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Specific safety precautions for those with special needs

This is an excerpt from Exercise for Frail Elders-2nd Edition by Elizabeth Best-Martini & Kim Jones-DiGenova.

Following are some specific safety precautions for leading resistance exercises for people with specific needs, particularly when they are beyond an early or mild stage. Therefore, these precautions may not apply to every person with a particular condition. For example, a person with mild symptoms of arthritis may have few limitations with resistance exercises, whereas severe symptoms may prohibit resistance training. Also, remember that an individual's performance ability can vary from day to day. See chapter 1 to learn more about common special needs. For further information see the category “Fitness, Wellness, and Special Needs” in “Suggested Resources.”

Alzheimer's Disease and Related Dementias

• Do not use rigid free weights (handheld weights, such as dumbbells or canned foods), which can cause injury if dropped. Safer alternatives are wrist weights or an improvised weight such as a 1-pound (.45 kg) bag of beans in a sock.

• Because confused or disoriented participants may be unable to rate perceived exertion dependably, be especially vigilant of their response to resistance training.

• Some resistance exercises require the instructor to be extra watchful with participants who may not remember directions or pose a risk of copying others who are doing an exercise that is contraindicated for their condition. Have those participants sit near you in clear sight. If they have other special needs, ensure that they follow the specific safety precautions for those needs.

• When leading resistance training, if an exercise is performed on one side and then the other, slowly move uninterruptedly from one side to the other. For example, give a visual and verbal cue such as by saying, “Switch sides.” Then, after you see them change sides, continue relevant cueing. This approach helps those with memory issues remember what side they just trained.

Arthritis

• Short, frequent exercise sessions are better tolerated than long, less frequent ones. For example, instead of combining resistance training and aerobics into a 1-hour class on Monday, Wednesday, and Friday, people with arthritis might respond more favorably to shorter, more frequent classes, such as resistance training on Monday and Thursday and aerobics on Tuesday, Wednesday, and Friday or Saturday. Two days of resistance training per week are generally better tolerated than 3. If shorter, more frequent classes are not feasible, people with arthritis may take as many breaks as necessary with longer exercise classes.

• Gradually build up to 8 to 10 repetitions with slight or light resistance (Arthritis Foundation 2009) (an RPE of 2), keeping the resistance below the participant's discomfort threshold. When a participant responds favorably, progress carefully (refer to “Progressing Your Exercise Class” in chapter 8). The Arthritis Foundation (2009, 102) cautions the instructor that multiple repetitions of resistance exercises may cause joint flare-ups.

• If an isotonic resistance exercise (exercise involving contractions against resistance with joint movement, such as standard free-weight training shown in exercises 5.1 through 5.12 in this chapter) causes pain to any joint, decrease the workload or adjust the exercise technique, body position, or speed of the movement. If pain persists, consult the physician or physical therapist.

• Mild isometric resistance exercises (exercise involving contractions against resistance in a stationary position with no joint movement) can strengthen the joint and surrounding muscles while reducing the chance of increasing inflammation. Isometric exercises are less likely to cause inflammation than isotonic exercises are. For further information, refer to the section “Resistance Bands and Isometric Exercises” in “Suggested Resources.”

• When a joint is significantly inflamed, rest or significantly modify the program to include only isometric strengthening and gentle ROM exercises (Rahl 2010). A participant can experiment with doing a few repetitions, such as 1 to 3 to begin with (Arthritis Foundation 2009) without weights within a strain-free and pain-free ROM. In the in-between-time when other participants are performing up to 12 to 15 reps, suggest an exercise that the participant can enjoy and benefit from, such as three-part deep breathing. When appropriate, slow and smooth ROM exercises (still with fewer repetitions) may be a beneficial alternative.

• After acute inflammation has subsided, encourage the participant to resume resistance training cautiously to benefit the joints. Well-conditioned muscles are necessary for joint stability and function and may decrease the impact load on the joints (Rahl 2010, 182, 188).

Cerebrovascular Accident (CVA, Stroke)

• See also the safety precautions for those with coronary artery disease (heart disease).

• Providing clear resistance-training instructions is extremely important to participants who have experienced stroke. If a participant has paralysis on the right side, focus on leading exercises mainly by demonstration, using few verbal instructions. If there is paralysis on the left side, rely more on verbal instructions, using fewer gestures (American Senior Fitness Association 2012c).

Chronic Obstructive Pulmonary Disease (COPD)

• Avoid sustained isometrics, holding the breath, heavy weight training, and holding any weight overhead for more than a few seconds to prevent straining the respiratory and cardiovascular systems.

• Avoid hard or heavy resistance (an RPE of 5 or more) without medical clearance, especially for those on long-term steroid medication who are susceptible to muscle or tendon rupture (AACVPR 2011, 46).

• Additionally, chronic steroid use has a side effect of bone density reduction and increased risk of compression fracture (AACVPR 2011, 45; Biskobing 2002). In these cases, the specific safety precautions for osteoporosis apply.

Coronary Artery Disease (Heart Disease)

• Cardiac patients should not resistance-train if they have any of the following conditions: unstable angina, uncontrolled hypertension, uncontrolled dysrhythmias, recent history of congestive heart failure (that has not been evaluated and effectively treated), severe valvular disease, or left ventricular outflow obstruction (AACVPR 2006, 86-87).

• For cardiac patients without contraindications (mentioned earlier), mild to moderate (approximately 50 percent of the maximal voluntary contraction according to AACVPR 2006, 76) resistance training can provide a safe and effective method for improving muscular strength and endurance (ACSM 2009a).

• Avoid actions that excessively raise blood pressure (see the special precautions for COPD and hypertension).

• Stop exercising at the first signs or symptoms of overexertion or cardiac complications, particularly abnormal heart rhythm, unusual shortness of breath, chest discomfort, or dizziness (notice the mnemonic ABCD).

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