I’m now living with my 92-year-old friend Rick. He’s lived alone for a decade. He has a bad hip so he gets around with a walker. A caregiver Betty comes in the morning to fix his breakfast and again in the evening to fix his dinner. The rest of the time he is happily on his own.
He has a set of exercises given him by a physical therapist, which he faithfully did once a day. He also has a stationary bike, which until recently he rode for 15 minutes after breakfast including sprinting at the end.
One a month ago after Betty had left he was doing the slight knee bends prescribed by the PT while holding onto the kitchen counter for stability. He lost his balance and fell. He’s not strong enough to get up so he spent the night on the floor because he couldn’t get his cell phone to work. Betsy found him the next morning and called the fire department because the two of them couldn’t get him up.
He then had trouble moving his left leg so we took him to the ER. He spent two nights in the hospital getting thoroughly checked out and they found he’d broken his pubic bone, which was why he couldn’t use his left leg. Otherwise he was a healthy nonagenarian. Nothing can be done for a broken pubic bone so we ordered a hospital bed and a wheel chair and brought him home. It took two people for the transfers to get him out of bed, into the wheel chair and then into his chair in the family room. We hired two more caregivers on different shifts to help me. For each transfer we’d put a belt around him and used it to lifted him up from bed and then lowered him to the wheelchair, etc.
Every day he’s getting stronger. He now just needs one of us to hold the belt to help him balance during a transfer and to spot him in case he starts to fall. He’s doing all the work. To get around the house he now can move himself in the wheelchair. What can we learn?
Preventive care.
10 years ago he needed a hip replacement but didn’t get one because he was helping to care for his wife. In retrospect they should have hired help so he could have had the surgery. He also could have started doing exercises for his strength and balance. I have a hammer toe that could have been fixed with just a week or two off the bike …. but I was busy riding and skiing and kept putting it off. Now it requires surgery and six weeks recuperation with my foot in the air.
Balance.
Falls are the number one reason people 65 and older go to the ER and one out of five falls causes a serious injury such as broken bones or a head injury. For this reason the American College of Sports Medicine (ACSM) recommends we older folks do 20 to 30-minutes of balance exercises at least two or three days a week. Each exercise should involve balance, agility, coordination, gait and proprioception. I practice tai chi daily, which helps my balance. Last week Rick commented that if he’d started tai chi 10 years ago he wouldn’t be in the condition he’s in now.
Bone strength.
You are constantly renewing your bones by making new bone content as old bone content disappears. Bone renewal peaks in your 20s, and after about age 40 bone mass is lost by about 0.5% or more per year. Osteoporosis is a progressive condition of lower bone mineral density resulting in thinner and more brittle bones. As a result, you are more vulnerable to fractures, particularly of the wrist, hip and spine as a result of falls. Because Rick was getting almost no weight-bearing exercise he had weak bones and just falling a couple of feet was enough to break his pubic bone. Several years ago when he fell he broke one of his hips.
The ACSM recommends at least 30 to 60 minutes per day of weight-bearing exercise three to five days a week. Cycling is easy on your joints because it is not weight bearing and, for that reason, you need to supplement it with weight-bearing exercise. (Even when a pro sprints standing on the pedals, the racer is putting less than full body weight on the pedals and thus isn’t overloading the skeleton.)
Given Rick’s physical condition weight-bearing exercise is out, so we’re working on his balance and strength and using someone to spot him to reduce as much as possible the risk of falling.
Atrophy.
Before he fell Rick was strong enough to get in and out of bed and around the house with his walker. After just 48 hours in the hospital his muscles had atrophied so much that he needed two of us to move him. The ACSM recommends two or three days of strength training per week using a variety of exercises and equipment. You can incorporate weight-bearing calisthenics of 8-10 exercises involving the major muscle groups as well as stair climbing, which are weight-bearing exercises.
Dedication and commitment.
Rick wants to recover enough that he can live independently again. He has a son, two daughters and three granddaughters now in their 30s. He enjoys all of their visits and takes great pride in granddaughters personal and professional growth. Although he hates exercise he is committed to doing what he needs to do to meet his goals of living independently and enjoying family time.
Professional help.
A physical therapist and an occupational therapist came weekly when he came home from the hospital. The PT gave him a new strength program that includes exercises such as standing up, holding onto his walker, remaining upright for about a minute and then sitting down. While standing he works on his practicing putting his weight forward on his toes so he is more stable. The OT helped us learn how to do safer transfers and worked with him on daily activities. He’s using a commode and the OT tried to get him use the wheel chair to get into the bathroom to use the regular toilet but he thinks that’s too hard. Hell, he’s 92 and he can do whatever he wants!
Home strength program.
Rick’s goal is to progress to where he can live at home much more independently. Fortunately, strength training has the same effects on the muscles of nonagenarians as it does on 25-year-olds! His strength program from the PT is all about functional fitness to achieve that goal. He stands up and then uses his arms to lower himself back down. He marches while in his chair to strengthen his legs and get a bit of cardio. He does seated leg extensions to strengthen his quads and ankle pumps to strengthen his calves. To strengthen the two muscle groups that are essential for stability and balance, he his knees to the outside to strengthen his adductors and squeezes a ball between his knees to strengthen his abductors. He’s progressing to standing up, holding the walker and marching in place and also doing ankle and toe raises. For his hands he is opening his fingers wide and then clenching his fists and also touching his thumb to each finger.
To get him to bed initially it took two of us to lift him out of the wheel chair, lay him down, lift his legs to the bed and then lift him closer to the head of bed. Now he stands up from the wheel chair using the walker for balance and lowers himself to the bed rather than just collapsing. He then uses his arms to lift his body enough to scoot sideways toward the head of the bed and then he lies down and lifts his own legs.
Use technology.
Rick has trouble using his cell phone so now wears an emergency call button in case he needs help when no one else is home. It’s programmed to alert his primary care giver. A walker is too hard to get around the house so now he rolls himself around the house in a wheel chair. My bike has a triple chain right and a big cluster. Some day I’ll graduate to an e-bike. And then a trike.
If my 92-year-old friend can get in better shape so can you!
Anti-Aging.
I designed and wrote my eBook Anti-Aging 12 Ways You Can Slow the Aging Process to help you slow and even reverse your physical decline by increasing your aerobic capacity, doing intensity training, building and maintain muscle strength and power, increasing your flexibility, working on your balance and reducing bone loss. Anti-Aging incorporates the latest research and most of it is new material not published in my previous eArticles on cycling past 50, 60 and beyond. Anti-Aging: 12 Ways You Can Slow the Aging Process is your comprehensive guide to continuing to ride well into your 80s and even your 90s. The 106-page eBook is $14.99.
Coach John Hughes earned coaching certifications from USA Cycling and the National Strength and Conditioning Association. John’s cycling career includes course records in the Boston-Montreal-Boston 1200-km randonnée and the Furnace Creek 508, a Race Across AMerica (RAAM) qualifier. He has ridden solo RAAM twice and is a 5-time finisher of the 1200-km Paris-Brest-Paris. He has written over 40 eBooks and eArticles on cycling training and nutrition, available in RBR’s eBookstore at Coach John Hughes. Click to read John’s full bio.
Great story. Yes, strength training and balance work are absolutely critical for seniors to adopt as part of ant fitness program. I and 2 other trainers (all of us cyclists and seniors) lead a twice a week class at the Berkeley YMCA – “Strength Training for Seniors” that focus on these areas of functional fitness training. However, because of the pandemic our class been temporally discontinued. In these difficult circumstances educational work like yours is more important than ever. Thanks, Dan Greene, Albany, Ca
Dan I’m glad you found this helps
John, this is a two subject story. How Rick is responding to what life is throwing at him is beyond inspirational to those of us who have quit putting candles on our birthday cake because it sets off the smoke alarm. And your caring for him and seeing to his needs is what true friendship is all about. He is lucky to have you and vice-versa.
What Dan pointed out is undeniable. I never did much upper body work then last year my muscle mass seemed to just go poof over the period of a summer. I’m 86 so late starting, but doing it. I’m fortunate in that I live in Oro Valley, AZ and summer in Longmont, CO so I can ride regularly.