“The effect of exercise on bone health results from the strain on bone created by weight-bearing exercise,” explains Polly de Mille, RN, RCEP, CSCS, USAT, clinical supervisor at the Tisch Sports Performance Center of the Weill Cornell-affiliated Hospital for Special Surgery. “Strain causes a release of molecular signals in the bone that lead to the synthesis of new bone, which makes the bone stronger at the exact site where the strain is applied.”

Activities That Benefit Bones

Weight-bearing exercise is any activity in which you support your own weight; these activities work your bones and muscles against gravity. Brisk walking, jogging, racquet sports, stair climbing, dancing, hiking, jumping rope, and exercising with weights are some of the activities that can help strengthen bones. Other terms for these types of activities are “load-bearing” and “strength-building.” Doing lunges, squats, and jumping jacks also can help your bones.

Exercises that are not weight-bearing include swimming, bicycling (including stationary and recumbent bikes), water aerobics, canoeing, kayaking, some yoga and Pilates exercises, doing upper‑body exercises while seated or lying down, and range‑of‑motion exercises such as seated leg lifts. However, any type of exercise will benefit your health in many ways.

A good, comprehensive exercise program will include weight-bearing exercises, aerobic exercises that get and keep your heart rate up, and exercises that will improve your balance and flexibility.

Helpful Tips

Here are some recommendations from de Mille for bone-strengthening exercise.

Do a variety of exercises for different areas of your upper and lower body, including exercises that target your arms, shoulders, chest, back, hips, thighs, calves, and ankles.

Exercise in short bouts. Bone gets stimulated fairly quickly and reaches a saturation point, meaning there’s no benefit to doing more; it’s better to do 10 repetitions twice daily than 20 repetitions all at once.

Your muscles attach to your bones at various points, so it’s important to work the muscles in different directions when possible. For example, do leg lifts in different directions—forward, back, and to the side—rather than in just one direction.

If You Have Osteoporosis

If you have already been diagnosed with osteoporosis (see What You Should Know for information on bone mineral density testing), exercise can still be beneficial, but you need to be cautious to prevent fractures.

Avoid jumping and other highimpact activities. “It is true that jumping can build bone, but if you have osteoporosis, jumping can fracture bones,” advises de Mille.

Don’t do crunches, heavy lifting, or other activities that involve bending forward; they put pressure on your vertebrae. “If you have severe osteoporosis, you can sustain a compression fracture of the spine simply by bending over the sink to brush your teeth,” de Mille warns.

If you have a vertebral compression fracture, you may experience suddenonset back pain that is moderate to severe; if this occurs, see your doctor as soon as possible. If you have one vertebral fracture, you have a much higher risk of having another one, so be vigilant about avoiding activities that can cause these fractures. You may also want to talk with your doctor about treating your osteoporosis with medication if you are not already doing so.

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While you might not be in that ideal place right now, you can get closer to it by starting an exercise program now. It’s never too late to improve your fitness. The body loves and responds to a challenge. So even if it’s been awhile since you’ve seen the inside of a gym or gone for a vigorous walk, there’s no better time to start than today. You don’t need to run a marathon (but you could train to walk one) and you don’t have to be a body builder (but resistance training will help you feel and be stronger). Research shows that there are significant health benefits especially when progressing from no physical activity to even just a little activity. This chapter will provide you with the latest science-based recommendations to guide you in setting appropriate physical-activity goals.

Science-Based Guidelines

Research garnered in the past decade has greatly expanded knowledge about the relationship between physical activity and health. We now know that moving has even more health benefits than previously thought—and there are more options in how we can achieve those benefits. What matters most is movement, be it in a gym, on a bike, in a kayak, or dancing around in your living room with your grandkids. New research indicates that regular physical activity helps people sleep better, feel better, and perform daily tasks more easily, and some of these benefits happen after just one exercise session. Getting plenty of regular exercise also helps prevent weight gain.

How much you should exercise continues to be debated. It is also a heavily researched topic. A group of nationally recognized experts in physical activity and public health performed a systematic review of the latest scientific evidence on physical activity, fitness, and health, and used their findings to propose recommendations to improve health. The U.S. Department of Health and Human Services issues physical-activity guidelines based on this latest scientific information. The guidelines are updated every 10 years, and the most recent recommendations were released in 2018.

It’s recommended that all adults get 150 to 300 minutes a week of moderate-intensity aerobic exercise. That’s just 2½ to five hours per week to gain the tremendous wealth of benefits that exercise offers. Vigorous-intensity exercise can help you reach your activity goals more quickly. Seventy-five minutes (1¼ hours) of vigorous aerobic activity is equivalent to 150 minutes of moderate-intensity activity. For examples of moderate and vigorous intensity exercises, see “Classifying Aerobic Exercise.”

In addition to aerobic activity, experts recommend resistance training (muscle-strengthening exercises) for all adults, but particularly older adults. Aim to work each major muscle group (arms, shoulders, chest, abdomen, back, hips, and legs) at least twice a week.

Remember that the best exercise activity varies from person to person, based on individual goals and abilities. The most important thing is to find an exercise routine that you enjoy and are likely to maintain. Whether you’re just getting started or looking to step up your exercise plan, slowly increase the amount of time you exercise then gradually increase the intensity.

Exercise Types

Getting at least 150 minutes (2½ hours) a week of any activity that gets your heart pumping is a highly effective way to help you be healthy, energized, and active now and in the future. Any activity counts, from everyday tasks and recreational activities to organized exercise opportunities. There is an aerobic activity to fit every taste, budget, and fitness level.

Sometimes called endurance or cardiovascular exercise, aerobic activity involves moving large muscle groups in a rhythmic manner for an extended time. Common examples are brisk walking, dancing, swimming, jogging, and biking.

Aerobic exercise enhances the performance of your heart, circulatory system, lungs, and muscles, so you may have more stamina and reduced risk factors for chronic disease, such as elevated blood pressure, cholesterol, and triglycerides. A large study published in the March 2018 Journal of the American College of Cardiology showed that going for a walk just a few times a week could protect you from developing heart failure.

With vigorous exercise, you get similar health benefits in half the time it takes you with moderate exercise. For example, 15 minutes of vigorous walking (such as walking up hills) is equivalent to 30 minutes of moderate-intensity walking. A particularly vigorous form of exercise that has been shown to have tremendous health benefits is high intensity interval training (HIIT, see “HIIT It”).

Walking is a great choice for aerobic activity, especially if you’re just starting out. It’s inexpensive, simple, and carries a low risk of injury, but it can have a big impact on your health. Although walking is something you’ve likely been doing since you were a toddler, it’s a good idea to brush up on proper walking techniques for fitness walking, which you will find in “Proper Walking Technique.”

Begin by walking slowly to warm up, then increase your speed to a pace that raises your heart rate but still allows you to speak and breathe easily. When you have had enough, cool down by walking at a slower pace. Start at a distance and speed that are comfortable for you, then add five minutes a week until you are at your walking goal.

To step it up a notch, increase your intensity by adding hill or stair walking, wearing a weighted vest, and/or by increasing your speed.

The National Institute on Aging has good suggestions for walking safely in your community:

• Walk during daylight hours. If you must walk at night, wear reflective materials and carry a flashlight.
• Walk on a sidewalk rather than the road when possible.
• Choose routes that are well lit and well used. Consider local parks and walking trails.
• Wear appropriate walking shoes and watch out for uneven sidewalks or debris that could cause you to trip.
• If wearing headphones, keep the volume low so you can hear cars, cyclists, runners, and other walkers approaching.
• Cross streets at crosswalks or intersections (don’t jaywalk) and choose to cross at intersections with traffic lights and pedestrian crossing signals if it’s a busy road.
• Never assume a driver sees you crossing the street. Try to make eye contact as they approach.
• If your vision is limited, walk with a buddy or a group.

Build Stronger Muscles

Performing muscle-strengthening activities at least two days a week will help preserve muscle and keep bones strong as you age. Also known as strength training or resistance training, this form of physical activity exercises a muscle or muscle group against external resistance. Resistance training slows down the loss of muscle mass and strength that occurs with age and helps keep bones strong.

Working hard against resistance—weights, stretchy resistance bands, or your own body weight—builds strength. Some of the benefits of regularly engaging in resistance exercise include:

• Preserving or increasing muscle mass typically lost as you age
• Maintaining your ability to perform activities of daily living in advanced age
• Lowering body fat
• Strengthening connective tissue around the muscle to prevent injury
• Strengthening bones to help prevent osteoporosis
• Decreasing blood pressure
• Raising good (HDL) cholesterol levels

Muscle-strengthening exercises include push-ups, pull-ups, sit-ups, arm circles, lifting weights (free weights), using strength-training machines, working with resistance bands, and even climbing stairs, carrying heavy loads, and heavy gardening. Anything that provides something for your muscles to push against (resistance) can be used to increase muscle strength. Machine-based exercises are regarded as the safest form of resistance exercise for beginner exercisers.

In general, it’s recommended you target each of the major muscle groups (legs, hips, chest, back, abdomen, shoulders, and arms) two to three times a week. The key is to perform each muscle-strengthening exercise until it would be difficult to perform the movement again without help.

Core Strength. Core muscles help you stand, bend, twist, reach, stoop, and turn. These are the muscles that surround your torso like a corset. They include your abdominals, back, shoulders, and hip muscles. When these muscles are strong, they help you stand up straight (rather than hunching over), and they promote good balance, helping prevent falls. A strong core also helps reduce the likelihood of injuring your lower back.

When core muscles are weak, not only is physical activity more difficult, but eventually daily activities, such as getting dressed, carrying groceries, or vacuuming, can become a challenge. Signs of a weak core include poor posture, lower back pain, and muscle weakness in your arms and legs. Clues you may have poor posture include a head that’s commonly thrust forward, slouching, rounded shoulders, and excessive arching of your lower back with your stomach protruding.

Core muscles can and should be used during all activities. When the core is strong, it automatically supports what you are doing. Pilates in particular is designed to strengthen the core by challenging the muscles during a wide variety of movements. In short, to engage your core, pull in your muscles like you’re trying to zip up a tight pair of jeans. For sample Pilates exercises that strengthen these muscles in various positions, see Hundred Modified, Saw, and Swimming in the Sample Exercises section at the back of this book.

Resistance Training Terms. A repetition, or “rep,” is the number of times you perform a complete movement of a given exercise, such as a bicep curl. A “set” is a group of reps. If you do 10 bicep curls (10 reps), rest, and do 10 more, you have done two sets of 10 reps each time.

The development of muscle strength and endurance is progressive over time. When what you’re doing becomes easy, add more repetitions. When you can do three sets of 10 to 15 reps, it is time to increase the weight or resistance you are using, decrease the number of sets and reps, and begin working your way back up again. Progressively overloading muscles is key to building strength.

Rest one to three minutes between sets and between different exercises to keep your muscles from becoming overly tired. Do not exercise the same muscle groups on two consecutive days. After resistance exercise, muscles need recovery time, as your body starts to repair and replace damaged muscle fibers, forming new strands of muscle protein that result in stronger muscle tissue and, in some cases (particularly in younger individuals and men), bigger muscles. Living in a toned, strong body is a wonderful place to be, and it’s available to virtually everyone. Start where you are and in a few weeks of dedicated, consistent practice you will feel the difference.

Maximizing Power

Muscle power—the combination of strength and speed that determines how quickly your muscles can produce a desired movement—may be even more important than muscle strength for preventing physical disability as you age. It’s muscle power that gets you across a street before the light changes, allows you to hit the brakes quickly when another driver cuts you off, and helps you react swiftly when you trip so you don’t fall. A decline in muscle power has been shown to start earlier in the aging process and progress more quickly than loss of muscle strength. Researchers have found that a person’s muscle power is a better predictor of their functional ability than their muscle strength.

While strength-training exercises are traditionally performed relatively slowly, power training often involves doing the same exercises but contracting the muscles as quickly as possible (for example, bending your arms quickly in a bicep curl and straightening them more slowly, or rising from a chair as quickly as you can then gently sitting back down). Research has found high-velocity power training is safe and effective, even for frail elderly exercisers.

In a study of 45 older adults with self-reported mobility limitations, 12 weeks of high-velocity training improved muscle power approximately twice as much as a traditional strength-training program. Other research shows that high-velocity resistance training not only improves muscle power more than conventional strength training, it also results in greater improvement in physical functioning in older adults, which is the key to remaining active and independent.

Fast-paced resistance exercise is the most-discussed form of power exercise, but research also has found benefits to stair-walking programs and the wearing of a weighted vest while performing certain basic activities. It’s not necessary to use heavy weights or high resistance to increase your muscle power, although using heavier weights will lead to a greater increase in strength and endurance.

Mind-Body Exercise

Mind-body exercises—yoga, tai chi, and Pilates—also have significant health benefits and are excellent low-impact ways to improve strength, flexibility, and balance. These exercise programs, which relax the mind while strengthening the body, are growing in popularity. According to the American College of Sports Medicine, more than 18 million Americans practice yoga and/or tai chi, and 10.5 million do Pilates. Each of these arts can be practiced with or without a spiritual component designed to help users increase mindfulness or gain a deeper level of consciousness.

Yoga. The word yoga means “yoke,” referring to the union of mind and body sought in this ancient, relaxing practice. There are many forms of yoga, but they all focus on postures and breathing. Yoga can be gentle and meditative or vigorous. It’s important to find a level that is appropriate for you. A good instructor will demonstrate how each pose can be modified to fit your level of flexibility, balance, and conditioning, and most classes offer props like foam blocks, straps, and blankets to help you stay safe and comfortable in various positions.

Research shows that regular yoga practice may lower risk for heart disease, with significant positive impacts on body weight, blood pressure, cholesterol, and triglycerides. Yoga, like aerobic exercise, has been linked to a decrease in depression. It also shows promise for managing arthritis, reducing stress, and improving sleep quality. A small trial, published in the February 2018 Complementary Therapies in Clinical Practice, found that people with chronic pain and illnesses who practiced yoga over an eight-week period reported significantly less pain in addition to better balance, increased upper and lower body strength, and a higher quality of life.

Tai Chi. This ancient Chinese mind/body practice combines martial arts with meditation. It is a series of slow movements that are performed with attention to posture and breathing and an awareness of the interplay between force and relaxation. Tai Chi Easy is a specific program designed to be accessible to beginners.

Tai chi is said to improve physical, mental, and spiritual well-being. Research indicates it also shows promise for reduction of stress, anxiety, and depression. It is often recommended for fall prevention because of its role in improving balance (see “Tai Chi Is Effective for Preventing Falls”).

Additionally, a study published in the January 2018 issue of Physical Medicine and Rehabilitation found that tai chi is as good as physical therapy for reducing osteoarthritis pain and may be helpful for patients suffering with fibromyalgia. In this study, after just two weeks, participants found a 20 percent improvement in pain and function.

Pilates. Based on the teachings of Joseph Pilates in the late 1920s, Pilates is a non-impact exercise program designed to strengthen your core muscles while simultaneously developing flexibility, balance, control, and inner awareness. It quickly became popular with dancers and other athletes.

In Pilates, quality is much more important that quantity. The twisting, stretching, pushing, pulling, and rolling exercises are either done on the floor in mat classes or on specialized spring-based machines. Designed by Joseph Pilates, the machines provide both resistance and assistance, which helps you learn the key principles more quickly and deeply. This full-body exercise modality is an excellent choice for post rehab and to enhance any activity, be it golf, tennis, or picking up the grandkids.

Pilates is best started on equipment as a one-on-one training experience with a certified Pilates instructor who has at least 500 hours of education. Because it requires focused, precise, and controlled movements that actively stretch and strengthen the body at the same time, Pilates has become an increasingly popular exercise program within physical therapy centers (see “Pilates for Bones and Joints”).

Movement Matters

Even if you don’t reach the 150- to 300-minute weekly target range, simply replacing sedentary behavior—like sitting at a desk, watching television, or reading—with light-intensity physical activity reduces the risk for premature death from any cause. It also has been found to reduce the risk of developing or dying from cardiovascular disease and decrease the risk for diabetes.

Perhaps even more encouraging for those who have trouble fitting exercise into their schedule is data showing that there is no required duration of exercise sessions needed to achieve benefits. While previous guidelines recommended active sessions of 10 minutes or longer, new data shows that episodes of moderate-to-vigorous activity of any length can be added together to reach a daily total.

If you are already achieving the physical activity target range, increasing your activity even further will enhance the substantial benefits you are already receiving from activity.

Injury Prevention

The best way to prevent injury is to not overdo it. Increase your level of physical activity slowly and choose workouts that are appropriate for any health conditions you may have (see Chapter 9 for more information on exercising with common chronic conditions). Talk to your doctor before you begin any new exercise, especially if you have pain, tightness, or pressure in your chest during normal activity; if you currently experience dizziness or lightheadedness; if you have high blood pressure, pain, stiffness, or swelling that limits activity; or if you feel unsteady or are prone to falls. “No pain, no gain” has been proven wrong. If an activity hurts, stop doing it right away.

Choosing the right workout for your needs or physical limitations and learning the proper technique for performing each exercise can keep you from hurting yourself. Staying hydrated and varying your workouts so you aren’t stressing the same muscle groups every time are important as well.

The main risk is that your muscles may be sore in the first few weeks of starting an exercise program. Although you likely won’t be able to avoid this completely, and it’s important to challenge yourself, one of the best ways to reduce muscle soreness is to gradually progress in your exercise program rather than trying to do too much at the start. Muscle soreness generally resolves by itself within a few days.

Warming up and cooling down also can help prevent injury. Warming up before exercise helps provide a safe transition to moving your body, and cooling down at the end of a session supports your body’s recovery after exercise.

Warm Up

Regardless of what kind of exercise you’re going to do, take about five to 10 minutes at the beginning of your workout to warm up. Warming up helps gradually increase your heart rate and breathing, improving the delivery of oxygen and fuel to working muscles. It also helps warm your muscles so they’re ready to work, which reduces the risk of injury and muscle soreness after exercise.

Avoid static stretches—stretching to a challenging but comfortable position and holding it for several seconds—during the warm-up. Save these for the cool down when muscles are warm. A few ideas of how to warm up include:

• Walk around or march in place while swinging your arms, along with some knee lifts and small kicks.
• Walk up and down stairs a few times.
• Dance around your living room to a couple of songs.
• Mimic some of the same movements you’ll be doing during the actual exercise, but at a slower pace and lower intensity, for example: Warm up for a walk by walking slowly at first, then gradually increase your pace.
• If you’re going to play tennis, hit some easy groundstrokes from the middle of the court. Or, if you are going to play a round of golf, warm up by taking some easy swings on the driving range.

Cool Down

Take about five to 10 minutes at the end of your workout to cool down. It’s a bit like the warm-up but in reverse and can include some flexibility stretches and relaxation breathing. Stretching at the end of your cool down may help increase your range of motion in future exercise. Stretch the same muscles you worked during your exercise session.

Cooling down at the end of your exercise session helps you gradually decrease your body temperature, heart rate, and breathing, as well as reduce the risk of dizziness associated with abruptly stopping exercise. Keeping your arm and leg muscles moving during the cool down helps prevent blood from pooling in your hands and feet and can help reduce muscle stiffness after your session.

While a mix of aerobic and strength-training exercise is ideal—and mind-body and power training are very valuable—any activity, at any level, is better than none. Remember that the benefits of exercise begin to accrue after just one session. According to the Physical Activity Guidelines for Americans advisory committee, just one bout of moderate-to-vigorous physical activity will reduce blood pressure, boost insulin sensitivity, enhance sleep, reduce anxiety symptoms, and perk up cognition on the day that it is performed.

Being active on a regular basis makes these improvements even larger. The reduction in disease risk and improved physical function can be seen within days to weeks aft

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“Older adults may benefit greatly from Pilates exercises, as studies have shown that it can improve balance, strength and flexibility for this population,” says physical therapist and certified Pilates instructor Leena Uranwala, UCLA Medical Center. “The workout can be challenging for any fitness level or modified to accommodate people with various conditions, such as arthritis or those recovering from surgeries or injuries. This is why it is so frequently used by physical therapists worldwide.”

Myth vs. Reality

Here’s the reality behind most of the common myths about Pilates.

➥ It’s too expensive. One-on-one private sessions can be pricy, but to get started, it’s the recommended way to learn the exercises and prevent injuries. You can cut the cost in half by scheduling a “duet” or “semi- private,” session meaning two clients work with one instructor. After a number of these sessions, you can typically transition into small group equipment classes.

In contrast to equipment sessions, mat classes are typically no more expensive than yoga classes and may be free at fitness centers and YMCAs. Silver Sneakers may have live classes in your area (often without charge for those over age 65). Excellent videos can be found from such companies as Stott, Balanced Body, and PilatesAnytime.com (an online professional educational streaming source). All of them offer beginner videos appropriate for older adults.

➥ It’s too hard. To build strength, muscles need be challenged, so a solid effort is required. What distinguishes this from lifting weights is that Pilates is also “active stretching.” By strengthening and stretching at the same time, muscles are less sore in the days following a workout. In the beginning as you are learning, good instructors will keep you focused on doing movements correctly and at your level, which is essential.

➥ It’s just for dancers. Joseph Pilates was a boxer and gymnast. Though popular at dance schools today, in the early days dancers went to Joseph and Clara Pilates to rehab musculoskeletal injuries. As others learned of his method it spread and developed through devoted students. Mary Bowen, age 89, is one of the last remaining so-called “elders” who studied with Joe and Clara Pilates.

Look for Real Pilates

A lawsuit decreed that no one person or business could own the name Pilates. That led to an ever-expanding range of offerings, including some hybrids such as Yogalates and mat certifications that could be earned in a weekend. The best and most authentic Pilates comes from instructors who went through “comprehensive” training, which usually requires 300 hours or more of study. The exercise system taught closer to its original intention will garner the quickest and broadest benefits of strength, flexibility, balance, coordination, and control. Also, seek out Pilates instructors who have experience working with older adults.

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Pilates (pronounced Pea-LAH-tease) is a total body workout, best known for how effectively it develops core muscles. In the method, the core is called the “powerhouse,” because every movement is done with greater stability when it comes from a powerful center.

“Without a strong core, loss of balance can occur,” explains physical therapist Ellen Wilson, Director of Therapy Services, UCLA Department of Rehabilitation. “Almost all Pilates exercises incorporate core strengthening. Pilates movements also carry over to functional movement, so improvement is seen in everyday activities.”

Joseph Pilates has said in 10 sessions you’ll feel the difference, in 20 sessions you’ll see the difference, in 30 sessions you’ll have a whole new body. While that may sound like a big marketing promise, if you take two or three sessions per week for several weeks, it’s really not such a far-fetched claim. Like anything in life, you get out of it what you put into it.

Welcome to the Machines

Most people are introduced to Pilates in group mat classes. But to truly understand and gain the benefits of Pilates, private sessions with a certified Pilates instructor on the machines can’t be beat. Your body is worth the investment. And these sessions provide an unprecedented opportunity to get to know your body better, and feel better in it.

Joe Pilates created several pieces of exercise equipment. The main spring-based machines are the Reformer, Wunda Chair, and the Trapeze Table (also called the Cadillac).

The concept of working with spring-based Pilates machines is similar to working with flexible bands or tubing. The idea is to control the motion as you push, pull, twist or bend. The advantage of working with the spring-based machines is that they support and challenge your movements, and make it easier for you to find and develop core muscles.

Pilates Mat Work

Joe’s original teachings include 34 exercises performed in a sequence. Most classes teach a dozen or so movements until they are mastered and then new ones are added. It’s important in the method to do each exercise correctly. Of course, no one can do these exercises perfectly the first time, which is why instructors offer preparatory exercises and modifications. It’s vital to approach the method with a beginner’s mind and do these foundational exercises. Not doing so can lead to injuries. Pilates exercises point out your weaknesses thereby providing clear knowledge on what needs to be improved. Through Pilates, you can learn how to assess your own body’s capabilities, and what you need to do strengthen specific areas.

Regardless of level, a complete class should include exercises that move the spine in all directions—forward, backward, side-bending, and twisting.

From the Hundred to Swan, Saw, and Teaser, each exercise requires your full attention to get the most out of it. As you progress, the exercise doesn’t change but your relationship to it does. Skilled athletes can make his or her sport look easy, but lots of practice hours are needed to achieve such beauty and grace. You, too, can become stronger, move more gracefully, and feel more at home in your body through Pilates.

Common Principles for Mat and Machine

No matter where it is done, Pilates has several key principles. In general, the emphasis is whole body integration with a focus on quality of movement over quantity of repetitions.

The following six concepts are considered fundamental to the work:

• Pilates wrote “Above all else, breathe.” The general rule is inhale to prepare for the movement; exhale as you move.
• This is a mind and body method where all movements are intentional. Think about and feel your body as you move.
• Exercises are typically done slowly, especially in the beginning. Avoiding momentum requires a lot of control.
• The center, or core, is also referred to as the powerhouse in Pilates. Everything flows out from the center, that corset of muscles that wraps around your torso and includes back, abdominal, hip, and shoulder girdle muscles.
• As in ballet, tennis and other sports, Pilates asks for precise movements. This concept requires knowing where your body is in space (called proprioception).
• Pilates exercises are fluid not statically held, encouraging freedom of movement.

Joseph Pilates was a self-educated movement master. His concepts benefit people worldwide. He wrote two books where he passionately describes his work and philosophy, Return to Life through Contrology and Your Health.

“The exercises are adaptable to all levels of fitness, and can be progressed as you improve,” explains Wilson. “Pilates is also low impact, which is better for seniors with arthritis or painful joints.”

Pilates truly is for every body, at any age. It meets you where are, and can take you where you want to go. Look for instructors certified in equipment and mat (comprehensive certified) and who have been teaching for several years.

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“The effect of exercise on bone health results from the strain on bone created by weight-bearing exercise,” explains Polly de Mille, RN, RCEP, CSCS, USAT, clinical supervisor at the Tisch Sports Performance Center of the Weill Cornell-affiliated Hospital for Special Surgery. “Strain causes a release of molecular signals in the bone that lead to the synthesis of new bone, which makes the bone stronger at the exact site where the strain is applied.”

Activities That Benefit Bones

Weight-bearing exercise is any activity in which you support your own weight; these activities work your bones and muscles against gravity. Brisk walking, jogging, racquet sports, stair climbing, dancing, hiking, jumping rope, and exercising with weights are some of the activities that can help strengthen bones. Other terms for these types of activities are “load-bearing” and “strength-building.” Doing lunges, squats, and jumping jacks also can help your bones.

Here are some recommendations from de Mille for bone-strengthening exercise.

Exercise in short bouts. Bone gets stimulated fairly quickly and reaches a saturation point, meaning there’s no benefit to doing more; it’s better to do 10 repetitions twice daily than 20 repetitions all at once.

Do a variety of exercises for different areas of your upper and lower body, including exercises that target your arms, shoulders, chest, back, hips, thighs, calves, and ankles.

Your muscles attach to your bones at various points, so it’s important to work the muscles in different directions when possible. For example, do leg lifts in different directions—forward, back, and to the side—rather than in just one direction.

Exercises That Are Not Weight‑Bearing

Swimming, bicycling (including stationary and recumbent bikes), water aerobics, canoeing, kayaking, some yoga and Pilates exercises, doing upper‑body exercises while seated or lying down, and range‑of‑motion exercises such as seated leg lifts are not weight-bearing exercises.

If You Have Osteoporosis

If you have already been diagnosed with osteoporosis (see “What You Should Know”for information on bone mineral density testing), exercise can still be beneficial, but you need to be cautious to prevent fractures.

Avoid jumping and other high-impact activities. “It is true that jumping can build bone, but, if you have osteoporosis, jumping can fracture bones,” advises de Mille.

Don’t do crunches, heavy lifting, or other activities that involve bending forward; they put pressure on your vertebrae. “If you have severe osteoporosis, you can sustain a compression fracture of the spine simply by bending over the sink to brush your teeth,” de Mille warns.

If you have a vertebral compression fracture, you may experience sudden-onset back pain that is moderate to severe; if this occurs, see your doctor as soon as possible. If you have one vertebral fracture, you have a much higher risk of having another one, so be vigilant about avoiding activities that can cause these fractures. You may also want to talk with your doctor about treating your osteoporosis with medication if you are not already doing so.

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Pilates is a low-impact, joint-friendly method that invigorates mind and body. It was originally a one-on-one training system done on a mat and also on specialized machines developed by Joseph H. Pilates in the early 1900s. He originally called his system “Contrology” and preached about the benefits of doing his exercises with full concentration and control.

Pilates is a total body workout, best known for how effectively it develops core muscles. In the method, the core is called the “powerhouse,” because every movement is done with greater stability when it comes from a powerful center.

“Without a strong core, loss of balance can occur,” explains physical therapist Ellen Wilson, Director of Therapy Services, UCLA Department of Rehabilitation. “Almost all Pilates exercises incorporate core strengthening. Pilates movements also carry over to functional movement, so improvement is seen in everyday activities.”

Joseph Pilates said in 10 sessions you’ll feel the difference, in 20 sessions you’ll see the difference, in 30 sessions you’ll have a whole new body. While that may sound like a big marketing promise, if you take two or three sessions per week for several weeks, it’s really not such a farfetched claim. Like anything in life, you get out of it what you put into it.

Welcome to the Machines

Most people are introduced to Pilates in group mat classes. But to truly understand and gain the benefits of Pilates, private sessions with a certified Pilates instructor on the machines can’t be beat. Your body is worth the investment. And these sessions provide an unprecedented opportunity to get to know your body better and feel better in it.

Joe Pilates created several pieces of exercise equipment. The main spring-based machines are the Reformer, Wunda Chair, and the Trapeze Table (also called the Cadillac). There are also non-spring-based pieces including the Ladder Barrel, Magic Circle, and the Spine Corrector.

Similar exercises are done on all the apparatuses, but the plane of motion (e.g., forward/back, rotating, side bending) and position of the body (e.g., sitting, standing, lying down) provides a different challenge in each situation.

The concept of working with spring-based Pilates machines is similar to working with flexible bands or tubing. The idea is to control the motion as you push, pull, twist, or bend, while also holding your trunk stable (which requires the use of the core muscles). For example, the exercise may focus on legs, but the whole body is typically involved.

Pilates helps you develop better coordination, precision, and control. The advantage of working with spring-based machines is that they support and challenge your movements and make it easier for you to find and develop core muscles.

Pilates Builds Muscles That Protect Your Back

Pilates, like lifting weights, is a muscle-strengthening regimen. But unlike weights, Pilates exercises strengthen and stretch the body at the same time, in the same exercise.

Elongation is a central concept, and it takes mental focus to feel and achieve this aspect of the work. For example, the whole back and torso can be stretched while also strengthening the smaller stabilizing muscles around the spine.

A stronger core helps you do everything more easily, from opening heavy doors to perfecting your tennis game. Pilates also fosters greater flexibility while building deep hip, shoulder, and spine muscles. That is why Pilates is an exceptional modality for those with back issues. For those without back pain, it offers some insurance against developing chronic back pain.

Pilates Mat Work

In the classical method, there are 34 exercises performed in a sequence. Most classes teach a dozen or so movements until they are mastered and then new ones are added. It’s important in the method to do each exercise correctly. Of course, no one can do these exercises perfectly the first time, which is why instructors offer preparatory exercises and modifications. It’s vital to approach the method with a beginner’s mind and do these foundational exercises. Not doing so can lead to injuries.

Pilates exercises point out your weaknesses, thereby providing clear knowledge as to what needs to be improved. Through Pilates, you can learn how to assess your own body’s capabilities and what you need to do strengthen specific areas.

Regardless of level, a complete class should include exercises that move the spine in all directions—forward, backward, side-bending, and twisting. From the “Hundred” mat exercise to Swan, Saw, and Teaser, each Pilates routine requires your full attention to get the most out of it. As you progress, the exercise doesn’t change, but your relationship to it does. A skilled athlete can make his or her sport look easy, but lots of practice hours are needed to achieve such beauty and grace. You, too, can become stronger, move more gracefully, and feel more at home in your body through Pilates.

Common Principles for Mat and Machine

No matter where it is done, Pilates has several key principles. In general, the emphasis is whole body movement with a focus on quality of movement over quantity of repetitions.

The following six concepts are considered fundamental to the work:

Breathe. Pilates wrote, Above all else, breathe. There’s a lot of focus on breathing correctly during Pilates. The general rule is inhale to prepare for the movement; exhale as you move. And it’s inhale through the nose and exhale through the mouth. Some styles of Pilates (such as through Ron Fletcher) requests an audible shhhh sound on the exhale. There are no absolutes, except you should never hold your breath during exercises.

Concentration. This is a mind-and-body method where all movements are intentional. Think about and feel your body as you move. Focus and concentrate on the details of form.

Control. Joseph Pilates Contrology method alludes to the way athletes train—aligning their bodies, focusing, and controlling movements. Exercises are typically done slowly, especially in the beginning. Avoiding momentum requires a lot of control.

Centering. The center, or core, is also referred to as the powerhouse in Pilates. Everything flows out from the center, that corset of muscles that wraps around your torso and includes back, abdominal, hip, and shoulder girdle muscles. Stabilizing the core is a part of every exercise.

Precision. As in ballet, tennis, and other sports, Pilates asks for precise movements. This concept requires knowing where your body is in space (called proprioception). Precise placement really helps you feel your body from the inside and awakens your awareness.

Flow. Pilates exercises are fluid not statically held, encouraging freedom of movement. In more advanced classical Pilates mat classes, each exercise transitions from one to the next in a continuous flow.
Pilates truly is for every body, at any age. It meets you where are, and can take you where you want to go.

“The exercises are adaptable to all levels of fitness and can be progressed as you improve,” explains Ellen Wilson. “Pilates is also low-impact, which is better for seniors with arthritis or painful joints.”

A Method Born from Illness

Joseph Hubertus Pilates was born in Germany in 1880. As a child, he was plagued by rickets, asthma, and rheumatic fever, and he was determined to overcome these illnesses. Influenced by his fitness-oriented parents (his mother was a naturopath and his father a celebrated gymnastic), Joe studied gymnastics, body-building, boxing, circus arts, and other modalities. He incorporated elements of those sports as well as Eastern and Western movement and wellness ideas into what ultimately became a cohesive and unique method.

Pilates spent some time in England, and after WWI broke out he was imprisoned. It was there that his Contrology method began to take shape. He used bed springs for resistance equipment and motivated prisoners to exercise.

After the war, he returned to Germany and eventually emigrated to the United States. En route, he met a young nurse named Clara, who became his wife and business partner.

They landed in New York City in 1926 where Joe began working in a boxing gym, which the duo eventually owned. Word spread to local dance studios that his unique method helped rehab injuries. Luminaries such as George Balanchine and Martha Graham were among the dancers who went to “Uncle Joe” to fix their injuries. Many became devotees of the method and began to teach it.

In the Pilates world, the instructors who studied directly with Joe and Clara are referred as Pilates elders and are highly respected. Romana Kryzanowska, a dancer, took over the studio in New York after Joe died. She was pivotal in maintaining the integrity of method.

Kryzanowska died in 2013 and left behind a legacy of instructors who passed through her very demanding training program. The term “classical Pilates” is most commonly associated with those who graduated from Romana’s program.

Mary Bowen and Lolita San Miguel, both in their 80s, are two elders who continue to practice and teach Pilates in their own distinct styles.

Joe Pilates wrote two books, Your Health and Return to Life Through Contrology. Like many pioneers, he never experienced the successful outcome of his genius, though he worked tirelessly to promote his method, equipment, and physical fitness as a prerequisite to wellness. Joseph H. Pilates died in October 1967 at the age of 87.

During the decades that followed, first- and second-generation teachers built their Pilates practices across the county. As the popularity of mind-body exercise grew, so too did interest in Pilates. And the term “Pilates” made its way into the dictionary.

A class-action trademark lawsuit was filed in the late 1990s attempting to claim an individual’s exclusive use of the word Pilates. The case was resolved in October 2000 by a judge who deemed that Pilates was a generic term for a form of exercise (like karate or yoga) and that no one person could “own” it. Since that time, Pilates has exploded into the mainstream.

Finding Good Instructors

A well-qualified, certified Pilates instructor will ensure you are doing the exercises correctly and safely. Each session should be challenging as well as reinvigorating.

A well-qualified instructor is one who has had at least 300 hours of training, is fully certified on mat and on all the apparatus, and has at least a few years teaching experience. Most Pilates certifications require knowledge of anatomy. But beware—some people can snag a Pilates certification in a weekend. You want someone who has studied for at least a year or two and then sits for a comprehensive exam. The best certification programs require observation hours and/or apprentice hours in addition to personal practice and mastery of the work.

Don’t hesitate to inquire about an instructor’s training. Doing Pilates exercises incorrectly, especially on equipment, can cause injuries.

Likewise, be sure to ask about an instructor’s experience in working with injuries or conditions that apply to you. Many studios offer discounted introductory sessions so you can determine whether that instructor is a good fit for you. Many physical therapists also incorporate Pilates techniques into their treatment sessions for specific conditions.

You may find group reformer classes in your area. While they are money-savers, it’s not wise to jump into these classes without some one-on-one experience.

Be leery of studios that allow you into an equipment class without some private instruction first. Most instructors recommend at least a few sessions before joining a group equipment class.

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What is “core fitness”? We define the core as the muscles of the hips, pelvis, abdomen, and trunk. Whether you’re sitting or standing as you read this, you’re using core muscles to maintain good posture. If you’re slumping or slouching as you sit or stand, a weak or unbalanced core is probably the problem.

When you rise to a standing position, the core gets you started. When you stand, turn, bend, reach, twist, stoop, carry something, maintain your balance, walk, jog, swim, or participate in any physical activity, the action begins from the center of your body and moves out to your arms and legs.

Core Exercises for Elderly and Young People are Key to Mobility

Core fitness is at the center, literally and figuratively, of strength and power. The most important muscles are those in the hips, trunk, shoulders, and neck— the core. They’re involved in every aspect of daily living. Whether you’re sitting or standing, you’re using core muscles to maintain good posture. Core muscles are necessary for flexibility, strength, and injury prevention. A well-planned program of balance and mobility fits in perfectly with a routine that includes core exercises for elderly as well as young people.

Within the core muscle group, trunk muscle strength is associated with improved balance, daily functions, and prevention of falls. A review of 20 studies investigated the associations between trunk muscle composition and balance, functional performance, and falls in older adults as well as the effects of core strength training and Pilates exercises on those variables. Small to medium correlations existed in both.

The study’s authors concluded that core strength training and/or Pilates exercises can be used as an adjunct or even alternative to traditional balance and/or resistance programs for older adults. Both types are easy to administer in a group setting or in individual programs because little equipment and space are needed to perform the exercises.

The Core and Flexibility

Beyond simply allowing or supporting certain movements, the core is necessary for flexibility, strength, and injury prevention. Flexibility is the ability to move joints through a range of motion. Weak or tight muscles limit flexibility; strong muscles enhance it.

In middle-aged and older adults, tight (less flexible) hamstrings and hip flexor muscles often affect muscles of the core, including those in the buttocks, pelvis, and lower back.

Some sample exercise routines to strengthen core muscles follow. For more exercises, download our free guide called Easy Exercises: How seniors can improve stability and core strength and prevent falls.

SEMI-SITS

(Illustration: Alayna Paquette)

• Stand in front of a chair, feet hip-width apart.
• Engage your abdominal muscles by gently pulling them in and up.
• Slowly lower your buttocks and bend your knees as though you are going to sit.
• Instead, touch the chair seat lightly and return to a standing position.
• Work up to 8-10 repetitions, 2-3 sets
• Variation for beginners and older adults. Lower your buttocks just a few inches instead of going far enough to touch the chair seat. Restrict the number of repetitions to 4-5 and the number of sets to 1-2

MODIFIED PUSH-UPS

(Illustration: Alayna Paquette)

• Lie on your stomach, palms near your shoulders.
• Slowly move your head, neck, shoulders, and upper core upward, keeping your head up, and looking ahead.
• Lift upward until your arms are fully extended. Avoid arching your neck.
• Work up to 8-10 repetitions, 2-3 sets.
• Variation for beginners and older adults: Restrict the distance your torso moves upward by not fully extending your arms.

LUMBAR ROTATION

(Illustration: Alayna Paquette)

• Lie on your back, legs bent, knees together and on the floor at your left side, and arms extended outward. Try to keep your shoulders grounded.
• Engage your abs (in and up), keep your upper body still, and slowly roll your knees from the left to the right until they touch the floor, or come as close to the floor as possible without lifting your shoulders.
• Hold for a few seconds, breathe easily, then roll your legs to the opposite side to complete one repetition.
• Variation for beginners and older adults: Reduce the number of reps to each side and/or the number of sets. Take 3-4 deep breaths after each rep.

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Originally published in 2016, this post is regularly updated.

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1. Great. It’ll be good for you.
2. Go with the program, but with certain restrictions.
3. A strength- or power-training program is not advisable at this time, but may be appropriate at a later date (probably after you have fully recovered from your injury, surgical procedure, or illness).

Limitations

Many conditions could present risks or exercise limitations, but in almost every case, a resistance-training program can be modified to fit individual needs. The following are examples, but they do not necessarily or automatically disqualify you from modified strength-training exercises. Again, check with your doctor. Chapter 3 includes 14 ways to modify exercises.

• Blood clots
• Cardiovascular disease family history
• Chest pain
• Chronic lung disease
• Diabetes
• Eye injuries/surgery
• Foot/ankle sores
• Heart disease
• Heart palpitations
• Hernia
• Hypertension
• Infections
• Knee/hip arthritis
• Pain walking after a fall
• Recent or chronic orthopedic injuries
• Shortness of breath
• Smoking

How do you compare?

The following informal self tests can be done at home and give you a rough idea of your current strength or lack of strength, power, and other fitness components. They can also double as strength-training exercises. They are safe, but you need to be careful. It’s okay to practice each move before taking the tests.

30-second chair stand

• Measures: Lower body strength, core strength, and muscle endurance.
• Equipment: Sturdy, straight-back chair with no arms, stopwatch.
• Instructions:
  • Sit in the chair with your arms crossed at the wrists.
  • When your test partner says “Go” complete as many sit-stand repetitions as you can in 30 seconds.
  • Don’t use your hands to push off. Rise to a full stand then sit all the way down (no touch and rise).
  • Box 2-1, “Normal range scores: 30-second chair stand,” gives normal range scores for men and women 60 years and older.

Arm curl

• Measures: Upper body strength.
• Equipment: An eight-pound weight for men; a five-pound weight for women (to conform to established testing norms), straight-back chair with no arms, stopwatch.
• Instructions:
  • Begin in a sitting position, arm straight down holding the dumbbell.
  • When your test partner says “Go” complete as many curls as you can in 30 seconds.
  • Move in a controlled manner, and touch the upper arm with the hand holding the weight with each repetition.
  • Box 2-2, “Normal range scores: Arm curl,” gives normal range scores for men and women 60 years and older.

Timed up-and-go

• Measures: Combination of strength (getting up), power (moving with speed), balance, and agility.
• Equipment: Chair, cone/marker eight feet from chair, stopwatch.
• Instructions:
  • Begin in a sitting position, hands on thighs, feet flat on floor, one foot slightly forward.
  • When your test partner says “Go” and starts the stopwatch, rise and walk as quickly as possible around the marker and back to your seat.
  • When you are seated, your test partner stops the watch and records your time to the nearest tenth of a second.
  • Box 2-3, “Normal range scores: Timed up-and-go,” gives normal range scores for men and women 60 years and older.

Finding a program

Anyone can begin a strength-training program at home. All you need is the right equipment, a little space, and an exercise guide (like this Special Report) or program to follow.

Although not a requirement, having a workout partner is a good idea for most people beginning a strength-training program. A friend, spouse, or other family member can assist with some exercises and share the same equipment. A workout partner also helps relieve the monotony of doing repetitive exercises.

Community centers and wellness facilities offer strength-training programs where others work out, but each person has to do most of the work alone. The National Council on Aging (www.ncoa.org) endorses programs that are proven to produce measurable health benefits, including strength training for older adults. The programs are administered through providers in local communities. They include:

• Active Living Every Day (ALED) uses a ALED book, and offers online support for participants.
• EnhanceFitness involves one-hour group classes that include stretching, flexibility, balance, low-impact aerobics, and strength training.
• EnhanceWellness is a self-care wellness program that involves a nurse and social worker who help develop an individual health and fitness plan.
• Fit and Strong combines flexibility, strength training, and aerobic walking with health education for older adults with lower extremity osteoarthritis.
• Healthy Moves for Aging Well is an in-home physical activity intervention for sedentary seniors.
• Walk with Ease is an Arthritis Foundation program that helps participants meet their needs, stay motivated, manage pain, and exercise safely.
• S.A.I.L. (Stay Active and Independent for Life), offered by UCLA, is an evidence-based flexibility, balance, strengthening, and aerobic exercise and education program, focused on fall prevention in the senior population.

Other facilities

Colleges and universities, wellness centers, YMCAs, hospitals, and physical therapy clinics also offer fitness and strength-training programs. Here, a fitness specialist conducts an assessment, recommends a program, instructs you on resistance training technique, and keeps an eye on you (and others) while you exercise.

Expect a one-time assessment cost of $50 to $100, then a monthly fee of $7 to $10 per session or $40 to $80 per month that should include two to three sessions per week (prices vary with location). Some programs are offered free to older adults or may be covered by health insurance (check with your provider).

Personal trainers

At home or in a fitness facility, personal trainers are another option for some. They can design and supervise individual strength-training programs, and you will be charged by the hour, or by a flat fee for a specified number of sessions. A National Strength and Conditioning Association survey found this costs an average of $50 per hour, but prices vary widely.

The advantages of having a personal trainer are expertise, instruction, efficiency, accountability, supervision, and motivation. The disadvantages are cost and difficulty in finding a trainer who is qualified and with whom you are comfortable.

The rate of turnover among personal trainers is high. Try to find one who is a career personal trainer instead of a person who does it part time or who is transitioning from one position to another. Get references and ask friends or family members for recommendations.

Make sure personal trainers are certified by one of the nationally recognized agencies—the National Academy of Sports Medicine, American College of Sports Medicine, National Strength and Conditioning Association, or American Council on Exercise.

Types of equipment

The most available and least expensive type of resistance-training equipment is you. Body-weight exercises can help any muscle or muscle group become stronger. Entire strength-training programs can be designed using only body-weight exercises.

Push-ups, sit-ups, and pull-ups are examples of the classic, old school body-weight exercises, but several varieties of the “Superman” exercise (see Box 2-4, “Superman”) are now used to strengthen core muscles.

Free weights

A free weight is one that is not attached to an apparatus. Dumbbells (handweights) and barbells are the two most frequently used free weights, but dumbbells (not barbells) are a good match for beginning strength-trainers and older adults. Begin with two- to three-pound weights for each hand, and gradually move up to dumbbells that weigh five pounds or more.

Vinyl-covered dumbbells are often easier to grip and hold than traditional metal dumbbells. They cost from $80 to $125 for a complete set. You can get started with light-weight dumbbells, if desired, for much less. Entry-level exercisers need a set that includes weights of one to eight pounds (with increments in between).

Kettlebells have become an increasingly popular free weight. They are cast iron weights of between five and 100-plus pounds, and used for a variety of swinging and pulling motions that involve momentum and centrifugal force. If you are a middle-aged or older adult and want to exercise with a free weight, stick with the dumbbells for now and consider kettlebells later.

Another equipment option is home-made free weights, such as water-filled milk cartons, or vegetable cans that weigh between one and three pounds. Any household object can substitute for a dumbbell, but for safety’s safe, make sure it’s something with a handle.

Stability balls

Stability balls are excellent for stretching and strengthening core-related muscles, but they can be used with weights for other muscle groups, as well (see Box 2-5, “Stability Ball Arm/Knee Lift”). The instability of sitting or lying on the ball forces one to use his or her core muscles to keep the body level.

It’s important to use a stability ball that is the right size. When sitting on one, your thighs should be parallel to the floor. Box 2-6 “Choosing the right size stability ball,” shows how to match individual height with the size of the ball. Prices begin at about $15.

The greater the inflation of the ball, the less stable it is as a base, so the more effort from core muscles are needed to stabilize it. Less air is better for beginners and intermediates.

Resistance bands

Resistance bands are inexpensive, space-saving, stretchable bands or tubes made from natural or synthetic rubber. Use them almost anywhere to work through a range of movements against resistance. Curls, shrugs, leg swings, and squats are examples (see Box 2-7, “Resistance band squats”).

However, there are limitations. Bands get old and lose their resistance feature, the amount of resistance is hard to measure (with free weights, you know exactly how much you are lifting), and the amount of resistance changes throughout the exercise motion.

Colors indicating amount of resistance vary among manufacturers, but with all of them the force is directly related to the percentage of elongation. The amount of resistance ranges from 3.3 pounds to about 22 pounds.

Check the bands before every workout for nicks and tears, don’t wear rings while using them, and avoid storing them in extremely hot or cold temperatures. Replace them every three to four months. Resistance bands are inexpensive—about $10 for a box of basic bands to $100 for bands with added features like handles (see Box 2-8, “Resistance bands with handles”).

Medicine balls

Medicine balls can help develop strength, power, and balance, but they are most effective for dynamic movement (strength plus speed of movement). Traditional medicine ball exercises were designed primarily for core muscles, but now they are also used for other muscle groups and can be incorporated into strength-training programs. Weights range from two to 30 pounds, and having several balls of varying weights allows for a variety of exercises and differences in exercise load. Prices begin at about $20.

Cuff weights

Cuff weights with Velcro-type straps wrap around wrists and ankles to provide resistance during movement. Some have a single weight, but most allow to you to add and remove small weight plates (one pound each) to increase or decrease the load. They are particularly effective for people who might have trouble gripping a dumbbell or similar weight, but who would benefit from performing upper body exercises with weights attached to their wrists or ankles. A single cuff weight costs less than $15; a complete set is $100 or more.

Chairs (for chair-based exercises)

If you need extra support or lack mobility, chair-based exercises might be a way to perform strength-training exercises. The concept was confirmed by a study published in BMC Geriatrics (see Box 2-9, “Chair-based exercises enhance strength and flexibility in older adults”). From a sitting position, examples include leg extensions and arm curls. Box 2-10, “Resistance band seated curls,” illustrates a method of incorporating resistance bands into a chair-based routine. Any kind of chair will work as long as it’s sturdy, not too light, and has a straight back for support.

Weight machines

Weight machines are for people working out at wellness or fitness centers, and for more experienced exercisers. They are not for people beginning a strength-training program at home. Wait until you are more certain of your commitment and strength training goals before investing in weight machines.

The advantages include focusing on one muscle group at a time, performing an exercise through a specific range of motion, controlling movement, and using proper form throughout the lift.

The disadvantages are the cost (a few hundred to thousands of dollars), the lack of “functional fitness” movements, the emphasis on one muscle group instead of simultaneous muscle group movements (which can lead to muscle imbalance), and difficulty in adding small amounts of weight (most machines can be adjusted, but in increments of five to 10 pounds at a time).

Complementary forms of exercise

Yoga, tai chi, and Pilates are forms of exercise defined by the National Center for Complementary and Alternative Medicine (NCCAM) as alternative or complementary. All three have gained immense popularity in the United States in the past two decades.

The National Center for Health Statistics reports that more than 21 million Americans, including three percent of those aged 65 and older, have participated in yoga in the past year (see Box 2-11, “Twenty-one million Americans have done yoga during the past year”). More than two million people in the country engage in tai chi, and as many as eight million sign up for Pilates classes annually.

All three forms of exercise provide health and fitness benefits, but their contributions to strength and power depend on the type of yoga, tai chi, or Pilates exercises, movements, and poses performed. Their direct associations with strength development are difficult to measure, but not impossible.

A study in the Journal of Aging and Physical Activity found that yoga resulted in moderate improvements in gait, balance, flexibility, weight loss, and lower body strength. The International Journal of Yoga reported that yoga enhances muscular strength and flexibility.

As with traditional forms of strength training, improvement though yoga, tai chi, and Pilates comes only when they involve the principles of overload, progression, and specificity. None of the three basic forms incorporate movements that would increase power.

Yoga

Yoga is not a single exercise program, but rather a mind/body series of movements, postures, breathing techniques, and meditation/relaxation. There are more than 20 styles, including Hatha yoga, which is the form most often used in the United States and Europe. Other popular styles include Iyengar, Ashtanga, Kundalini, and Bikram. Here is a more detailed look at each.

• Hatha itself incorporates simple poses (see Box 2-12, “Yoga”), called asanas, that flow from one to the next. Participants are allowed to move at their own pace. One of the main benefits is controlled breathing, or improving oxygenation of the body to alleviate stress.



• Iyengar is characterized by attention to detail in poses, poses held for longer periods of time, and using props, such as chairs, straps, belts, blankets, blocks, and pillows, to compensate for a lack of flexibility. Iyengar yoga has been called meditation in action. Its benefits are said to include muscle toning, tension elimination, and easing chronic pain, as well as to “strengthen weak areas and stretch tight ones.”
• Ashtanga, also called power yoga, is popular among athletes because of its emphasis on developing strength, flexibility, and stamina. The sequence of poses range from simple to difficult, and students move quickly from one pose to another. Poses include combinations of standing, sitting, back extensions, inversions, balancing, and twisting. Ashtanga does not reply on props for support and is often not advised for beginners and those with flexibility issues.
• Kundalini is a gentler form of yoga that focuses on mind, body, and emotion, and incorporates poses, body locks, chanting, meditation, visualization, and guided relaxation to achieve its goals.
• Bikram (also known as “hot yoga”) is a 90-minute program performed in heated environments (100-plus degrees Fahrenheit), where 26 poses are performed in a specific order. The exercises are described as physical and intense, designed to raise the heart rate and exercise muscles to a point of fatigue. They are recommended only for extremely fit individuals, and should be avoided by most older adults and all beginning exercisers.

The NCCAM provides the following guidelines for those considering yoga as a form of exercise:

• Do not use yoga to replace conventional medical care.
• Talk to your doctor before beginning a program, especially if you have a medical condition.
• Ask a trusted healthcare provider to recommend a yoga instructor.
• Choose a yoga style that best fits your ability.
• Advise all of your healthcare providers about complementary practices you use, including yoga.

Tai chi

Tai chi is a combination of relaxation, meditation, deep breathing and slow, continuous exercises called forms. The number of forms ranges from 18 to more than 100. Newcomers can begin with one brief (five-minute) session and gradually increase the number and duration of sessions each week.

Tai chi can improve balance, lower the risk of falls, and provide a sense of well-being. Reputable health institutions associate tai chi with less joint pain and better aerobic capacity, energy, stamina, and flexibility, but conclusive evidence regarding tai chi and strength is hard to find.

An often cited study was conducted at Stanford University and published in Alternative Therapies in Health and Medicine. Here, 39 women, average age 66, with below-average fitness and at least one cardiovascular risk factor, took 36 tai chi classes over the course of 12 weeks. Tests taken before and after the trial showed that the subjects significantly increased strength and flexibility in the upper and lower body.

Tai chi is safe for most people and effective for specific goals (balance, fall prevention, feeling of well-being). While its value for strength training is still debatable, it is not a way to improve power. People with the following conditions should consult a physician before enrolling in a tai chi program:

• osteoporosis
• chest pain with minimal exertion
• severe shortness of breath
• dizziness or fainting spells
• uncontrolled high blood pressure
• gait and balance disorders

Pilates

Pilates is generally recognized as a means of building strength in core muscles, which has a direct or indirect effect on other muscle groups and is particularly beneficial for improving posture. It consists of 25 to 50 low-impact strength, flexibility, and endurance movements, most of which are performed on the floor, a mat, or specially designed Pilates equipment called reformers. Programs can be individualized for beginners and older adults.

A study in the Journal of Strength & Conditioning Research suggested that individuals can improve their muscular endurance and flexibility using relatively low-intensity Pilates exercises that do not require equipment or a high degree of skill. Other studies have shown that Pilates may be useful in regaining strength following debilitating conditions.

Even so, support in the scientific and medical communities for Pilates appears to be hindered, not necessarily because of the practice itself, but by a lack of clinical studies.

As with yoga and tai chi, talk with your doctor before beginning a Pilates program. It is not recommended or should be modified for people who have high blood pressure, a risk of blood clots, severe osteoporosis, or a herniated disc.

Apparel

Workout clothes vary with the activity. For traditional resistance training, all you need are comfortable shorts, tops, and sneakers. For some exercises—yoga and Pilates, for example—most people prefer tight-fitting, stretchable pants (and/or tops) that don’t bunch up or slip on mats. Comfort is important in lifting weights or using weight machines, so loose-fitting tops and bottoms are okay as long as they don’t interfere with the exercise or get caught in machines.

Proper footwear is important, but high cost does not necessarily mean better quality. Basic sneakers and training shoes are available in the $50 to $100 range. More important considerations are fit, traction (to avoid slipping), lateral support, comfort, durability, and a design that complements your resistance exercise of choice.

Fashionable colors and styles elevate the price, but don’t necessarily enhance the experience. However, never buy shoes off the rack. Make sure to get professionally fitted at a running or other specialty store to ensure you buy shoes that fit your arch and foot width. Also, most athletic shoes should be purchased a half-size larger than your regular, everyday footwear.

Studio wraps for yoga and Pilates are less expensive than shoes, and no-slip socks are a consideration, but talk with friends or the instructor before investing a lot of money in footwear. You can always upgrade later.

Weight gloves for resistance training are available, but unless you need padded gloves to protect your hands, they are not must-have accessories.

Compression sleeves for arms and calves are designed to increase circulation in an area of the body. Better blood flow decreases the likelihood of swelling, but unless you are already using them for medical reasons, there is probably no reason to use them during resistance training. Ask your doctor.

Nutrition and strength

As mentioned in Chapter 1, age-related loss of muscle mass and muscle strength is a particular concern among middle-aged and older adults. Maintaining and building muscle and bone strength requires a combination of strength training plus three specific nutritional factors—protein, vitamin D, and intake of fruits and vegetables.

Protein

Protein is a building block for muscle and bone health and helps support the growth and recovery of body tissue after exercise. Current United States Department of Agriculture (USDA) dietary guidelines for Americans suggest men age 50 to 70 consume 56 grams (g) of protein per day, while women should eat 46 g. (Men and women have the same protein requirements per kilogram of body weight, but men usually weigh more than women, so they require more protein.)

Of course, these are estimates, and an individual’s requirements depend on factors like height, weight, past medical history, and activity level.

To find your individual protein number, convert your weight to kilograms (kg) by dividing that number by 2.2 and then multiplying that figure by 0.8. For instance a 150-pound person would weight 68 kg and thus need a minimum of 54.4 g of protein per day. You should increase this amount by about 1.2 to 1.5 grams when you exercise.

While lean meats like beef, chicken, and fish are popular protein sources, you can also opt for plant sources like beans, legumes, nuts, seeds, quinoa, soy, and leafy greens (like broccoli), which offer more dietary variety. A scoop of whey or vegan protein powder added to a smoothie or mixed into oatmeal or yogurt also can help supplement your intake.

Vitamin D

Vitamin D helps fuel muscle growth and is necessary for calcium absorption in order to keep bones strong and healthy. Adequate vitamin D comes with safe exposure to sunlight and/or food or supplementation, if required. Sensible sun exposure is 10 to 20 minutes on the arms, legs, and face (or approximately 50 percent of your body), two or three times a week. Vitamin D is naturally present in few foods. Cod liver oil is a rich source, as is some oily fish, such as tuna and salmon. Most milk, orange juice, yogurt, cheese, cereals, breads, and soy drinks are fortified with vitamin D. Check with your doctor before taking any vitamin D supplement. The recommended dietary allowances for vitamin D are:

• 600 international units (IU) for men and women age 51 to 70
• 800 IU for those older than age 70
• 800 to 1000 IU for those who are vitamin D deficient

A blood test from your doctor can determine if you are deficient. It is best to get tested in the winter or early spring when vitamin D levels are often the lowest due to reduced sunlight exposure.

Fruits and vegetables

Excessive intake of acid-producing foods, when combined with a low intake of fruits and vegetables, may have a negative effect on muscle and bone health.

The USDA recommends two cups of fruits per day for people 51 years and older who get less than 30 minutes of moderate physical activity per day beyond normal activities. Those who are more active may be able to consume more while staying within calorie needs.

The USDA recommends two-and-a-half cups of vegetables per day for men 51, and older and two cups for women. Again, those who are more active can consume more.

Same-day eating and exercise

Three organizations—the American College of Sports Medicine, the Mayo Clinic, and the American Heart Association—give the following suggestions regarding same-day nutrition and exercise in general. While these are not for strength training specifically, they can be used as a guideline for all strength-training workouts.

Before

Eat at least an hour before mild-to-moderate exercise with the emphasis on carbohydrates, and include foods such as whole-grain cereals, bread, juices, water, coffee with breakfast, fat-free yogurt, pancakes, waffles, and fruits.

Eat large meals at least three to four hours before vigorous exercise, small meals (more than a snack) at least two to three hours before you begin, and snacks (apples, bananas) an hour prior to exercise.

After

After strenuous exercise, the American Heart Association recommends refueling with fluids (water or water blended with 100 percent fruit juice, carbohydrates (the main fuel for muscles), and protein (to repair and grow muscle tissue.)

Among the suggested foods are whole-grain English muffins, bagels, crackers, low-fat chocolate milk, juice-water blend, energy bars, low-fat granola bars, yogurt, fruits, smoothies, vegetables, peanut butter sandwiches, pretzels, and pasta.

Several studies have shown that chocolate milk provides “unique benefits” during the recovery period after strenuous exercise. Endurance athletes (not older adult strength trainers) who drank fat-free chocolate milk had elevated markers of muscle protein repair compared to those who drank carbohydrate beverages. Still, it may be helpful for older adults and you can consider adding to your recovery nutrition.

Calorie needs

Calories are fuel used for exercise. NIH SeniorHealth recommends the following calorie intake for women and men age 50 and older:

Women

• 1,600 calories a day if the level of physical activity is low (only performs activities associated with day-to-day life)
• 1,800 calories daily if moderately active (walks the equivalent of one to three miles a day at three to four miles p er hour)
• 2,000 to 2,200 calories if an active lifestyle (walks the equivalent of more than three miles a day at three to four miles per hour).

Men

• 2,000 to 2,200 calories a day if level of physical activity is low (only performs activities associated with typical day-to-day life)
• 2,200 to 2,400 calories daily if moderately active (walks the equivalent of one to three miles a day at three to four miles per hour)
• 2,400 to 2,800 calories if highly active (walks the equivalent of more than three miles a day at three to four miles per hour)

To determine the recommended intake of calories, grains, vegetables, fruits, dairy products, and protein based on your height and weight, go to the USDA’s choosemyplate.gov and type My Daily Food Plan in the search engine. This can help you create an individual nutrition plan from which to begin.

Preventing injuries

Exercise carries the risk of injury, but you can reduce the risks in several ways, beginning with warming up before a resistance training session and cooling down afterward.

Warming up

Regardless of the activity, every workout should begin with a warm up—the more prepared the body is, the less likely it is to get injured. But don’t confuse warming up with stretching—whatever you do, don’t stretch first. One sure way to strain a muscle or muscle group is to stretch it too far before doing any physical activity. A proper warm up for resistance training involved three stages:

Stage 1: Warm up to loosen up

Do something to slowly elevate your heart rate, increase circulation, raise the temperature of your muscles, and break a sweat. Wearing warm-up apparel while doing light physical activity is enough to increase the body temperature. Calisthenics, slow-paced swimming or cycling, and moderately paced walking or slow jogging can be effective first-stage warm ups.

Foam rollers are also a way to loosen muscle tissue. They involve applying pressure to the target area using the foam roller and changing the area of pressure by rolling back and forth along the length of the muscle. Foam rollers are inexpensive and can be an effective replacement for some of the stretches or massages normally performed in the second warm-up stage.

Stage 2: Static stretches

The second stage of a warm up is a little more complicated and a lot more controversial. Flexibility should be a part of every good warm up, according to the American College of Sports Medicine, but how to incorporate flexibility into the warm up is unclear.

Static stretches involve gently stretching a muscle or muscle group to a point of resistance and holding (but not bouncing) in that position for about 10 to 30 seconds. UCLA physical therapists recommend it for muscles known to be at risk of injury during certain activities, for muscles that have been previously injured, and for preventing diminished flexibility.

Stage 3: Dynamic stretches

Dynamic stretches move the body through a range of motion that mimics the activity that will follow. Dynamic stretches used to simply be called “warming up.” Golfers and tennis players warm up by hitting shots they’ll need on the course or court. Warming up for resistance training during stage two could be as simple going through the motions of exercises you will perform, but at slower speeds and with less resistance.

Ballistic stretching

The one kind of stretching to avoid is called ballistic. Ballistic stretches involve rapid, bouncing movement that moves the joint beyond its normal range of motion, or a range of motion limited by muscle tightness. Ballistic stretching can cause injury and soreness, and it doesn’t allow enough time for the muscle tissues to adapt to the stretch. Instead of relaxing the muscle, it increases tension and makes it hard to stretch the surrounding connective tissues. Remember: no ballistic stretching and no bouncing.

Once you’ve completed the three warm-up stages—1) increased circulation/body temperature; 2) static stretching, if recommended by your physician or therapist; and 3) dynamic stretching—you are ready to begin your resistance training exercises.

Cooling down

You are not finished once your session ends. Take a few minutes to cool down. It reduces the risk of blood pooling in your legs, avoids the risk of a sudden drop in blood pressure, and allows your pulse rate to return to normal in a controlled manner.

A general guideline is to cool down until your pulse rate drops below 120 beats per minute, but that number does not take into consideration individual differences or age-related target heart rates. Your level of fitness improves as your recovery time declines. Here are some cool-down strategies:

Walk slowly for a few minutes after a session, or ride an exercise bike.Take a few minutes to go through some static stretches—the kind you do as part of your warm up. Static stretching increases subsequent range of motion. Include stretches for the upper body, core, and lower body.

See Box 2-13, “Lunges,” Box 2-14, “Back extensions,” and Box 2-15, “Overhead reach,” for examples of cool-down static stretches.

10 safety guidelines

The best way to lessen the risk of injury during resistance training is to use correct form. Specific technique instructions for 40 exercises are given in Chapter 3. Here are general safety tips:

1. Begin with a weight you can comfortably lift eight to 12 times to complete a set.
2. Choose lifts that involve the major muscle groups—arms, legs, chest, back, shoulders, and abdominals—but not all at the same time.
3. Move the weight in a smooth, controlled manner—don’t rush or jerk the weights.
4. Maintain a grip that is firm, but not too tight.
5. Stop if you experience pain in your joints. However, expect general muscle soreness at first.
6. Maintain upright posture when the exercise allows it—back straight, head up, shoulders back.
7. Use muscle strength to move a weight, not momentum created by the weight itself.
8. Breathe out as you lift a weight; breathe in as you lower it. Avoid holding your breath at all times.
9. Work toward completing two to three sets with good technique before increasing the load.
10. Rest 48 hours between lifts involving the same muscle groups.

Common injuries

If you do get hurt during resistance training, some of the more common injuries are muscle soreness, blisters, strains, sprains, and cramps.

Older adults have a higher risk for many types of injuries, including those sustained while exercising, but there are ways to make strength training an injury-prevention strategy rather than an injury-risk factor. A 2014 study found that older adults are particularly susceptible to shoulder injuries (see Box 2-16, “The shoulder is a common injury site in resistance training”). Here is a look at other common injuries you may encounter:

Muscle soreness

Muscle soreness (see Box 2-17) is normal when beginning an exercise program and should resolve itself within a couple of days. Minimize it by warming up properly, gradually increasing exercise intensity and duration, and not overdoing it.

Delayed onset muscle soreness (DOMS) is also a condition involving muscle overuse that usually develops a day or two after an especially hard workout. While some soreness after almost any vigorous exercise session is normal, DOMS is less common and probably indicates you have stressed the muscle tissues beyond their normal capacity.

The discomfort begins at a muscle-tendon junction and spreads throughout the affected muscle. DOMS lasts for a couple of days, but it’s not a serious condition and the symptoms go away with rest.

Blisters

The most likely places for blisters (see Box 2-18) to develop for resistance-training exercisers are on the hands, but wearing gloves can reduce the risk.

Most blisters heal by themselves when the source of friction is removed. If the top area of the skin remains intact, a doughnut-like pad placed over the top protects the skin and relieves the discomfort. The fluid can be drained if you have access to a sterile needle, but the overlying skin should be left as a protective dressing.

If the skin has already been removed, treat the area as an abrasion. Wash it with mild soapy water or an antiseptic, then cover with a bandage, or ask about over-the-counter medicated blister dressings at a pharmacy. If the blister is not showing signs of healing within a few days, consult a physician.

Strains

Muscle strains (see Box 2-19) refer to stretched or torn muscles or tendons. They can occur almost anywhere, but especially the shoulders, neck, abdominal area, back, hip/groin, and legs. The injury often happens when a person needs to exert force with speed, but does not usually happen in strength training. It can be more of a problem with power training.

Strains are graded 1, 2, or 3 by physicians, according to the severity of the injury. Exercisers at higher risk for strained muscles are those who have a history of the injury, those who are overweight, and those in poor physical condition.

When the muscles are fatigued, overused, or not adequately warmed up, they are at increased risk of a strain. An imbalance between weak and strong muscles (hamstrings and quadriceps, for example) can also cause the injury, as can simply having an overly tight muscle group.

The initial treatment is rest with ice applications for 15 to 20 minutes, three to four times a day for the first 48- to 72-hour period. After that, apply moist heat for the next 48- to 72-hour period, three to four times a day. If possible, use pillows to elevate the affected area during the first day and night.

Over-the-counter medications like aspirin, acetaminophen, ibuprofen, and naproxen may relieve pain. All but acetaminophen reduce both pain and inflammation. (Note that this may not be safe for older adults, so check with your doctor.)

Sprains

Although any joint can be sprained (see Box 2-20), the ankle is the most frequently injured part of the body among exercisers. The severity of the injury ranges from one that allows the person to return to normal activity in a few days to an injury that keeps a person out of action for several weeks. Those who have had a sprained ankle are the ones most likely to suffer the same injury again.

A sprained ankle is a stretch, tear, or rupture of at least one of the ligaments that hold the bones of the ankle joint together. The tears may be microscopic in size or large enough to represent a complete disruption of the fibers. One of the ligaments that wraps around the outside of the ankle is the weakest of the ankle ligaments, and is the one most frequently injured. It is possible that all three ligaments supporting the ankle, from front to back, may be sprained.

Symptoms vary according to the severity and grade—1, 2, or 3—of the sprain. The best-case scenario is mild pain, localized swelling, and tenderness, but no instability. You can walk, but don’t try to jog or jump. Grade 2 and 3 sprains involve greater pain, a popping sound, bleeding, bruising, ankle instability, and difficulty in walking.

First aid is rest, ice, compression with an elastic bandage, wrap, or support device, elevation, and pain medication.

Some sprained ankles may be prevented by wearing protective shoes with side-to-side support, bracing or taping the ankle, and following the rule that says do not increase the resistance, frequency, or duration of an exercise by more than 10 percent a week.

Cramps

More than 90 percent of muscle cramps (see Box 2-21) happen in the hamstrings (back of the thighs), quadriceps (front of the thighs), or calves (back of the lower leg). The symptoms are unmistakable: sudden, involuntary, and painful muscle contractions.

Cramps can be caused by fatigue, hot and humid weather, prolonged overuse, dehydration, and electrolyte deficiencies. Electrolytes are potassium, calcium, and sodium, and people who take diuretics can develop electrolyte imbalances.

Attempts to relieve cramps include stretching the affected muscle group, applying pressure, and/or massage. A common mistake is trying to resume exercise immediately after the pain subsides. It won’t work, and the muscle is likely to cramp again. If cramps persist, apply cold packs for 15 to 20 minutes, three to four times a day.

Reduce the risk of cramps returning by performing easy stretches and drinking plenty of fluids before, during, and after vigorous exercise.

Another way to help with cramps, as well as muscle soreness, is by using foam rollers over the problem area. These small cylinders of compressed foam are color coded according to firmness. White rollers are the softest, followed by blue or green (medium density), and black (firmest). White rollers are best for seniors and beginners, as they are the least dense and will allow some movement between the muscles, bones and the roller, and produce less pressure and pain.

Most foam rollers have a six-inch diameter with lengths ranging from 12 to 36 inches. A longer 36-inch roller is ideal for your back, as it will allow you to roll with it perpendicular to your back without worrying about slipping off the ends.

What’s next?

The next chapter, 40 Strength & Power Exercises, contains 40 total resistance-training exercises for the upper body, core, and lower body. Each exercise has a name, corresponding number for easy reference, instructions, and illustration.

The post 2. Before You Begin appeared first on University Health News.

Enroll in programs for groups or do your own program at home. Your problem won’t be finding a program, but in choosing one that is right for you.

Sticking with the program

The biggest problem with exercise programs is that too many people don’t stick with them. A recent study showed that about half of older women who enrolled in programs dropped out (see Box 2-1, “Lack of motivation cited as factor in high drop-out rate among older women in exercise programs”).

One of the most important factors in choosing the right program—and sticking with it—is to know what you expect to get out of it. What are your goals with improved flexibility? Strength? Balance? Overall fitness? Prevention? All of the above?

All of those expectations are reasonable, but your chances of succeeding are better if you set a few modest, realistic goals, and keep track of your progress. Give your program time to work—weeks and months, not days.

A study in Current Gerontology and Geriatrics Research found that goal setting, among other factors, is beneficial in getting adults to adhere to exercise programs (see Box 2-2, “Setting goals increases adherence to group exercise programs”).

Finding a good program match is also more likely if you choose one that has built-in supervision and support (see Box 2-3, “Supervision helps adults adhere to exercise programs,” on the following page). Doing flexibility exercises at home is quick and easy, but having an exercise partner or a group of exercisers with the same goals is more likely to become a good habit instead of a one-and-done experience.

Getting enjoyment and positive results significantly increases participation in physical activity, according to a survey of adults engaged in a National Council of Aging-approved program called Active Living Every Day (see Box 2-4, “Active Living Every Day program improves enjoyment of physical activity”).

Box 2-5 on the opposite page, “10 ways to stick with an exercise program,” is a composite list of all the factors, beginning with goal setting, support/supervision, enjoyment, and positive results, that make it more likely you won’t quit. Adhering to a program and achieving your goals means you have made the right choice.

Choices

This special report, Easy Exercises for Flexibility, is one choice. Chapter 3 has 64 stretching exercises from which to choose, divided among three categories to offer all-around flexibility: lower body, trunk/core, and upper body. Chapter 5 offers sample flexibility workout programs to help you get going. And if you enroll in a group exercise program, use this book to supplement what you do and learn in a supervised program.

At wellness centers, clinics, or in your home, physical and occupational therapists can design and supervise individual flexibility programs that are appropriate for you. The advantages are expertise, instruction, efficiency, accountability, supervision, and motivation.

The disadvantages are cost, lack of social interaction gained by working out with a group, and difficulty in finding qualified professionals who are knowledgeable. You also have to find someone with whom you are comfortable.

The rate of turnover among personal trainers is high. Look for someone who has made a career of working with people like you, rather than someone who is transitioning to another position or working as a personal trainer in his or her spare time. Get references and ask friends or family members for recommendations.

Another option is to participate in range-of-motion exercises that revolve around dynamic stretching. These include low-impact aerobic classes, yoga, tai chi, and Pilates.

Low-impact aerobic classes

The best one-size-fits-all class for flexibility is an aerobic exercise group class. The ultimate goal is aerobic (cardiovascular) fitness, but instructors and their students have to go through warm-up and flexibility exercises before getting to the aerobic component.

If you are a beginner or older adult not used to regular exercise, make sure you choose a class appropriate for your age and condition, and that your instructor knows your limitations.

Yoga

Yoga is a mind/body series of movements called asanas that combine stretching and controlled breathing to achieve relaxation and a stabilized mood. Its main purpose is not to improve range of motion or flexibility, but those attributes are clear benefits.

Yoga continues to gain in popularity, according to a new report from the U.S. National Center for Health Statistics. More than 21 million American adults, including three percent of those age 65 and older, say they’ve tried yoga in the past year (see Box 2-6, “Yoga gaining in popularity among Americans”).

For some people, yoga is an alternative or complementary exercise that promotes flexibility, strength, and endurance. For others, it is more of a spiritual experience. The general consensus is that yoga offers both physical and psychological benefits. The following is a summary of recent research, most of it yoga-positive, but not conclusive.

• Yoga may help reduce pain and improve function. — National Center for Complementary and Integrative Health, 2015
• Yoga results in moderate improvements for gait, balance, upper and lower body flexibility, lower body strength, and weight loss. — Journal of Aging and Physical Activity, January 2011
• Yoga is effective in improving function and symptoms of chronic low back pain, but is no more effective than stretching. — Archives of Internal Medicine, October, 2011
• Yoga enhances muscular strength and body flexibility. — International Journal of Yoga, July-December, 2011
• Older adults are at higher risk of developing musculoskeletal problems, such as sprains and strains, when doing yoga. — BMC Complementary and Alternative Medicine, January 9, 2013 (see Box 2-7, “Older adults at higher risk of strains and sprains in some yoga poses,” on the following page).
• Yoga may be effective as an adjunct to address some medical conditions, but is not yet a proven stand-alone, curative treatment. — Evidence-Based Complementary and Alternative Medicine, July 2012

Says one UCLA physical therapist, “Key yoga movements promote overall flexibility in multiple muscle groups and in a coordinated way, as opposed to just stretching single muscles and/or muscles groups. The results translate better to real life.”

There are many varieties of yoga from which to choose based on your age, comfort level, and physical limitations. Many gyms offer “silver” yoga classes designed for older adults. Most integrate slow, gentle movements with a mixture of both standing and sitting poses.

Also, check with your local YMCA, community senior center, or even hospital. Most offer gentle or restorative yoga classes modified for seniors with physical limitations or that are less demanding than traditional yoga classes.

Hatha and Iyengar yoga are all-around styles adopted by many yoga studios and gym classes. These styles place a greater emphasis on proper body alignment and balance. They also rely on props such as straps, bolsters, and blocks to help with support and reduce the risk of strain or injury.

Certain yoga styles might be better suited for older adults. For instance, chair yoga, in which all the movements are practiced while sitting in or using a chair for support, is ideal if you have mobility or balance problems.

The case for yoga, as with all forms of exercise, depends on the needs, goals, and the physical condition of the person. Its benefits have been widely promoted and occasionally backed by scientific evidence. For some people, the same benefits are available in other and less demanding forms of exercise, such as flexibility training, static stretching, and range of motion exercises.

Tai chi

Studies have shown that tai chi can improve balance, lower the risk of falls, and provide a sense of well-being. Reputable health institutions associate tai chi with aerobic capacity, less joint pain, energy, and stamina, but the evidence regarding tai chi and flexibility is not as strong.

The study most frequently cited was conducted at Stanford in 2006 and published in Alternative Therapies in Health and Medicine. The group comprised 39 women, average age 66, with below-average fitness and at least one cardiovascular risk factor, who took 36 tai chi classes over the course of 12 weeks. Tests showed significantly increased strength and flexibility in the upper and lower body.

However, since 2006, no major studies have associated tai chi with increased flexibility. In 2011, a presentation at the annual scientific meeting of the American College of Rheumatology reported that tai chi improved pain, fatigue, and stiffness caused by arthritis.

The National Center for Complementary and Integrative Health says, “In general, studies of tai chi have been small or they have had designs that may limit their conclusions. The cumulative evidence suggests that additional research is needed before tai chi can be widely recommended as an effective therapy.”

That said, there remains some evidence that it is beneficial for some individuals and that it is safe. In this way, its slow, gentle movements may be a easy entry point for some older adults to begin range-of-motion exercise. 

Keep in mind that people with the following conditions should consult a physician before beginning a tai chi program:

• osteoporosis
• chest pain with minimal exertion
• severe shortness of breath
• dizziness or fainting spells
• uncontrolled blood pressure
• gait and balance disorders

Pilates

Pilates is a program of low-impact strength and endurance movements designed to increase core strength for better posture, balance, and flexibility. Most of the movements can be done on the floor or a mat, or specialized designed machines called reformers. These consist of a platform that moves back and forth along a carriage and straps to help execute and support movements . Programs can be individualized for beginners or seasoned exercisers.

Because Pilates is not aerobic exercise, it should be combined with other activities that get the heart rate into its target zone and keep it there for 10 to 30 minutes per session. The Centers for Disease Control and Prevention recommends 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity per week.

Still, Pilates, like yoga, can offer range-of-motion movements that can improve flexibility. Pilates places a greater emphasis on strengthening the core compared to yoga, and helps to improve posture, both of which are key to greater flexibility. This is one reason Pilates is so popular among professional dancers, who rely on the practice to keep them limber and mobile.

A 2010 study in the Journal of Strength & Conditioning Research suggested that people can improve their muscular endurance and flexibility using relatively low-intensity Pilates exercises that do not require equipment or a high degree of skill, and are easy to master.

In 2013, BMC Medical Research Methodology used a review of studies to determine that there was inconclusive evidence that Pilates was effective in reducing low back pain. There was no mention of flexibility.

A 2005 study in Geriatric Rehabilitation concluded that older adults may benefit from Pilates-based exercises that are integrated into traditional resistance and balance training programs.

A study of low back therapy published in 2014 found that Pilates offers equivalent improvements to massage therapy and other forms of exercise therapy (see Box 2-8, “Pilates offers short-term improvement in low back pain equal to other forms of exercise”).  The implication is that the improvement would involve increased flexibility.

Pilates is not recommended for people who have unstable blood pressure, a risk of blood clots, severe osteoporosis, or a herniated disc. Check with your doctor if you are not sure before enrolling in a Pilates course or class.

Do they help?

Each of these range-of-motion exercises have proven to be beneficial for certain individuals and physical conditions over extended periods of time. But keep in mind that what works for one person is not necessarily as effective for others.

In light of current research that indicates flexibility exercises and stretches should be task- or activity-specific, it is fair to ask how each of these exercise forms will help people—especially middle-aged and older adults—perform the normal activities of daily life. Does holding a yoga position, assuming a tai chi pose, or performing a Pilates exercise help you reach something on the top shelf, get up and out of a chair, or get into, drive, and get out of a car? If they do, then they might be the right choice of flexibility exercise for you. If not, there are other ways to safely achieve flexibility goals.

Stretching Guidelines

Doctor- or physical therapist-approved range of motion exercises and static or dynamic stretches are all acceptable ways to maintain or improve flexibility. Just as with other forms of exercise, you need to follow certain guidelines and parameters to ensure safety and make sure you gain the most benefits from your flexibility workout routines (see Box 2-9, “Eight times not to stretch”).

When?

Regardless of the time of day you choose to perform flexibility exercises, don’t stretch first. Warm up to loosen up, to raise muscle temperature, and to increase circulation. Then begin your flexibility exercise routine.

By preference or necessity, many people exercise in the mornings. It becomes part of their daily routine and helps them get ready for the rest of the day. Others find that exercising later in the day is more relaxing. If you have time, do both—a few minutes in the morning, and a few minutes in the late afternoon or evening.

Stretching and/or doing range of motion exercises during the workday is effective for relieving physical and mental stress. Workplace exercises (see Chapter 4) can be performed at a desk, computer, or workstation. If you are new to a flexibility routine, begin your program in the morning. Add other sessions as your body needs them and as your schedule allows.

How often?

The American College of Sports Medicine (ACSM) says to perform flexibility exercises at least two to three days a week. Eventually, as you improve your flexibility and stretching routines become more of a habit, you could increase the frequency to every day, if desired. However, in the beginning, stick with the ACSM’s recommendation and with a day off in between workouts. Also, do not worry, if you occasionally skip a day or two. Daily flexibility training is beneficial, but you won’t lose flexibility gains that quickly.

How far?

When you perform static stretching, hold the stretch to a point of resistance, but not to a point of pain. If you go too far with a stretch, you won’t be able to hold it for long and you’ll risk an injury. And again, never do any ballistic or “bouncing” stretches.

How long?

The ACSM recommends that each stretch should be held for 10 to 30 seconds. There is no research that says holding a position for a minute is more beneficial than holding a stretch for 30 seconds. You can even break the 30 seconds into three 10-second repetitions, if needed.

How many repetitions?

Repetitions depend on the type of stretching exercise. They can range from two to 10. Make sure to follow the recommended number of reps for each exercise.

How many exercises?

There is no perfect number. For those who need a general flexibility program, two or three stretching exercises for each major area of the body—lower body, core/trunk, and upper body—is the goal. In other words, Between six and nine stretches per session, divided among the lower body, core, and upper body. The sample workouts highlighted in Chapter 5 are based on this criteria and include a total of eight stretches per program.

Not a complete package

A flexibility program that includes static stretching routines and range-of-motion movements do not comprise a complete exercise program. It will not directly increase your cardiovascular fitness, strength, or power, which is why you need to complement your flexibility exercises with aerobic and strength training routines to ensure all-around fitness.

Avoid common mistakes

Here are some mistakes to avoid when beginning a flexibility program:

• Don’t static stretch first. Always warm up with dynamic stretching, then go into your static stretches. This is especially important early in the morning when you have been inactive for many hours.
• Don’t bounce or bob. Stretch and hold for 10 to 30 seconds.
• Don’t stretch an injured muscle unless you are working with a physical therapist.
• Don’t ignore problem areas. Older adults often have tight hamstrings, for example. Make sure your flexibility routine covers your entire body.
• Don’t go too fast. Slow down, take your time, take a break between stretches.
• Don’t hold your breath while performing a stretch.

Flex Tests: How flexible are you?

Before you begin a flexibility program, it is a good idea to gauge your current level of flexibility. This way you can target problem areas that may need extra attention, and help you measure your progress.

Testing for flexibility can be complex or simple. Exercise scientists and physical therapists use instruments called goniometers to measure degrees of joint rotation at the extremes of range of motion. Flexibility is joint-specific, according to the authors of the Exercise Testing and Prescription Lab Manual (Human Kinetics). Determining the range of motion for one joint is not an indicator of flexibility in other joints.

The simplest and least scientific way to measure flexibility is how a person performs activities of daily living. If you can flex and extend a joint, reach, turn, twist, kneel, climb stairs, and bend with relative ease, the joint is flexible.

Between those scientific and simple tests are a few flexibility self-tests you can do at home. They are strictly informal, do-it-yourself measurements that will give you a general idea of your current flexibility. Be careful, do them slowly, don’t hurt yourself, and don’t do them at all if there is the slightest risk of injury.

Lower body: sit-and-reach

1. Sit on the floor with your legs stretched outward. 
2. Keeping your back flat and not rounded, bend forward at the hips.
3. Reach toward your toes. Do not bounce or stretch to the point of pain.
4. Note the distance from the tips of the middle fingers to the top of your toes.
5. If you can reach past your toes, you have above average lower body flexibility.
6. If you can touch your toes, you have average lower body flexibility.
7. If you cannot touch your toes, or need to bend your knees to touch them, you have below average lower body flexibility.

Hips, buttocks: lying knee-to-chest

1. Lie on your back and draw your knees to your chest.
2. Continue holding the left knee in that position while you extend the right leg until it lies flat on the floor.
3. Repeat the movement with the other leg.
4. If you cannot completely extend one leg while bringing the opposite knee to within a few inches of your chest, your hip flexors and buttocks may be too tight.

Lower back, hamstrings: standing toe reach

Note: Do not perform this test if you have any question regarding the condition of your back.

1. Stand with your feet together, knees straight but not locked.
2. Bend forward and reach for the floor. Try to keep your back flat.
3. Your lower back and hamstring flexibility is good if you can touch or nearly touch your toes with little effort and no discomfort.
4. If you can’t come close, you may be susceptible to lower back injuries.

Shoulders: behind-the-back reach

1. In a standing position, place your left hand on the middle of your back, palm out, fingers reaching up.
2. Slide your right hand behind and down your back and try to touch your hands or fingers.
3. If they can touch you have good shoulder flexibility.
4. Switch hand positions and repeat with the other shoulder.
5. If your hands do not touch, place a ruler in the bottom hand and measure the distance between the opposing fingers.
6. If you are not within an inch of making contact, you may be susceptible to shoulder and neck pain.

What’s next?

Chapter 3, “64 Exercises,” describes and illustrates 64 stretching and range-of-motion exercises to improve flexibility.

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Ask About Experience

Inquire about their work with seniors and their experience with any injuries that apply to you. Many studios offer discounted introductory sessions so you can determine if that instructor is a good fit for you. Sometimes an instructor may be well-qualifed but your personalities may not be compatible. Many physical therapists also incorporate Pilates techniques into their treatment sessions for specific conditions.

“Pilates exercises are adaptable to all levels of fitness, and can be progressed as you improve,” explains Wilson. “It’s also low impact, which is better for seniors with arthritis or painful joints.”

Group Reformer Classes

These classes are increasingly popular and are money-savers, too. But you’ll need a few private sessions before jumping into these classes. Be leery of studios that allow you into a group reformer class without taking any privates. Generally, six or more one-on-one sessions are recommended. Private sessions help you better know your body and the equipment.

Pilates Essential Principles

Top instructors incorporate these fundamental concepts into all sessions:

Concentration. The mind and body connect to improve focus.

Control. Movements are neither jerky nor momentum based.

Flow. Exercises are fluid, not statically held, encouraging freedom of movement.

Precision. No sloppy movement allowed; each movement is conscious and intentional.

Breath. Full inhales and exhales help you to contact the core, energize the body, and focus the mind.

Balance. This refers to physical balance and balanced muscular development needed for proper body mechanics.

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