EXERCISES IN STRENGTH AND ENDURANCE
Many different physical activities can improve your health and independence.
Whether you choose to do the exercises shown in this chapter or other
activities that accomplish the same goals, gradually work your way up
to include endurance, strength, balance, and stretching exercises.
How Hard Should I Exercise?
We cant tell you exactly how many pounds to lift or how steep
a hill you should climb to reach a moderate or vigorous level
of exercise, because what is easy for one person might be strenuous
for another. It's different for different people.
We can, however, provide some advice based on scientific research:
Listen to your body. The level of effort you feel you are putting
into an activity is likely to agree with actual physical measurements.
In other words, if your body tells you that the exercise you
are doing is moderate, measurements of how hard your heart is
working would probably show that it really is working at a moderate
level. During moderate activity, for instance, you can sense
that you are challenging yourself but that you arent near your
way you can estimate how hard to work is by using the Borg Category
Rating Scale. It was named after Gunnar Borg, the scientist
who developed it. The numbers on the left of the scale don't
indicate how many times or how many minutes you should do an
activity; they help you describe how hard you feel you are working.
For endurance activities, you should gradually
work your way up to level 13 the feeling that
you are working at a somewhat hard level. Some people might
feel that way when they are walking on flat ground; others might
feel that way when they are jogging up a hill. Both are right.
Only you know how hard your exercise feels to you.
Strength exercises are higher on the Borg
scale. Gradually work your way up to level
15 to 17 hard to very hard to build muscle effectively.
You can tell how hard an effort you are making by comparing
it to your maximum effort. How hard does your current effort
feel compared to when you are lifting the heaviest weight you
can lift? Once you start exerting more than a moderate amount
of effort in your muscle-building exercises, your strength is
likely to increase quickly.
As your body adapts and you become more fit, you can gradually
keep making your activities more challenging. You might find,
for example, that walking on a flat surface used to feel like
you were working at level 13 on the Borg scale, but now you
have to walk up a mild hill to feel like you are working at
level 13. Later, you might find that you need to walk up an
even steeper slope to feel that you are working at level 13.
The Borg scale is simple to use. But if your level of effort
doesnât match the numbers you see on the Borg scale for example,
if you think you are doing the exercises correctly, but you
arent progressing or you are exhausted by your effort check
with a fitness professional. These experts are likely to understand
the science that went into developing the Borg scale, and they
can teach you how to match your level of effort with the right
number on the scale.
Here are some points to keep
in mind as you begin increasing your activity:
- If you stop exercising
for several weeks and then return, start out at about half the effort
you were putting into it when you stopped, then gradually build
back up. Some of the effects of endurance and muscle-building exercises
deteriorate within 2 weeks if these activities are cut back substantially,
and benefits may disappear altogether if they arenâ€™t done for
2 to 8 months.
- When an exercise calls
for you to bend forward, bend from the hips, not the waist. If you
keep your entire back and shoulders straight as you bend forward,
that will help ensure that you are bending the right way, from the
hips. If you find your back or shoulders humping in any spot as
you bend forward, thatâ€™s a sign that you are bending incorrectly,
from the waist. Bending from the waist may cause spine fractures
in some people with osteoporosis.
- Itâ€™s possible to combine
exercises. For example, regular stair-climbing sessions improve
endurance and strengthen leg muscles at the same time.
How to Improve
Endurance exercises are any
activity â€” walking, jogging, swimming, raking â€” that increases
your heart rate and breathing for an extended period of time.
How Much, How Often
- Build up your
endurance gradually, starting out with as little as 5 minutes
of endurance activities at a time, if you need to.
- Starting out at a lower
level of effort and working your way up gradually is especially
important if you have been inactive for a long time. It
may take months to go from a very long-standing sedentary lifestyle
to doing some of the activities suggested in this section.
- Your goal is to work your
way up, eventually, to a moderate-to-vigorous level that increases
your breathing and heart rate. It should feel somewhat hard
to you (level 13 on the Borg scale).
- Once you reach your goal,
you can divide your exercise into sessions of no less than
10 minutes at a time, if you want to, as long as they add
up to a total of a minimum of 30 minutes at the end of the day.
Doing less than 10 minutes at a time wonâ€™t give you the desired
cardiovascular and respiratory system benefits. (The exception to
this guideline is when you are just beginning to do endurance activities.)
- Your goal is to build
up to a minimum of 30 minutes of endurance exercise on most
or all days of the week. More often is better, and every
day is best.
- Endurance activities should
not make you breathe so hard that you cant talk. They should not
cause dizziness or chest pain.
- Do a little light activity
before and after your endurance exercise session, to warm up and
cool down (example: easy walking).
- Stretch after
your endurance activities, when your muscles are warm.
- As you get older, your
body may become less likely to trigger the urge to drink when you
need water. In other words, you may need water, but you wont feel
thirsty. Be sure to drink liquids when you are doing any activity
that makes you lose fluid through sweat. The rule of thumb is that,
by the time you notice you are thirsty, you are already somewhat
dehydrated (low on fluid). This guideline is important year-round,
but is especially important in hot weather, when dehydration is
more likely. If your doctor has asked you to limit your fluids,
be sure to check with him or her before increasing the amount of
fluid you drink while exercising. Congestive heart failure and kidney
disease are examples of chronic diseases that often require fluid
- Older adults can be affected
by heat and cold more than other adults. In extreme cases, exposure
to too much heat can cause heat stroke, and exposure to very cold
temperatures can lead to hypothermia (a dangerous drop in body temperature).
If you are exercising outdoors, dress in layers so you can add or
remove clothes as needed.
- Use safety equipment to
prevent injuries. For example, wear a helmet for bicycling, and
wear protective equipment for activities like skiing and skating.
If you walk or jog, wear stable shoes made for that purpose.
When you are ready to progress, build up the amount of time you spend
doing endurance activities first; then build up the difficulty of
your activities later. Example: First, gradually increase your time
to 30 minutes over several days to weeks (or even months, depending
on your condition) by walking longer distances, then start walking
up steeper hills or walking more briskly.
Tips on How to Gauge Your Effort
Here are some informal guidelines you can use to estimate how
much effort you are putting into your endurance activities.
- Talking doesnt take much effort during moderate activity.
During vigorous activity, talking is difficult.
- If you tend to perspire, you probably wont sweat during
light activity (except on hot days). You will sweat during
vigorous or sustained moderate activity.
- Your muscles may get a rubbery feeling after vigorous activity,
but not after moderate activity.
- One doctor who specializes in exercise for older adults
tells her patients this about how hard they should work during
endurance activities: If you cant talk while youre exercising,
its too difficult. If you can sing a song from an opera, its
Examples of Endurance
Examples of activities that are moderate for the average older adult
are listed below.
- Cycling on a stationary
- Gardening (mowing, raking)
- Walking briskly on a level
- Mopping or scrubbing floor
- Golf, without a cart
- Tennis (doubles)
The following are examples
of vigorous activities.
- Climbing stairs or hills
- Shoveling snow
- Brisk bicycling up hills
- Tennis (singles)
- Swimming laps
- Cross-country skiing
- Downhill skiing
How to Improve
Even very small changes in
muscle size can make a big difference in strength, especially in people
who already have lost a lot of muscle. An increase in muscle thatâ€™s
not even visible to the eye can be all it takes to improve your ability
to do things like get up from a chair or climb stairs.
Your muscles are active even
when you are sleeping. Their cells are still doing the routine activities
they need to do to stay alive. This work is called metabolism, and
it uses up calories. That can help keep your weight in check, even
when you are asleep!
About Strength Exercises
To do most of the following strength exercises, you need to lift or
push weights, and gradually you need to increase the amount of weight
you use. You can use the hand and ankle weights sold in sporting-goods
stores, or you can use things like emptied milk jugs filled with sand
or water, or socks filled with beans and tied shut at the ends.
There are many alternatives
to the exercises shown here. For example, you can buy a resistance
band (it looks like a giant rubber band, and stretching it helps build
muscle) at a sporting-goods store to do other types of strength exercises.
Or you can use the special strength-training equipment at a fitness
How Much, How Often
How Muscles Work
What makes your muscles look bigger when you flex them - when
you "make a muscle" with your biceps, for example?
Muscle cells contain long strands of protein lying next to
each other. When you want your muscles to move, your brain signals
your nerves to stimulate them. A chemical reaction in your muscles
follows, causing the long strands of protein to slide toward
and over each other, shortening the length of your muscle cells.
When you "make a muscle" and you see your muscle bunch up and
bulge, you are actually watching it shorten as the protein strands
slide over each other.
When you do challenging muscle-building exercises on a regular
basis, the bundles of protein strands inside your muscle cells
- Do strength exercises
for all of your major muscle groups at least twice a week.
Donâ€™t do strength exercises of the same muscle group on any 2
days in a row.
- Depending on your condition,
you might need to start out using as little as 1 or 2 pounds of
weight, or no weight at all. The tissues that bind the structures
of your body together need to adapt to strength exercises.
- Use a minimum
of weight the first week, then gradually add weight. Starting
out with weights that are too heavy can cause injuries.
- Gradually add a challenging
amount of weight in order to benefit from strength exercises. If
you dont challenge your muscles, you wont benefit from strength
exercises. (The â€śProgressing section will tell you how.)
- When doing a strength
exercise, do 8 to 15 repetitions in a row. Wait a minute, then do
another set of 8 to 15 repetitions in a row of
the same exercise. (Tip: While you are waiting, you might want to
stretch the muscle you just worked or do a different strength exercise
that uses a different set of muscles).
- Take 3 seconds
to lift or push a weight into place; hold the position
for 1 second, and take another 3 seconds to lower
the weight. Donâ€™t let the weight drop; lowering it slowly
is very important.
- It should feel somewhere
between hard and very hard (15 to 17 on the Borg scale) for you
to lift or push the weight. It should not feel very, very hard.
If you cant lift or push a weight 8 times in a row, its too heavy
for you. Reduce the amount of weight. If you can lift a weight more
than 15 times in a row, its too light for you. Increase the amount
- Stretch after strength
exercises, when your muscles are warmed up. If you stretch before
strength exercises, be sure to warm up your muscles first (through
light walking and arm pumping, for example).
Practice Sitting Straight
Sit or stand with your shoulders back, but not pinched, and
hold this position while you take slow, deep breaths. You can
do this anytime.
- Don't hold your
breath during strength exercises. Breathe normally. Holding
your breath while straining can cause changes in blood pressure.
This is especially true for people with cardiovascular disease.
- If you have had a hip
repair or replacement, check with your surgeon before doing lower-body
- If you have had a hip
replacement, don't cross your legs, and don't bend your hips farther
than a 90-degree angle.
- Avoid jerking or thrusting
weights into position. That can cause injuries. Use smooth, steady
- Avoid "locking" the joints
in your arms and legs in a tightly straightened position. (A tip
on how to straighten your knees: Tighten your thigh muscles. This
will lift your kneecaps and protect them.)
- Breathe out as you lift
or push, and breathe in as you relax. For example, if you are doing
leg lifts, breathe out as you lift your leg, and breathe in as you
lower it. This may not feel natural at first, and you probably will
have to think about it as you are doing it for awhile.
- Muscle soreness lasting
up to a few days and slight fatigue are normal after muscle-building
exercises, but exhaustion, sore joints, and unpleasant muscle pulling
aren't. The latter symptoms mean you are overdoing it.
- None of the exercises
you do should cause pain. The range within which you move your arms
and legs should never hurt.
- Gradually increasing the
amount of weight you use is crucial for building strength.
- When you are able to lift
a weight between 8 to 15 times, you can increase the amount of weight
you use at your next session.
- Here is an example of
how to progress gradually: Start out with a weight that you can
lift only 8 times. Keep using that weight until you become strong
enough to lift it 12 to 15 times. Add more weight so that, again,
you can lift it only 8 times. Use this weight until you can lift
it 12 to 15 times, then add more weight. Keep repeating.
Sarcopenia: A Word
You Are Likely to Hear More About
We know that muscle-building exercises can improve strength in most
older adults, but many questions remain about muscle loss and aging.
Researchers want to know, for example, if factors other than a sedentary
lifestyle contribute to muscle loss. Does age itself cause changes
in the muscles of older people? Is muscle loss related to changes
in hormones or nutrition? The answers to these questions may lead
to ways of helping us keep our strength as we age.
In this book, we use the
word "frailty" to describe the loss of muscle and strength often seen
in older people, because it's a word that most people are familiar
with. However, a better word to use is "sarcopenia" (pronounced sar
- ko - PEEN - ya). It means not only the loss of muscle and strength
but also the decreased quality of muscle tissue often seen in older
adults. You are likely to hear more about sarcopenia in the future
since it's a very active area of research.
- Build up to all exercises
and activities gradually, especially if you have been inactive for
a long time.
- Once you have built up
to a regular schedule, include endurance, strength, balance, and
- If you have to stop exercising
for more than a few weeks, start at half the effort when you resume,
then build back up to where you were.
- When bending forward,
always keep back and shoulders straight to ensure that you are bending
from the hips, not the waist.
- If you have had a hip
replacement, check with your surgeon before doing lower body exercises.
- To build stamina, you
can do specific exercises, like walking or jogging, or any activity
that raises your heart rate and breathing for extended periods of
- Do at least 30 minutes
of endurance activities on most or all days of the week.
- If you prefer, divide
your 30 minutes into shorter sessions of no less than 10 minutes
- The more vigorous the
exercise, the greater the benefits.
- Warm up and cool down
with a light activity, such as easy walking.
- Activities shouldnâ€™t
make you breathe so hard you canâ€™t talk. They shouldnâ€™t cause
dizziness or chest pain.
- When you are ready to
progress, first increase the amount of time, then the difficulty,
of your activity.
- Stretch after endurance
- Do strength exercises
for all your major muscle groups at least twice a week, but not
for the same muscle group on any 2 days in a row.
- Gradually increasing the
amount of weight you use is the most important part of strength
- Start with a low amount
of weight (or no weight) and increase it gradually.
- When you are ready to
progress, first increase the number of times you do the exercise,
then increase the weight at a later session.
- Do an exercise 8 to 15
times; rest a minute and repeat it 8 to 15 more times.
- Take 3 seconds to lift
and 3 seconds to lower weights. Never jerk weights into position.
- If you cant lift a weight
more than 8 times, its too heavy; if you can lift it more than 15
times, its too light.
- Donâ€™t hold your breath
- These exercises may make
you sore at first, but they should never cause pain.
- Stretch after strength
- Add the following modifications
to your regularly scheduled lower-body strength exercises: As you
progress, hold onto the table or chair with one hand, then one finger,
then no hands. If you are steady on your feet, progress to no hands
and eyes closed. Ask someone to watch you the first few times, in
case you lose your balance.
- Donâ€™t do extra strength
exercises to add these balance modifications. Simply add the modifications
to your regularly scheduled strength exercises.
- Another way to improve
your balance is through â€śanytime, anywhereâ€ť balance exercises.
One example: Balance on one foot, then the other, while waiting
for the bus. Do as often as desired.
- Stretching exercises may
help keep you limber.
- Stretching exercises alone
will not improve endurance or strength.
- Do stretching exercises
after endurance and strength exercises, when your muscles are warm.
- If stretching exercises
are the only kind of exercise you are able to do, do them at least
3 times a week, up to every day. Always warm up your muscles first.
- Do each exercise 3 to
5 times at each session.
- Hold the stretched position
for 10 to 30 seconds.
- Total session should last
15 to 30 minutes.
- Move slowly into position;
never jerk into position.
- Stretching may cause mild
discomfort, but should not cause pain.