Gregory L. Welch MS ATCGreg Welch, M.S., is an exercise physiologist and president of SpeciFit, An Agency of Wellness and Competitive Performance Enhancement, located in Seal Beach, California. Mr. Welch has published several articles in a wide spectrum of national journals. He travels extensively, lecturing to personal trainers across the country, and serves on the board of advisors of the Lifespan Wellness Center at California State University, Fullerton. He is the consulting physiologist to the Heartwise Fitness Institute in Whittier, California, and is a senior instructor for the American Academy of Fitness Professionals. Mr. Welch also serves as a consultant to the American Senior Fitness Association.
Slowly but surely America is awakening to the realization that resistance training is a necessary component of Wellness. For the older adult, weight lifting — a term often used interchangeably with resistance training — is more than just necessary; it is crucial. Independent living cannot be continued if the body’s lean muscle tissue is not maintained. While there are many benefits directly associated with resistance training, the intention of this article is to focus on the importance of stabilization as it relates to functioning within the scenario of “real life.”
This “real life” scenario pertains to the lifestyle of any individual and literally involves putting one foot in front of the other in order to carry out daily functions. Although diversity and intensity of lifestyle activities varies greatly among individuals, the common denominator to all physical activity is lean muscle tissue. In other words, muscle is the key to locomotion. Problems faced by the older adult include not only the general effects of aging, but also the outright neglect of physical exercise specific to maintaining lean muscle tissue.
Yet another issue of concern involves the widespread lack of understanding (and, indeed, a pervasive disbelief) that older adults should engage in muscle building exercise. Weight lifting is commonly thought to be only for the young. Older adults often fear sustaining injury or aggravating joints and muscles wherein discomfort is already a part of daily existence. This mentality fuels the fire for even further physical inactivity. The research clearly shows that reduced muscle mass is a primary factor responsible for the age-associated loss of strength that reflects a decline in total muscle protein brought about by inactivity, aging, or both.
By taking a closer look at human locomotion, one can begin to appreciate the fact that muscle tissue throughout the body works within patterns of synchronization. There is never a time when the body is performing a simple function of daily living that one muscle acts alone. Moving through the kitchen, preparing a meal, tending to the garden, or just opening a window requires a concerted effort by a variety of muscles. Some muscles initiate a movement while others are necessary to curtail the action. Most importantly for the older adult, however, are the muscles that sustain and stabilize the body in order for the primary movement to occur in the first place.
By observing the walking gait pattern, one can identify many aspects of stabilization. Upon every strike of the heel, musculature from the ankle to the knee, through the hip and back, to the shoulders and neck must engage to stabilize the body, thus allowing the primary movement to continue. This collective effort, referred to as proprioception, is more commonly known as balance.
In proprioception, the brain is communicating with the muscles as to the specific level of involvement required to achieve the movement objective. The importance of this neuromuscular relationship becomes most obvious as the deterioration of the muscle tissue occurs. Older adults will adapt their movements to compensate for their muscular weaknesses. While single joint action or muscle isolation exercises are helpful, they cannot match the total neuromuscular involvement of a multi-joint or gross motor movement. Walking is an example of a gross motor movement which is vital to the older adult.
There are two phases of a normal walking gait cycle. Stance is the interval in which the foot of the reference extremity is in contact with the ground. Swing is that portion in which the reference extremity does not contact the ground. The normal gait cycle is 60% stance and 40% swing. Two additional components of the cycle are double limb support and stride length. Double limb support refers to the two intervals in the gait cycle during which body weight transfers from one foot to the other while both feet are in contact with the ground. Stride length is the distance of a full gait cycle from the point of heel strike of one extremity to the point of heel strike of the same extremity. Normal stride length is approximately 1.5 meters.
Weakness in different muscle groups will affect the gait in different ways. Decreased stride length reflects instability during single limb support of the opposite leg. Lack of stabilization will also lead to increased step width and to increased double limb support time, because less muscle tissue is available for balance control. The older adult then further compromises the gait pattern with side to side swaying and with shuffling of the feet. He or she typically fears that any wrong move may lead to a fall.
As the sedentary lifestyle continues, an inverse relationship is created: as caution regarding normal movement increases, the ambition for any movement decreases. Thus, lean muscle tissue proceeds down a spiral of progressive decline, ultimately leading to the requirement of a walker, motorized chair, or even nursing care because the individual is simply too weak to get out of bed and function in “real life.”
Although this is a painfully common scenario in our society, the good news is that it is definitely not inevitable. Stabilization techniques to build functional muscle strength and ensure a continued lifestyle of autonomy are easy to perform.
First, it is important to understand that an exercise program must be established based on some prerequisite information. The current level of function should be identified after medical clearance to exercise is given by a physician. This functional assessment is not to be confused with the typical tests for strength commonly used in the fitness industry. Regarding the older adult, much can be learned about his or her present lifestyle through a verbal interview process and through observation of selected gross motor movements. For example, have the individual sit in a chair, stand up, and sit down again. After performing the activity two or three times, does the individual need assistance? Does he or she manipulate other body parts to be successful at the maneuver? Can the individual perform the movement without swaying or needing to take a step for correction of balance when rising to the standing position? The answers to these and similar questions can provide definitive information as to which muscles need to be conditioned to perform the task properly.
Assessment of gait can also provide valuable information. Measuring stride length and width, in addition to observing the overall pattern, can help in determining whether there is a diminished capacity to support the entire body. Poor posture, torso sway, shuffling of the feet, and overall apprehension by the individual can all be related to weakness in muscle tissue.
Exercises specific to the development of gait stability focus primarily on the pelvic area. Closed-chain movements such as step-ups, squats and lunges, with proper progression, are the most specific to “real Life” function. Equipment such as the multi-hip machine is very beneficial for strengthening adductors, abductors, flexors and extensors. Although this machine is intended to isolate certain muscles, there is actually a two-fold benefit. While the active leg is performing work, the opposite leg must also work isometrically to facilitate the exercise.
Exercises that offer additional stabilization include a variety of agility patterns and trunk development methods. Toe walking (actually walking on the balls of the feet with heels raised), heel walking, cross-over forward patterning, and the grapevine maneuver, as well as torso work with stretch bands, tubing and large rubber balls, all stimulate neural recruitment that will help develop stabilization.
Remember that the older adult population varies tremendously with respect to individual differences and capabilities. Therefore, the exercise specialist must consider the appropriateness of each activity. However, regardless of the current functional level of the individual, a prudent exercise prescription can always be established and, likewise, “real life” function can always be enhanced.
Jim Strohecker
Tom Ferguson MD
