Benefits and considerations of aquatic exercise for older adults
This is an excerpt from Aquatic Fitness Professional Manual-7th Edition by Aquatic Exercise Association.
Aging is a natural and gradual physiological process characterized by a decrease in functional capacities. Although many countries have accepted the World Health Organization's definition for the terms elderly or older person as a person with a chronological age of 65 years or more, it is important to understand that the rate of physical decline will vary from person to person (figure 12.1). Functional age is the level of physical independence, while chronological age is measured in years. Although both are relevant to programming, chronological and functional ages do not always align. Many older adults might have an advanced chronological age but a young functional age, and the reverse is possible as well.
Figure 12.1 Many adults may be chronologically older, but they function like people much younger than themselves.
The American Medical Association's Committee on Aging (www.ama-assn.org) found that it was almost impossible to distinguish between the effects of aging and the effects of physical inactivity. Low energy, weakness, poor muscular strength, stress and tension, high cholesterol, diabetes, stiffness, constipation, hypertension (high blood pressure), obesity, insomnia, back problems, and decreased range of motion are all common issues associated with both aging and physical inactivity. The good news is that research shows that participation in regular exercise at any age can help improve many of these conditions and reduce the risk for developing them.
Physical changes occur as part of the aging process. The degree to which these changes occur varies from person to person, and may be influenced by lifestyle choices.
- Decreased visual sharpness and perception, smaller visual field, and impaired judgment of the speed of moving objects
- Decreased hearing sharpness and reduced ability to discriminate among different sounds
- Reduced sensitivity to touch
- Decreased communication between muscles and nerves and decreased reaction time, leading to altered mobility, response time, spatial awareness, and balance
- Decreased height, partially due to spinal compression
- Decreased bone density, with increased risk of fractures
- Decreased fitness levels (cardiorespiratory endurance, muscular strength and endurance, and flexibility)
- Enlarged heart with reduced function, decreased ability to contract, reduced pumping capacity, and reduced maximum attainable heart rate
- Reduced elasticity and diameter of blood vessels; increased blood pressure
- Decreased response of the immune system and ability to fight infection
- Decreased function of the respiratory system and reduced breathing capacity
Although psychological changes are harder to document, many older adults experience depression, anxiety, insomnia, and other psychological conditions.
The ACSM guidelines for older adults are similar to the general recommendations provided in chapter 11, with additional suggestions regarding the time and intensity of training. Older adults will benefit more by using perceived exertion to monitor exercise intensity (ACSM 2018). Instructors should select aerobic activities that do not create orthopedic stress, choose weight training or weight-bearing movements to target muscular fitness, and employ slow movements that pause in a sustained stretch to enhance flexibility. Programs should also include neuromotor exercises to both improve balance and reduce the risk of falling.
Exercise programs for older adults should focus on the physiological and psychological changes associated with the aging process, while also respecting the individual needs of the participants. A specific class for seniors should do the following:
- Promotemusculoskeletal health, joint function, bone strength, muscular strength and endurance, posture
- Improve physical fitness and physical function: cardiorespiratory endurance, muscular strength and endurance, flexibility, body composition, power, coordination, and agility
- Assist with fall prevention: lower-body strength, balance, and walking skills
- Improve mental health: self-esteem, social interaction, sense of achievement and productivity, memory, and motivation
Five minutes spent before class acclimating new students to the pool surroundings can prevent accidents and alleviate the need for rescue or emergency assistance. Make sure participants are familiar with pool lifts, ramps, and accessible ladders for the shallow and deep ends as well as for changes in pool depths. Because of possible limitations with balance and reaction time, vision, and hearing, deliver instructions in a manner that is easy for participants to hear, see, and understand.
Many of the aquatic program formats discussed in chapter 11 can be adapted for an older adult population, including continuous, interval, and circuit training for both shallow and deep water. Offer low-impact options for participants who cannot safely or comfortably perform high-impact activities, even in the aquatic environment. Use all three planes for movement to encourage increased range of motion and better enhance performance of activities of daily living (ADLs). Include movements that change direction to improve balance and coordination. Transitional moves allow time to readjust body alignment during changes in movement planes or directions of travel. Plan movements that target muscular balance in both strength and flexibility, focusing on common areas of misalignment, such as rounded shoulders (scapular protraction) and forward head posture.
Incorporate both audible and visual cues to accommodate participants with sensory limitations. Older adults benefit from eye contact and instructor interaction, both of which also allow you to monitor student comfort (e.g., becoming chilled, overheated, fatigued) and understanding of exercise technique. Encourage socialization and interaction among participants through planned activities. This can help maintain control of the class and minimize unwanted talking during times when the focus needs to be directed to intensity, form, alignment, and safety. Consider the pool acoustics when determining music use; participants must be able to hear your audible cues during class. If you incorporate music, choose an appropriate tempo for the population, class format, and water depth. Base the music style on the preferences of the participants.
Upper-body drag equipment, especially gloves or mitts that do not require gripping, can be easier for older adults to use safely and effectively. The resistance level can be individualized and based on the participant's capacity to apply force against the water. Gloves should fit loosely to prevent a reduction in blood circulation. When using buoyancy equipment, remember that older adults may have a lower body density and a high level of buoyancy due to body composition. Choose buoyancy equipment that does not compromise body alignment and stability or the participant's capacity to apply force against the water. People who are not completely comfortable in the aquatic environment, as well as those with balance issues or limitations with walking, may benefit from using equipment for support, such as holding a noodle or kickboard on the surface of the water.
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