SilverSneakers classes provide a safe exercise experience for older adults, including those with one or more chronic conditions. In all SilverSneakers classes, there are certain movements that are considered high risk for our participants when teaching in a group exercise setting. Review the movements below as many of them can exacerbate a chronic condition.
- Avoid seated forward flexion at the hip greater than 45 degrees – Hinge forward no further than halfway, or 45 degrees, when in a seated position. Forward flexion greater than 45 degrees while in a seated position creates a great deal of strain on the low back, especially for those individuals with osteopenia or osteoporosis, or who already experience low back pain.
- Avoid momentum – Avoid using momentum as it relates to a full range of motion. Always move with control. This applies especially to those with musculoskeletal chronic conditions.
- Avoid inversions – Make sure to avoid movements where the head goes below the heart during a group exercise class. To keep your class participants safe, always transition them to a seated position first before retrieving water or equipment from under the chair. From a seated position, cue “step out to the side, then lean to the side,” making sure to support with the opposite arm to retrieve items in a safe manner. Additionally, avoid bringing the head below the heart as it can cause a rapid change in blood pressure. Inversions are considered very high risk for those with high blood pressure or heart disease as well as for individuals with some eye issues such as glaucoma or retinal detachment.
- Avoid overuse – Overuse is especially common in the hips and shoulders. Generally, the shoulders are engaged in upper-body resistance training movements, so it is important to alternate upper and lower body movements to avoid overuse of that joint. The SilverSneakers repetition recommendation is to perform no more than one set of movement of 20-24 repetitions maximum for each exercise utilizing each muscle group. For example, one set of “variably paced” repetitions to equal 4 to 8 repetitions at a slow (half-time tempo) rhythm for a rehearsal, 8 repetitions at tempo, followed by 8 repetitions at a double time “pulse” for a total of 20 to 24 repetitions. Staying within this guideline will help keep your SilverSneakers members safe and free from overuse syndrome, especially those with musculoskeletal chronic conditions.
- Avoid seated exercises where both feet are unsupported off the floor – While performing any movements, including core exercises, from a seated position, avoid lifting both feet off the floor at the same time. The lack of support caused by elevating both feet simultaneously off the floor can cause participants to lose their balance, as well as creating the potential for injury to the low back. A creative option might include keeping one foot supported on the floor or on the SilverSneakers ball while lifting the other leg to strengthen the core. Again, be creative with your options, but choose safety over creativity.
- Avoid excessive flexion, extension and movement at the joints – Be aware of joint position, avoiding any excessive movement or forced movement. Additionally, avoid outside force on any joint including movements like wall push-ups or push-ups on the chair. Both exercises are weight-bearing movements that apply excessive force on an extended wrist. Keep your joints in a safe position and avoid using force.
- Avoid double-arm overhead triceps extension with hand-held weights – Shoulder impingement is the most prevalent shoulder diagnosis, accounting for 40-65 percent of all reported shoulder pain (Clark, Lucett & Sutton, 2014). Many older adults suffer from this condition. For the body to effectively perform a double-arm triceps extension with hand-held weights, because of the gravity-resisted nature of this tool, the shoulder must be in close to 180 degrees of flexion to apply force in the correct direction. Because shoulder range of motion is limited for a large segment of the older adult population, a safer alternative, such as triceps kickbacks with weights or tubing, can be more beneficial to participants.
- Avoid overhead arm work directly above the head – The SilverSneakers overhead position is up and slightly in front of the body instead of directly above the head. Practicing overhead resistance exercises in the SilverSneakers overhead position will allow and assist in compensating for shoulder impingement. SilverSneakers recommends a maximum of 8 consecutive repetitions in one set for an overhead exercise performed with resistance.
- Teach a modified isometric exercise option instead of a true isometric hold – The SilverSneakers-style isometric movement is a small range of motion pulse instead of a sustained contraction or “hold.” True isometric contractions, or holds, can encourage breath holding which, in turn, may elevate blood pressure in class members. High-risk isometric exercises include movements like wall sits or sustained shoulder flexion in which class members raise arms to the front of the body for an extended amount of time. These modified isometric exercise options keep those with cardiovascular chronic conditions safe while helping those with arthritis.
There is a lot to learn and understand when it comes to chronic conditions. As an instructor, one of the key takeaways is that research supports the use of exercise and mindfulness to help manage and even improve many of these conditions. Teaching a safe and effective SilverSneakers class, with modifications for those with chronic conditions, will give all participants the tools for success.