers of fitness myths; it is being attentive, kind, supportive and encouraging. Some clients may have Cognitive Impairment or Dementia and not be able to follow multi-step cues. Some clients might have Parkinson’s and need to be rhythmically and constantly coached. There are many variations!

According to a 1999 study published by the American Physical Therapy Association, reported, “Some aspects of prescribed exercise regimens, such as the complexity, intensity, and meaning of the exercise program, have an effect on [sic] compliance… treatments requiring more than one step or item task produced a higher rate of noncompliance (apta.org). Granted, this study deals with compliance of home-based exercise programs, but I find that verbose or overly complex cue lists can confuse and even frustrate. It’s a fine line between flowery language and functional description.

 Some Simple Cuing Suggestions For Seniors

  • Assign Functional Meaning – I have my client place their hands on their belly and ask them to pretend that they are zipping up a tight pair of pants; assigning a functional meaning to an exercise helps increase understanding.
  • Visual Cues -I show them what I mean on my own body or I do an exercise with them so they can mimic me.
  • Set a Foundation – I start with a simpler exercise that focuses solely on one muscle group so they know what I mean. (Before teaching Theraband Rows, I have to teach what the core is!)
  • Suggest Modifications
  • Repetition, Repetition Repetition!
  • Use a Person-Centered Approach – what uniquely works for each person? (If the client has a background in dance, try to teach functional movement like dance.)

For more information on cueing, check out this link.

As always, I would love your thoughts and feedback about cueing or Senior Fitness!

 

Morning Workout Musings

This morning, I was up at my now-standard time of 4:45am and promptly enjoyed a big mug of black-mango tea with milk. After some tooling around on the internet (including a fantastic Facebook-based discussion about the script adaptation of the Lord of the Rings and Harry Potter books) I prepared for my morning workout.

Since the soon-to-be-hubby is basically living in his mancave at the moment, I am free to listen to dubstep and do my workout without interruption… not that he interrupts me; usually it’s the other way around.

Lately, I’ve been reading a lot about CrossFit and while it’s a little out of my price range to pay for a gym membership when I already work at a fitness center, I really like the concept of getting cardio while strength training. I think this is a power lifting concept since body builders and hard core lifters seem to do very little if any cardio (like motoring along on the elliptical for 45 minutes).

I had a brief discussion with a stylist at my salon who is RIPPED. “I lift big-weights, and do minimal what most people consider cardio. I also eat a specific diet,” she says. Hm.

Anyway, as for CrossFit, there are some people who are REALLY into it and others who think it’s just the worst thing for  your body. From a therapeutic standpoint I can see why doing hundreds of reps of any exercise can have negative effects on the body; namely extreme fatigue can cause bad form and can lead to injury.

So, on to what I did this morning:

Thanks to katrina-runs.com for providing this workout with the lovely curly-cue writing.

First, I made it through just under 4 rounds in 20 minutes.

Second, the worst part of this exercise was the push-ups which I did with my knees down (hey, that’s where I’m at) and had to take loads of pauses to ensure that I was maintaining proper form. I was also feeling the tricep work I did yesterday… oy.

Second B, I could totally feel the push ups creeping into my upper traps and neck… this is the fatigue leading to bad form thing I mentioned earlier.

Third, definite cardio! Elevated heart rate, the whole shebang.

Fourth, I’m sad to say that this kind of kicked my ass. I ran a marathon once and now this 20 minute thing kicks my ass. More on topic with senior fitness: I’m aging too.

I am recovering from a back injury caused by biomechanical deficiencies and imbalances in my hips and knees. With a focus on building core strength and endurance, I finally have more pain-free days than pain-full days. I’m not interested in undoing any of the therapeutic work I’ve done nor am I interested in creating new injuries. So I employ my yoga training to 1) breathe and 2) listen to my body, hence the copious pauses during the push up part of this WOD.

Does anyone out there have any thoughts about CrossFit, WODs, or bodyweight work? I’d love to hear them!

Another Hip Exercise (So hip, man.)

Believe in the hype about the hip! An addendum to yesterday’s blog post:

Hip Abduction with a Band

This is a therapeutic and functional exercise that some runners out there might recognize especially if you have tightness in your Illiotibial Band. I use this exercise with all of my ambulatory clients in order to build strength in the gluteus medius.

Instructions:

1) Stand with feet together with a rubber band around your ankles; hold on to a stable surface with both hands or one hand (or no hands!!) depending on fitness level and ability.

2) Take weight in one foot and slightly lift the other foot off the ground; the lifted foot should remain off the ground for the entire exercise (this can be challenging for some seniors, so while I encourage them to keep the foot lifted, it’s okay if they put it on the ground after each rep especially if they are at the beginning of their training program or if they are recovering from an injury).

3) Kick out to the side with the lifted foot keeping both feet parallel. A lot of seniors have a tendency to externally rotate the hip during this exercise which causes the active toe to point out. I might tell a client to “lead with your heel” or “keep your feet parallel to the best of your ability.” To better target the glut. med. the active foot should be slightly behind the standing foot.

4) Repeat action for 2 sets of 8-15 repetitions on both sides of the body as tolerated.

**for particularly frail seniors or those just getting started, I may not even use a band around the ankles.

**an alternative to the band can be light ankle weights.

It’s All In The Hips

Terrible. Just Awful… but hilarious.

As a shout out to my late sister, Heather, every time I hear “It’s all in the hips,” I think of that Adam Sandler movie, Little Nicky.

Yeah, it’s not a great film. Until just now I secretly found it hilarious.

Anywho, fire-breathing Adam Sandler aside, you can see that this post will be about the hips!

Having strong, flexible, mobile hips can be the difference between healthy, productive aging and costly, emotionally/physically draining hospital and rehab trips after a fall and a broken hip. Strong, healthy hips can also lead to the ability to remain functionally independent for longer periods of time (1). There are many exercises that can increase mobility in and strengthen the hips; all of these exercises can be modified regardless of the senior’s fitness level and mobility.

First, a little anatomy!

Did you know that the most common location of a “hip fracture” is actually the femoral neck?

Rehabilitation after a fracture can be long, painful and unpleasant. Aside from weak or tight musculature, another cause of hip fracture is osteopenia or osteoporosis.

This picture illustrates basic hip structure:

The hip is one of the largest joints in the body and is responsible for many everyday functional actions from walking, to rising from a chair to shaking your booty (that last one is “FUN-ctional“). It is a major weight bearing joint that is a ball and socket, meaning one bone ends in a ball (head of the femur) and that ball fits into an area on another bone which acts as the socket (acetabulum in the pelvis). Because of this formation, the hip joint has a wide range of motion (ROM).There are 4 groups of 17 or so muscles that cause movement around the hip joint. The groups are defined by their location around the joint:

  • gluteal group – the muscles in your butt move your leg back behind you
  • lateral rotator group – muscles that move your legs away from each other
  • adductor group – muscles that move your legs towards each other
  • iliopsoas group.-hip flexors or the muscles that lift your leg forward

MEAT! But seriously….

Typically older adults (and those younger adults who have a sedentary lifestyle, a desk job or drive a lot, like me) tend to have very tight hip flexors and a weak gluteal group. I see a lot of tightness and weakness in these areas particularly when a client attempts a squat or a sit-to-stand action. Tight hip flexors and weak gluteals often go hand-in-hand with weakness in the core particularly the Transverse Abdominus which can lead to dreaded low-back pain, lack of balance and eventual falls in frail elderly.

Exercises

One of my goals is to work the muscles of the hip in such a way that I am targeting all the muscles of the hip as well as creating some muscle confusion by mixing up movements. For example, a sample hip-strength program might include alternating movements in different plains of motion (forward then side –to-side).  The following is example of a simple exercise that can be taught to seniors who can walk with some assistance. If my client uses an ambulatory aid, I encourage that they ditch the walker/cane for this, and I spot them.

  1. a 4-square grid is taped to the floor with masking tape.
  2. I ask my client to stand in one square with their feet together.
  3. I instruct the client to make a box by stepping into each square: first to the right (or left), then forward, to the left (or right), then backward.
  4. This exercise can help increase range of motion (ROM) the hip and can help develop muscular coordination, so it is helpful for balance.

    FUN-ctional!

  5. It can be made more complicated by introducing a band around the legs or by introducing jumping or hopping from grid to grid.
  6. Many of my clients have said, “Oh, it’s like doing the fox trot.” Add music or I sometimes hold hands with my client and dance with them. (Believe it or not, they seem to do better if I make the exercise like a dance instead of keeping it robotic!)

But what about strength? There are numerous exercises that can strengthen the hips but one of my favorites is the old sit-to-stand. It’s more or less a squat except we use an actual chair to instill the idea of functional movement in the client.

Those people who have a interest or background in fitness tend to better understand and execute a true squat, but the chair is good for those who have a fear of falling or who are deconditioned. Once they are able to execute a sit-to-stand with proper form, I remove the chair. For added challenge, I do the sit-to-stand with the client and they have to keep up with me. Sometimes I see how many we can do in 30 seconds.

Other exercises include standing scissor kicks (hip abduction or movement away from the midline of the body), Psoas (hip flexor) Stretch, and walking! Some exercises for the hips also help build strength in the quadriceps (thighs) which is also important for maintaining functional independence.

Contraindications

Be aware of hip replacements and those recovering from a broken hip. We try to avoid hip extension and squat-like motions for at least 6 weeks after a hip replacement surgery, although walking is encouraged as are therapeutic exercises that can be done laying down (2).

Also, be mindful of bone loss and certain power exercises, total strengthening drills should be preformed for several weeks before attempting jarring movement to prevent injury.

Weekly Core Challenge

I opened a Pinterest Page recently and am sucked in to the world of witty aphorisms, colorful photos and quirky infographics. Much like this little beauty that I discovered. I tried this workout today just to see if I could do it. Not only did I do it, but I think I kicked it’s a**!

Of course, as I sit here writing, the muscles of my torso are twitching and starting to ache so maybe I’m jumping the gun here…

Although though I don’t intend to use this tool in this form with most of my clients, some of these exercises can be modified for a senior population for example: Raised plank can be done against a wall, desk or other stable surface.

I’d love to hear what other fitness gurus and trainers have to say about this. What are your thoughts? Would you change anything about this exercise for yourself or your clients?

If it makes you happy…

So much about exercise conjures up images of thin, fit and happy people doing thin, fit and happy things. But how does exercise make you feel?  When I exercise I feel:

  • sweaty
  • elated
  • accomplished
  • strong
  • breathless
  • warm
  • sexy
  • energized

How do YOU feel when you exercise?

Source: backonpointe.tumblr.com via AgeFit on Pinterest

Out of the Dark

My goal here is to give some insight into how a fitness program for seniors encompasses more than just muscles and bones. I may use clients as examples but names will always be changed.

Jane (not her real name)

  • Age: 94
  • Current Basic Status: Cardiovascular issues, arthritis, neuropathy, legally blind, hearing aids, uses a walker, needs assistance with some ADLs (Activities of Daily Living)
  • Background: former educator; college-educated; married; husband recently deceased; no children; well-traveled
  • Personality: Sensitive, likes to feel included in activities; talkative; enjoys puns, storytelling, and singing; determined; enjoys learning; inquisitive; wants to get things right, likes to be challenged.
  • Fitness Goals: To walk without the walker, to feel less afraid of falling.
  • Current Program Includes: A healthy dose of balance training, proprioception (body awareness) drills, and resistance training

To be honest, Jane is one of my favorite people to work with because she is so determined to make her body work better within its current constraints. Even after she has a 30-minute training session with me, she will motor along with her walker. It is such a joy to hear her say, “I almost walked a full mile today!” You go girl!

Jane is not unique in her vision issues, though she provides a challenge for me in that visual cues simply do not work. For example, if we are working on a balance drill where Jane is asked to stand on one foot for 30 seconds, I can not ask her to pick a focal point. Another challenge is that I can’t demonstrate an exercise and expect her to “see” what I am doing. Vision impairment is a common factor behind fear of falling. Additionally, when an older adult loses their vision they can socially withdraw.

Jane is unique in that she is extremely aware of her surroundings and responds well to specific instructions like, “Please turn 90 degrees to your right,” or “Take 3 giant steps backward.”  Because Jane responds to these instructions and because she uses her sense of touch to navigate around the world when working with her I direct her attention inward to her muscles, bones and joints so that she can feel what she is doing.

standing mountain pose emerging from the darkness.

For example, when we are doing balance drills, I cue her as if I were cueing Tadasana. For those non-yogis out there, Tadasana is standing mountain pose and looks like the picture to the left. I cue this by saying, “Feel your feet in your shoes, feel your feet on the floor. Now, move up your leg and feel your ankles, now notice your calves and shins. Now feel your knees, thighs, hips, tummy, back, shoulders, neck, head.” Drawing internal attention to each major section of the body gives her the opportunity to focus on individual body parts and how they relate to the whole.

After several sessions of cueing Tadasana before executing any balance drills, Jane now does this on her own and she feels more confident. I love hearing her say to herself: “feet, ankles, calves, knees, thighs, hips, belly, back, shoulders, neck, head.” She straightens right up! This is the basis of proprioceptive training.

Jane’s resistance training protocol includes a variety of leg and core strengthening exercises such as the Payloff Press (arms only!), leg press, hamstring curl, dorsiflexion with resistance (lifting toes while heels stay on the ground) and the obstacle course.

Welcome to AgeFit!

My intention behind this blog is to create awareness and open discussion for senior fitness in both an institutional and home setting.  First, much senior fitness looks like rehabilitation treatment or physical therapy simply because so many seniors, particularly frail seniors, are unfortunately introduced to fitness after a medical trauma like a serious fall, a stroke or lengthy hospitalization. I am not a physical therapist, nor am I a nurse; I am a personal trainer with a passion for working with older adults. I dedicated my Master’s degree work on the development of comprehensive fitness programs and the research of aging anatomy and physiology.

My name is Corinne. I have worked in Elder Care for four years as a home care agency administrator, a homecare companion and a personal trainer. I hold a Bachelor’s Degree in Communication and Film Production from Boston University (I was a creative producer for a local news station in my former life) and a Master’s Degree in Gerontology from UMass Boston. I am an experienced fitness trainer and am in the process of being certified by the American Senior Fitness Association. I am currently the Fitness Director at Scandinavian Living Center, an assisted living community in West Newton, MA. I am also a registered Yoga Teacher trained at the Kripalu Center for Yoga and Health. In addition, I am mentored by Adam Poock, PT of The Ranks Academy.

The day I knew I truly loved my work was the first day I awoke from an intellectual dream about a particular client’s fitness program. An intellectual dream because I was actually trying to solve a problem that I’d had with this client’s program for a few weeks now and, upon waking, immediately went to my computer and started doing research on plyometrics and frail elderly.

My goal is to bring a fun, comprehensive fitness program to your loved one so that they may maintain their health and independence.

If you would like to learn more about in-home fitness training for seniors, you may contact me at corinne.bennett80@gmail.com.