Elevated Arms: The broad statement that older adults should not raise their arms above their head against any resistance is illogical. Granted, this maneuver can increase blood pressure, but only if the arms are left in that position for an extended period of time. From a biomechanical standpoint, there can be a risk of impingement with a high number of repetitions. However, for anyone who places household objects in overhead cabinets, a shoulder press exercise can be quite helpful for maintaining the integrity of the shoulder joint and the strength of the associated muscles.
Squats: The same perceptual problem seems to exist with the squat. Many fear the squat is too aggressive for older adults. Yet anyone who sits in a chair and stands up again is performing a squatting motion. The squat is arguably one of the most important exercises for functioning in real life.
Very few movements are produced by the musculature of one joint without additional musculature working to stabilize the other joints in the body. With the squatting exercise, for example, there is a great deal of work occurring to stabilize the joints in the upper body so the primary lower-body action can continue successfully.
"When very frail people want to exercise, many doctors recommend walking because they think it's safe. But people who are weak and have terrible balance are likely to fall. They should get strength training before they start walking," writes Dr. Maria Fiatarone, assistant professor in the Division on Aging at Harvard Medical School. A walking program is best performed after the body has been prepared to sustain the activity.
Falls and Gait Instability
These are among the most serious problems facing the aging population. Accidents are the fifth leading cause of death in people age 65 and older, and falls constitute two thirds of these accidental deaths (Rubenstein 1988). One study of persons 75 years of age and older suggested that the predisposition to fall may result from the accumulated effect of multiple disabilities. Even the "fear of falling" has been reported as a viable cause of falling (Tinetti et al. 1988).
Measuring a full gait cycle is an excellent way to ascertain information about real-life function. One way to measure stride length is to wet the feet, ask the person to walk and then measure from the point of heel strike of one extremity to the point of heel strike of the same extremity, which constitutes one full gait cycle. (Normal stride length averages 1.5 meters [not quite five feet]. Remember, do not be too concerned about the norms. What matters is the individual's performance.)
A decreased stride length most likely reflects instability or muscle weakness during support of the opposite leg (Trueblood & Rubenstein 1991). Again, stabilization becomes crucial in the performance of a primary action. Assisted squatting would be highly appropriate, and step-up and balancing exercises would also be helpful.
For example, if your client has difficulty standing on both feet, that's the base level skill to improve. Progress to swaying right to left, then to holding a small stride and rocking back and forth to work on balance. Then progress to standing on one leg next to a stable object she or he can grab, then practice doing a heel lift.
Another consideration is the speed of the normal gait pattern. According to Visser (1983), the gait pattern slows five to 15 percent due to aging. This is an important consideration in real life when, for example, an older adult needs to cross the street within the time permitted by a stoplight.