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Jae Chung
03-12-2010, 10:32 AM
I've got a 58-year-old female client with a bunch of mobility issues (both knees, right shoulder). She is about 5'4", about 150 lbs. (She's lost about 15-20 lbs. in the last 12 weeks.) Active, but no real prior weight training.

Diet compliance is relatively ok (she has greatly reduced grains, sugar, dairy, processed foods) but she does not eat or sleep enough, despite my constant harping. Takes a small amount of fish oil, probably 1.5-2g/daily on average (hates taking pills and hates the liquid even more), + 10,000 IU D3 most days.

Back squat and front squat are currently out of the question due to shoulder mobility issues (right "frozen shoulder"). Any advice on what else we can do? We've done goblet squats for several weeks and she is approaching her limit, meaning, the DB is getting too heavy for her to hold up for more than 2-3 reps at around 60-65 lbs.

I have been doing dumbbell press and push press with her, but the poundages are just getting to be too much. She is stuck at 20 lb. DBs for about 4-5 reps and is unable to use 22.5 lb. DBs with good form on the PP. We have already done a reset once, going back down to 10 lb. DBs.

We've been doing straight linear progressions, adding 5 lbs. to DL and goblet squats for around 3 weeks now, SS-style, about 3x per week. We started at very low weights to work on form, initially 3x5 and then 5x5 to get more volume out of the light weights.

Form has improved dramatically on all lifts, but we're approaching weights now that are not going to work for her.

Any advice on movement substitutions? Rep schemes? I'd really appreciate it!

Grissim Connery
03-16-2010, 02:21 PM
does the frozen shoulder inhibit zercher squats?

Jae Chung
03-16-2010, 09:26 PM
Wow, I had not considered zerchers. I think she lacks the back and arm strength to make them work with anything other than very light weights.

Maybe step-ups would work with dumbbells in the hang position?

Steven Low
03-17-2010, 06:22 AM
Pistols, lunges variations, SL RDL, etc.

There's lots of stuff you can do unilaterally you just have to be creative.

Priority in correcting frozen shoulder though....

Jae Chung
03-17-2010, 07:37 PM
I agree about correcting the frozen shoulder. Unfortunately I am not very knowledgeable about mobility issues. I am making my way through the sticky... hopefully that will give me some ideas?

Any quick suggestions? She hates rolling around on a rubber band ball but I make her do it sometimes. Mobility has improved somewhat just from doing ring rows, scaled push-ups, but I feel like it's time to do some dedicated mobility stuff.

Thanks!

Steven Low
03-18-2010, 03:27 AM
Well, what is she doing for physical therapy?

Diet is one of the huge things though that I can see be corrected. The more chronic inflammation the worse off you are because it's called adhesive capsul-ITIS for a reason. The synovial tissues get inflammed and then get gummed up and stick to each other limiting mobility.

If she's getting good stretching and decent mobility work from PT then all you can really do is focus on proper sleep and diet.

If she isn't doing PT then I'll talk more about it here..

Jae Chung
03-18-2010, 08:19 AM
She's doing no PT. I'm not qualified on that account and my knowledge of basic mobility is not good, either. I can do basic PNF stretches and warmup mobility drills, but I don't know enough anatomy to do a proper assessment and target specific issues.

So, any tips would be awesome. :)

I can post this in the recovery section, too, if that would be better.

Thanks!

Steven Low
03-18-2010, 02:32 PM
What mobility does she have so far in:

flexion (raising arm above head)
abduction (raising arm above head sideways)
internal rotation (sleeper stretch, arm up behind the back)
external rotation (both with elbow near side, and arm abducted to 90 deg)

Jae Chung
03-21-2010, 12:16 PM
What mobility does she have so far in:

flexion (raising arm above head)
abduction (raising arm above head sideways)
internal rotation (sleeper stretch, arm up behind the back)
external rotation (both with elbow near side, and arm abducted to 90 deg)

I finally got a chance to measure these last night.

Flexion: pretty good, but last 15 degrees of range is painful at the top for right side

Abduction: same as flexion

Internal rotation: arm up behind back: L side is ok, can get forearm near 45 degrees, hand ends up between scapulae. R side, cannot get behind back at all without pain, and forearm is parallel to floor.

External rotation: L side is fine, R side is short about 30 degrees.

Thanks Steven!

Steven Low
03-21-2010, 12:32 PM
Gonna have to stretch out all of those back to full ROM.

It's fine to do after workouts.. and yes there is going to be pain stretching them out so beware that. Add in mobility work like wall slides and band dislocates.

Also, really stretch out the lats, pec major and minor.. get some tennis ball/foam roll, corner stretching, etc. with thise.

Ice afterwards.

I assume you are doing general strength work. Add in some rotator cuff strengthening as well.

Robert Callahan
03-21-2010, 02:03 PM
We've been doing straight linear progressions, adding 5 lbs. to DL and goblet squats for around 3 weeks now, SS-style, about 3x per week. We started at very low weights to work on form, initially 3x5 and then 5x5 to get more volume out of the light weights.


Keep in mind the older you get the worst your recovery is. Linear progression will thus be shorter the older you get. Reducing lift frequency and moving to more advanced training programs to facilitate recovery is something to always keep in mind while working with older populations :)

Linda Kardos
03-21-2010, 03:31 PM
I can only speak from my own experience as a female close to your client's age who has been able to "hang" with a crossfit crowd.

IMHO I think you'll have to respect her eating habits and preferences. They are not bad and her lack of interest in supplements is common. After experimenting with "recommended" supplement pills for better health and fitness improvement (over 25 years), I don't believe that they are worth the $$ or annoying size they come in, at least not at this level of athletic endeavor.

I find that finding balance with (not eliminating) alcohol, added sugar and dairy in the diet help best for fueling workouts and recovery and inflamation control. Don't forget adequate (not necessarily excessive) protein.

I also think a more general strength focus to her programming might help. Get her doing more bodyweight exercises and scale the dumbell work accordingly.

Try to get her in to a certified A.R.T. therapist. That stuff heals injuries fast! 3 sessions did more for me (hip tendonitis) than 5 months with a traditional PT.

I guess the other big thing I would ask is if she knows what her fitness goals are? If they are not defined then likely trying to find a program for her is just shooting at a moving target. Make sure her priorities are the same ones that you see for her.

Sleep, life's stresses and motivation are more important than they used to be at this stage for her. If she is not stressing over work or family then she can get by on less sleep but if there is a lot going on in other areas of life then working on getting lots if sleep goes a long way.

I hope I am not out of line with my comments and your knowledge/experience. I just find that living "this side" of the fitnesss and age equation is a lot different than what I thought it would be as a younger fitness enthusiast.

Jae Chung
03-23-2010, 08:48 AM
Gonna have to stretch out all of those back to full ROM.

It's fine to do after workouts.. and yes there is going to be pain stretching them out so beware that. Add in mobility work like wall slides and band dislocates.

Also, really stretch out the lats, pec major and minor.. get some tennis ball/foam roll, corner stretching, etc. with thise.

Ice afterwards.

I assume you are doing general strength work. Add in some rotator cuff strengthening as well.

Got it, thanks for the great suggestions!

Keep in mind the older you get the worst your recovery is. Linear progression will thus be shorter the older you get. Reducing lift frequency and moving to more advanced training programs to facilitate recovery is something to always keep in mind while working with older populations :)

Yes, I was quite unprepared for the shortness of linear gains in the upper body (like 3 sessions) which was exacerbated by the inability to use barbells for microloading (due to shoulder mobility). The dumbbells only go up in 2.5 lb. increments so that is 5 lbs. which made it impossible to sustain any kind of linear progress (we went from press X 5 to push press x 5 to push press x 3 and still could not sustain progress for more than 3-4 sessions). Thanks for the reminder to move to more advanced programs.

Jae Chung
03-23-2010, 09:03 AM
Linda, thanks for the thoughtful reply.


IMHO I think you'll have to respect her eating habits and preferences. They are not bad and her lack of interest in supplements is common. After experimenting with "recommended" supplement pills for better health and fitness improvement (over 25 years), I don't believe that they are worth the $$ or annoying size they come in, at least not at this level of athletic endeavor.

It's not that she's not interested, it's that she physically can't stomach them. The large fish oil pills make her gag and the fish oil liquid is even worse (even the Carlson's lemon-flavored). Sigh.

Given her knee pains, migraines, etc. I think that it's absolutely worth it to her from a quality of life POV to take more fish oil. It's just that she doesn't like pills or the liquid. At this point, the athletic endeavors are far less important and are not a factor in terms of the fish oil.

I find that finding balance with (not eliminating) alcohol, added sugar and dairy in the diet help best for fueling workouts and recovery and inflamation control. Don't forget adequate (not necessarily excessive) protein.

Agreed on this... I am positive she is not getting enough protein.

I also think a more general strength focus to her programming might help. Get her doing more bodyweight exercises and scale the dumbell work accordingly.

Try to get her in to a certified A.R.T. therapist. That stuff heals injuries fast! 3 sessions did more for me (hip tendonitis) than 5 months with a traditional PT.

Will do, thanks!

I guess the other big thing I would ask is if she knows what her fitness goals are? If they are not defined then likely trying to find a program for her is just shooting at a moving target. Make sure her priorities are the same ones that you see for her.

Unfortunately she has not been willing to talk to me about these goals for some reason. I think she was reluctant to regard training as anything other than having fun in the gym and did not want to be all serious about it. She has been training with me for several months now and may have had a bit of change of perspective. I'll ask her again.

My primary goals for her at this point are to restore some mobility to the shoulder and gain some remedial strength. She has gone from doing 5 painful push-ups on the kitchen counter to doing 5-10 push-ups with no shoulder pain on the ground (from her knees). This is a tremendous start!

Sleep, life's stresses and motivation are more important than they used to be at this stage for her. If she is not stressing over work or family then she can get by on less sleep but if there is a lot going on in other areas of life then working on getting lots if sleep goes a long way.

Unfortunately she sleeps about 4-6 hours a night, and claims she has been this way for most of her adult life. I know that some people seem to do ok on less sleep, but 5 hours per night?! I don't expect her to change this at all, though, so it's kinda moot. :(

I hope I am not out of line with my comments and your knowledge/experience. I just find that living "this side" of the fitnesss and age equation is a lot different than what I thought it would be as a younger fitness enthusiast.

Not at all... thanks so much for your thoughts!

I think I am decently knowledgeable in working with novice clients who have few mobility problems. Working with older clients with multiple (and severe) mobility issues, and with very different goals, has been a challenge for me. I lack the technical knowledge to improve their mobility quickly, and I lack the experience in dealing with people who are motivated by different goals than I am. So, I appreciate your insights and comments!

Gant Grimes
03-24-2010, 07:04 AM
Here is one of the dumbest statements ever written on the subject of fitness.

The needs of an Olympic athlete and our grandparents differ by degree not kind.

This is wrong, wrong, wrong. If I didn't know better, I'd think a drunken maniac wrote that. Oh wait...

She needs hip flexibility, spinal mobility, and muscle mass. She needs fish oil and probably more protein and iron.

If she can't squat with a bar, don't worry about it. I wouldn't ask her to Zercher, either, if she already has problems with her joints. Get her to goblet squat, and she'll be fine. Work on her rhomboids and hips, and you can fix a lot of postural issues.

3 sets of 10 and a foam roller is your friend here. Constantly varied crap done at high intensity and a puke bucket is not.

Good luck.

Jae Chung
03-24-2010, 01:42 PM
Thanks, Gant.

I'm going to ask some stupid questions because, hey, better to get answers than to keep being ignorant.

Would it be reasonable to do a progression like this?

Goblet squat
Day 01. 3X10 @ 40 lbs.
Day 02. 3x8 @ 45 lbs.
Day 03. 3x5 @ 50 lbs.

Day 04. 3x10 @ 45 lbs
Day 05. 3x8 @ 50 lbs.
Day 06. 3x5 @ 55 lbs.

(Assuming that the dumbbell is getting too heavy to add 5 lbs. every session or every other session.)

Gotta run but will be back with some more questions later!

Linda Kardos
03-24-2010, 04:08 PM
Nice to see you are up for a challenge working with a mature client with very common mobility limitations. (Good on her too for wanting to stay active)

It's not that she's not interested, it's that she physically can't stomach them. The large fish oil pills make her gag and the fish oil liquid is even worse (even the Carlson's lemon-flavored). Sigh.

Given her knee pains, migraines, etc. I think that it's absolutely worth it to her from a quality of life POV to take more fish oil. It's just that she doesn't like pills or the liquid. At this point, the athletic endeavors are far less important and are not a factor in terms of the fish oil.



I respectfully disagree with the benefits of fish oil for everyone, but I'll stay out of that debate since I know it is currently very popular and well supported by users. If people believe something is working for them then go for it.

Swallowing large pills, capsules and softgels are an issue and can be scary if you've ever had one stuck on your windpipe or scratch your throat going down sideways usualy the result of getting anxious about taking them. I've been known to chew them and wash down the nasty grit rather than stressing over them. Probably it's an age-developed thing. When I reflect back on all the dessicated liver pills I took without a flinch back in the 80's when they were on everyone's basic supplement list, I had no problems. Today no way.

Another technique I've learned is to hide oils/liquids in my food when my palate just didn't want to swallow it. (I used to mega-dose (3-6 tbsp per day) on flax seed oil when I had a nasty skin condition that Rx meds couldn't resolve.)

Maybe your client can learn to do the same with fish oil by putting it in salad dressings and sauces. I ate plenty of salads and cooked veggies topped with a blend of olive oil, flaxseed oil and lemon juice. Also butter and oil mixtures or even home made mayo with flaxseed oil as part of it. There is nothing like upping her salmon intake either. That would address both fish oil and protein issues.

With regards to the slow progression in making gains...

One trainer I know had a middle-aged male client who was looking for PT just for general fitness to support weight loss. This man did not even have the strength to hang from a bar to do an assisted pull up when they started. That became the goal ...to hang from to bar first. Gradually they worked towards one pull up as a goal but they didn't do them specifically the outset.

I think you should plan your weight increase progressions based on how her last performance of the exercise went, not by expecting her to be at a certain weight by the next consecutive day. Lots of trial and error. If she's having a good day, up the weight. If its a struggle then dial it down for the day.