Worksheet: Plan and adapt

exercise programmes for

independently active, older people
Kate O'Hara
Learners name:

1 Complete the table by giving two examples of age-related body system changes and their
influences on the planning and delivery of exercise programmes
Body system changes Influence on planning Influence on delivery

Muscular changes - sarcopenia,
reduced size of type 2 fibres, reduced
flexibility, reduced number of
mitochondria
Impaired thermoregulation, reduced
pelvic floor funtion, reduced balance,
reduced ROM, reduced anaerobic
capacity and threshold
Consider exercises which help improve
balance, consider the ambient room
temperature as greater propensity to
feel the cold, longer warm up and cool
down, be aware more likely to feel
breathless - consider appropriate RPE,
and working on muscular strength,
especially pertaining to activities of
daily living.

Decay of mitochondria Consideration that the client is more
likely to become breathless and may
need to rely more on anaerobic
pathways to fuel work. Clients are more
likely to fatigue and tire even during
light to moderate intensity activity.
Consider a programme which steadily
builds and improves cardiovascular
fitness. Use appropriate RPE and
consider that the client may be working
harder than it seems. If the client
exercises regularly, the rate at which
mitochondria decay can be slowed or
even reversed.

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 2 Complete the following table to give an explanation of how evidence-based guidelines will impact
on the planning and delivery of exercise session components
Component Impact of evidence-based guideline on planning
and delivery of exercise
Muscular strength, power and endurance Planning:
Muscular power exercises should only be introduced into a
programme once the client has developed the appropriate
level of strength and technique.

Delivery:
Start with a programme which starts with focus on muscular
endurance so that good form and technique can develop,
then progress to strength then to power once the
appropriate level of proficiency has been achieved.

Flexibility Planning:
Consider any areas of limited ROM or muscular imbalance
from the functional assessments and build in appropriate
stretches to develop greater flexibility in these areas.
Passive, active and PNF stretching may all be appropriate.

Delivery:
Slow and controlled stretches increasing the ROM until mild
muscular tension is felt. Problematic areas in the aging
population tend to be upper and lower back, shoulders,
hamstrings and neck.

Aerobic power and endurance Planning:

Duration of exercise should precede the intensity initially
until the client is meeting the recommended level of activity.
Once recommended levels of activity are reached, intensity
can be increased appropriately.

Delivery:
Any movement that does not overly stress the joints is
appropriate. Intensity can be increased by adding arm
movements, increasing range of movement, increasing
spped or resistance.

Metabolic function Planning:

Metabolic function decreases with increasing age - the BMR
generally decreases by 1-2% per decade after the age of 20
years. Sarcopenia may be associated with weakness and
frailty. Consider strength exercises especially related to
activities of daily living.
Delivery:

Work on developing leg strength to facilitate sit to stand and

strength for lifting heavy objects. Any dietary advice needs
to consider decrease in BMR with advancing age.

Motor skills Planning:

Loss of motor units with advancing age may lead to
impaired muscular strength and coordination. Consider
exercises which develop fine and or gross motor skills.

Delivery:
As well as gross motor skills, fine motor skills can be
incorporated e.g. hand exercises - thumb to finger pinches
working from first to little finger and back, wrist exercises,
finger exercises and co-ordination exercises e.g. catching a
ball in the hands.

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 3 Explain the need for the following
Pre-exercise health screening
Pre exercise health screening is important to establish that the client is medically fit and safe to exercise. It highlights any
specific medical needs and considerations that need to be taken into account when designing a programme. Screening also
highlights certain medical conditions which may have certain exercise considerations e.g. hypertention and the PAR-q will
highlight conditions where there may be certain exercise contraindications e.g. osteoporosis or certain measurements which if
exceeded mean the client is unable to exercise on that particular session. Ultimately screening is there to ensure the safety of
the client throughout their programme and to highlight any medical issues which need to be considered during programme
design. If there are positive responses on the screening tests, it may be necessary to liase with the clients GP or medical
professional to ensure they are safe to begin a programme.

Assessment of functional capacity

Functional capacity assessments are important to establish a baseline from which start a programme. It will also help to
determine what areas need to be worked on during the programme to be of the most benefit to the client. Functional
assessments will enable the programme to be tailor made to the specific needs of the client e.g addressing any muscular
imbalances or areas lacking in flexibility. Functional capacity enables a client to evaluate their subsequent progress and
compare to how they were originally and will help to encourage adherence and motivation. Functional assessments can also
help to identify and evaluate smart goals and can give a clear and measurable demonstration of progress.

4 Describe how to set person-centred SMART goals.

The goals should be short, medium and long term.

The goals should be specific to the client - they should be what the client wants to achieve and should be relevant to them and
any medical conditions they may have.
The goals should be measurable e.g. attend 3 times a week, lose 2 lbs, be able to walk without stopping for 20 minutes etc.
The goals should be achievable - it should in theory be possible for the client to achieve the goal set with the effort they are
able and willing to put in.
The goal should be realistic and relevant to the client and any limitations/conditions they may have.
The goal should be time based i.e there should be a time frame set in which the goal should be reached.

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 5 Give three reasons for planning a progressive programme.
1 Because it is important to build up a clients fitness slowly - the duration should be increased first until they are reaching the
recommended activity levels and then intensity can be increased.

2
To ensure that the client develops good technique and muscle memory before progressing the programme - this will help to
build confidence and reduce the risk of injury.

3
To keep the client motivated and adherent - doing the same thing every time will become boring but seeing progress and
improvement will help to motivate them to carry on with the programme.

6 Complete the table below, outlining the differences between current and previous physical activity
and exercise guidelines for independently active, older people (please reference the two sets of
guidelines you are comparing)
Current guidelines Previous guidelines
Frequency
Daily After an extensive Internet search, I was unable to
find previous guidelines.

Intensity
Moderate activity

Time At least 150 minutes throughout the week in bursts

of at least 10 minutes

Type Cycling, walking, swimming, dancing, aqua aerobics

Reference NHS Live Well

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 7 Complete the table below, applying the principles of training to each component of physical
fitness for the independently-active, older person
Component Frequency Intensity Time Type
Cardiovascular Moderate intensity 5-7 Moderate RPE 11-13 30-60 minutes per day Walking, cycling,
times per week (at least 10 minutes water aerobics, cross
each time) trainer, recumbant
Vigorous intensity or Vigorous RPE 13-15 20-30 minutes per day cycling, swimming
moderate/vigorous
mixture 3-5 times per
week

Muscular fitness Moderate 50-60% 8-10 exercises Machines, free

2 days a week with 48
hours rest between 1RM, 15-20 reps, 1-2 involving major muscle weinghts, bands,
sets groups, 15-20 mins, 2 bodyweight
mins rest

Flexibility 2 days a week Moderate 5-6 out of Hold for 10-60 secs, Static stretching for
minimum, daily 10, increasing ROM slow and controlled each muscle group - in
stretching preferable stretching particular upper back,
Before 10 sec neck, shoulders, lower
stretches, after 60 sec back, hamstrings
stretches
Repeat 1-5 times per
stretch

Motor skills 2-3 days a week Easy to moderate 9-13 30 minutes minimum Yoga, Pilates, Tai Chi,
seated exercise,
balance classes,
dance

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 8 Give an example of a prevalent disease and complete the table to show how a programme may
need to be adapted
Name of prevalent disease:
Adaptation to the structure
Osteoathritis
Consider the joints affected and tailor the programme to strengthen these joints and
increase ROM over time where appropriate. Consider a broad range of activities within
the programme with a view to cross training where appropriate if clients have difficulty
with certain movements/activites. Shorter duration of exercises due to the repetitive
nature on the joints.Consider the timing of the activity, first thing in the morning may be
when clients are most stiff so mid morning may be more appropriate. A longer warm up
and lots of stretching to increase ROM of the joints would be of benefit.

Adaptations to the content Longer warm up.

More focus on stretching to increase ROM around joints.
Shorter duration to repetitive exercises.
More focus on cross training.
Focus on strengthening muscles around affected joints and increasing ROM.
Consider exercises which may help with activities of daily living.

Adaptations to the room
layout/equipment
Make sure equipment is easy to access and that there is plenty of space as clients may
find more difficulty getting on and off equipment.
Consider free weights/equipment at a raised height/on a bench for those who have
difficulty bending over.
Consider the temperature of the room and make sure it is not draughty.
A hand rail around the edge of the room may be of great benefit. Consider that the client
may have a walking aid - leave enough room for this to be used.

Adaptations to
Speak clearly and concisely to the client using appropriate terms and language. Visual
communication strategies cues as appropriate. Encourage and give feedback throughout and be empathetic and
understanding to any limitations they may have due to their condition.

9 Give an example of when communication would need to be adapted and complete the table to
show how you would adapt verbal and non-verbal communication
Reason adaptation is required Example of verbal adaptation Example of visual adaptation

Client is hard of hearing Increase the volume and projection of Greater use of visual cues to prompt
the voice making sure to speak clearly and remind clients of what is next will
and concisely (without shouting). help those who are hard of hearing.

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 10 Give an example of when the speed of an exercise needs to be adapted to ensure safety and
effectiveness when teaching older people.

During a group warm up, the BPM of the music needs to be slower than for the general population. This is to allow for slower
movements. All exercises should start off in their simplest forms with the option of layering in more complicated movements or a
greater range of movement so that it is all inclusive and does not make any one feel excluded e.g. tap the toes of alternating
feet, option to tap the heels instead, option to add in a bicep curl (these exercises can also be performed in a seated position if
needs be). Exercises can start off every 2 beats with the option of speeding up to every beat for those who are able. Clients
should be encouraged to go at their own speed and slow down, hold onto a hand rail or chair or move to a seated position
should they feel the need.

11 When teaching older people, explain how to ensure safe transitions between the following:
Session components

If clients are moving from one posture to another, the transition should be gradual and flow properly. It is not appropriate to go
from standing to supine exercises and back to standing continuously. Sessions should be planned accordingly so that clients
can gradually work down and back up again with appropriate chance to rest in between if required to minimise the risk of
dizziness/adverse postural changes. If altered postures are required, it would be more appropriate to e.g. start standing, move
to seated, down to the floor, to the knees, back to seated and then to standing and options should be given if clients are
reluctant/unable to participate in floor exercises. Session components should be made clear to the client so that they are
aware what they are doing, why they are doing it and know what to expect next. An instructor should be on hand and available
to give assistance if required and to closely monitor clients to make sure they are supported and ecouraged.

Exercises
The room should be clearly laid out with thought to health and safety regarding falls. Clients should be instructed as to which
direction to move around equipment and this should be in a simple and logical way. Time should be given for clients to make
transitions between exercises and there should be chairs available for rest in between if required. Any rapid changes in
direction should be avoided. If exercises are labelled, a visual label may be advisable to help the client to remember the
instruction as well as the name of the exercise, often a stick man performing an exercise can help a client remember what to
do and give them a grater feeling of independence.

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 12 Give an example of a functional impairment and explain how instruction may need to be adapted
accordingly.

A client with dementia - instruction will need to be given and reinforced regularly in a clear and concise manner. It may help to
pair the client up with a buddy to perform the same exercise if possible. Visual and verbal instruction is appropriate with regular
positive reinforcement. Empathy and patience are required in abundance when dealing with a client with dementia as the need
to repeat instruction can be very frequent. Often a client with dementia who has been exercising regularly will have the muscle
memory to perform a task but will lack the cognitive function to realise this and can become easily stressed due to the nature of
their condition.

13 Complete the table below, identifying appropriate, age-friendly resources for the older person.
Age-friendly environment Age-friendly equipment

Correct ambient temperature, flat floor surface to decrease
risk of falls, equipment stored off the floor where
possible/practicable to prevent trip hazards otherwise to be
stored around the edge of the room, good lighting, disabled
access, hand rails round the edge of the room to be held if
required, good access to water and toilet facilities, chairs out
to enable rest if required.
Lower weights due to decreased strength, larger grip
surfaces/handles, therabands to enable resistance to be
altered to suit the individual, free weights and equipment
suitable for use in a seated position as well as standing,
balance equipment - pads to stand on, stepping stones, bosu
ball, wobble boards/cushions, body blades.

Result (Pass/Refer)

I confirm that the information within this worksheet is entirely my own work.
Kate O'Hara 6/9/17
Learners name: Signature: KJO'Hara Date:

Assessors name: Signature: Date:

IQAs name: Signature: Date:

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