Lesson 2.1: Risk versus Benefit Exercise Selection

Risk vs. Benefit Exercise Selection Principles

Risk is often elevated when teaching older adults due to common chronic conditions, musculoskeletal limitations and communication challenges. Remember, we want our participants to be challenged enough to make progress, but we need to execute each movement in our Classic classes without unnecessary risk of harm to class participants.

Risk vs. benefit refers to an exercise selection analysis. When applying risk versus benefit to SilverSneakers Classic, exercises should be utilized only when the benefits of a specific exercise outweigh the potential risk. The safety and efficacy of a movement can differ from class to class and from individual to individual, depending on the fitness level and physical limitations of class members and the ability of an instructor to teach and cue an exercise effectively.

Risk vs. Benefit Exercise Selection Principles:

• What is the potential risk of the exercise?
• What is the benefit of the exercise?
• Can the exercise be modified?
• If the risk outweighs the benefit, avoid the exercise.

Let’s apply risk vs. benefit exercise selection principles to an overhead shoulder press:

• What are the potential risks for movement in which the arms go overhead? Some possible risks of overhead shoulder press include:
  
  • Overhead movement may aggravate existing shoulder injury. 
  • Elevating the arms for an extended period may increase blood pressure.
• What are the potential benefits of overhead movement?
  
  • An overhead shoulder press is a functional movement – an upper body push movement. 
  • This exercise trains for shoulder strength and endurance. 
  • The overhead shoulder press recreates an activity for daily living (ADL). For example, it mimics placing groceries in an overhead cabinet or taking an item off the top shelf. 

Since there are both risks and benefits to the overhead press, consider a few additional questions:

• Can it be modified?
  • Yes, an overhead press can be performed with one arm at a time as a unilateral movement. Other modifications would include limiting the range of motion for the exercise or performing it with a different tool, such as the ball.
• Do I know how to mitigate the risk of overhead press as an instructor?
  • Lift up and to the front (SilverSneakers overhead position).
• How many overhead repetitions can I perform in one set.
  • 8 max.
• Offer the modified option first and then provide the full variation of the movement if participants are able to do the exercise safely.