Other/Mixed Grinds, blood pressure, and grandparents

[Snowman]

In the next few years I'm (hopefully) going to be a primary care doc. That means one of the groups I get to work with will be the elderly. The biggest issue the prevents someone from being able to care for themselves as they age is loss of strength, as well as flexibility. To put it simply, if you can't stand up from the couch, or turn around to clean yourself, someone has to help. That someone usually ends up being a nursing home CNA being paid a fraction above minimum wage.
I'm not so worried about how to train flexibility, but I've found disappointingly little about strength training for our grandparents. It's usually just advice to "do 20 reps with super light weight, and get on the elliptical for a while." I would assume that learning tension generation techniques is relevant no matter your age, and I know that relatively high impact/high strain exercises are critical for maintaining bone mass. One thing that worries me is that most high tension techniques cause temporary spikes in blood pressure, and I don't know if that's a great thing to expose a sedentary elderly person to right off the bat. Am I wrong? Are there some good progressions that produce strength but minimize the BP spike?
Here's the scenario: You have an 80 y/o female with moderate osteoarthritis in her back, knees, shoulders, and hands. She is an appropriate weight for her age, but she walks with a cane and it is starting to become difficult for her to stand up from a seat, or to walk very far. She's doesn't want to be put in a home, and is very compliant. What do you do?

 

[Harald Motz]

Hello Snowman,
This is a really important topic, as the population in developed countries is getting older. As an idea/suggestion I take reference on Al Ciampa's superb little handbook on "Physical Training Culture".
"You should not train for strength and conditioning on a foundation of poor movement" it starts with building up movement competency and reflexive strength with the very basics of human movement patterns, rolling, rocking and crawling to "rebuild the chassis" to walking, to develop posture, mobility and some strength. Getting up from the floor can be a daunting task for some folks, but to lead them to do just this...could be a great accomplishment, for the student as well as for the teacher in this regard. "Crawling and loaded carries can increase movement quality and reflexive tension without thought, just through practice...it is also a great way to practice proper breathing."
This is just, what comes to my mind to have an idea of a possible starting point.

 

[Al Ciampa]

Thank you Harald, but allow me to give credit to Grey Cook & Co, the OS guys, and Brandon Hetzler as well. Their ideas helped to shape mind.

 

[Kyrinov]

Snowman,

Interesting discussion as I'm contemplating something similar. I'm a primary care paramedic in a service with a rather robust experiment in what we call "Community Paramedicine" up here in Ontario, a combination of education and checkups for those at risk and more ongoing in-community management by advanced care paramedics for those at high risk of ED readmission due to the usual chronic culprits (COPD, CHF, Diabetese etc.) We are basically trying to use the medic skill set and infrastructure to manage the patients who tax the healthcare system, in particular the ED and emergency services, by managing their conditions in the community and staying ahead of acute events. I had a little bug in my ear about the possibility of using fall-mitigation and self-rescue training based in part off the Systema basic training curriculum as well as some related stuff in the SF/Dan John/OS spectrum. My thought process on the question is very simple. Are these people going to pursue a systematic strength and conditioning program if they have not been doing so throughout their life? Not bloody likely. Is the benefit of a general physical preparation likely to take root in someone who has been largely sedentary and is now at the end of their lifespan? Not bloody likely. The time for GPP has passed...which is why all these "fitness for seniors" programs have limited utility IMO. Much better to target the problems directly with a specialized solution. In this case, as you well know one of the greatest threats to continued independence and well being at this point is the dreaded hip fracture. Pt falls, fractures hip, develops bedsores, goes septic, spends time in ICU, recovers but has completely atrophied...aaaaand you get the picture. Even if they don't get a fracture, we get the dreaded 9-1-1 lift assist call which ties up resources for "real" emergencies. My thoughts are target the fall-mitigation elements in the nervous system directly through gentle, progressive proprioceptive stimulation, try to rebuild some of those infant movement patterns and help learn to organize the body from the floor. The general health benefits of such work will be there, but you're targeting the "threat" directly by giving the body the specialized stimulus it needs rather than taxing a limited recovery capacity with random general work. Just my thought, but something that has been very much on my mind of late. I am going to hold off on proposing it to our Commander of Community Paramedicine until the new year as I'm already overdoing it in life but would love to stay in touch to let you know how it goes.

 

[Steve Freides]

I would assume that learning tension generation techniques is relevant no matter your age

Absolutely, and it's never too late to learn as long as the doc says it's OK.

One thing that worries me is that most high tension techniques cause temporary spikes in blood pressure, and I don't know if that's a great thing to expose a sedentary elderly person to right off the bat.

Unless the doctor says it's a problem, it's not a problem - have an older client check with their doctor first. I don't think it has to be more complicated than that.

-S-

 

[MikeMoran]

As a soon to be certified OS coach I would recommend starting with the basic 5 OS Resets as outlined in the book Original Strength or the updated version Pressing Reset Original Strength Reloaded.

These simple drills can reactivate their reflexive strength and allow them to move better,feel better and then you can start loading them with proper exercises like a KB Swing/Get Up.

 

[Snowman]

Thanks everyone for the great input! This, as was mentioned, seems to be more of an issue as developed countries get better at prolonging life, but lag behind in preserving quality of life and independence. I still have a while before the issue is really on my plate, as I'm only about halfway through the pipeline right now, but I hope to be as prepared as possible when I finally get out the other side.

@Kyrinov, I have to agree with your sentiment regarding self motivation. Giving a sedentary 60 y/o a KB and a copy of S&S will probably accomplish exactly nothing. Ideally, one could develop a 6-12 month program/class that allows people to come in 2-4 times a week. Anything else seems unlikely to really build a new habit, and would most likely peter out after a week or three without supervision. Of course, then one is faced with scheduling and staffing issues. I certainly won't pretend like I'm anywhere close to figuring it out. But I do like the idea of at least treating the acute/high profile issues with targeted, shorter duration training.

It looks like I probably have an OS and FMS cert in my future, but that's seemed likely for a while now.