Hierarchy of activities for the elderly

[Huffman_Tree]

Dear BBM crew,

suppose there is someone in my family who is old and probably needs to do resistance training. Let's also suppose there's no way for me to get them to train with barbells (I can't coach 'em in person either since they're on the other end of the world).

For someone who is not suffering from any particular medical issue, but is simply old and weak, I would suppose that resistance training would have been the #1 thing for them to do in order to improve their general quality of life.

What's the second best thing? What could be the third best thing if they don't want to do the second best thing? Machine training, swimming, biking?

I hope this question isn't too broad to answer - thanks in advance!

[Jordan Feigenbaum]

Huffman,

Thanks for the post and I hope you're doing well. While I don't love these assumptions, I'll play

Barbell Medicine's Non Nuanced Hierarchy of Physical Activity for "Older" Adults

1) Resistance training- Compound ground-based barbell loaded lifts (squat, press, dead, etc.) > machine based RT > calisthenics
2) Conditioning- If RT with barbells , then low to mod intensity steady state cardio is advised initially with later transition to mix of LISS and HIIT. If no RT, prefer HIIT for those able to engage in it (and who will comply)
3) Regular social interactions with peer network
4) Cognitive memory/learning activities
5) Age appropriate medical screenings

[quark]

Jordan, this could be too specialized a question, but do you have any recommendations for people well into their 90s for whom going 50' with a walker is about as much exercise as they can tolerate? With no real access to equipment. Obviously gradually increasing the distance is one thing to do.

What do you recommend for cognitive memory/learning activities?

At least 3 and 5 seem to be happening.

[Austin Baraki]

Are they able to stand up from a chair without using their arms for assistance?

[quark]

Are they able to stand up from a chair without using their arms for assistance?

I'm thinking of two people. One is on the edge. He often uses arms for balance and, with some chairs, to get going. The other is able to stand without using her arms.

[Austin Baraki]

That's usually part of my quick in-office screen for older/frail patients in clinic. If they can't get out of a chair without using their arms, that's the first thing you start working towards.

[quark]

What do you have them do to move towards being able to get out of a chair without using their arms?

[Austin Baraki]

Assuming, as you said, there is no access to equipment whatsoever, I'd find the lowest height they can stand up from without using their arms (might need simulate a high box squat by stacking something in a chair, for example), and have them "squat" a few sets to that "box", allowing them to bend over as much as they'd like to "hip drive" off the boxes.

Then incrementally work that height down over time.

[quark]

That makes sense and doesn't seem to entail any fall risk. Now I just need to convince him to do it.

Thanks!

[JStrause]

I am a PT in an independent and assisted living facility and the majority of the residents are > 85. I put most of my patients on the "sit to stand LP" as Austin described and it works really well!

[quark]

I am a PT in an independent and assisted living facility and the majority of the residents are > 85. I put most of my patients on the "sit to stand LP" as Austin described and it works really well!

JStrause and Austin, do you agree with this:

"Here’s the movement. Start sitting down. When you are ready to stand, start the movement by leaning forward so that your chin is IN FRONT of your toes (if this feels scary, just practice the lean for a while without actually standing up). Next, stand up from that position. It SHOULD feel much easier than staying upright when you stand."

"To sit down, you reverse the movement. You will bend your knees to start sitting (don’t let yourself rest the backs of your legs on the bed/chair), and focus on keeping your chin in front of your toes until your bottom hits the seat."

If not, do you have better instructions?

[Austin Baraki]

No, it needs to be simpler than that. Teach them how to stand up first.

1) I'd have them sit down completely.
2) While seated, set their feet into a squat stance with the knees out.
3) With arms outstretched, I'd have them rock their torso back and forth to get the idea of how to start the movement, and press on the low back in the same way we'd teach the "hip drive" concept.
4) Explain that you'd like for them to rock forward, then drive that part of their hips/low back up off the chair as hard as they can. Remind them that it's okay to bend over.

Repeat for a set. Don't worry about how they're sitting down to the chair at first.