"The gym is mostly for grandma; she belongs there more than the rest of us do. We are doing this for recreation, she is doing this to sustain her independent way of life." (Isratel, 2021)
Regular exercise and strength training is critical for older adults to maintain or improve overall strength, coordination, balance, flexibility, and metabolic functioning. Most importantly, regular training will prolong the ability of older adults to live independently (Powers & Howley, 2018).
If you decide to become a Senior Fitness Specialist with NASM, you are doing your part in keeping older populations as healthy as they can be.
Why is Training Seniors Important?
Human bodies tend to be at their peak strength capability between the ages of 20 and 30, with a decline in muscle mass, bone mass, and functional capacity becoming noticeable after 50 years old. The decline in circulating anabolic hormone levels (i.e., testosterone, estrogen, growth hormone), reductions in metabolic functioning (i.e., cellular health and insulin sensitivity) coupled with an increase in catabolic hormones is thought to be a driving force behind the decline in muscle function.
Generally, muscle mass declines at a rate of approximately 1 to 2 percent a year, and strength decreases at a rate of 1.5 to 5 percent per year in untrained individuals after 50 years old (Keller & Engelhardt, 2014).
Likewise, cardiorespiratory fitness also declines with age with the average 65-year-old having approximately 30 percent less aerobic capacity than their 40-year-old counterparts (Milanovic et al., 2013). This combination of factors can lead to a gradual decline in physical activity which eventually leads to the inability to complete activities of daily living safely and independently.
Exercise is the most powerful tool to combat age-related loss of strength, aerobic capacity, balance/coordination, and cellular functioning. Talar et al. (2021) conducted a meta-analysis to determine the effectiveness of a progressive resistance training program in adults over the age of 65 years old diagnosed with sarcopenia (muscle wasting).
The researchers determined that an 8-week strength training program resulted in significant gains in agility, handgrip strength, lower limb strength, postural stability, and gait speed in those who participated in the training program.
Similarly, regular aerobic activity can greatly improve cardiorespiratory fitness in older adults. Sbardelotto et al. (2019) noted greatly improved aerobic fitness scores via the Rockport Walk test in a group of 60- to 80-year-old men who participated in either a land-based or water-based aerobic training program.
Overall, an appropriately designed exercise program combining all elements of fitness (balance, flexibility, strength, and aerobic activity) is extremely effective at improving markers of overall function and health in older adults, despite lowered training responses and levels of anabolic hormones. However, there are things to consider when designing an exercise program for a senior-aged client.
General Principles of Personal Training for Seniors
Focus on Function - Exercise can promote and prolong independence in older adults. First and foremost, functional goals are more appropriate for most clients in this population rather than weight loss goals. Although weight loss is a common recommendation for improving health in children and adults, weight loss in seniors can often result in more loss of muscle mass and can lead to impairments in functioning.
Weight loss in senior-aged females can lead to a nearly two-fold increase in the risk of hip fracture. Rather, a well-designed exercise program balanced with a nutrient-dense caloric diet is recommended for seniors to protect their health (Miller & Wolfe, 2008). Training goals related to improvements in strength, balance, and coordination, increases in lean body mass, increases in metabolic health (including insulin sensitivity), and enhancement in the ability to complete activities of daily living are all appropriate for older adult clients (Clark et al., 2014).
Assessments - The assessment process, as for any client, is especially critical when working with older adults. Equally, several assessments should not be overlooked.
Medical history is important to obtain with the use of the PAR-Q questionnaire along with an in-depth history that includes the use of medications, pre-existing medical conditions, and prior or current orthopedic injuries (Clark et al., 2014).
The overhead squat assessment (OHSA) is appropriate for seniors; however, having your older adult client squat into a chair may help prevent falls, or get true results when a client may be afraid or unable to squat effectively (Clark et al., 2014).
Single leg squat assessments may also be useful as they are a powerful predictor of functional ability, though it is important that the fitness professional carefully determine if a client can complete a single leg squat assessment safely (Hockings et al., 2013).
Balance assessment such as the Berg Balance Scale - Muscle strength assessments such as the Chair Stand Test (asking the client to stand from a seated position without using the upper body) and the Arm Curl Test (requiring the client to complete as many repetitions as possible in a 30-second time frame, ideally above 8 repetitions) are quick and easy ways to determine baseline strength and the risk of functional limitations in this population (Golden, 2020).
Cardio assessment such as a Rockport Walk Test is safe for most seniors, and relatively simple to complete to evaluate VO2 max, a common measure of cardiorespiratory fitness (Clark et al., 2014).
Exercise Prescription and Program Design - The National Institute on Aging currently recommends 150 to 300 minutes per week of moderate activity or 75 to 150 minutes per week of vigorous physical activity for older adults. Likewise, it is recommended that older adults participate in strength training at least twice weekly with two sets of exercises including all muscle groups of approximately 8 to 12 repetitions per set (National Institute on Aging, 2019).
Periodization through the Stabilization Endurance and Strength Endurance phases of the OPT model is more than adequate to meet these training goals in seniors (Clark et al., 2014). These concepts only represent a very brief overview of some important principles to follow when training older adults.
Psychological Considerations - Crowded gyms and competition are factors that may deter older adults from participating in physical activity. Similarly, older adults that feel more successful with their exercise programs and have positive perceptions of their health and ability are likely to continue and succeed within an exercise program. It is therefore critical that fitness professionals communicate clearly and effectively with their older clients and design programs that meet their goals and not goals that may appeal to younger clients (Lautenschlager et al., 2004).
Important Learning Concepts within the NASM-SFS Course
The NASM-SFS course is designed to give learners a deep understanding of how to work with older adults safely and effectively. The course consists of thirteen modules covering a range of topics to give the fitness professional the knowledge and confidence to work with this population.
• Module 1: Defining the Older Adult Population
• Module 2: Physiological and Anatomical Considerations of Aging
• Module 3: The Psychosocial Considerations of Aging
• Module 4: Fitness Assessments for the Active Older Adult Client
• Module 5: Exercise Safety Guidelines for Active Older Adults
• Module 6: Flexibility Guidelines for Active Older Adults
• Module 7: Cardiorespiratory Guidelines for Active Older Adults
• Module 8: Core, Balance and Reactive Training for Fall Prevention
• Module 9: Resistance Training for Active Older Adults
• Module 10: Program Design for the Active Older Adult Client
• Module 11: Common Medical Conditions and Exercise Modifications
• Module 12: Nutrition for Active Older Adults
• Module 13: Professional Development
What is the Career Outlook for a Senior Fitness Specialist?
The career potential for certified personal trainers is enormous according to the Bureau of Labor and Statistics. Nearly 80 percent of adults over the age of 65 will present with functional challenges or health concerns and can benefit greatly from the services of a highly skilled personal trainer (Bureau of Labor and Statistics, 2021). Senior Fitness Specialists provide valuable health-sustaining services for older adults seeking personal training services.
It is becoming more common practice for physicians to prescribe exercise as they would any other medication. Some medical schools are including the concept of exercise as medicine into their curriculum. The University of South Carolina Greenville School of Medicine integrates exercise as medicine into all four years of their medical students' curriculum.
This push for physician training in lifestyle modification (proper exercise and nutrition) is becoming more widespread as chronic medical conditions run rampant amongst older and younger adults (Adedokun et al., 2021). This will lead to a need in the fitness industry for highly qualified certified personal trainers with specialized training to work with older adults with chronic health conditions.
Adults over the age of 65 make up 16 percent of the total U.S. population, and this is expected to increase to nearly 21 percent by the year 2040 (Bureau of Labor and Statistics, 2021). This growing population will translate to a growing need for personal trainers with the skills and credentials to work with older adults. The fitness professionals that work with this special population must have the knowledge and skills to properly assess these clients and design appropriate, safe, and effective exercise programs for them.
Are Salaries Higher for Fitness Professionals with Specialized Training?
Currently, the demand for certified fitness professionals is predicted to grow by almost 40 percent by 2030 with an even higher demand for fitness professionals working with special populations such as older adults.
The median salary for a certified personal trainer in 2021, is $40,510 annually (Bureau of Labor and Statistics, 2021). Yet, the average annual salary for a certified personal trainer specializing in senior fitness is closer to $55,000 (Ziprecruiter, 2021) which is a 37 percent increase over the average salary for general fitness professionals.
There is an ever-growing demand for specialized certified fitness professionals in the fitness and health industries. The NASM Senior Fitness Specialist course can provide personal trainers with increased earning potential, increased career advancement potential, and the opportunity to make a huge impact on the lives of older adults. For more information on the NASM Senior Fitness Specialist course, visit Senior Fitness Specialization (SFS).
Adedokun, C. A., Curles, W. G., DeMaio, E. L., & Asif, I. M. (2021). Analysis of American Medical Students' Knowledge of Physical Activity Recommendations. PRiMER, 5. https://doi.org/10.22454/primer.2021.249084
Bureau of Labor and Statistics. (2021). Fitness Trainers and Instructors: Occupational Outlook Handbook:: U.S. Bureau of Labor Statistics. https://www.bls.gov/ooh/Personal-Care-and-Service/Fitness-trainers-and-instructors.htm#tab-5
Clark, M. A., Lucett, S. C., & Sutton, B. (2014). NASM essentials of personal fitness training. Burlington Jones & Bartlett Learning.
Golden, N. (2020, May 18). Training Considerations for Older & Younger Populations. Blog.nasm.org; The National Academy of Sports Medicine. https://blog.nasm.org/training-older-and-younger-clients
Israetel, M. (2021, July 21). Size, Strength, and Aging. https://www.youtube.com/watch?v=r8zcF6Ut7lo
Keller, K., & Engelhardt, M. (2014). Strength and muscle mass loss with the aging process. Age and strength loss. Muscles, Ligaments and Tendons Journal, 3(4), 346–350. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3940510/
Lautenschlager, N. T., Almeida, O. P., Flicker, L., & Janca, A. (2004). Can physical activity improve the mental health of older adults? Annals of General Hospital Psychiatry, 3(1), 12. https://doi.org/10.1186/1475-2832-3-12
Law, T. D., Clark, L. A., & Clark, B. C. (2016). Resistance Exercise to Prevent and Manage Sarcopenia and Dynapenia. Annual Review of Gerontology and Geriatrics, 36(1), 205–228. https://doi.org/10.1891/0198-8794.36.205
McPhee, J. S., French, D. P., Jackson, D., Nazroo, J., Pendleton, N., & Degens, H. (2016). Physical activity in older age: perspectives for healthy aging and frailty. Biogerontology, 17(3), 567–580. https://doi.org/10.1007/s10522-016-9641-0
Milanovic, Z., Jorgić, B., Trajković, N., Sporis, Pantelić, S., & James. (2013). Age-related decrease in physical activity and functional fitness among elderly men and women. Clinical Interventions in Aging, 549. https://doi.org/10.2147/cia.s44112
Miller, S. L., & Wolfe, R. R. (2008). The danger of weight loss in the elderly. The Journal of Nutrition Health and Aging, 12(7), 487–491. https://doi.org/10.1007/bf02982710
National Institute on Aging. (2019). Exercise and Physical Activity. National Institute on Aging. https://www.nia.nih.gov/health/exercise-physical-activity
Powers, S. K., & Howley, E. T. (2018). Exercise physiology: theory and application to fitness and performance (10th ed.). Mcgraw-Hill Education.
Sbardelotto, M. L., Costa, R. R., Malysz, K. A., Pedroso, G. S., Pereira, B. C., Sorato, H. R., Silveira, P. C. L., Nesi, R. T., Grande, A. J., & Pinho, R. A. (2019). Improvement in muscular strength and aerobic capacities in elderly people occurs independently of physical training type or exercise model. Clinics, 74. https://doi.org/10.6061/clinics/2019/e833
Talar, K., Hernández-Belmonte, A., Vetrovsky, T., Steffl, M., Kałamacka, E., & Courel-Ibáñez, J. (2021). Benefits of Resistance Training in Early and Late Stages of Frailty and Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Journal of Clinical Medicine, 10(8), 1630. https://doi.org/10.3390/jcm10081630
Ziprecruiter. (2021). Senior Fitness Specialist Salaries. https://www.ziprecruiter.com/Salaries/Senior-Fitness-Specialist-Salary