MAR 29, 2021 | BY NETWORK
In this second of a two-part series, Leigh Sherry and Lianne Tiemens explore the key areas to focus on in order to deliver effective and safe workouts for the increasing mature aged population.
Leigh Sherry is an accredited Exercise Physiologist based in Sydney’s Northern Beaches, where she runs SmartLife® Health & Fitness. Leigh is also a group fitness instructor of more than 20 years. Leigh and I share an unstoppable drive and passion for fitness. The kind where we can push our clients and members to go further in life. We also both work closely with mature age participants. We recently sat down to discuss the image of mature fitness in the fitness industry.
A RECAP OF PART 1…
- Strength, stamina, and flexibility significantly decline after age 55, but with appropriate training these declines can be reversed
- Despite consistently being listed as a leading fitness trend, many fitness professionals and businesses appear reluctant to embrace training programs for older adults
- Fitness training for mature adults also makes sense from a public health standpoint, as it increases health status and reduces government spend on health conditions
- Fitness professionals may be limiting their own business success by failing to cater to a market that has greater discretionary spending power than younger fitness consumers
How old is ‘mature’?
What exactly is ‘mature age’? I looked it up. It wasn’t straight forward. I soon came to the realisation that there is no global, standard classification for the term. Definitions vary from ‘old age’ to ‘aged’ and ‘elderly’ and the age at which one is considered to fall into the category ranges from 55 to 65. Looking for a reliable source I browsed through the World Health Organisation (WHO) website. The WHO states that ‘most developed world countries characterise old age starting at 60 years and above.3” In Australia, however, the terms ‘elderly’ and ‘aged’ mean people aged over 65 years of age.
To further compound matters, when it comes to health, biological ageing is only loosely associated with a person’s age in years; there’s no ‘typical’ older person. Some 80-year-olds have physical and mental capacities similar to many 20-year-olds. Other people’s physical and mental capacities decline at much younger ages.3
Leigh puts these sometimes conflicting pieces of information into perspective: “We are talking about people aged 60 and up who want to live well. Our aim is to train them as functionally as we can to increase the quality of their everyday life for as long as we can.”
“We are talking about people aged 60 and up who want to live well.”
In the context of our discussion, it is essential to make a distinction between general population mature age participants and mature age participants who require clinical guidance from an allied health professional. “We are not aiming to train mature age participants who require clinical guidance, in a gym setting. Clinical exercise is very different, and – most importantly – out of scope for a personal trainer or group fitness instructor.”
This brings us to the first key area to focus on when considering training the mature age population: a referral network.
Key area 1: Referral network
I’ve always been a firm believer of staying in my Scope of Practice, as defined by the AUSactive (formerly Fitness Australia) position statement, as I care about the wellbeing of my clients and participants and want what’s best for them. However, it is exactly this desire to help, and the many grey areas, that make it sometimes very tempting to step outside of this scope, especially when clients and participants seek advice. Voicing these concerns to Leigh, she recognises the dilemma, but reinforces: “Even though I am an accredited exercise physiologist, when I run my group fitness classes at the gym, I am there as a group fitness instructor, a subject matter expert in group fitness. In this capacity I stay within the scope of work of a group fitness instructor – not an exercise physiologist. It is all about the professional approach to client care, for fitness and allied health professionals.” I couldn’t agree more.
“Getting a referral network is always important, but especially when working with a mature population,” Leigh states; “You would want to be involved with – for example – your GP and other allied health professionals such as exercise physiologists, physios and dietitians. Working with allied health professionals actually extends your knowledge and your access information. It extends the group of people you could be working with. You become part of the chain of management and achieve more within your Scope of Practice.”
How to set up a referral network
TIP 1: Make an appointment with your own allied health professionals, such as your GP, to discuss potential options.
TIP 2: Where possible, with the consent of your participant/client and the allied health professional, sit in on consults between them.
TIP 3: If you are unable to sit in on a consult, ask your participant/client if their allied health professionals can provide you relevant details. NOTE: Participants/clients must provide consent for this information to be released.
It is unlikely allied health professionals will contact you, so you have to be proactive and take the lead. Building a referral network presents a huge business opportunity that many do not seize, and also has the added bonus of providing chances to upskill.
Key area 2: Exercise prescription
Spoiler alert: there is no magic trick. Looking for a ready-made program for your mature age participants? You won’t find one in this article. Looking for flashy exercises? Also, not in this article. This too is not straightforward. Both Leigh’s and my mum are of mature age. When talking exercise prescription Leigh asks, “Would you prescribe your mum chair exercises?” “Definitely not!” I reply, “my 71-year-old mother planks like a pro. I have photo proof.” Leigh laughs, “If I were to give my mother chair-based exercises, she’d shoot me! It’s a matter of offering appropriate options.” There it is, exercise prescription for mature age is offering appropriate options.
“Some have lost faith in their bodies; some have started to believe the stereotypes about themselves”
Exercise prescription for this demographic is, in essence, not different to exercise prescription for the general population, on the condition that the options provided are tailored to the individual needs of your clients and participants. It’s not rocket science: establish a referral network around you (see Key Area 1) and if you don’t know how to program for your clients and participants, source the right training.
Training people of any age involves risks, but we can become more aware of these risks when working with the mature age population. There seems to be a reluctant attitude attached to this increased awareness. A reluctance to take on participants and clients from this demographic. The stigmas that mature age participants need to be handled with kid gloves, and that training them is boring, are not helping. Is it the unknown? A lack of experience?
Leigh continues, “I can’t emphasise this enough: if someone is frail, they should be trained in the clinical space – not in the traditional gym setting. Let the health sector deal with the scary stuff. They are qualified and trained for this.”
Exercise prescription for the mature age general population
– Refer. Know your scope of practice and refer clients who require clinical exercise to an allied health professional.
– Become a fitness subject matter expert. Be the expert and know all regressions and progressions, plus the most common injury options, for the exercises you prescribe. The more extensive your repertoire is, the better you become at thinking on your feet, offering the most suitable options for your participants and clients.
– Continue to upskill. Education should never stop.
– Use free motion. Continue to use free motion as much as possible, within the personal ability of your participant or client.
– Use machine-based or chair-based exercises when necessary. Use these with purpose, i.e., because they are the best option for your participant or client
– Use training protocols you use for the general population. Making alterations if needed. There is no reason you cannot do an AMRAP or TABATA with mature age participants. How can you modify them without compromising on safety or efficiency?
– Continue to improve power. Within the personal ability of your participant or client, and considering their training objectives, continue to work on the improvement of their power; when ageing, we lose power before we lose strength.
– Think about how you are delivering your program. When planning your sessions, think about the flow of movements. For example, when and where in the session do you incorporate the floor-based work?
– Challenge yourself to be creative. How can you change it up and keep things fresh?
– Underestimate the ability of mature age participants. Ever.
– Set and forget. This is not an option. Exercise programs for mature age need to be progressive; if you set a program in your class, set a training progression.
– Be boring. Mature age participants are like anyone else in the gym: they like to keep fitness interesting. Change is the only constant.
Key area 3: The delivery
Often mature age clients or participants who start working out in the gym need to train their own belief system as much as their bodies. Some have lost faith in their bodies; some have started to believe the stereotypes about themselves. The delivery of a program is therefore as important as the actual exercise prescription. We’re talking phrasing here, also known as cueing or scripting.
Leigh uses some examples from her own experience; “If I bench press with my mature age classes, I will say, “If you are working on mobility issues with your back or knees, put more risers under your bench” rather than saying “If you have bad knees or find it hard to get up and down, put more risers under your bench.” The aim is to make it more empowering, not patronising or condescending.”
“You need to give participants information in a palatable way, so they can make it land in their body.”
Leigh strongly believes in this; “Using your cueing in a certain way can yield something totally different in a class. When I’m delivering my mature age classes I think to myself ‘They know so much more than I and have so much more life experience than I do. But I know my job better than anyone else in the room. I know what I’m talking about. You need to give participants information in a palatable way, so they can make it land in their body. It actually empowers them and makes them interested in what they are doing. Your phrasing can do that.”
“It’s all about the way we interact. I don’t allow my exercise physiology clients to refer to their ‘bad’ leg, for example, and instead say “We’re going to manage this”. By doing so, I’m changing the way I interact with them, and if I do so for long enough it changes the way they interact with their own body. It becomes a more empowering feeling. I’ve always been very big on this when it comes to group fitness as well” Leigh says; “I’m very careful how I’m teaching. There always has to be an uplift. That’s part of the job.” This is another passion Leigh and I share: the desire to take our mature age participants to a positive physical and mental place they wouldn’t be accessing by themselves.
TIP 1: Make your language inclusive.
TIP 2: Empower clients and participants by using open, positive language, instead of saying ‘You can’t do that’, for example, say “We’re going to try getting up and down.”
TIP 3: Focus on what is possible.
TIP 4: Be clear on contraindications.
One day it will be us
Although it’s a fact that humans live longer nowadays, the WHO notes that “if these added years are dominated by declines in physical and mental capacity, the implications for older people and for society are more negative.”1 Maintaining good health is of the essence. To contribute to this, we have an obligation to make the gym setting more appealing, and welcoming, to the mature age general population.
The problem, as Leigh points out, is that “at the moment, there are not enough trainers in gyms who are well enough trained to deal with this demographic. As a result, the group is only lightly represented in the gym setting and consequently gyms don’t necessarily offer senior programs.”
I add, “the tone of most fitness marketing campaigns is not helping either. There is a huge discrepancy between what is portrayed in the media and our actual gym reality. The fitness industry tries to focus very hard on the young, the strong and the beautiful. Anybody who feels they don’t fit that profile would be intimidated. Marketing strategies almost solely focus on the aesthetic outcomes of exercise, when this is only one of its many benefits.”
We are the fitness industry. We must change. We need to throw the doors of our training facilities wide open to the mature population – and change our marketing to let them know that we’re ready, willing and able to welcome them and improve their quality of life.
The fact is, we’re getting older
Ageing and health
– Between 2015 and 2050, the proportion of the world’s population aged over 60 years will nearly double from 12% to 22%.1
– By 2050, 2 billion people will be aged 60 or older, up from 1 billion in 2020. 2
– This increase is occurring at an unprecedented pace and will accelerate in coming decades, particularly in developing countries.2
– All countries face major challenges to ensure that their health and social systems are ready to make the most of this demographic shift.1
Health in older age is not random
Although some of the variations in older people’s health reflect their genetic inheritance, most is due to their physical and social environments, and the influence of these environments on their opportunities and health behaviours. Importantly, these factors start to influence ageing from childhood. This means that an older person from a disadvantaged background is both more likely to experience poor health and less likely to have access to the services and the care that they may need.3
Older people may be living longer, but not necessarily better
A longer life brings with it opportunities, not only for older people and their families, but also for societies as a whole. Additional years provide the chance to pursue new activities such as further education, a new career or reconnecting with a long-neglected passion. Older people also contribute in many ways to their families and communities. Yet the extent of these opportunities and contributions depends heavily on one factor: health. There is little evidence to suggest that older people today are experiencing their later years in better health than their parents.
Yes, it may be more challenging to train a mature participant – experts on the subject of life. The ones with the experiences and the stories. The young at heart. The people knowing that freedom of movement will keep you going further in life. The resilient. The strong. The keen and the loyal. The ones who do not suffer fools. We need to be so well skilled and connected that they feel comfortable trusting us with their fitness. They may be life’s specialists, but we are the fitness experts. Here to help, opening the doors to the ‘invisible generation’, all ages welcome.
Lianne is a Group Fitness Leader, PT and Aqua Fitness Presenter based in Adelaide. A passionate and in-demand instructor and mentor at leading gyms and aquatic centres, she specialises in land- and water-based group HIIT workouts. instagram.com/lianne_tiemens_group_fitness / facebook.com/liannetiemensgroupfitness
The founder of SmartLife Health & Fitness based on Sydney’s Northern Beaches, Leigh is a wellness advocate, Accredited Exercise Physiologist and Accredited Exercise Scientist. smartlifehealth.com.au