Training Considerations for Older Adults

According to the US Census Bureau, between 2010 and 2050, the United States is projected to experience rapid growth in its elderly population. Many want and need dedicated trainers who understand the aging process and proper injury prevention.


Falls Are One of the Deadliest Events to Happen to an Older Person

Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head injuries, and can increase the risk of early death or earlier admission to nursing homes. Fortunately, falls are a public health problem that is largely preventable.1

Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness and, in turn, actually increases their risk of falling.

With the increase in the older population it becoming evident that exercising and staying fit must be continued as one ages to prevent falls, improve balance, maximize lung and heart capacity and even help improve memory. Overall exercise can improve the quality and quantity of life of the older adult allowing them to live longer with less disease, less depression and avoid institutionalization into a nursing home or other facility.

Physiological Changes

When training an older adult in any fitness activity, it is important to understand that physiological changes occur as one ages. For example, the cardiovascular system output decreases by 20-30% by age 65. Maximal oxygen uptake decreases approximately 9% and 5% percent every decade, for sedentary men and women, respectively.2 There is a loss of elasticity of major blood vessels, contributing to increases in blood pressure from stiffening of the vessels.

Lower body muscle loss is more affected than upper body as a person ages. The muscular system undergoes a 40% loss of muscle mass and 30% decrease in strength by age 70.3 Muscle fibers shorten and production of synovial fluid (a lubrication in joints) decreases. As a result, muscle mass and movement becomes hindered in the lower body. Osteopenia (thin bones) is a consequence as well.

Decreased Sensory Changes

Older persons, especially those who are very sedentary, may have a particularly hard time getting up and down from a chair due to loss of lower body strength and decrease in hip mobility. Maximizing lower body strength is essential in optimizing the person’s moving, stepping and bending ability.

A decrease in depth perception of the eyes (inability to tell how high or low a step is) can lead to problems climbing stairs or curbs. The sense of touch in the hands and feet may decrease, especially if there is a history of diabetes. Diabetes can damage nerves to the feet and hands creating difficulty when grasping objects or walking on uneven surfaces. Hence, when training someone on a step machine or treadmill, the importance of holding on to safety rails while exercising should be emphasized.

Hearing decreases, especially to high pitched sounds. More often, this happens in men much earlier than women, so speaking at a lower pitch can help when explaining exercises or routines.

Balance decreases, so falls become more likely. This is especially true when bending, lifting, doing moves on one leg or reaching on toes. Training in balance and lower body strength can improve this tremendously. Don’t let these physiological changes deter you from training an older adult. Awareness of changes requires just a little more patience and perception when choosing moves that will improve their cardiovascular health, balance and strength.

Benefits of Exercise for the Older Adult

Enhancing fitness and muscle strength can improve many age related changes like improving bone density and balance. Functional daily living activities such as reaching, bending, lifting and preventing falls are also benefits. This can increase self-confidence so that the older person’s fear of falling is greatly reduced. With exercise and strength training they can move, bend, reach and steady themselves much easier and quicker to prevent a fall.

According to G. Scott, it is important that exercise focuses on strength, particularly the legs, at least two times a week, improving balance and making sure exercise becomes more challenging over time.4


1. Centers for Disease Control and Prevention National Center for Injury Prevention and Control (NCIPC References)

2. Elia, E.A. (1991). Exercise in the elderly. Clinics in Sports Medicine, 10, 141-155.

3. Rogers, M.A., & Evans, W.J. (1993) Changes in Skeletal Muscles in aging: Effect of exercise training. ( Rogers and Evans, 1993)

4. G. Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990; 16(3):

About the Author

Chiffon Okuda is a graduate of Muhlenburg School of Nursing in Plainfield, NJ, and holds a BAAS from the University of North Texas in Health Promotion and Community Services. She has been a registered nurse for over 20 years, specializing in the older adult and currently works for a large public hospital as a geriatric case Manager. She is an NFPT-certified personal trainer, fitness nutrition specialist, and a SECA (Strength, Endurance,Combat, Agility) Senior Group Kettlebell Instructor, holding classes at a local recreation center as well as providing private personal training.


These resources are for the purpose of personal trainer growth and development through Continuing Education which advances the knowledge of fitness professionals. This article is written for NFPT Certified Personal Trainers to receive Continuing Education Credit (CEC). Please contact NFPT at 800.729.6378 or [email protected] with questions or for more information.
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