Training Dose and Programming |
Introduction
What You'll Learn
We'll take a look at the recommendations and recognise what is classed as moderate and vigorous-intensity aerobic activity, and what, specifically, are the strength training recommendations for older adults. We will also consider how these compare with the current body of research.
Why is This Important?
At the end of this module, you will be given workout templates based on all of the above, enabling you to quickly and confidently create programmes for most types of senior clients that you will encounter.
We'll take a look at the recommendations and recognise what is classed as moderate and vigorous-intensity aerobic activity, and what, specifically, are the strength training recommendations for older adults. We will also consider how these compare with the current body of research.
Why is This Important?
At the end of this module, you will be given workout templates based on all of the above, enabling you to quickly and confidently create programmes for most types of senior clients that you will encounter.
So, why is it important to understand what is classed as moderate or vigorous aerobic intensity activity?
If you look at the tests outlined in the assessments unit in the previous module, you will see that one of them, the Physical Activity Scale of the Elderly PASE, is designed to determine the amount of activity person already does. This helps you identify how much of the recommended aerobic activity is already being done outside the gym, so that when you work with your clients, you can programme for maximum effectiveness.
If you look at the tests outlined in the assessments unit in the previous module, you will see that one of them, the Physical Activity Scale of the Elderly PASE, is designed to determine the amount of activity person already does. This helps you identify how much of the recommended aerobic activity is already being done outside the gym, so that when you work with your clients, you can programme for maximum effectiveness.
What is moderate and vigorous aerobic intensity activity?
These rates are calculated based on the METS. A MET (Metabolic Equivalent) is defined as the resting metabolic rate, i.e. the amount of oxygen consumed in a resting state sitting quietly in a chair. This is approximately 3.5 ml 02/kg/min (1.2 kcal/min for a 70-kg person).
“As such, work at 2 METS requires twice the resting metabolism or 7.0 ml O2/kg/min and three METS requires three times the resting metabolism (10.5 ml 02/kg/min), and so on.” Jetté M, et al. (1990).
Moderate aerobic activity is described between 3 and 6 METS and vigorous aerobic activity is ≥6 METS. Below, I will post examples of aerobic activities, including some qualifying daily living activities. You can compare these with the results you get from PASE test, which will give you a practical guideline on how much aerobic activity is required in the gym in order for your client to meet the guidelines.
Moderate:
Vigorous:
You can view the full guidelines upon which these recommendations were established, together with references, via this link:
www.gov.uk/government/uploads/system/uploads/attachment_data/file/213743/dh_128255.pdf
Other advantages that including aerobic training in your senior clients’ routines will offer, are as follows:
The downside of using the above recommendations to establish the aerobic needs of your clients, is that they don’t take into the account the precise effort used. [143] Nevertheless, as a coach, they do provide you with a more specific framework with which to plan and execute accurate sessions that are tailored to every client.
One approach that you can consider implementing based on the above findings, is to focus on shorter bouts of activity that require higher effort, as this is shown to positively impact all-cause mortality risk reduction.
The Physical Activity Guidelines for Americans recommends that older adults should also include muscle-strengthening activities that involve all major muscle groups, on 2 or more days per week.
The American College of Sports Medicine states the following guidelines:
“As such, work at 2 METS requires twice the resting metabolism or 7.0 ml O2/kg/min and three METS requires three times the resting metabolism (10.5 ml 02/kg/min), and so on.” Jetté M, et al. (1990).
Moderate aerobic activity is described between 3 and 6 METS and vigorous aerobic activity is ≥6 METS. Below, I will post examples of aerobic activities, including some qualifying daily living activities. You can compare these with the results you get from PASE test, which will give you a practical guideline on how much aerobic activity is required in the gym in order for your client to meet the guidelines.
Moderate:
- Dancing
- Golfing - walking and pulling cart, or carrying clubs
- Hiking
- Skiing (depends on the skill)
- Mowing Lawn
- Walking the dog
- Weeding the garden
- Ball games
- Cycling under 10 mph
- Hiking
- Horse riding, walk and trot
- Hunting
- Sailing on a small boat
- Swimming 2-2.5 kph
- Walking 5-7 kph
- Yoga
Vigorous:
- Cycling at around 12.5 mph
- Running 5 mph 8 kph
- Cross-Country Skiing
- Tennis
- Chopping wood
- Badminton
- Cricket
- Jogging
- Mountaineering
- Rowing
- Squash
You can view the full guidelines upon which these recommendations were established, together with references, via this link:
www.gov.uk/government/uploads/system/uploads/attachment_data/file/213743/dh_128255.pdf
Other advantages that including aerobic training in your senior clients’ routines will offer, are as follows:
- Colcombe et al. (2006) researched that aerobic training 60 min/session 3x week “showed a significant increase in VO 2 and brain volume of the dorsal anterior cingulate cortex, supplementary motor area (ACC/SMA), middle frontal gyrus (rIFG), left superior temporal lobe, and anterior white matter tracts, compared with older adult controls.”
- Wen CP, et al. reported in a 2011 cohort study, that just 15 minutes of daily moderate-intensity aerobic activity carries a 14% reduced risk of all-cause mortality, compared to an inactive group that carries 17% of the increased risk of mortality.
- Harber et al., 2009, showed that aerobic activity “has been found to promote protein synthesis and expression of growth-related genes and inhibit the expression of muscle breakdown-related genes.” [141]
- Aerobic training also increases vitality; more so than strength training (Solberg P. A., et al., 2012).
The downside of using the above recommendations to establish the aerobic needs of your clients, is that they don’t take into the account the precise effort used. [143] Nevertheless, as a coach, they do provide you with a more specific framework with which to plan and execute accurate sessions that are tailored to every client.
One approach that you can consider implementing based on the above findings, is to focus on shorter bouts of activity that require higher effort, as this is shown to positively impact all-cause mortality risk reduction.
The Physical Activity Guidelines for Americans recommends that older adults should also include muscle-strengthening activities that involve all major muscle groups, on 2 or more days per week.
The American College of Sports Medicine states the following guidelines:
As you can see, the guidelines provide a broad range to work with, that will produce similar results for the majority of the population.
The recommendation targets each muscle group with between 32 to 180 repetitions each week. As I said, it’s a big range.
Several studies have been done on older adults, and there are multiple potential programming approaches that can achieve positive muscular and strength results, as well as improvement in activities of daily living. However, please take into account that most studies are done on an untrained population. This is not necessarily a bad thing, as you will meet a lot of clients who are just starting their journey with fitness, but it doesn’t provide much guidance for working with people who have been training all their lives.
Now, let me delve into a couple of studies that are worth mentioning due to their protocol, length, or sample size.
In a study released in 2013 in Experimental Gerontology, untrained adults over the age of 60 were placed in one of these 3 groups:
- The 1st group HIGH) was lifting for two sets at their 80% RM for 10-15 reps.
- The 2nd group (LOW) was lifting for one set of 80-100 repetition at their 20% RM.
- The 3rd group (LOW+) was lifting for one set of 60 repetitions at their 20% RM, after which the resistance immediately increased to 40% and they were instructed to lift for a further 10 to 20 repetitions.
The study lasted 12 weeks.
Muscle volume didn’t change significantly between the groups.
The HIGH and LOW+ groups had better strength gains in comparison to the LOW group, but the LOW group still achieved impressive improvement in strength (over 20 kg increase in 1 RM Leg press). This shows that you can achieve strength and muscle hypertrophy gains, even with loads as low as 20% RM, when the exercise is taken to perceived failure and when the volume is high.
All groups improved in functional outcomes.
In terms of volume, the LOW group did 275 repetitions a week for Leg Press and 263 for Leg Extension; the LOW+ group did 243 for Leg Press and 230 repetitions for Leg Extension; and the HIGH group did 93 repetitions for Leg press and 77 for Leg Extension.
There were no injuries reported during the study, showing that even going beyond the recommended volume at low intensity (20-40%) yields a positive and safe result.
Another paper, called ‘Periodization Strategies in Older Adults: Impact on Physical Function and Health’ by Jenny Conlon and colleagues, tested three training methodologies with 41 healthy adults in their 70s over the course of 6 months, training three days per week.
The first group, ‘NP’ (non-periodized), completed all training using three sets of 10RM strategy.
The second group, ‘BP’ (block periodization), completed four weeks of three sets of 15RM, four weeks of 3x10RM and four weeks of3x5RM; then repeated the same cycle.
The third group, ‘DUP’ (daily undulating periodization) did the same combination as group ‘BP’, but on a weekly basis, i.e. Session 1: 3x15RM; Session 2: 3x10RM; Session 3: 3x5RM; then repeated.
The overall volume, excluding one training session during the week before and one during the week prior to the main test, was as follows:
- Group ‘NP’: 90 repetitions per week, per muscle group; totalling 1980 repetitions during the 22-week resistance training period
- Group ‘BP’: 135 repetitions per week for four weeks, followed by 90 repetitions per week for four weeks, followed by 45 repetitions per muscle, per week, for four weeks, and then repeated; totalling 2,160 repetitions.
- Group ‘DUP’: 90 repetitions per week, totalling 1,980 repetitions.
The results of the test were as follows:
- Group ‘NP’ had a significant result in lowering systolic blood pressure, and whilst not statistically significant, an impressive drop in diastolic blood pressure was observed.
- Group ‘BP’ experienced a great increase in bone mineral content.
- There was a significant change in high-density lipoproteins(HDL) and low-density lipoprotein (LDL) amongst all groups. All groups got significantly stronger, with Group ‘BP’ seeing the best results.
From functional improvements, all groups experienced significant improvement in chair rise and stair climbing, with the biggest improvement in Group ‘NP’.
In summary, these results show you that more volume and intensity is better; but, less is fine as well. Your first priority should always be to reduce the barriers for training that I mentioned in the previous module, then work from there.
A study looking at the dose-response relationships of resistance training in healthy older adults (Borde, R et al. 2015), concluded that the optimal training for increased muscle strength is as follows:
- Training period of 50-53 weeks
- Training intensity of 70% - 79%
- 7 to 10 repetitions per set
- TUT (time under tension) 6s per repetition
- Rest 60 seconds between sets
- Three sets per exercise
- Three sessions per week
To increase muscle size, the following training is recommended:
- Training period of 50-53 weeks
- Training intensity of 51% - 69%
- 7 to 9 repetitions per set
- TUT 6s per repetition
- Rest 120 seconds between sets
- Three sets per exercise
- Three sessions per week
While I do not think it is realistic to achieve these reps with the matching %RM, unless you’re training the intermediate population, the recommendation does outline similar total volumes to those shown in the other studies we’ve explored.
Optimal workout time is another thing to consider when programming for older adults. In two papers from 1997, where dose-response was measured in self-reported pain intensity and disability score, the optimal time for the main workout was set at 35-40 minutes; with participants that exercised for longer periods reporting higher pain intensity.
Taking all the above information into account, the best programme choice for our older adults seems to be a variation of full body workouts, additional cardiovascular exercise, and a mixture of motor-skill or balance work.
When we look at a weekly schedule, we should consider the variations of full body workouts:
- Full Body,
- Full Body Anterior, Full Body Posterior,
- Full Body Push, Full Body Pull.
- Full Body 6-12 repetitions, Full Body 10-15 repetitions
A sample session schedule could look as follows:
- Warm up, movement preparation, getting ready: 5 - 7 minutes.
- Main workout: 35 - 40 minutes, with 75% of the workout spent in 8 - 12 repetition range and the remaining 25% spent in 12 - 15 or 6 - 8 repetition range.
- Balance Work / Movement Skill / >6 METs Finisher: 5 - 7 minutes.
- Cool down: 5 minutes
Regarding progressions, my recommendations are as follows
Progressions
RPE progressions - for beginner and intermediate clients
Double-Progression; 12–15 repetition range - directed at novice clients
Double-Progression; 10–12 repetition range - directed at novice clients
Double-Progression; 8-10 repetition range - directed at novice clients
Wave Loading - for intermediate clients
- Set the number of repetitions as per templates and set RPE at 7/10 or 8/10
- Keep the load and repetitions until RPE goes down to 5/10, then increase the weight and start again
Double-Progression; 12–15 repetition range - directed at novice clients
- Start a client with a resistance that they can safely and properly perform 12-15 repetitions per set, with a perceived exhaustion level of 7/10
- When the client can safely perform 15 repetitions throughout all sets prescribed and RPE goes down to 5/10, then increase the weight and start from 10-12 repetition range with RPE at 7/10 again
Double-Progression; 10–12 repetition range - directed at novice clients
- Start a client with a resistance that they can safely and properly perform 10-11 repetitions per set with a perceived exhaustion level of 7/10
- When the client can safely perform 12 repetitions throughout all sets prescribed and RPE goes down to 5/10, then increase the weight and start from 8-10 repetition range with RPE at 7/10 again
Double-Progression; 8-10 repetition range - directed at novice clients
- Start a client with a resistance that they can safely and properly perform 8-9 repetitions per set with a perceived exhaustion level of 7/10
- When the client can safely perform 12 repetitions throughout all sets prescribed and RPE goes down to 5/10, then increase the weight and start from 6-8 repetition range with RPE at 7/10 again
Wave Loading - for intermediate clients
- Alternate between increasing volume and weight, e.g.
- Week 1 Weight 10kg Reps 10
- Week 2 Weight 10kg Reps 12
- Week 3 Weight 11kg Reps 10
- Week 4 Weight 11kg Reps 12
More Lessons From This Module
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