In 2012, baby boomers will be turning 67 years old. The largest segment in our economy with the largest percentage of wealth will be looking to the fitness industry for help with their aging bodies. The number of "special populations" seeking fitness professionals is about to reach a tipping point. Among the many conditions a boomer client may face are joint replacements (often two or more), osteopenia, sarcopenia, cardiovascular disease, diabetes, metabolic syndrome, obesity, arthritis, Parkinson's, peripheral neuropathy and cancer. Many will be presented with multiple challenges on top of a deconditioned body with limited fitness ability. However, the situation is not bleak or discouraging if one is readily prepared for the challenge. This is not your average client seeking a flat tummy or sexy love handles.
There are two simple models that I like to show senior clients to demonstrate their progression or trajectory through the aging process. There are some things you cannot modify or change on that aging course. For example, you cannot change your gender, your age, genetic factors or vision problems, but as fitness professionals we can impact lifestyle and facilitate a training program that will maintain high levels of function for your clients into their 90s.
The Nagi Disability Model above describes a four-stage progression to disability (pathology, impairment, functional limitations, disability). The takeaway from this revised model is that the individual may hold a significant influence with regard to impairment(s), functional limitations and ultimately disability. While each individual may not be able to control diseases, lifestyle is a personal choice and choosing inactivity may result in the consequence of impairment, leading to functional limitation ultimately to disability.
This is the next model I use in every consultation with a client over the age of 55. This graph really shows that as individuals there is a tremendous range of function that our future may hold, and exercise may be the difference between golfing in our 80s-90s and living in a nursing home.
This chart depicts the trajectory that a client is on as they age. We know that typically people peak around age 30. For some sports it is younger, for others it is older, but if we begin to decline at age 35, then it really is important that we be in the best shape possible at age 50, 60, 70. You notice there are two trajectories pictured: one that drops below the disability threshold and one that stays above it; which one would you choose? I fully believe that most older adults should follow the higher trajectory, and in many cases lifestyle is the significant separating factor. In a simple sense that choice is up to each individual. I believe this should make for a lifetime client. If you sign someone up to train at the age of 65 you might have them as a client for five to 20 years! This is very different from the 34-year old looking to drop weight and then drop you as a trainer.
No client is typical: a case study
One of the biggest challenges with working with this age group is that no two clients will be alike. As a fitness professional, you simply cannot expect to train people all the same as you might do with the 20-30s crowd.
To give a simple case study of a "typical client," here is an example of a client I have worked with; I will call him "Ron." When Ron first walked in to consult with me, he really was in a desperate situation. He was 72, retired from his first career and worked at a golf course almost full-time so he could play all the golf he wanted and hang around the golf course all day. Golf was his real passion. He happened to be a phenomenal golfer, with approximately a 6-8 handicap. So this was not the typical older client coming in saying, "My golf game is falling apart, I can't hit the ball far anymore, my back hurts, etc." I was expecting something along those lines. He had several total joint replacements, a hip and both knees. One knee was replaced three times due to complications and infections and every nightmare scenario. That one knee was his real problem.
As trainers we immediately think how to improve range of motion, strength, power, technical outcomes. When working with this population, however, we have to shelve this personal trainer-thinking for a moment and find out what this client is really after. Ron was not thinking about any of these improvements specifically; he had one singular goal: to tie his own shoes again. It may sound like a simple goal, but for someone with multiple joint replacements he simply could not get to his feet anymore and consequently teeing up a golf ball or bending over to pick up a birdie putt out of the hole had become nearly impossible. He was in great physical shape otherwise. He was fit, active, strong, no cardiovascular issues; all the prospects of playing golf well to the age of 90. All in his favor except for his knee.
Once I established his real desired outcome, I set about designing a plan based on where his functional limitations were at present and where we needed to get him. We set about incorporating a number of simple mobility exercises, range of motion exercises and lower body strength and flexibility. It was clear early on that his physical therapy program following his third knee replacement was not effective and left him in a state I like to call "good enough for his age."
A month after we began training, he walks in and says to me, "Check out my shoes." I was thinking he bought a new pair of shoes; I looked down expecting to find some flashy new shoes, but what I found was laced-up shoes. Then it hit me! I realized why he was beaming. I said, "Ron you tied those yourself didn't you?" He said, "Yep, I couldn't believe tying my own shoes again would make me so overwhelmed. I can't thank you enough!"
That example is just one of many I could share, but what makes working with this population special is that each client will be unique. The outcomes can be as simple or as huge as tying shoes or as majestic as climbing Mt. Kilimanjaro -- as my current client in his 50s achieved -- or riding a bike for several hundred miles on the French countryside like my 70-year old client.
The fitness industry has to prepare itself for special populations to become the norm. These clients once thought of as the exception are reaching a level of need where they will be seeking the best of the best from our industry to serve them. I believe as fitness professionals we owe it to them to be fully ready.
Dan Ritchie PhD, CSCS, HFI-ACSM, has a broad background in the fitness industry including training and management in commercial and university/hospital-based fitness, for-profit, not-for-profit and educational facilities. His primary areas of expertise are in personal training for special populations including athletes, pregnancy, blind, stroke recovery, Parkinson's, multiple sclerosis, cerebral palsy, Fibromyalgia and Alzheimer's. He has a Ph.D. in Health and Kinesiology with a minor in Gerontology from Purdue University. www.btfit.com
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June 1 2012
