Senior Fitness

Third Edition
Karl Knopf, EdD
CONTRIBUTORS
Karl Knopf, EdD
Frederick C. Hatfield, PhD, MSS
Judy Taggart, MS, MFS

Specialist in Senior Fitness

(Third Edition)
Official course text for: International Sports Sciences Association’s Specialist in Senior Fitness program.
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This text is informational only. The data and information contained herein are based upon information from various pub-
lished and unpublished sources that represents training, health, and nutrition literature and practice summarized by the
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 AUTHOR iii

ABOUT THE AUTHOR

Karl Knopf, EdD
ISSA Director of Fitness for
the Physically Limited
Dr. Knopf is the co-author of the ISSA Senior
Fitness Certification course and the ISSA Exercise
/ Fitness Therapy Certification course. He began
his teaching career at Foothill College in Los Altos,
California in 1976 as the coordinator of Adapted
Physical Education. The program has evolved into
the largest in California. Dr. Knopf has been
instrumental in developing programs for mature
adults, persons with arthritis and chronic pain, persons with disabilities, and the
developmentally delayed. He has written three books: Water Workouts, Fitness
Over Fifty, and his most recent, Senior Fitness for the ISSA. Dr. Knopf has been
writing, consulting and speaking professionally throughout his career and is a
frequent guest on television and radio talk shows. Since 1986 he has been a con-
sultant with Stanford School of Medicine for older adult research projects and
is a recent recipient of the respected NISOD, Excellence in Teaching Award. The
ISSA is proud to have Dr. Knopf join our growing staff and lend his expertise in
the field of Adaptive Physical Education and Older Adult Fitness.
TABLE OF CONTENTS Section II: Understanding
Preface, i Exercise and Working with
the Older Adult
Section I: Age and Exercise
Facts and Myths of Fitness, 70
It’s Never Too Late to Make a Client
Feel Great!, 1 Exercises Older Adults Should Avoid, 82

Controversial Exercises, 84
Making Your Client Fit for Life, 10
Exercises to Eliminate, 86
Age Related Changes, 12
Special Precautions to Be Aware of with Older
Exercise, the Anti-Aging Solution, 14
Adult Clients, 90
Ageism, 16
Effective Teaching, 94
Causes of Premature Aging, 17
How to Teach Older Adults, 96
Getting Old Does Not Equal Becoming
Disabled, 21 Accommodating, 97
Behaviors of Effective Teachers, 100
Biomarkers of Aging, 24
Professional Conduct, 101
“Normal” Effects of Aging, 25
Getting the Older Adult Started, 103
Theories of Aging, 28
Fitness and Stress, 107
Men’s and Women’s Health Issues, 32
The Importance of Balance, 109
Physiology of Aging, 36
Motivating the Older Adult, 112
Lungs, 37
Knowledge As a Motivator, 114
Heart, 39
A Different Era, 115
Brain, 39
Socialization, 116
Kidneys, 39
Goal Setting, 117
Body Fat, 40
Excuses or Barriers to Exercise, 119
Muscle, 40
Sight, 41 Thoughts for Consideration, 121

Hearing, 41 Section III: Program Design

Personality, 41
Basic Assessment, 124

Healthy Aging, 44 Basic Assessment, 125

Cardiovascular System, 48
Respiratory System, 50
Musculoskeletal System, 52
Nervous System, 63
Intensity of Exercise: Target Heart Rate, 138
Progressing, 141
Using MET Equivalents to Measure Exercise
Intensity, 142
Assessment for Cardiovascular Endurance, 144
Assessment for Muscular Strength, 150 Chronic Conditions III: Orthopedic, 242
Assessment for Muscular Endurance, 152 Arthritis, 243
Assessment for Flexibility, 154 Fibromyalgia Syndrome (FMS), 248

Cardiovascular Fitness and the Neck Problems, 250

Older Adult, 158 Low Back Problems, 252
Frequency of Exercise, 160 Shoulder Problems, 254
Safety Considerations, 162 Hip Problems, 258
Cardiovascular Exercises, 163 Knee Problems, 259
Ankle Problems, 260
Strength Training Guidelines, 168
Osteoporosis, 262
Goals and Techniques, 170
Amputations, 263
Phases of a Strength Training Program, 172
Strength Exercises, 174 Sensory Problems in Older Adults, 266
Deafness and Hearing Loss, 268
Maintaining Flexibility As We Age, 182
Visual Impairments, 272
Optimal Conditions for Eliciting a Stretch, 184
Stretching Techniques, 185 Section V: Marketing
Contraindications for Performing Stretching, 188 Business and Marketing Basics, 282
Performance Requirements for Stretching Business Basics, 283
Techniques, 188
Marketing Basics, 289
Stretches, 192
Frequency and Intensity, 198 Section VI: Appendices
Safety, 198
Transfers and Ambulation Aids, 296
Progressing, 199
Basics of Assisting a Person in a Wheelchair, 297
About Floor Exercises, 200
Transfers, 299
Section IV: Chronic Progressive Mobilization, 305
Ambulation Aids, 307
Conditions
Assessment of Posture, 314
Chronic Conditions I: Cardiovascular
Posture Evaluation, 316
and Pulmonary, 204
Procedures for Spinal Screening, 320
Cardiovascular Conditions, 207
Pulmonary Conditions, 216 Glossary, 323

Chronic Conditions II: Neurological Index, 331

and Metabolic, 222
Neurological Disorders, 224
Exercises for the Neurologically Impaired, 233
Metabolic Disorders, 235
S e n i o r F i t n e s s

PREFACE
 PREFACE vii

America, as well as the rest of the world, is graying. Adults over the
age of fifty represent a large and important segment of the popula-
tion, which is often under-served by the fitness community. If
something is not done soon to keep this group fit for life, many
older adults are going to “rust out” before their time. As this group
moves through middle age and into old age, if they are not proper-
ly maintained and kept well, the medical costs to keep this group
alive will be enormous. Many of the causes for poor health in older
adults are the result of poor health decisions. This, coupled with the
effects of a sedentary lifestyle, makes the later years more challeng-
ing. Many fifty-plus adults already have some chronic health issues
that necessitate a lifestyle change in addition to corrective exercise.
Fortunately for older adults, good choices and regular physical
activity can remediate many of these health issues.

The medical system of today is not well equipped to handle long-

term, chronic conditions. The medical system is good at “fixing”
sick bodies but is not very good at preventing illness. While our
health care system does an excellent job of handling acute condi-
tions, it often fails to keep “fixed” patients motivated to follow a
wellness program to prevent further problems after they have been
discharged. The fitness educator of the future can play a pivotal role
in the health care system. The future looks good for fitness profes-
sionals who know how to keep chronic health conditions from
advancing. Also, the fitness educator who can work in partnership
with the medical community to provide successful rehabilitation
will be highly sought after. An expert in the field of gerontology
said, “Most things that get worse with age can be positively influ-
enced with regular and prudent exercise.” With proper wellness
intervention, older adults can be healthier and fitter tomorrow than
they were yesterday. Isn’t that the fountain of youth?

Unfortunately, what many of today’s fitness professionals lack is the

ability to address the unique needs and varied functional abilities of
 S e n i o r F i t n e s s
viii

older adults. Fitness professionals of the future should be able to

individualize instruction based on the health status of the client.
While staying within their professional scope of practice, they
should be able to provide a safe and effective fitness program for
enhancing quality of life that is appropriate to the client’s goals.
Most personal trainers in the gym are not trained to treat this
important segment of the population. The fitness educator of the
future who can work together with older adult clients and their
therapists to keep older individuals operating at an optimal capac-
ity will be highly valued.

Many times when older adults wish to improve their fitness and
wellness, they go to a gym and sign up with a trainer who pushes
them to work too hard and too fast only to get hurt and drop out.
Other older adults feel they can do it all themselves and try to pick
up where they left off when they were younger. They end up using
outdated methods and once again fail, get hurt and quit. What is
urgently needed is a group of knowledgeable and compassionate
instructors who can assess the client’s age, health status, goals, and
 PREFACE ix

lifestyle then incorporate all of these elements into a realistic fit-

ness program. An older adult cannot and should not be trained in
the same manner as a young person. This is where this book
comes in. It is designed to give the reader the most practical and
realistic information available to train older adults to improve
their functional fitness in order to increase their quality of life for
as long as possible.

This book addresses the skills and techniques necessary for today’s
fitness educator to completely serve active older adults. Its focus is
to provide the reader with the skill set necessary to be a respected
member of the wellness community. The creed of the medical com-
munity is to “do no harm,” which is also the motto of this book.
Everything contained
within this book is based
on sound science. The
book does not go into
detail to explain this sci-
ence, but there are many
excellent texts that
address this very well.
Also the book is not
designed to inform the
reader how to work with
the frail elderly. Rather,
its goal is to explain how
to empower the older
adult to avoid becoming
frail and losing the abili-
ty to function fully with-
in the mainstream of life, to help the older individual continue to
carry groceries, walk the dog, climb stairs, reach for items on high
shelves, and so forth. This book is appropriate for all fitness educa-
tors. Group exercise teachers, personal trainers, health/wellness
educators, fitness facility managers, therapists, and activity direc-
tors will all benefit from the information presented.
 S e n i o r F i t n e s s
x

This text will take the theory behind older adult fitness and show
the reader how to apply it by providing a set of “best practices” for
working with all levels of older adults. All too often what sounds
good in a research environment fails when taken into the “trench-
es.” In particular, this manual will help fitness professionals who
work with older adults do the following:

• Become knowledgeable about the needs of

older adults

• Understand the common chronic conditions

associated with aging

• Assess needs, evaluate progress, and modify

instruction appropriately

• Apply fitness principles in a practical manner

for older adults

• Prescribe appropriate exercises or modifications

to best fit older adults’ needs

IT IS NEVER TOO LATE TO

MAKE A CLIENT FEEL GREAT!
Age & Exercise

It’s Never Too Late To Make a Client Feel Great!

Making Your Client Fit For Life
Biomarkers of Aging
Physiology of Aging
Healthy Aging
 S e n i o r F i t n e s s

UNIT 1

IT’S NEVER TOO LATE TO

MAKE A CLIENT FEEL GREAT!
 I t I s N e v e r To o L a t e t o M a k e a C l i e n t F e e l G r e a t !
UNIT 1 1

UNIT OUTLINE

I. Trend toward longer lifespan

a. Health implications
b. Role of fitness professional
c. Common perceptions regarding aging

II. Benefits of exercise for older adults

a. Chronological vs. physiological age

b. Experts’ views on exercise and aging

LEARNING OBJECTIVES

After completing this unit you will be able to:

• Describe current trends regarding aging

• Understand the importance for the fitness profes-

sional of being able to work effectively with an
aging population

• Explain the difference between chronological age

and physiological age

Today, people are living healthier into old age with fewer disabili-
ties, and this trend is expected to continue. For older adults of
today, life has never been so good. Life expectancy at birth has
increased by 4.7 years for men and 3.5 years for women over the last
twenty years of the twentieth century. Most older adults are living a
lifestyle that wasn’t imaginable twenty or thirty years ago. Today’s
older adults are less disabled, and the rate of disability is on the
decline as well.

Of course, more can be done to postpone chronic health problems.

This is where the fitness education of older adults can play a pivotal
role. If the fitness educator of older adults could teach simple
 S e n i o r F i t n e s s
2

lifestyle modifications such as increased exercise, weight control,

smoking cessation, and healthy eating habits, the risk of lifestyle ill-
nesses like cancer, cerebrovascular accidents, heart disease, and
osteoporosis could be reduced, thus saving society millions of dol-
lars. In concert with health professionals, we as fitness educators
have the means to reduce and postpone these chronic and often
expensive and disabling diseases. And the interventions we provide
are relatively inexpensive, providing the client a good return on
investment. This is not to say people will not still die, but those
clients who engage in healthy behaviors can compress the time
between the onset of disability and death.

Welcome to the profession of Senior Fitness. Older adults will

come to you for various reasons and with varied backgrounds.
Some of your clients will be very able and fit, while others will
be frail and in need of therapeutic exercise. However, all will be
entering “senescence,” a time of growing out of adulthood and
into old age. Senescence, much like adolescence, prepares the
person for the next stage of life, which in this case is “elder-
 I t I s N e v e r To o L a t e t o M a k e a C l i e n t F e e l G r e a t !
UNIT 1 3

Being Sedentary Can Be Hazardous sedentary: Sitting a lot;

not involved in physical
to Your Health activity that could produce
significant fitness benefits.
The following list includes information and facts regarding
physical inactivity.

• Inactivity and poor diet cause at least 300,000

deaths a year in the United States.

• Adults who are less active are at greater risk of

dying of heart disease and developing diabetes,
colon cancer, and high blood pressure.

• More than sixty percent of U.S. adults do not

engage in the recommended amount of activity.

• Approximately forty percent of U.S. adults are

not active at all.

• Physical inactivity is more common among older

adults than it is among younger adults.

• Inactivity increases with age. By age 75, about

one in three men and one in two women engage
in no physical activity.

• Regular physical activity has a strong correlation

to social support from family and friends.

• People with disabilities are less likely to engage in

regular moderate physical activity, than people
with no physical disabilities; yet they have similar
needs to promote health and prevent lifestyle-
related disease.
 S e n i o r F i t n e s s
4

hood.” Elderhood offers a time for reflection that is most fully

appreciated after a life complete with happiness, sadness,
health, and illness.

Some experts define the aging population in two segments—the

young/old and the old/old. An important concept to know as a
trainer of older adults is that not all older adults are the same.
Generally, the arena of the young/old is the Kingdom of the Well
and Healthy. These individuals are mobile and for the most part
healthy, even though some might have some health issues. The
old/old inhabit the Kingdom of the Frail and Sick. The old/old have
entered a time of loss—loss of health, loss of a spouse, loss of
friends, loss of independence, loss of function, and many times loss
of memory. The “one size fits all” theory will not work with this
population. Whether young/old or old/old, however, your clients
can benefit from your compassion and knowledge.

We now know that exercise increases your odds of living longer. The
data clearly shows that people who are active and do have a heart
attack have much better survival rates than unfit heart attack vic-
tims. A classic study involved a group of Harvard alumni. It fol-
lowed 16,000 men, aged thirty-five to seventy-four, for twelve to
fifteen years and found that, all else being equal, the more these
men participated in moderate to vigorous activity, the longer they
lived. Those who were active could expect to add one to two years
to their lives by the time they reached eighty years of age.

Yet another study, this one in the March 14, 2004, New England
Journal of Medicine, reached similar conclusions. This study found
that men with the greatest capacity for exercise live the longest. The
findings suggest that exercise capacity is a better predictor of
longevity than any other health marker. Dr. Walter Bortz, a Stanford
University professor, agrees with this and takes it a little further,
suggesting that leg strength is the best predictor of whether a per-
son can live independently.

We all know that physical and mental changes occur as we age.

 I t I s N e v e r To o L a t e t o M a k e a C l i e n t F e e l G r e a t !
UNIT 1 5

Perceptions Versus Realities

Percent of Percent of
Americans age Americans age
28 to 34 who 65+ who
anticipate: experience:

41% Less Active 69%

28% New Skills 64%

50% Less Stress 58%

25% Serious Illness 48%

15% Can’t Drive 47%

30% Walking Difficulties 41%

14% Lose Bladder Control 38%

2% Become Senile 29%

5% Dependent on Children 29%

Source: Adapted Physical Education for Adults with Disabilities

Aging affects all systems of the body; however, the amount of the
effect varies by individual. Dr. Bortz believes that everything he was
taught in medical school about aging was wrong. Today, medical
doctors, along with physiologists and gerontologists, are redefining
the aging process. We know that normal aging, healthy aging, and
sickness as seen in older people, are not the same. It wasn’t too long
ago that we expected heart disease to occur in older men and
women; now we are aware that heart disease is the result of an
unhealthy lifestyle and is not a factor of aging.

If someone were to ask you to describe the typical, eighty-year-old

person, what would you think of? Hopefully, you would describe this
person as vibrant and active. Unfortunately, many people would
describe an eighty-year-old person as frail, possibly using a walker,
and most likely, sedentary. However, aging does not have to be syn-
onymous with disability and infirmity. For decades we’ve seen shriv-
eled and non-energetic individuals among the older segment of the
 S e n i o r F i t n e s s
6

population and have come to think

of this as the norm in our society.
Studies like those previously men-
tioned suggest otherwise, however,
as do recent studies of older athletes
in which researchers are finding
that these individuals don’t slow
down like their sedentary counter-
parts. Their muscle mass doesn’t
decrease as much, and when such
deterioration does occur, it’s not the
result of old age but, again, of dis-
use. According to a study conducted by Stanford University, long-
time runners live longer and have less pain, disability, and disease
than their sedentary peers. The runners in the study were leaner, had
fewer joint problems, and needed less medication than non-runners.

What we’re learning is that our clients need to be proactive partici-

pants in the aging process rather than passive observers. Many of
the negative changes observed in aging were detected in the bed rest
studies of the 1970’s. The changes noticed in the bed rest studies are
similar to the changes seen in people who have a sedentary lifestyle.
Some experts on aging believe that total bed rest for twenty-one
days is equivalent physically to thirty years of aging. Other scientists
suggest that one hour of exercise increases life by one hour. Few
people die strictly from old age. Rather, they die from the repercus-
sions of diseases such as cancer and heart disease, so often found in
older, unhealthy people.

The expectation of a slow, steady decline with progressing years

does not hold true for those individuals who show interest in fitness
and a healthy lifestyle. We know that a very fit person of seventy,
someone on a regular exercise program, can be compared to a mod-
erately fit person of thirty who exercises only occasionally. As
remarkable as that may seem, more and more evidence supports the
fact that chronological age has very little to do with aging and is
 I t I s N e v e r To o L a t e t o M a k e a C l i e n t F e e l G r e a t !
UNIT 1 7

nothing to worry about. The stigma of slow decline associated with

aging need no longer be an issue for those committed to fitness and
health. Ask yourself how old “old” would be if you didn’t know how
old “old” was. Research suggests that there is a significant difference
between chronological age and physiological age.

Unfortunately, many older adults believe it is too late to start exer-

cising and that their past abilities and present disabilities are pre-
dictors of how fit or healthy they can become. This is false! No
matter how well one maintains oneself, the physiological process
will eventually take its toll. However, people need to take to heart
the idea that proper exercise is an important ingredient in maxi-
mizing physiological capacity. Regular daily activity has been a way
of life for virtually every person who has reached the age of one
hundred in sound condition. Exercise training does not stop the
biological clock, but at the present time, it is the safest means avail-
able of slowing it. Alex Lief, M.D., a Harvard Medical School pro-
fessor of gerontology, has said that exercise is the closest thing we
 S e n i o r F i t n e s s
8

have to an “anti-aging pill.” If a person wishes to age successfully,

they must commit to engaging in a program of systematic exercise.

Science supports the idea that exercise can slow down the aging
process, and researchers continue to be persuaded that fitness for
older adults is a must:

• Dr. Herbert DeVries is convinced that men and

women in their seventies and eighties can achieve
levels of vigor usually associated with people thirty
years younger.

• Dr. Steven Blair, of the Institute for Aerobic

Research in Dallas, found that as much as one and
one-half of all functional decline typically associat-
ed with aging is the result of disease and can be
reversed with proper exercise.

• Dr. Walter Bortz, author and professor, said, “Our

aging is in our own hands. It is no one else’s
responsibility. If we depend on our doctors, our
families, our government, we risk compromising
the quality of our lives.” If we take charge of our
lives we can ensure that our future years are cre-
ative and radiantly alive.

• Dr. Spirduso believes that older adults who stay

engaged physically, socially, and mentally age bet-
ter than those who do not.

• Dr. Fries, of Stanford University, believes that older

people can age well with grace and wisdom, wit
and experience, energy and vitality.
The bottom line is that it is never too late to feel great!
 I t I s N e v e r To o L a t e t o M a k e a C l i e n t F e e l G r e a t !
UNIT 1 9

UNIT SUMMARY

I. Individuals are living longer than ever before.

a. A longer lifespan makes the need to maintain

health well into old age significantly more impor-
tant in terms of both quality of life for the individ-
ual and the economic interests of the individual
and the larger community.
b. Fitness professionals carry the message of healthier
aging and prolonged independence to older adults.

II. While aging affects all systems of the body, healthy

aging differs significantly from “normal” aging.

a. Traditionally, aging has been synonymous with dis-

ability and infirmity.
b. New research shows that fit individuals defy the
stereotypes commonly associated with aging.