E X E R C I S E : A G u i d e f rom t h e N a t i o n a l I n s t i t u t e o n Ag i n g

Exercises

Motivation

Safety

Exercise:
A Guide from
the National
Institute
on Aging

U.S. Department of Health and Human Services

Public Health Service
National Institutes of Health
National Institute on Aging
800-222-2225
www.nia.nih.gov
NIH Publication No. 01-4258
Reprinted September 2006

S e l f - Te s t s

Benefits

Nutrition

Designed by Levine and Associates, Washington DC

Dear Friends:
You are never too old to get in shape. I am often asked what Ive done over the years to
stay in shape. At different times, I have engaged in many different activities. When I was
in school I played football and basketball. The Marine Corps provided its own unique
brand of physical training or PT. While in the space program and for many years afterwards, I jogged to stay in shape. And my wife Annie and I have enjoyed hiking and skiing
over the years. Most of all, I have always valued staying active in one way or another.
From my involvement with NASA, both in the Mercury program and with the Shuttle
Mission STS-95, I have become keenly aware of the effect that weightlessness can have
on the human body. Without the effect of gravity, astronauts muscles and bones begin
to deteriorate while theyre in space. A number of other changes occur to the astronauts in
orbit from which they recover upon their return that also happen as part of the natural
aging process right here on Earth. For one, osteoporosis sets in. These same things can
happen to us if we maintain a sedentary lifestyle. This is especially true as we get older.
The good news is that exercise is just a step away. I am pleased to recommend
Exercise: A Guide from the National Institute on Aging as an excellent manual for anyone
who wants to take those first steps toward an active lifestyle. The scientists and doctors at
the National Institute on Aging at the National Institutes of Health collaborated to produce
this top-notch book. This guide contains valuable information about how exercise and
proper nutrition are crucial for staying healthy as we age and provides useful tips on
establishing and maintaining a regular exercise program.
In my case, I had to make accommodations to my advancing years by modifying
my exercise regime. In the past, I was an ardent jogger, but as I got older my doctor said
that the impact of running was putting too much stress on my knees and other joints. He
suggested that I take up speed walking instead. Along with that, I do some weight lifting
and stretching. So now I still get a great workout, but by doing exercise that is appropriate
for my age and physical condition. This guide will help you do the same.
I hope you will read this book and follow its suggestions. We can all enjoy healthy
and productive senior years by heeding these recommendations.
Senator John Glenn

Table of
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 1:
What Can Exercise Do for Me? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Chapter 2:
Is It Safe for Me to Exercise? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Chapter 3:
How to Keep Going . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Chapter 4:
Sample Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chapter 5:
How Am I Doing ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Chapter 6:
What Should I Eat? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Appendix:
A.
B.
C.
D.

Target Heart Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Exercise Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Activity and Progress Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Mail-in Certificate Request . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Acknowledgments
The National Institute on Aging, part of the National
Institutes of Health, brought together some of the
nations best-informed experts on the topic of exercise
for older adults to discuss the writing of this book.
They include:
Panel co-chairpersons: Chhanda Dutta, Ph.D.,
and Marcia Ory, Ph.D.; Health Scientist
Administrators; National Institute on Aging,
National Institutes of Health
David Buchner, M.D., M.P.H.;
Professor, Department of Health Services,
University of Washington
Marie Elaine Cress, Ph.D.; Associate Professor,
Department of Exercise Science and Gerontology
Center, University of Georgia
William Evans, Ph.D.; Director of Nutrition,
Metabolism, and Exercise Laboratory at Donald W.
Reynolds Department of Geriatrics, University of
Arkansas for Medical Sciences
Maria Fiatarone Singh, M.D.; Associate
Professor, School of Nutrition and Science Policy,
Tufts University
Alan Jette, Ph.D.; Dean, Sargent College of Health
and Rehabilitation Sciences, Boston University
Thomas R. Prohaska, Ph.D.; Director, Center for
Research on Health and Aging, University of
Illinois at Chicago
Anita Stewart, Ph.D.; Professor in Residence,
Institute for Health & Aging, University of
California San Francisco
2

We also extend special thanks to Steven N. Blair,

P.E.D., Director of Research at the Cooper Institute
for Aerobics Research; and to Roger Fielding, Ph.D.,
Assistant Professor of Health Sciences and Brookdale
National Fellow at the Sargent College of Health
and Rehabilitation Sciences, Boston University, for
their contributions.
Each of these experts is a major force in research
devoted to improving the health and independence
of older adults through exercise. We are grateful to
them and to other leaders in the field whose work is
reflected in these pages for sharing their expertise.
We are also grateful to Jerome L. Fleg, M.D., and
Edward G. Lakatta, M.D., of the Gerontology Research
Center; the American College of Sports Medicine; the
American Heart Association; the American Physical
Therapy Association; the National Center for Medical
Rehabilitation and Research; the National Heart, Lung
and Blood Institute; the National Institute of Arthritis
and Musculoskeletal and Skin Diseases; the National
Institute of Child Health and Human Development;
the Office of Disease Prevention of the National
Institutes of Health; the National Aeronautics
and Space Administration; and the Public Health
Service Office on Womens Health.

Introduction

Studies show that, in the long term, older

adults in all age groups hurt their health far
more by not exercising than by exercising.
As a rule, older people should stay as physically active as they can.
Chapter 2 of this book explains that
there are certain situations in which you
should check with your doctor before starting to exercise. You will also find out about
a couple of conditions that prohibit exercise. More than likely, though, reading
Chapter 2 will reassure you, but if you still
have any doubts about exercise, talk to your
doctor before you start.

Getting Past
The Barriers

You may be reluctant to start exercising,

even though youve heard that its one of
the healthiest things you can do. You may
be afraid that physical activity will harm
you; or you might think you have to join a
gym or buy expensive equipment in order
to exercise. Or, you may feel embarrassed
to exercise because you think its for
younger people or for people who look
great in gym clothes. You may think exercise is only for people who are able to do
things like jogging.
About This Book
In fact, just about every older adult can
The first three chapters of this book explain
safely do some form of physical activity at
what exercise and physical activity can do
little or no cost. And you dont have to
for you, how to exercise safely, and how
exercise in a public place or
to stay motivated to exercise.
use expensive equipment, if
If you already know the mateyou dont want to.
The good news...
rial in Chapters 1 and 2
Even household chores can
is that people can
for example, if your doctor
improve your health. The key
benefit from even
already has talked to you
is to increase your physical
moderate levels
about the benefits of exercise
activity, by exercising and by
of physical activity.
and has advised you how to
using your own muscle power.
exercise safely skip to the
summary at the end of each
Surgeon General of the
United States
chapter to make sure that you

Welcome to one of the healthiest things

you can do for yourself. Exercise! Regular
exercise and physical activity are very important to the health and abilities of older people.
In fact, studies suggest that not exercising is
risky behavior. That is why we wrote this
book. We are the National Institute on Aging,
part of the National Institutes of Health, and
our research is aimed at improving the health
of older people.
For the most part, when older people
lose their ability to do things on their own,
it doesnt happen just because they have
aged. More likely, it is because they have
become inactive. Older inactive adults lose
ground in four areas that are important
for staying healthy and independent:
endurance, strength, balance, and flexibility.
Fortunately, research suggests that you
can maintain or at least partly restore these
four areas through exercise or through
everyday physical activities (walking
briskly or gardening, for example) that
accomplish some of the same goals as
exercise. What may seem like very small
changes resulting from exercise and
physical activity can have a big impact.

Who Can Exercise?

Fa c t :
Together, lack of exercise and poor diet are the second-largest
underlying cause of death in the United States.
(Smoking is the #1 cause.)

arent missing any important information,

At the end of the book, you will find
then go to Chapter 3, which discusses
resources to contact for more information
motivation.
about exercise and special programs for
Chapter 4 is a how-to chapter.
older exercisers. Some of the resources are
It shows how to exercise to improve or
for people with diseases or disabilities. You
maintain endurance, strength, balance, and
will also find charts to record your progress
flexibility. You certainly arent restricted
and a form you can fill out and send to us
to these exercises. We show
after you have been exercisyou these examples to help
ing for at least a month. We
I walk, garden,
you get started.
will send you a National
and do housework.
Chapter 5 also is a howInstitute on Aging certificate
Exercise keeps
to chapter. It gives examples
that acknowledges your comme limber.
of ways you can check your
mitment to improving your
Most people
progress. The last chapter is
health through exercise.
dont think Im
about nutrition. Each chapter
my age.
summary lists important points
to remember.

Darrell Randall, 81,

Washington, D.C.

A Word About Words

erms used to discuss exercise can be confusing.

We want to explain a few key words used in this book.
You probably have heard the term aerobics or aerobic
exercises. We call them endurance exercises or
endurance activities. These activities increase your
heart rate and breathing for an extended period of time.
The term cardiovascular refers to your heart and
circulatory systems.
The word frailty has more than one meaning. We use it
here to mean the physical condition that results, in part,
from severe muscle loss the kind of muscle loss seen in
people who have been inactive for many years. Frail people
have severe loss of strength and often cannot perform
everyday tasks.

We frequently use the word independence; in this book,

it means older adults ability to live and do things on their
own. Being independent doesnt necessarily mean doing
things alone; it means being able to do for yourself, in
your everyday tasks and your leisure activities, to the
greatest extent possible.
Exercises that build muscle have a variety of names,
including strength-training, resistance-training,
weight-training, or weight-lifting. In this book,
we call them muscle-building or strength exercises.
What is considered a physical activity and what is considered an exercise? A physical activity is any voluntary body
movement that burns calories. Exercise is physical activity
that follows a planned format. Its done with repeated
movements, with the goal of improving or keeping up
one or more specific areas of physical fitness.

Benefits

His Garden Grows

My exercise focus is on gardening, Arthur Canfield,
83, of Fairfax, Virginia, told us. I hate the
thought of exercise for exercises sake. Ive never
done that, he said.
Mr. Canfield grew up close to the soil. He
remembers driving horses pulling hay, sometimes
all day, and carrying water down to the garden on
his uncles farm. His wife grew up in a family that
made its living in the wholesale florist trade, so she,
too, understood gardens.
Mr. Canfield and his wife brought their lifelong
affinity for gardening with them into their marriage.
When they settled in Fairfax, near Mr. Canfields job
as an economist, the house they bought had about
an acre of land, and they worked it and worked
it. I didnt want to be deskbound when I became
a bureaucrat. Thats when I decided to become a
serious gardener, he said.
Gardening, Mr. Canfield told us, gives you an
opportunity to exercise every part of your body and
get satisfaction out of it at the same time. He said
that gardening does more than build muscle and
endurance. You have to keep your balance. Youre
reaching up to prune trees, bending over to check
your tomato plants. The actual energy output at
any given moment may not amount to much, but

your whole system is participating the whole time,

he said. It adds up.
Mr. Canfield lives on his own and drives himself
wherever he needs to go. He works in his garden
3 or 4 hours every day.
Its got to be fun, he said. I like to work
what I do into a rhythmic pattern. Splitting wood,
chopping down trees the rhythmic pattern of
exercise is like music. Youre absolutely a free spirit.
You forget about it as youre doing it.
Mr. Canfield thinks that the idea of exercise
sounds grim to most people as though they have
to do it, because there will be penalties if they dont.
But raking leaves is not something you should
dread; its a joyous thing. In New England, its
as much of an event as
sugaring-off the maples;
its the center of things
for a while, he said.
He wants to give other
older adults the following
message about increasing
their physical activity:
Once they start, theyll
see that it builds on itself.
It feels so good.

What Can Exercise

Do for Me?
Most people know that exercise is good for
them. Somehow, though, older adults have
been left out of the picture until recently.
Today a new picture is emerging from
research: Older people of different physical
conditions have much to gain from exercise
and from staying physically active. They also
have much to lose if they become physically
inactive.
Exercise isnt just for older adults in the
younger age range, who live independently
and are able to go on brisk jogs, although
this book is for them, too. Researchers have
found that exercise and physical activity also
can improve the health of people who are 90
or older, who are frail, or who have the diseases that seem to accompany aging. Staying
physically active and exercising regularly can
help prevent or delay some diseases and disabilities as people grow older. In some cases,
it can improve health for older people who
already have diseases and disabilities, if its
done on a long-term, regular basis.

What Kinds of Activities

Improve Health and
Ability?
Four types of exercises help older adults
gain health benefits:
Endurance exercises increase your
breathing and heart rate. They improve the
health of your heart, lungs, and circulatory
system. Having more endurance not only
helps keep you healthier; it can also improve
your stamina for the tasks you need to do to
live and do things on your own climbing
stairs and grocery shopping, for example.
Endurance exercises also may delay or prevent many diseases associated with aging,
such as diabetes, colon cancer, heart disease,
stroke, and others, and reduce overall death
and hospitalization rates.
Strength exercises build your muscles,
but they do more than just make you
stronger. They give you more strength to
do things on your own. Even very small
increases in muscle can make a big difference in ability, especially for frail people.

Benefits

Chapter 1

Fa c t :
More than two-thirds of older
adults dont engage in regular
physical activity.
Strength exercises also increase your metabolism, helping to keep your weight and blood
sugar in check. Thats important because obesity and diabetes are major health problems
for older adults. Studies suggest that strength
exercises also may help prevent osteoporosis.
Balance exercises help prevent a common problem in older adults: falls. Falling
is a major cause of broken hips and other
injuries that often lead to disability and loss
of independence. Some balance exercises
build up your leg muscles; others require you
to do simple activities like briefly standing on
one leg.
Flexibility exercises help keep your
body limber by stretching your muscles
and the tissues that hold your bodys structures in place. Physical therapists and other
health professionals recommend certain
stretching exercises to help patients recover
from injuries and to prevent injuries from
happening in the first place. Flexibility also
may play a part in preventing falls.

Fa c t :

Which Ones Should

I Do, and How Much
Should I Do?

Many people 90 and older who have become physically frail

from inactivity can more than double their strength through simple
exercises in a fairly short time. For some, that can mean the difference
between getting up from a chair by themselves or depending on someone
to help them. In one study, some people 80 and older progressed
from using walkers to using canes after doing simple muscle-building
exercises for just 10 weeks.

Some types of exercise improve just one

area of health or ability. More often, though,
an exercise has many different benefits.
In other words, exercise as much as you
can. Its best to increase both the types and
amounts of exercises and physical activities
you do. Gradually build up to include:
endurance, strength, balance, and flexibility
types of exercises that you can manage and
exercises. (We show you how in Chapter 4.)
that you really can fit into your schedule,
Now that you have read about all
then add more as you adjust to ensure that
the benefits of exercise, we hope you are
you will stick with it.
enthusiastic about getting started. However,
How much you exercise depends on you
its important to start at a level you can
and on your unique situation.
manage and work your way up
For some, muscle-building
gradually.
Exercise
is
like
a
exercise might mean pushing
For one thing, if you do
savings
account.
more than a hundred pounds
too much too quickly, you can
of weight at the local gym to
damage your muscles and tisThe more you put
keep your legs in shape for
sues, and that can keep you on
in, the more
hiking or jogging. For others,
the sidelines. For another, your
youre going to
it might mean lifting 1-pound
enthusiasm needs to last a lifeget out of it.
weights to strengthen your
time. The benefits of exercise
arm muscles enough to use a
and physical activity come
Ron
Ekovich,
61,
Leesville,
washcloth. That might mean
from making them a permanent
South Carolina
the dignity that comes from
habit. Start with one or two

10

being able to wash yourself, instead of

having someone else do it for you. The
goal is to improve from wherever you are
right now.
Some people are reluctant to start exercising because they are afraid it will be too
strenuous. Researchers have found that you
dont have to do strenuous exercises to gain
health benefits; moderate exercises are effective, too. (You will read more about the difference between vigorous and moderate
exercises later in this book.)

Benefits

How Much Physical Activity Is Enough?

veryday physical activities can accomplish some of the
same goals as exercise. But just how much should you
do to get health benefits?
We cant always give you answers, yet, but we can give
examples of what researchers have found out. For instance,
bus and taxi drivers, who are physically inactive, have a
higher rate of heart disease than men in other occupations.
And studies show that people who remain physically active
have a lower death rate than people who dont.
In another study, researchers measured muscle strength
in 75-year-olds who regularly did tasks like housework and
gardening and in 75-year-olds who were inactive. Five
years later they found that the active people kept more
of their strength than did the inactive people.

While we cant yet tell you exactly how much everyday

physical activity you should get to gain specific health
benefits, the message of these studies is clear: Whatever
your age, stay physically active!
In Chapter 4, we give you specific types and amounts
of exercises to do. They can help you not only maintain
your current levels of strength and fitness, but also help
you build them up. Our examples also might encourage
you to exercise muscles and joints that you have stopped
using or that you use less often without even realizing it.

11

Chapter Summary
Research suggests that growing older does
not mean you have to lose your strength and
ability to do everyday tasks and the things
you enjoy doing. But an inactive lifestyle
does mean that you probably will lose some
of your strength and ability, and that you
will be at higher risk for diseases and disabilities. Fortunately, even many frail people can improve their health and independence by increasing their physical activity.
Challenging exercises and physical
activities done regularly can help many
older adults improve their health, even when
done at a moderate level. They may prevent
or delay a variety of diseases and disabilities associated with aging.

12

Four types of exercises are important:

(1) Endurance activities increase heart rate
and breathing for extended periods of time.
They improve the health of the heart, lungs,
and circulatory system, and help prevent or
delay some diseases.
(2) Strength exercises make older adults
strong enough to do the things they need
to do and the things they like to do.
(3) Balance exercises help prevent falls, a
major cause of disability in older adults.
(4) Stretching helps keep the body limber
and flexible.

Safety

Every Crisis Is an Opportunity

Dr. Andrew Puckett is a busy man with an impressive
list of titles after his name. The 60-year-old associate dean for medical education at Duke University,
in Durham, North Carolina, has a Ph.D. in adult
education and a minor in clinical psychology, and
he has been a counselor for years. He also has
Parkinsons disease, a chronic condition that causes
muscles to tremble and become rigid. He was diagnosed with it a few years ago.
Has his chronic condition slowed down his
activities? It doesnt appear that way. In addition
to his regular activities, 2 years ago, Dr. Puckett volunteered to take part in a study of how stretching
exercises affect people with Parkinsons disease.
He enjoyed the feeling of stretching so much that
he kept doing the exercises after the 10-week study
ended, and now does them at least 3 days a week
for 40 minutes at a time.
Its not yet clear whether or not stretching
exercises have an effect on Parkinsons disease
specifically, but its very clear to Dr. Puckett that
they have helped him feel better overall.
I literally feel so much better from doing the
exercises, he told us. Im more flexible than Ive
been in 20 years. Stretching has given me so much

14

ease of movement. Its a fluid feeling, he said.

In addition, Dr. Puckett finds that stretching exercises give him a sense of well-being. He likens it to
the runners high that some joggers experience.
Dr. Puckett noted another positive aspect of his
stretching exercises: the feeling that he is nurturing
himself. He described it as a secure feeling; a feeling that he is doing something good for himself.
Another motivator for keeping up with his
stretching exercises is the fear of being stiff
and rigid; bent over. I want to keep that from
happening, he told us.
Besides working at the university, Dr. Puckett
splits his own firewood, plays tennis, gardens, mows
his lawn with a push mower, and walks a mile or
more at least 3 days a week.
But people shouldnt feel that physical activity
has to be some super-human or highly disciplined
effort, he said. I dont want them to be scared
off from the idea of exercising. I think once they
experience how much better they feel, theyll want
to keep on doing
it. It has so
many built-in
benefits.

Chapter 2

Chronic Diseases:
Not Necessarily a Barrier
Chronic diseases cant be cured, but usually
they can be controlled with medications and
other treatments throughout a persons life.
They are common among older adults, and
include diabetes, cardiovascular disease
(such as high blood pressure), and arthritis,
among many others.
Traditionally, exercise has been discouraged in people with certain chronic conditions. But researchers have found that

exercise can actually improve some chronic

conditions in most older people, as long as
its done when the condition is under control.
Congestive heart failure (CHF) is an
example of a serious chronic condition common in older adults. In people with CHF, the
heart cant empty its load of blood with each
beat, resulting in a backup of fluid throughout
the body, including the lungs. Disturbances in
heart rhythm also are common in CHF. Older
adults are hospitalized more often for this
disease than for any other.
No one is sure why, but muscles tend to
waste away badly in people with CHF, leaving them weak, sometimes to the point that
they cant perform everyday tasks. No medicine has a direct muscle-strengthening effect
in people with CHF, but muscle-building
exercises (lifting weights, for example) can
help them improve muscle strength.
Having a chronic disease like CHF probably doesnt mean you cant exercise. But it
does mean that keeping in touch with your
doctor is important if you do exercise. For

At our age, you have to exercise.

I just feel that exercise
enhances our state of living.
You can walk, for example.
You dont have to be out there
competing with everybody.

Too old and too frail are not, in and of

themselves, reasons to prohibit physical
activity. In fact, there arent very many
health reasons to keep older adults from
becoming more active.
Most older people think they need their
doctors approval to start exercising. Thats a
good idea for some people. Your doctor can
talk to you not only about whether its all
right for you to exercise but also about what
can be gained from exercise.

Safety

Is It Safe for Me
to Exercise?

example, some studies suggest that endurance

exercises, like brisk walking, may improve
how well the heart and lungs work in people
with CHF, but only in people who are in a
stable phase of the disease. People with CHF,
like those with most chronic diseases, have
periods when their disease gets better, then
worse, then better again, off and on. The same
endurance exercises that might help people in
a stable phase of CHF could be very harmful
to people who are in an unstable phase; that
is, when they have fluid in their lungs or an
irregular heart rhythm.
If you have a chronic condition, you
need to know how you can tell whether your
disease is stable; that is, when exercise
would be OK for you and when it wouldnt.
Chances are good that, if you have a
chronic disease, you see a doctor regularly

Jeanette Chamberlain, 73, Silver Spring, Maryland

15

(if you dont, you should, for many reasons).

Fa c t
Talk with your doctor about symptoms that
The Surgeon General has issued a report warning people
mean trouble a flare-up, or what doctors
including older adults that physical inactivity is
call an acute phase or exacerbation of your
a major risk to their health.
disease. If you have CHF, you know by now
that the acute phase of this disease should be
people who have heart disease but dont
body cardiovascular disease, eye disease,
taken very, very seriously. You should not
know it because they dont have any
or changes in your nervous system, for examexercise when warning symptoms of the
symptoms.
ple check with your doctor to find out
acute phase of CHF, or any other chronic
How can you tell if the activity you plan
what exercises will help you and whether
disease, appear. It could be dangerous.
to do is vigorous? There are a couple of
you should avoid certain activities. If you
But you and your doctor also should disways. If the activity makes you breathe hard
take insulin or a pill that helps lower your
cuss how you feel when you are free of those
and sweat hard (if you tend to sweat, that is),
blood sugar, your doctor might need to adjust
symptoms in other words, stable; under
you can consider it vigorous. Charts in
your dose so that your blood sugar doesnt
control. This is the time to exercise.
Chapter 4 explain more about how to tell
get too low.
Diabetes is another chronic condition
if your exercise is moderate or vigorous.
Your doctor might find that you dont
common among older people. Too much
If you have had a heart attack recently,
have to modify your exercises at all, if you
sugar in the blood is a hallmark of diabetes.
your doctor or cardiac rehabilitation therapist
are in the earlier stages of
It can cause damage throughshould have given you specific exercises to
diabetes or if your condition
out the body. Exercise can help
do. Research has shown that exercises done
is stable.
your body use up some of
I feel my day
as part of a cardiac rehabilitation program can
If you are a man over 40
the damaging sugar.
isnt complete
improve fitness and even reduce your risk of
or a woman over 50, check
The most common form of
without some
dying. If you didnt get instructions, call your
with your doctor first if you
diabetes is linked to physical
physical activity.
doctor to discuss exercise before you begin
plan to start doing vigorous,
inactivity. In other words, you
I know I do
increasing your physical activity.
as opposed to moderate,
are less likely to get it in the
miss it on the days
For some conditions, vigorous exercise is
physical activities. Vigorous
first place, if you stay physicalthat I dont do it.
dangerous and should not be done, even in
activity could be a problem
ly active.
the absence of symptoms. Be sure to check
for people who have hidIf you do have diabetes and
Harriet Erickson, 72,
with your physician before beginning any
den heart disease that is,
it has caused changes in your
Durham, North Carolina
kind of exercise program if you have:

16

Most older adults, regardless of age or

condition, will do just fine in increasing their
physical activity. You might want to show
your doctor this book, to open the door to
discussions about exercise.

Chapter Summary
Contrary to traditional thinking, regular
exercise helps, not hurts, most older adults.
Older people become sick or disabled more
often from not exercising than from exercising. Those who have chronic diseases, or
risk factors for them, may actually improve
with regular exercise, but should check
with their doctor before increasing their
physical activity.
There are few reasons to keep older adults
from increasing their physical activity, and
too old and too frail arent among them.
If you plan to work your way up to a vigorous level, check with your doctor first if you

are a man over 40 or a woman over 50. Also

check with your doctor first if you have any of
the conditions listed under Checkpoints.
Your doctor or cardiac rehabilitation
specialist can give you guidelines for physical
activity if you have had a heart attack recently. Controlled exercise usually is an important
part of long-term heart-attack recovery.

People with conditions called abdominal

aortic aneurysm or critical aortic stenosis
should not exercise unless their physicians tell
them they can.
Almost all older adults, regardless of age
or condition, can safely improve their health
and independence through exercise and
physical activity.

Safety

abdominal aortic aneurysm, a weakness

in the wall of the hearts major outgoing
artery (unless it has been surgically
repaired or is so small that your doctor
tells you that you can exercise vigorously)
critical aortic stenosis, a narrowing of one
of the valves of the heart.

Checkpoints
You have already read about precautions you should take if you have a chronic
condition. Other circumstances require caution, too. You shouldnt exercise until
checking with a doctor if you have:
chest pain
irregular, rapid, or fluttery heart
beat
severe shortness of breath
significant, ongoing weight loss
that hasnt been diagnosed
infections, such as pneumonia,
accompanied by fever
fever, which can cause dehydration
and a rapid heart beat
acute deep-vein thrombosis
(blood clot)

a hernia that is causing symptoms

foot or ankle sores that wont heal
joint swelling
persistent pain or a problem walking after you have fallen
certain eye conditions, such as
bleeding in the retina or detached
retina. Before you exercise after a
cataract or lens implant, or after
laser treatment or other eye
surgery, check with your physician.

17

Motivation

Building Strength, Inner and Outer

At the age of 70, Harriet Erickson, of Durham,
North Carolina, tended her husband through the

my life a lot better. I was slumped over. Now, I

terminal illness that took his life. The loss of her

stand up straight, and I can look the world right

husband hurt her deeply. It was a horrible time

in the eye. I dont intend to stop. I know what

for me. I wasnt in very good shape, physically or

a difference it has made for me.

emotionally, she told us.

Soon after, Ms. Erickson volunteered to take part

Researchers have shown that exercise can help

relieve anxiety and stress, and can improve mood.

in a study of exercise for older adults. Participants

They just arent able to tell you that in quite the

did endurance and flexibility exercises. Erickson

same way Ms. Erickson can.

liked how the exercises made her feel and kept

doing them at home after the study ended.

20

She has this to say about exercise: Its made

Chapter 3

How to Keep Going

For many older adults, motivation to keep
exercising and doing physical activities isnt
a problem. They say that regular physical
activity makes them feel so much better
that it would be hard to stop.
Others say that, while physical activity
makes them feel better, a little extra motivation helps them get going. For example,
Georgia Burnette, 68, of Amherst, New York,
told us that she used to put on headphones
and listen to recorded books borrowed from

Sticking With It: What Works

According to the U.S. Surgeon Generals
report, you are more likely to keep doing
physical activities if you:
think that, overall, you will
benefit from them
include activities you enjoy
feel you can do the activities correctly and safely
have regular access to the activities
can fit the activities into your
daily schedule

feel that the activities dont impose

financial or social costs you arent
willing to take on
have few negative consequences from
doing your activities (such as injury,
lost time, or negative peer pressure)
In other words, set yourself up to succeed right from the start. Choose realistic
goals, learn to do the exercises correctly
and safely, and chart your progress to see
your improvement.

Motivation

Definitely NOT! Thats what 75-year-old

Emma King told us when we asked her if she
ever intended to stop exercising. Ms. King
lives in Durham, North Carolina, and has
taken long walks at least 4 or 5 days a week,
for years. Recently, she took part in a study
of exercise for older adults and added stretching to her weekly routine. I can really tell
the difference if I miss 2 or 3 days. I dont
know what it would be like not to exercise,
she said.

the library to make her 40-minute walks more

interesting. Now, she mall-walks for an hour,
5 days a week, with a friend. Having that
companionship is a good motivator, says
Ms. Burnette.
We have included this section on motivation because physical activity needs to be a
regular, permanent habit to produce benefits
like those listed in Chapter 1. So does staying
motivated!
Recording your scores and watching
them improve can be an excellent motivator
to exercise, and we have included charts at
the end of this booklet so you can do that.
But dont get discouraged if you see that
your scores have improved by only a few
seconds or just one or two lifts of a weight.
In terms of real-life benefits, those slight
improvements are multiplied many times
over as you include them in your everyday
activities. You incorporate that extra little
bit of endurance and strength into everything
you do, and it adds up to a lot.
But no matter how enthusiastic you are
about exercise, there may be times when
you need extra motivation. Its common for
beginning exercisers, especially those who
are frail, to make fast progress at first. You
might get discouraged when the improvements you were making taper off at times.
21

be times that you dont show rapid

These leveling-off periods are normal.
progress and that you are still benefiting
Often, they mean that its time to gradually
from your activities during those times.
make your activities more challenging. If
Plan ahead for travel, bad weather, and
you have any doubts about whether you are
house guests. For example, an exercise
doing the right things to progress, check the
video can help you exercise indoors
guidelines listed under each type of exercise
when the weather is bad.
in Chapter 4, or check with your doctor or a
qualified fitness professional (see page 23).
When you need extra motivation, try the
Let Us Acknowledge
following:
Your Efforts
When it comes to motivation, the first month
Ask someone to be your exercise buddy.
is crucial. If you can increase your physical
Many older adults agree that having
activity for a month and keep going after
someone to exercise with helps keep
that, you will have passed a critical landmark.
them going.
Its a good sign that you are on your way to
Follow Georgia Burnettes advice: Listen
making exercise and physical activity regular,
to recorded books or music while you do
life-long habits.
endurance activities.
We want to give you credit
Set a goal, and decide on a
for that. If you increase your
reward you will get when
Everybody
physical activity for more than
you reach it.
has to find
a month, send us the form at
Give yourself physical
their own way
the end of this book. We will
activity homework assignto exercise.
send you a National Institute
ments for the next day or
They have to
on Aging certificate acknowlthe next week.
embrace it and
edging your commitment.
Think of your exercise sesmake it work
sions as appointments, and
for them.
mark them on your calendar.
Keep a record of what you
Georgia Burnette, 68,
do and of your progress.
Amherst, New York
Understand that there will

22

Chapter Summary
Starting with one or two types of exercises
or physical activities and a schedule that you
really can manage, then adding more as you
adjust, is one way of ensuring that you will
keep exercising. You are also more likely to
keep exercising if you feel you can do your
exercises correctly and safely, feel that they
fit into your schedule, and dont feel that
they result in negative experiences, such as
financial burdens or lost time.
Just knowing that physical activity can
improve your health and abilities can be
enough to keep you exercising, but you might
need extra motivation sometimes. For those
times, try exercising with a friend, listening
to music, charting your progress, marking
your calendar for exercise sessions, giving
yourself exercise assignments ahead of
time, and rewarding yourself when you
achieve your goals.
Overall, your fitness should improve.
If it doesnt, review the instructions on how
to progress in Chapter 4.
If you stick with your exercises for more
than a month, its a good sign that you are
on your way to making it a permanent habit.
If you would like acknowledgment of your
efforts, fill out the form at the end of this
book, and we will send you a National
Institute on Aging certificate.

Finding A Qualified Fitness Professional

sionals who have a college degree in

exercise physiology. They can help you
start an exercise program tailored to your
needs, build it up to your best possible
level, then show you how to continue
safely on your own.
Physical therapists also are qualified
to design exercise plans for older people,
especially those who have conditions
affecting their muscles and skeletal systems, or nervous-system conditions that
affect their muscles. Some physical therapists take special training for a certification in geriatrics.
The American College of Sports
Medicine (ACSM) also trains and certifies
people to work with older adults. The
ACSM is made up of health professionals
and scientists with an interest in fitness.
ACSM-certified fitness instructors work in
a variety of settings; for example, you
might find them leading hospital-based
exercise programs for older adults, working
with older people in exercise studies, or
working as personal trainers.

Cardiologists can advise you on how

to improve your cardiovascular system
through endurance exercise. Orthopedic
doctors can help you understand how to
prevent injuries to your muscles, bones,
and other structures.
Many hospitals and health plans now
have wellness centers that offer exercise
programs. Some colleges and universities
hold special exercise classes for older
adults or conduct studies on exercise for
older people. Its likely that the fitness
instructors hired by these organizations
are carefully screened and are qualified to
teach you how to exercise correctly. Try
calling them to find a fitness professional
in your area.
If you do consult a fitness instructor,
ask for his or her credentials. Any instructor who is qualified to work with older
people is likely to be proud of his or her
credentials and will be happy to share
them with you. Also ask about expense.
Costs vary, and insurance plans differ as
to what kinds of services they will cover.

Motivation

ost older people can exercise just

fine on their own, without advice
from a fitness instructor. Some have special needs and may want to consult a professional. If you decide to seek advice,
how can you tell whom to trust? Anyone
can call himself or herself a fitness professional, and many people do but
that doesnt always mean they have the
training to help older people exercise
safely and effectively.
Instructors who arent trained to work
with older adults, specifically, might not
be aware of their needs. For example, they
might not know that certain conditions or
medications can change older peoples
heart rates or that people with osteoporosis risk spine fractures if they do some
types of forward-bending exercises
incorrectly.
A number of professionals are familiar
with the special physical needs of older
people. Doctors who specialize in sports
medicine are highly qualified to help
you exercise the right way. So are profes-

23

Exercises

Ma k i ng It Wo r k
There are lots of ways to increase your physical
activity. Exercising at home is just one of them,
and we feature it here because its within the reach
of most older people. Or, you might decide to follow
Phyllis Wendahls example, instead, and do something different.
Ms. Wendahl is 85 years old and lives in the
small town of Bothell, Washington. On the phone,
she sounds much younger. She is a widow and lives
on her Social Security income, and, like many older
adults, she wont let her kids spoil her as much as
they would like to. She would rather do things on
her own.
Thats why, when she was scouting around for a
fitness club where she could use strength-building
equipment, she bargained the owner down to a
monthly fee that she felt she could afford
$25 a month for unlimited use.
Look, I know that not everybody is as bold as I
am about that kind of thing, Ms. Wendahl told us.
Nonetheless, she has some advice for older adults
who are thinking about going to a fitness center:
They dont need to feel self-conscious about going
to the club. The owner of my club holds me up as
an example now.

26

Ms. Wendahl said that she has always been

active, but never as much as she is now. She began
doing aerobic exercises in her 70s, moved on to
water aerobics, and most recently to strength-building and stretching 3 times a week. She lives on her
own and drives herself wherever she needs to go.
After 6 months of endurance and strength exercises,
measurements showed that Ms. Wendahl was able
to perform household tasks carrying groceries,
making her bed, and transferring laundry more
quickly. She could also carry more weight.
It has just done me a world of good, she
said of her physically active lifestyle. My family
is so thrilled and proud of me, she added.
She wants older adults who read this book to
know that, when it comes to exercise and physical
activity, theres always something within someones
capabilities. Theres no reason older people need to
be sitting in a rocking chair.

Chapter 4

Sample Exercises
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.
Here are some points to keep in mind as
you begin increasing your activity:

Its possible to combine exercises.

For example, regular stair-climbing sessions improve endurance and strengthen
leg muscles at the same time.

e 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. Its 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 limit.
One way you can estimate how hard
to work is by using the Borg Category
Rating Scale, shown on the next page. It
was named after Gunnar Borg, the scientist
who developed it. The numbers on the left

Exercises

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 arent 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, thats a
sign that you are bending incorrectly,
from the waist. Bending from the waist
may cause spine fractures in some
people with osteoporosis.

How Hard Should I Exercise?

27

How Hard Should I Exercise?

of the scale dont 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

The Borg Category Rating Scale

Least effort
6
7
very, very light
8
9
very light
10
11
fairly light
ENDURANCE
12
TRAINING
ZONE
somewhat hard
13
14
15
hard
STRENGTH
16
TRAINING
very hard
ZONE
17
18
19
very, very hard
20
Maximum effort

28

continued from page 27

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 doesnt 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 (see page 23). 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.

How to Improve
Your Endurance
Endurance exercises are any activity
walking, jogging, swimming, raking
that increases your heart rate and breathing
for an extended period of time.

How Much, How Often

Safety
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.

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.

Exercises

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 wont 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.

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 too easy!

29

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 restriction.
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.

30

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.

Progressing
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.

Examples of
Endurance Activities
Examples of activities that are
moderate for the average
older adult are listed below.

Vigorous:
Climbing stairs or hills
Shoveling snow
Brisk bicycling up hills
Tennis (singles)
Swimming laps
Cross-country skiing
Downhill skiing
Hiking
Jogging

Exercises

Moderate:
Swimming
Bicycling
Cycling on a
stationary bicycle
Gardening (mowing,
raking)
Walking briskly
on a level surface
Mopping or
scrubbing floor
Golf, without a cart
Tennis (doubles)
Volleyball
Rowing
Dancing

The following are examples

of vigorous activities.

31

How to Improve
Your Strength
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 thats 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

32

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 center.

How Much, How Often

Do strength exercises for all of your
major muscle groups at least twice a
week. Dont 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 Progressing
section on page 34 will tell you how.)

How Muscles Work

hat 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 musclebuilding exercises on a regular basis,
the bundles of protein strands inside
your muscle cells grow bigger.

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.

Safety
Dont 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 exercises.
If you have had a hip replacement, dont
cross your legs, and dont bend your hips
farther than a 90-degree angle.
Avoid jerking or thrusting weights into
position. That can cause injuries. Use
smooth, steady movements.
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 arent. 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.

Exercises

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. Dont 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 of weight.
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).

33

Progressing
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.

34

Fa c t :
Although they might not notice it as it happens,
most people lose 20 to 40 percent of their muscle tissue as they get older.
Strength exercise can at least partly restore muscle and strength.

Sarcopenia: A Word You Are Likely to Hear More About

e 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 its 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 its a very active area of
research.

Examples of
Strength Exercises

Strengthens shoulder muscles.

1. Sit in armless chair with your back supported
by back of chair.
2. Keep feet flat on floor even with your shoulders.
3. Hold hand weights straight down at your sides,
with palms facing inward.
4. Raise both arms to side, shoulder height.
5. Hold the position for 1 second.
6. Slowly lower arms to sides. Pause.
7. Repeat 8 to 15 times.
8. Rest; then do another set of 8 to 15 repetitions.

Exercises

Arm Raise

Chair Stand
Strengthens muscles in abdomen and thighs. Your goal is to do
this exercise without using your hands as you become stronger.
1. Place pillows on the back of chair.
2. Sit toward front of chair, knees bent, feet flat on floor.
3. Lean back on pillows in half-reclining position. Keep your back
and shoulders straight throughout exercise.
4. Raise upper body forward until sitting upright, using hands as
little as possible (or not at all, if you can). Your back should no
longer lean against pillows.
5. Slowly stand up, using hands as little as possible.
6. Slowly sit back down. Pause.
7. Repeat 8 to 15 times.
8. Rest; then do another set of 8 to 15 repetitions.
35

Strength
Exercises

Biceps Curl

Plantar Flexion

Strengthens upper-arm muscles.

Strengthens ankle and calf muscles. Use ankle weights,

if you are ready.

1. Sit in armless chair with your back supported by back

of chair.
2. Keep feet flat on floor even with your shoulders.
3. Hold hand weights straight down at your sides, with palms
facing inward.
4. Slowly bend one elbow, lifting weight toward chest.
(Rotate palm to face shoulder while lifting weight.)
5. Hold position for 1 second.
6. Slowly lower arm to starting position. Pause.
7. Repeat with other arm.
8. Alternate arms until you have done 8 to 15 repetitions with
each arm.
9. Rest; then do another set of 8 to 15 alternating repetitions.

36

1. Stand straight, feet flat on floor, holding onto a table or

chair for balance.
2. Slowly stand on tiptoe, as high as possible.
3. Hold position for 1 second.
4. Slowly lower heels all the way back down. Pause.
5. Do the exercise 8 to 15 times.
6. Rest; then do another set of 8 to 15 repetitions.
Variation:
As you become stronger, do the exercise standing on one leg only,
alternating legs for a total of 8 to 15 times on each leg. Rest; then
do another set of 8 to 15 alternating repetitions.

Strength
Exercises

Triceps Extension

1. Sit in chair with your back supported by back of chair.

2. Keep feet flat on floor even with shoulders.
3. Hold a weight in one hand. Raise that arm straight toward
ceiling, palm facing in.
4. Support this arm, below elbow, with other hand.
5. Slowly bend raised arm at elbow, bringing hand weight toward
same shoulder.
6. Slowly straighten arm toward ceiling.
7. Hold position for 1 second.
8. Slowly bend arm toward shoulder again. Pause.
9. Repeat the bending and straightening until you have done the
exercise 8 to 15 times.
10.
10. Repeat 8 to 15 times with your other arm.
11.
11. Rest; then do another set of 8 to 15 alternating repetitions.

This pushing motion will strengthen your arm muscles even if

you arent yet able to lift yourself up off of the chair. Dont use
your legs or feet for assistance, or use them as little as possible.

Exercises

(If your shoulders arent flexible enough to do this exercise,

see alternative Dip exercise.)
Strengthens muscles in back of upper arm. Keep supporting
your arm with your hand throughout the exercise.

Alternative Dip
Exercise For Back of Upper Arm

1. Sit in chair with armrests.

2. Lean slightly forward, keep your back and shoulders straight.
3. Grasp arms of chair. Your hands should be level with
trunk of body or slightly farther forward.
4. Tuck feet slightly under chair, heels off the ground, weight
on toes and balls of feet.
5. Slowly push body off of chair using arms, not legs.
6. Slowly lower back down to starting position. Pause.
7. Repeat 8 to 15 times.
8. Rest; then do another set of 8 to 15 repetitions.

37

Strength
Exercises

38

Knee Flexion

Hip Flexion

Strengthens muscles in back of thigh. Use ankle weights, if

you are ready.

Strengthens thigh and hip muscles. Use ankle weights,

if you are ready.

1. Stand straight holding onto a table or chair for balance.

2. Slowly bend knee as far as possible. Dont move your upper
leg at all; bend your knee only.
3. Hold position for 1 second.
4. Slowly lower foot all the way back down. Pause.
5. Repeat with other leg.
6. Alternate legs until you have done 8 to 15 repetitions with
each leg.
7. Rest; then do another set of 8 to 15 alternating repetitions.

1. Stand straight to the side or behind a chair or table,

holding on for balance.
2. Slowly bend one knee toward chest, without bending
waist or hips.
3. Hold position for 1 second.
4. Slowly lower leg all the way down. Pause.
5. Repeat with other leg.
6. Alternate legs until you have done 8 to 15 repetitions
with each leg.
7. Rest; then do another set of 8 to 15 alternating repetitions.

Strength
Exercises

Knee Extension

Strengthens shoulder muscles.

Strengthens muscles in front of thigh and shin.

Use ankle weights, if you are ready.

1. Sit in armless chair with your back supported by

back of chair.
2. Keep feet flat on floor even with your shoulders.
3. Hold hand weights straight down at your sides,
with palms facing inward.
4. Raise both arms in front of you (keep them straight
and rotate so palms face upward) to shoulder height.
5. Hold position for 1 second.
6. Slowly lower arms to sides. Pause.
7. Repeat 8 to 15 times.
8. Rest; then do another set of 8 to 15 repetitions.

Exercises

Shoulder Flexion

1. Sit in chair. Only the balls of your feet and your toes should rest
on the floor. Put rolled towel under knees, if needed, to lift your
feet. Rest your hands on your thighs or on the sides of the chair.
2. Slowly extend one leg in front of you as straight as possible.
3. Flex foot to point toes toward head.
4. Hold position for 1 to 2 seconds.
5. Slowly lower leg back down. Pause.
6. Repeat with other leg.
7. Alternate legs until you have done 8 to 15 repetitions
with each leg.
8. Rest; then do another set of 8 to 15 alternating repetitions.

39

Strength
Exercises

40

Hip Extension

Side Leg Raise

Strengthens buttock and lower-back muscles. Use ankle

weights, if you are ready.

Strengthens muscles at sides of hips and thighs. Use ankle

weights, if you are ready.

1. Stand 12 to 18 inches from a table or chair, feet

slightly apart.
2. Bend forward at hips at about 45-degree angle; hold onto
a table or chair for balance.
3. Slowly lift one leg straight backwards without bending your
knee, pointing your toes, or bending your upper body any
farther forward.
4. Hold position for 1 second.
5. Slowly lower leg. Pause.
6. Repeat with other leg.
7. Alternate legs until you have done 8 to 15 repetitions with
each leg.
8. Rest; then do another set of 8 to 15 alternating repetitions.

1. Stand straight, directly behind table or chair, feet slightly apart.

2. Hold onto a table or chair for balance.
3. Slowly lift one leg 6-12 inches out to side. Keep your back and
both legs straight. Dont point your toes outward; keep them
facing forward.
4. Hold position for 1 second.
5. Slowly lower leg. Pause.
6. Repeat with other leg.
7. Alternate legs until you have done 8 to 15 repetitions
with each leg.
8. Rest; then do another set of 8 to 15 alternating repetitions.

How to Improve
Your Balance
Each year, U.S. hospitals have 300,000
admissions for broken hips, and falling
is often the cause of those fractures. Balance
exercises can help you stay independent by
helping you avoid the disability often
permanent that may result from falling.
As you will see, there is a lot of overlap
between strength and balance exercises; very
often, one exercise serves both purposes.

About Strength/
Balance Exercises
Any of the lower-body exercises for
strength shown in the previous strength section also are balance exercises. They include
plantar flexion, hip flexion, hip extension,
knee flexion, and side leg raise. Just do your
regularly scheduled strength exercises, and
they will improve your balance at the same
time. Also do the knee-extension exercise,
which helps you keep your balance by
increasing muscle strength in your
upper thighs.

Progressing
These exercises can improve your balance
even more if you add the following modifications: Note that these exercises instruct you
to hold onto a table or chair for balance. Hold
onto the table with only one hand. As you
progress, try holding on with only one fingertip. Next, try these exercises without holding
on at all. If you are very steady on your feet,
move on to doing the exercises using no
hands, with your eyes closed. Have someone
stand close by if you are unsteady.

Safety
Exercises

Dont do more than your regularly

scheduled strength-exercise sessions to
incorporate these balance modifications.
Remember that doing strength exercises
too often can do more harm than good.
Simply do your strength exercises, and
incorporate these balance techniques as
you progress.

41

Examples of Strength/
Balance Exercises

Knee Flexion
Plantar Flexion
Plantar flexion is already included in your strength exercises.
When doing your strength exercises, add these modifications
to plantar flexion as you progress: Hold table with one hand,
then one fingertip, then no hands; then do exercise with eyes
closed, if steady.
1.
2.
3.
4.
5.
6.
7.
42

Stand straight; hold onto a table or chair for balance.

Slowly stand on tip toe, as high as possible.
Hold position for 1 second.
Slowly lower heels all the way back down. Pause.
Repeat 8 to 15 times.
Rest; then do another set of 8 to 15 repetitions.
Add modifications as you progress.

Do knee flexion as part of your regularly scheduled strength

exercises, and add these modifications as you progress: Hold
table with one hand, then one fingertip, then no hands; then
do exercise with eyes closed, if steady.
1.
2.
3.
4.
5.
6.

Stand straight; hold onto a table or chair for balance.

Slowly bend knee as far as possible, so foot lifts up behind you.
Hold position for 1 second.
Slowly lower foot all the way back down. Pause.
Repeat with other leg.
Alternate legs until you have done 8 to 15 repetitions
with each leg.
7. Rest; then do another set of 8 to 15 alternating repetitions.
8. Add modifications as you progress.

Strength/Balance
Exercises

Hip Extension

Do hip flexion as part of your regularly scheduled strength

exercises, and add these modifications as you progress:
Hold table with one hand, then one fingertip, then no
hands; then do exercise with eyes closed, if steady.

Do hip extension as part of your regularly scheduled strength

exercises, and add these modifications as you progress:
Hold table with one hand, then one fingertip, then no hands;
then do exercise with eyes closed, if steady.

1. Stand straight; hold onto a table or chair for balance.

2. Slowly bend one knee toward chest, without bending
waist or hips.
3. Hold position for 1 second.
4. Slowly lower leg all the way down. Pause.
5. Repeat with other leg.
6. Alternate legs until you have done 8 to 15 repetitions
with each leg.
7. Rest; then do another set of 8 to 15 alternating repetitions.
8. Add modifications as you progress.

1. Stand 12 to 18 inches from a table or chair, feet slightly apart.

2. Bend forward at hips at about 45-degree angle; hold onto a table
or chair for balance.
3. Slowly lift one leg straight backwards without bending your knee,
pointing your toes, or bending your upper body any farther forward.
4. Hold position for 1 second.
5. Slowly lower leg. Pause.
6. Repeat with other leg.
7. Alternate legs until you have done 8 to 15 repetitions
with each leg.
8. Rest; then do another set of 8 to 15 alternating repetitions.
9. Add modifications as you progress.

Exercises

Hip Flexion

43

Strength/Balance
Exercises

Walk heel-to-toe.

Side Leg Raise

Do leg raise as part of your regularly scheduled strength
exercises, and add these modifications as you progress:
Hold table with one hand, then one fingertip, then no hands;
then do exercise with eyes closed, if steady.

44

1. Stand straight, directly behind table or chair, feet slightly apart.

2. Hold onto table or chair for balance.
3. Slowly lift one leg to side 6-12 inches out to side. Keep your
back and both legs straight. Dont point your toes outward;
keep them facing forward.
4. Hold position for 1 second.
5. Slowly lower leg all the way down. Pause.
6. Repeat with other leg.
7. Alternate legs until you have done 8 to 15 repetitions with
each leg.
8. Rest; then do another set of 8 to 15 alternating repetitions.
9. Add modifications as you progress.

Anytime, Anywhere
Balance Exercises
These types of exercises also improve your balance. You can
do them almost anytime, anywhere, and as often as you like,
as long as you have something sturdy nearby to hold onto if
you become unsteady.
Examples:
Walk heel-to-toe. Position your heel just in front of the toes
of the opposite foot each time you take a step. Your heel and
toes should touch or almost touch. (See illustration.)
Stand on one foot (for example, while waiting in line at the
grocery store or at the bus stop). Alternate feet.
Stand up and sit down without using your hands.

How to Improve
Your Flexibility
Stretching exercises give you more freedom
of movement to do the things you need to
do and the things you like to do. Stretching
exercises alone can improve your flexibility,
but they will not improve your endurance
or strength.

How Much, How Often

If you have had a hip replacement,

check with your surgeon before doing
lower body exercises.
If you have had a hip replacement,
dont cross your legs or bend your
hips past a 90-degree angle.
Always warm up before stretching
exercises (do them after endurance or
strength exercises, for example; or, if
you are doing only stretching exercises
on a particular day, do a little bit of
easy walking and arm-pumping first).
Stretching your muscles before they
are warmed up may result in injury.
Stretching should never cause pain,
especially joint pain. If it does, you are
stretching too far and you need to
reduce the stretch so that it doesnt hurt.
Mild discomfort or a mild pulling
sensation is normal.
Never bounce into a stretch; make
slow, steady movements instead.
Jerking into position can cause muscles
to tighten, possibly resulting in injury.
Avoid locking your joints into place
when you straighten them during
stretches. Your arms and legs should
be straight when you stretch them, but

dont lock them in a tightly straight

position. You should always have a
very small amount of bending in
your joints while stretching.

Progressing
You can progress in your stretching exercises; the way to know how to limit yourself is that stretching should never hurt. It
may feel slightly uncomfortable, but not
painful. Push yourself to stretch farther,
but not so far that it hurts.

Exercises

Stretch after you do your regularly

scheduled strength and endurance
exercises.
If you cant do endurance or strength
exercises for some reason, and
stretching exercises are the only
kind you are able to do, do them
at least 3 times a week, for at least
20 minutes each session.
Do each stretching exercise
3 to 5 times at each session.
Slowly stretch into the desired position, as far as possible without pain,
and hold the stretch for 10 to 30
seconds. Relax, then repeat, trying
to stretch farther.

Safety

45

Examples of
Stretching Exercises

46

Hamstrings

Alternative Hamstrings Stretch

Stretches muscles in the back of the thigh.

Stretches muscles in the back of the thigh.

1. Sit sideways on bench or other hard surface (such as two chairs

placed side by side).
2. Keep one leg stretched out on bench, straight, toes pointing up.
3. Keep other leg off of bench, with foot flat on floor.
4. Straighten back.
5. If you feel a stretch at this point, hold the position for 10 to 30
seconds.
6. If you dont feel a stretch, lean forward from hips (not waist)
until you feel stretching in leg on bench, keeping back and
shoulders straight. Omit this step if you have had a hip
replacement, unless surgeon/therapist approves.
7. Hold position for 10 to 30 seconds.
8. Repeat with other leg.
9. Repeat 3 to 5 times on each side.

1. Stand behind chair, holding the back of it with both hands.

2. Bend forward from the hips (not waist), keeping back and
shoulders straight at all times.
3. When upper body is parallel to floor, hold position for 10 to 30
seconds. You should feel a stretch in the backs of your thighs.
4. Repeat 3 to 5 times.

Stretching
Exercises

Ankles

Stretches lower leg muscles in two ways: with knee straight

and knee bent.

Stretches front ankle muscles.

1. Stand with hands against wall, arms outstretched and

elbows straight.
2. Keeping your left knee slightly bent, toes of right foot slightly
turned inward, step back 1-2 feet with right leg, heel, and foot
flat on floor. You should feel a stretch in your calf muscle, but
you shouldnt feel uncomfortable. If you dont feel a stretch,
move your foot farther back until you do.
3. Hold position for 10 to 30 seconds.
4. Bend knee of right leg, keep heel and foot flat on floor.
5. Hold position for another 10 to 30 seconds.
6. Repeat with left leg.
7. Repeat 3 to 5 times for each leg.

Exercises

Calves

1. Remove your shoes. Sit toward the front edge of a chair and
lean back, using pillows to support your back.
2. Stretch legs out in front of you.
3. With your heels still on the floor, bend ankles to point feet
toward you.
4. Bend ankles to point feet away from you.
5. If you dont feel the stretch, repeat with your feet slightly
off the floor.
6. Hold the position for 1 second.
7. Repeat 3 to 5 times.

47

Stretching
Exercises

48

Triceps Stretch

Wrist Stretch

Stretches muscles in back of upper arm.

Stretches wrist muscles.

1. Hold one end of a towel in right hand.

2. Raise and bend right arm to drape towel down back. Keep your
right arm in this position, and continue holding onto the towel.
3. Reach behind your lower back and grasp bottom end of towel
with left hand.
4. Climb left hand progressively higher up towel, which also pulls
your right arm down. Continue until your hands touch, or as
close to that as you can comfortably go.
5. Reverse positions.
6. Repeat each position 3 to 5 times.

1. Place hands together, in praying position.

2. Slowly raise elbows so arms are parallel to floor, keeping
hands flat against each other.
3. Hold position for 10 to 30 seconds.
4. Repeat 3 to 5 times.

About Floor Exercises

To get into a lying position:
Stand next to a very sturdy chair that
wont tip over (put chair against wall
for support if you need to).
Put your hands on the seat of
the chair.
Lower yourself down on one knee.
Bring the other knee down.
Put your left hand on the floor and
lean on it as you bring your left hip
to the floor.
Your weight is now on your left hip.
Straighten your legs out.
Lie on your left side.
Roll onto your back.
Note: You dont have to use your left
side. You can use your right side, if
you prefer.

To get up from a lying position:

Roll onto your left side.
Use your right hand, placed on the
floor at about the level of your ribs,
to push your shoulders off the floor.
Your weight is on your left hip.
Roll forward, onto your knees, leaning
on your hands for support.
Lean your hands on the seat of the
chair you used to lie down.
Lift one of your knees so that one leg
is bent, foot flat on the floor.
Leaning your hands on the seat of
the chair for support, rise from this
position.
Note: You dont have to use your left
side; you can reverse positions, if
you prefer.

Exercises

Most of the remaining exercises are

done on the floor and stretch some
very important muscle groups. If you
are afraid to lie on the floor to exercise
because you think you wont be able to
get back up, consider using the buddy
system to do these. Find a buddy who
will be able to help you.
Knowing the right way to get into
a lying position on the floor and to get
back up also may be helpful. If you
have had a hip replacement, check with
your surgeon before using the following
method. If you have osteoporosis,
check with your doctor first.

49

Stretching
Exercises

Quadriceps
Stretches muscles in front of thighs.
1. Lie on side on the floor. Your hips should be lined up so that
one is directly above the other one.
2. Rest head on pillow or hand.
3. Bend knee that is on top.
4. Reach back and grab heel of that leg. If you cant reach
your heel with your hand, loop a belt over your foot and
hold belt ends.
5. Gently pull that leg until front of thigh stretches.
6. Hold position for 10 to 30 seconds.
7. Reverse position and repeat.
8. Repeat 3 to 5 times on each side. If the back of your thigh
cramps during this exercise, stretch your leg and try again,
more slowly.

50

Double Hip Rotation

Stretches outer muscles of hips and thighs. Dont do this
exercise if you have had a hip replacement, unless your
surgeon approves.
1. Lie on floor on your back, knees bent and feet flat on the floor.
2. Keep shoulders on floor at all times.
3. Keeping knees bent and together, gently lower legs to one side
as far as possible without forcing them.
4. Hold position for 10 to 30 seconds.
5. Return legs to upright position.
6. Repeat toward other side.
7. Repeat 3 to 5 times on each side.

Stretching
Exercises

Shoulder Rotation
Stretches shoulder muscles.

Stretches muscles of pelvis and inner thigh. Dont do

this exercise if you have had a hip replacement,
unless your surgeon approves.
1. Lie on your back on floor, knees bent and feet flat
on the floor.
2. Keep shoulders on floor throughout exercise.
3. Lower one knee slowly to side, keeping the other leg
and your pelvis in place.
4. Hold position for 10 to 30 seconds.
5. Bring knee back up slowly.
6. Repeat with other knee.
7. Repeat 3 to 5 times on each side.

Exercises

Single Hip Rotation

1. Lie flat on floor, pillow under head, legs straight. If your

back bothers you, place a rolled towel under your knees.
2. Stretch arms straight out to side. Your shoulders and upper
arms will remain flat on the floor throughout this exercise.
3. Bend elbows so that your hands are pointing toward the ceiling.
Let your arms slowly roll backwards from the elbow. Stop when
you feel a stretch or slight discomfort, and stop immediately if
you feel a pinching sensation or a sharp pain.
4. Hold position for 10 to 30 seconds.
5. Slowly raise your arms, still bent at the elbow, to point toward
the ceiling again. Then let your arms slowly roll forward, remaining bent at the elbow, to point toward your hips. Stop when you
feel a stretch or slight discomfort.
6. Hold position for 10 to 30 seconds.
7. Alternate pointing above head, then toward ceiling, then toward
hips. Begin and end with pointing-above-head position.
8. Repeat 3 to 5 times.

51

Stretching
Exercises

Neck Rotation
Stretches neck muscles.
1. Lie on the floor with a phone book or other thick book
under your head.
2. Slowly turn head from side to side, holding position each
time for 10 to 30 seconds on each side. Your head should
not be tipped forward or backward, but should be in a
comfortable position. You can keep your knees bent to
keep your back comfortable during this exercise.
3. Repeat 3 to 5 times.

52

Chapter Summary

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 time.
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 each.
The more vigorous the exercise, the
greater the benefits.
Warm up and cool down with a light
activity, such as easy walking.
Activities shouldnt make you breathe so
hard you cant talk. They shouldnt 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 exercises.

Strength
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 exercise.
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.
Dont hold your breath while straining.
These exercises may make you sore at
first, but they should never cause pain.
Stretch after strength exercises.

Exercises

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 stretching exercises.
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.

Endurance

53

Balance
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.
Dont 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 anytime, anywhere balance
exercises. One example: Balance on one
foot, then the other, while waiting for the
bus. Do as often as desired.

54

Stretching
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.

Progress

Enjoying Retirement
Until he was 48 years old, Ron Ekovich, of Leesville,

itches, he said, hes able to just reach back and

South Carolina, smoked a pack of cigarettes every

scratch it. This example might seem funny...

day. Looking to the future made him decide to quit.

unless you arent able to scratch your own back.

I figured I had to make some changes in my

life if I was going to enjoy my retirement, he

you feel. The achievement makes you feel great

told us.

emotionally, and it makes you feel good physically,

Needless to say, Mr. Ekovich, who is now 61

years old, no longer smokes. He works out with

he said.
Mr. Ekovich also cites a persons outlook as an

strength-building equipment 3 days a week, and he

important component of physical activity and

carries his own bag of clubs on the 3 days a week

exercise. The only thing that limits peoples ability

that he plays golf.

to achieve their goals is themselves, he said.

And he stretches. If I had to choose the

He recently finished shoveling about 10 tons of

most important thing you can do as you get older,

earth thats 20,000 pounds to make a new

it would be stretching. It helps keep you self-

garden for his wife.

sufficient, he said. Mr. Ekovich was only halfjoking when he gave an example: When his back

56

The more physical activity you get the better

Chapter 5

How Am I Doing?
people make rapid progress soon after they
start exercising, and you might find the
improvement you see in your scores after
just a month encouraging.
For another, these tests are a good way
of letting you know if you really are progressing. Although its normal for your improvement to slow down at times, your test scores
should get better overall (unless you have
reached your goal and are maintaining your
current level).
If you are not in condition to do these
tests right now, keep working on your current
exercises and activities until you are. Whether
you are testing or actually exercising, your
pace should never make you feel dizzy, lightheaded, or nauseated, and you shouldnt feel
pain. If you have a chronic medical condition,
or are at risk of developing one, follow
the guidelines in Chapter 2 before testing
yourself.

1 Endurance
See how far you can walk in exactly
6 minutes. Write down how far you
walked (in feet, blocks, laps, miles,
number of times you walked up and
down a long hallway, or whatever is
convenient for you). Do this test
every month. As your endurance
improves, you should find that you
can walk farther in 6 minutes.

2 Lower-Body Power
Time yourself as you walk up a flight
of stairs (at least 10 steps) as fast as
you safely can. Record your score.
Repeat the test, using the same
stairs, one month later. It should
take you less time.

Progress

There are ways to tell when its time to move

ahead in your activities, and we have mentioned some of them in the preceding chapter.
For example, when you can lift a weight
more than 15 times, you know its time to
add more weight in your strength exercises.
And when endurance activities no longer
feel somewhat hard to you, its time to exercise a little longer, then to add a little more
difficulty, like walking up steeper hills.
As you progress, you can do some simple
tests, shown in this chapter, that will tell you
just how far you have come. These tests also
can help you assess how fit you are before
you start exercising. After that, try them again
every month. Record your scores each time,
so you can see your improvement the next
time you test yourself.
You might be interested in doing these
tests for a couple of reasons. For one, most

57

4 Balance

3 Strength

Time yourself as you stand on one

foot, without support, for as long
as possible (stand near something
sturdy to hold onto, in case you
lose your balance). Record your
score. Repeat the test while standing on the other foot. Test yourself
again in one month. The amount of
time you can stand on one foot
should increase.

Each time you do your strength

exercises, use the chart in the back
of this book to record how much
weight you lift and how many times
you lift that weight. Another chart
shows how much more weight you
can lift, and how many more times
you can lift it, compared to the
month before.

Fa c t :
When astronauts come back to earth after extended space missions,
they sometimes cant walk or perform other physical activities
very well, at first. Because the weightlessness of space makes it possible
for astronauts to push and pull objects without effort,
their muscles become weak. Back on earth, the same principle
applies to the muscles of sedentary older adults: If you dont use them,
you lose them. The good news is that, at any age, almost any older adult
or astronaut can improve strength through exercise.

58

Chapter Summary
This chapter describes simple tests to see
how you are progressing. They measure
endurance, lower-body power, strength,
and balance. Do the tests before you begin
increasing your physical activity, to establish
a baseline measurement. Repeat the tests
each month. If you test yourself more often,
you are not likely to see improvement, and
that may discourage you. On the other hand,
watching your scores improve every month
can be very encouraging.
Be sure to use the safety guidelines listed
for the exercises shown in Chapters 2 and 4
when you do these tests.
You might not be able to complete the
tests shown in this chapter, at first. That
means you arent ready yet. Try again after
a month of exercises and physical activities.

Nutrition

Mo re T h a n O ne Wa y
I want to walk young I think exercise does that
for you. You feel better. You feel younger. Thats
what Cecile Cress, 83, of Pueblo, Colorado, told us.
Ms. Cress used to ride her bicycle everywhere, up
and down the hilly roads of her town, to get where
she needed to go. She recently retired from her job
as a librarian.
Ms. Cress stopped riding her bike when she found
that it was hard for her to get started going up steep
hills after traffic had stopped for red lights, making it
unsafe for her.
The thing I thought was so great about bike
riding is that, going up a hill, you just feel like your
heart is really pushing your blood through those veins
and arteries, she said.
She didnt have to give up that feeling entirely
when she stopped riding her bike. At least 3 days a
week, Ms. Cress does exercises, including endurance
and stretching, with the help of two videos for older
adults. She began doing that years ago, during
the winter, when it was too icy to ride her bike.
To make up for the activity she would miss when
she stopped bike riding, Ms. Cress began going to a
rehabilitation center to use strength-building equipment to improve her muscles and balance. She could
have gone to a fitness club instead of a rehabilitation

60

center, but there wasnt one that suited her needs in

her area. With a little creative thinking, she and her
daughter came up with the idea of asking if she could
use the weight room at a local rehab center, instead.
I knew I had to do something when I stopped riding
my bike, she said.
There are seniors aerobics groups in Ms. Cress
area, but their hours dont fit into her schedule.
I know seniors who are doing it, though, and they
look great, she said.
She has a secret she would like to share with
other older adults who would like to stay in shape:
Dont stop buying new clothes. Ms. Cress said that
occasionally buying something new is one of the
things that keeps her inspired to stay fit. Its
important to have more pride in your appearance as
you get older. Its good to keep your weight down,
she said.
I never have to diet, she added. I watch what
I eat, but I dont diet.

Chapter 6

What Should I Eat?

smallest amount should come from fats, oils,
and sweets. The guidelines put heavy emphasis on vegetables and fruits, and less on meat
and dairy products.

Food Guide Pyramid

Fats, Oils, & Sweets

USE SPARINGLY

Milk, Yogurt, &

Cheese Group
2-3 SERVINGS

Vegetable Group
3-5 SERVINGS

Fat (naturally occurring and added)

Sugars (added)
These symbols show that fat and added
sugars come mostly from fats, oils, and
sweets, but can be part of or added to
foods from the other food groups as well.

Meat, Poultry, Fish, Dry

Beans, Eggs, & Nuts Group
2-3 SERVINGS

Fruit Group
2-4 SERVINGS

Bread, Cereal, Rice,

& Pasta Group
6-11 SERVINGS

61

Nutrition

Your body needs fuel for exercises and

physical activities, and that fuel comes from
food. Eating the right nutrients from a balanced diet helps build muscle and energy.
But just what does balanced diet mean?
What should you eat, and exactly how
much of it should you eat?
The diagram shown on this page is the
U.S. Department of Agriculture (USDA) food
pyramid. If you use it as a guideline, you will
be following a balanced diet. It tells you how
many servings of each kind of food you
should eat each day. We have also included a
chart that shows you what, exactly, counts as
one serving of each kind of food.
If you use the food pyramid as a guideline, you may also be helping to prevent or
delay some of the diseases associated with
growing older. For example, by cutting down
on fats, you will be reducing your risk of getting cardiovascular diseases like high blood
pressure. By increasing the amount of fruits
and vegetables you eat, you will be lowering
your risk of getting some types of cancer.
Looking at the guidelines, you will see
that the biggest part of the calories you take
in each day should come from grains, and the

Some older adults are on restricted diets

because of certain health conditions. Kidney
disease is just one example of a condition that
often requires restrictions of certain foods or
fluids. If your doctor or nutritionist has asked
you to follow a special diet, please follow his
or her advice.

What is a serving?
Grains
1 slice of bread
1/2 cup of cooked rice or pasta
1/2 cup of cooked cereal
1 ounce of ready-to-eat cereal
Fruits
1 piece of fruit
1 melon wedge
3/4 cup fruit juice
1/2 cup canned fruit
1/4 cup dried fruit
Vegetables
1/2 cup of chopped raw or cooked
vegetables
1 cup of leafy raw vegetables

62

Milk, Yogurt, and Cheese

1 cup of milk or yogurt
1-1/2 to 2 ounces of cheese
Example: a 1-inch cube of hard cheese
weighs about 1/2 ounce
Note: Buy low-fat or skim dairy products
to avoid harmful fats.
Note: Some people have trouble digesting lactose, the sugar in milk products.
If you have this problem, try eating
yogurt with active cultures, low-fat
cheese, or lactose-reduced milk. Pills
and drops that help digest lactose also
are available.
Meat, Poultry, Fish, Dry Beans,
Eggs, and Nuts
1/2 cup of cooked beans, 1 egg, or
2 tablespoons of peanut butter
make up 1/3 of a serving of this
food group.
2-1/2 to 3 ounces of cooked lean meat,
poultry, or fish make up one
serving of this food group.

Examples: a slice of cooked, lean

meat or poultry that is about 1/4inch thick and measures 3 inches by
4 inches weighs about 2 ounces; a
cooked, lean hamburger patty that
weighs 3 ounces is about 3 inches
across and 1/2-inch thick about
the size of a large mayonnaise jar lid.
Note: Before cooking, a patty this
size weighs about 4 ounces.
Note: Half of a skinless, cooked chicken breast weighs about 3 ounces.
Note: Egg whites are a good source
of protein, but egg yolks are high
in fat and cholesterol. Consider
discarding the yolk.
Note: Nuts are a good source of
protein, but are high in fat.
Fats, Oils, and Sweets
The less fats, oils, and sweets you
eat the better.

Chapter Summary
Its Really Not Hard to Eat a Balanced Diet
o you look at the USDA food guidelines and think, How in the world will
I be able to follow them? Id have a hard time just eating the 6 to 11 servings of grain Im supposed to eat daily! Take a look at the sample menu below,
and you might change your mind. This menu provides the minimum amount recommended for each of the food groups. You might find that you are already eating a balanced diet and that you even have room to add more grains or fruits
and vegetables.

Breakfast:
Western-style omelet
(use egg whites or egg
replacers and
low-fat cheese)
Oven-baked hash-brown
potatoes
Whole-grain
toast and jelly
Small glass of
fruit juice

Lunch:
Broiled salmon
patty on a toasted
whole-grain bun
Spinach
Rice
Fruit salad with
low-fat or nonfat yogurt
dressing

The Big Picture

fit. Think about other lifestyle changes you

can make, too. For example, smoking contributes to a variety of serious diseases and
can keep you from exercising. So does excessive alcohol. Together, habits like exercise,
a balanced diet, and giving up smoking will
help you achieve what we wish for you:
the best of health.

63

Nutrition

Often, people decide to exercise and eat

a balanced diet because they want to control
their weight. For many people, these healthy
habits do result in weight lossbut thats
only part of the big picture. Exercise and a
healthy diet can help make you healthier. But
they are just one part of becoming physically

Dinner:
Pasta with tomato-andonion sauce, topped
with low-fat parmesan
cheese (lean meatballs
optional)
Garlic bread
Salad with low-fat or
nonfat dressing
Low-fat ice cream
or frozen yogurt

A balanced diet is important for everyone,

including older exercisers. To find out
what balanced diet means, see the U.S.
Department of Agriculture food-pyramid
guidelines shown in this chapter. The guidelines say that the largest part of your calorie
intake should be from grain-based foods; the
next largest from vegetables and fruits; then
fish, poultry, meats, and dairy products. The
less fats, oils, and sweets you eat the better.
The best way to get the nutrients you
need is through a healthy diet, not through
expensive supplements that you might not
need. Whole foods provide many nutrients we
know about, and probably contain others that
havent been discovered. You might read or
hear many convincing, scientific-sounding
claims about nutritional supplements, such as
megadoses of vitamins and minerals, but not
all of them are based on fact. Some supplements may be helpful in certain situations,
but others may cause harmful side effects.
Before taking supplements of any kind,
check with your doctor.
If your doctor or nutritionist has asked
you to eat or avoid certain foods or fluids
because of a medical condition, please
follow his or her advice.

Supplements: Costly and Not Necessarily Helpful

upplements are helpful for some older

adults who cant eat all the nutrients they
need nutrients like vitamins and minerals.
Recently, however, some new kinds of supplements have been appearing in stores even
though they havent been shown to improve
health and their safety remains unproven.
A balanced diet is the best way for most
older exercisers to get the nutrients they
need. But some people in the marketing
industry are doing a good job of convincing
older people that they need expensive nutritional supplements, some of which havent
been shown to be helpful or safe and some
of which most older people may not even
need. Some of these claims give older adults
the impression that certain supplements
can restore youthful energy and strength.
For example, one persuasive clerk at a
popular health-food store recently told an
older shopper interested in exercise that she
should buy certain supplements that cost
about $70 a month to increase her energy
and her ability to build muscles. The supplements included a protein powder and a vitamin-mineral pill containing the same ingredients as generic-brand vitamins, available
at a fraction of the cost at drug stores, and

64

some other substances not proven to build

muscles or energy in older people.
This 75-year-old shopper had eaten an
excellent diet based on the USDA food pyramid for years, and really didnt need these
supplements.
No one likes to spend money needlessly,
but for older adults on a limited income
Social Security, for example unnecessary
expenditures can deprive them of things they
really do need (the money to buy whole
foods rich in nutrients, for example). Whats
more, too much protein puts extra demands
on the kidneys and can lower calcium levels.
Although protein, vitamin, and mineral supplements are helpful to older people who
truly need them, excessive doses can have
harmful side effects.
A clerk at another health-food store
told the same shopper that, if she planned
to start exercising, she should buy a powder
made of protein, vitamins, and minerals
that cost $19 for a 10-serving bottle. Taken
once a day, that comes out to about $60 a
month. One of the reasons she needed this
supplement, the clerk told her, was that
it contained the mineral potassium, and
older people require more of that.

Taken as directed on the label, the

supplement wouldnt have harmed our
intrepid shopper. But the clerks scientific
sounding advice might have. Overdoses
of potassium can cause an irregular heart
beat and even death.
For most older adults, standard FDAapproved multivitamin-mineral supplements
that contain potassium are just fine if taken
as directed. It would be virtually impossible
for most people to overdose on potassium
by eating foods that contain this essential
mineral naturally. Some people really do
need potassium supplements, as prescribed
by a doctor, only, for very specific medical
conditions and in very specific, carefully
monitored amounts. The point we are making
here is that anyone can make scientificsounding claims, but it doesnt necessarily
mean that those claims are true or safe. This
caution is especially important for people
who are on diets with special restrictions
people with kidney disease, congestive heart
failure, or diabetes, for example.
Buyer, beware and check with your
doctor before spending your hard-earned
money on supplements that promise to
restore youthful energy and strength.

Fa c t :
Did you know that your body uses vitamin D to absorb calcium, which makes
your bones stronger and helps prevent fractures? Vitamin D is manufactured in
the skin following direct exposure to sunlight. The amount of vitamin D produced in the skin varies depending on the time of day, season, latitude, and
skin pigmentation.
While many people get enough vitamin D naturally, studies show that vitamin
D production decreases in older people and in those who are housebound.
These people may need to take vitamin D supplements to ensure a daily
intake of between 400 and 800 IU (international units) of vitamin D.
Tips: Major food sources of vitamin D are vitamin D-fortified dairy products,
eggs, saltwater fish, dark green vegetables, and liver. Some calcium supplements and most multivitamins contain vitamin D, so its important to read
the labels to find out how much each contains.
Caution: Massive doses of vitamin D may be harmful and are not recommended.

Nutrition

65

Appendix

Measuring Progress
When Marty Billowitz throws off his blankets in the
morning, he thinks first about his wife Harriet, but
seconds later, he is up and moving, pulling on comfortable clothes and lacing up his walking shoes.
Where does this 75-year-old grandfather dash off
to at 7:00 every morning? Mr. Billowitz goes to the
shopping mall not to get a jump on early-bird
bargains, but to join a group of mall-walkers organized by the local hospital. These seniors meet
each morning to exercise. Some move at a steady
clip through the arteries of the mall, others take a
slightly slower pace, but all of the walkers count
their laps and keep a daily record of their progress
pushing themselves each day to go a little faster,
a little farther.
Mr. Billowitz joined the mall-walkers at his wifes
insistence. Harriet was clear that once Id retired,
no matter what, we were going to walk each morning! That was nearly 7 years ago. Today Mr.
Billowitz says, The walkers have been a lifeline.
They keep me moving on days when all I want to
do is sit. You see, Mrs. Billowitz died unexpectedly
last year. It was quite a blow. I always thought
Id be the first to go, he says.

68

Still, during those years he spent walking miles

around mall halls, Mr. Billowitz had done more than
just improve his cardiovascular strengthhe also had
built lasting friendships. It was those friends who
brought him back into the walking routine after his
wifes death. At first, Mr. Billowitz walked because
it was something to do each morning. But over
time, I realized I liked how it felt to be moving.
I liked seeing my improvement. Measuring how
fast I could walk each morning gave me goals,
something to work toward. It also made me feel
good to see that I could take care of myself.
Mr. Billowitz believes that the mall-walking habit
was a small gift his wife left for him, I walk and
feel stronger every day. That really helps. Some
mornings I think of Harriet and silently thank her
for insisting that we walk together.

A p p e n d i x A : Ta r g e t H e a r t R a t e

Target Heart Rate

arget heart rate (THR) is a common way of judging how
hard you should exercise during endurance activities. It
tells you how fast the average person should try to make
his or her heart beat during endurance sessions. Its not
always the best way for older adults to decide how hard to
exercise, though, because many have long-standing medical
conditions or take medications that change their heart rate.
We recommend using the Borg scale shown in Chapter 4
instead. However, some older exercisers who are in basically
good health and who like taking a scientific approach to
their endurance activities may find the THR method useful.
Others should check with their doctors first.
For those of you who can use THR, the chart on the
next page shows an estimate of how fast you should try to
make your heart beat, once you have gradually worked your
way up to it. Gradually is an important word here. Going
immediately from an inactive lifestyle to exercising at the
rate shown in the chart is not advised.
One way to reach your THR gradually is to take your
pulse during an endurance-type activity that is already a
part of your life (walking, for example). Do it at the pace
you normally do it, and record your heart rate. From session

to session (or over several sessions), increase how hard you

work, so that your pulse rate gradually gets faster, over time.
Eventually, you can try to get your heart rate up to
70 to 85 percent of its maximum ability (the rate shown in
the chart). Making it beat faster than this is not advised.
Note: The goal is not for your heart rate to be faster
all the time just when you do your endurance activities.
In fact, you should find that, as your heart becomes more
efficient from endurance exercise, your resting pulse rate is
slower than it was before you took up this healthy habit.
continued on page 70

How to Take Your Pulse

To take your pulse, press the tips of your index and
middle fingers against the inside of the opposite wrist,
just below the mound at the base of your thumb, and
count how many pulsations you feel in a 10-second
period. Multiplying this number by 6 will give you your
heart rate. Dont count your pulse for an entire minute.
During the minute that you have stopped exercising to
take your pulse, your heart will have slowed down, and
you wont get an accurate reading.

69

Target Heart Rate,

continued from page 69

DO NOT Use the THR Method If...

You take medications that change your heart rate
You have a pacemaker for your heart
You have an irregular heart rhythm called
atrial fibrillation
You have any other condition that affects your pulse
rate. All of these situations can give you inaccurate
readings.

70

Age

Desired Range for Heart

Rate During Endurance
Exercise (beats per minute)

40

126- 153

50

119- 145

60

112- 136

70

105- 128

80

98- 119

90

\91- 111

100

84- 102

Many older adults take medications in a class called

beta blockers for high blood pressure or some heart
conditions. Your doctor can tell you if your heart or
blood-pressure medicine is a beta blocker, or if you have
other conditions or medications that will affect your pulse
rate during exercise. Some eyedrops used to treat glaucoma
also contain beta blockers.
Your heart rate is a reflection of how hard your body
is working. Beta blockers tend to keep your heart rate
slower, so no matter how hard you push yourself, you
might never reach the heart rate you are trying for. You
might end up exerting yourself too much, as you try in
vain to reach a heart rate that your beta blockers wont
allow. Being on beta blockers doesnt mean you cant
exercise vigorously; it just means you cant rely on your
heart rate or on your pulse rate to judge how hard you
are working.

Appendix B: Exercise Plan

How Much Exercise

Should I Get Each Week?
When you first start out, you might have
trouble keeping up with even the minimum
amount of exercise we suggest in the chart to
the right. Start out with a schedule that your
body can tolerate and that you think you
really can manage, and build up from there.
Note that the schedules are arranged so
that you are never doing strength exercises
of the same muscle groups on any two
days in a row. If you want to do strength
exercises every day, alternate muscle
groups. For example, do strength exercises
of your upper-body muscles on Monday,
Wednesday, and Friday and of your lowerbody muscles on Tuesday, Thursday, and
Saturday. Or you can do strength exercises
of all of your muscle groups up to every
other day.
Begin exercising gradually. Once you
have worked your way up to a regular
schedule...

...get at least this much exercise each week:

Sunday

Monday

Tuesday

Endurance

Wednesday

Thursday

Endurance
Strength/
balance,
all muscle
groups

Stretching

Friday

Saturday

Endurance
Strength/
balance,
all muscle
groups

Stretching

Stretching

...or
...you can exercise up to this often each week (more than this could cause injuries):
Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Endurance

Endurance

Endurance

Endurance

Endurance

Endurance

Endurance

Strength/
balance,
upper
body

Strength/
balance,
lower
body

Strength/
balance,
upper
body

Strength/
balance,
lower
body

Strength/
balance,
upper
body

Strength/
balance,
lower
body

Stretching

Stretching

Stretching

Stretching

Stretching

Stretching

Stretching

Anytime,
anywhere
balance

Anytime,
anywhere
balance

Anytime,
anywhere
balance

Anytime,
anywhere
balance

Anytime,
anywhere
balance

Anytime,
anywhere
balance

Anytime,
anywhere
balance

71

Appendix C: Activity and Progress Charts

Weekly Schedule

Week of __________________________

You might want to make copies of this form. Leave this one blank, so you can copy it as needed.
Write in the exercises and activities you plan to do. Create a schedule you think you really can manage.
You can change your plan as your fitness improves and you are able to do more.
Endurance

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

72

Strength/Balance

Flexibility

Notes

Daily Record

Week of __________________________

Endurance and Flexibility

You might want to make copies of this form. Leave this one blank, so you can copy it as needed.
This form is for keeping track of the activities and exercises you do each day.
Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

activity

Endurance:

List the activity you did

and how long you did it.
how long?

Flexibility. Check the

box of each stretching
exercise you did:
Hamstrings
Alternative Hamstrings
Calves
Ankles
Triceps
Wrists
Quadriceps
Double Hip Rotation
Single Hip Rotation
Shoulder Rotation
Neck Rotation
73

Daily Record

Week of __________________________

Anytime, Anywhere Balance

You might want to make copies of this form. Leave this one blank, so you can copy it as needed.
Check the box of each exercise you did.
Sunday
Anytime, anywhere
balance. Check the box
of each exercise you did:

Stand
on one
foot

Left
Right

Stand and sit

without using hands
Walk heel-to-toe

74

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Daily Record

Week of __________________________

Strength/Balance
You might want to make copies of this form. Leave this one blank, so you can copy it as needed.
This form is for keeping track of the activities and exercises you do each day.
Sunday
Arm Raise
Chair Stand
Biceps Curl
Plantar Flexion
Triceps Extension
Alternative Dip
Knee Flexion
Hip Flexion
Shoulder Flexion
Knee Extension
Hip Extension
Side Leg Raise

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

reps
lbs
# of
stands
reps
lbs
reps
lbs
reps
lbs
# of
dips
reps
lbs
reps
lbs
reps
lbs
reps
lbs
reps
lbs
reps
lbs

75

Monthly Progress Record

Year ________________

Endurance, Lower Body, and Balance

You might want to make copies of this form. Leave this one blank, so you can copy it as needed.
Fill out this form on the same day of each month. Compare your scores to see your improvement.
January

Endurance
Measure how far you
are able to walk in
6 minutes. Use the
same track and the
same unit of measure
each time.
LowerBody Power
Time how fast you can
walk up a flight of
stairs. Use the same
stairsat least 10
stepseach time.
Balance
Time yourself as you
stand on one foot,
then the other, without
support, for as long as
you can.

76

February

March

April

May

June

July

August

September October

November December

Monthly Progress Record

Year ________________

Strength/Balance
You might want to make copies of this form. Leave this one blank, so you can copy it as needed.
Fill out this form on the same day of each month. Compare your scores to see your improvement.
January February

Arm Raise
Chair Stand
Biceps Curl
Plantar Flexion
Triceps Extension
Alternative Dip
Knee Flexion
Hip Flexion
Shoulder Flexion
Knee Extension
Hip Extension
Side Leg Raise

March

April

May

June

July

August

September October

November December

reps
lbs
# of
stands
reps
lbs
reps
lbs
reps
lbs
# of
dips
reps
lbs
reps
lbs
reps
lbs
reps
lbs
reps
lbs
reps
lbs
77

Appendix D: Resources

Resources
Below are examples of some nonprofit
organizations that offer information
about exercise and exercise programs
for older adults.
American Academy of Orthopedic
Surgeons
6300 North River Road
Rosemont, IL 60018-4262
Phone: 1-800-824-BONES
Internet: http://www.aaos.org
Ask for free publications about how
to exercise safely.
American College of Sports Medicine
P.O. Box 1440
Indianapolis, IN 46206-1440
Phone: 317-637-9200
Internet: http://www.acsm.org

American Diabetes Association

1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1-800-342-2383
Internet: http://www.diabetes.org
Offers free pamphlets about exercise
for people of all ages who have
diabetes, including Exercise and
Diabetes, Starting to Exercise,
and 20 Steps to Safe Exercise.
American Heart Association
7272 Greenville Avenue
Dallas, TX 75231-4596
Phone: 1-800-242-8721
Internet: http://www.americanheart.org

Free pamphlet provides guidelines on

how to protect joints during exercise;
includes range-of-motion exercises
for joint mobility, and others.
Centers for Disease Control
and Prevention
1600 Clifton Road
Atlanta, GA 30333
Phone: 1-800-311-3435
Internet: http://www.cdc.gov

Offers free pamphlets about exercise

for people of all ages.

Part of US Department of Health and

Human Services. Offers physical activity
tips and the Surgeon Generals Report:
Physical Activity and Health.

American Physical Therapy

Association
1111 North Fairfax Street
Alexandria, VA 22314-1488
Phone: 1-800-999-2782
Internet: http://www.apta.org

Jewish Community Centers

(also appears as Young Mens Hebrew
Association or Young Womens Hebrew
Association.)

Request For the Young at Heart

(free exercise brochure).

78

Arthritis Foundation
1330 West Peachtree Street, Suite 100
Atlanta, GA 30309
Phone: 1-800-283-7800
Internet: http://www.arthritis.org

Check phone book for local listing,

or call national headquarters at the
phone number below.
Phone: (212) 532-4949
Internet: http://www.jcca.org
Most locations offer a variety of exercise
and physical activity programs for older
adults. All denominations welcome.

National Association of
Health and Fitness
c/o Be Active New York State
65 Niagra Square, Room 607
Buffalo, NY 14202
Phone: (716) 851-4309
Internet: http://www.physicalfitness.org
Sponsors physical-fitness events for
older adults. Ask for address and phone
number of your States association.
National Heart,
Lung and Blood Institute
NHLBI Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: (301) 592-8573
Internet: http://www.nhlbi.nih.gov
Part of the National Institutes of Health.
Offers free publications, on exercise, diet,
and cholesterol.
National Institute of Arthritis and
Musculoskeletal and Skin Diseases
National Arthritis and Musculoskeletal
and Skin Diseases Information
Clearinghouse
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 1-877-22-NIAMS
Internet: http://www.niams.nih.gov
Part of the National Institutes of Health.
Provides free information about exercise
and arthritis; large-print copies available on request.

National Institute on Aging

Bldg. 31, Room 5C27
31 Center Drive, MSC 2292
Bethesda, MD 20892-2292
Information Center:
Phone: 1-800-222-2225
TTY: 1-800-222-4225
Internet: http://www.nia.nih.gov
Part of the National Institutes of
Health. Call or write to receive free
publications about health and fitness
for older adults.
National Osteoporosis Foundation
1232 22nd Street NW.
Washington, DC 20037-1292
Phone: (202) 223-2226
Internet: http://www.nof.org

The Presidents Council on

Physical Fitness and Sports
200 Independence Avenue SW.
HHH Bldg., Room 738 H
Washington, DC 20201
Phone: (202) 690-9000
Internet: http://www.fitness.gov
Provides Pep Up Your Life, a free
exercise booklet for older adults,
in partnership with AARP.
YMCA and YWCA
Check phone book for local listings.
Services vary from location to location;
many offer exercise programs for older
adults, including endurance exercises,
strength exercises, water exercises,
and walking.

Call to request free copy of The Role of

Exercise in the Prevention and Treatment
of Osteoporosis, Guidelines for Safe
Movement, and Fall Prevention.
National Senior Games Association
P.O. Box 82059
Baton Rouge, LA 70884-2059
Phone: (225) 766-6800
Internet: http://www.national
seniorgames.org
Conducts summer and winter National
Senior Games The Senior Olympics.

79

Index
Abdominal aortic aneurysm. . . . . . . . . . . 17
Amount of exercise,
desirable . . . . . . . . . . . . . . 10-12, 27-30
Arm exercises
strength . . . . . . . . . . . . . 35, 36, 37, 39
flexibility . . . . . . . . . . . . . . . . . . 48, 51
Balance exercises . . . . . . . . . . . . . . . 42-44
Bicycling . . . . . . . . . . . . . . . . . . . . 30, 31
Blood pressure . . . . . . . . . . . . . . . . . . . 15
Borg scale. . . . . . . . . . . . . . . . . 27, 28, 29
Breathing . . . . . . . . . . . . . . . . . 29, 33, 53
Cardiovascular. . . . . . . . . . . 5, 9, 15-17, 29
Charts, activity and progress . . . . . . . 72-77
Chronic diseases. . . . . . . . . . . . . . . . 15-17
Congestive heart failure . . . . . . . . . . . . . 15
Critical aortic stenosis . . . . . . . . . . . . . . 17
Dancing . . . . . . . . . . . . . . . . . . . . . . . . 31
Dehydration . . . . . . . . . . . . . . . . . . . 29-30
Diabetes . . . . . . . . . . . . . . . . . . . 9, 10, 16
Diet . . . . . . . . . . . . . . . . . . . . . . . . 61-65
Endurance exercises . . . . . . . . . . . . . 29-31
Fitness professionals . . . . . . . . . . . . . . . 23
Flexibility exercises. . . . . . . . . . . . . . 45-52
Floor exercises (lying down and
getting up safely) . . . . . . . . . . . . . . . 49

80

Food pyramid,
U.S. Department of Agriculture . . . . . . 61
Gardening . . . . . . . . . . . . . . . . . . . . 3, 31
Golf . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Heart rate, target . . . . . . . . . . . . . . . 69-70
Hiking . . . . . . . . . . . . . . . . . . . . . . . . . 31
Hip replacement . . . . . . . . . . . . . . . 33, 45
Jogging . . . . . . . . . . . . . . . . . . . . . 29-31
Leg exercises
strength. . . . . . . . . . . 35, 36, 38, 39, 40
balance . . . . . . . . . . . . . . . . . . . . 42-44
flexibility. . . . . . . . . . . . . 46, 47, 50, 51
Kidney disease . . . . . . . . . . . . . . . . . . . 30
Lung disease . . . . . . . . . . . . . . . . . . 15-16
Moderate
exercise . . . . . . . . 11, 16, 28, 29, 31, 69
Motivation. . . . . . . . . . . . . . . . . . . . 21-23
Nutrition . . . . . . . . . . . . . . . . . . . . . 61-65
Osteoporosis. . . . . . . . . . . . . . . . . . . 9, 27
Progressing
in endurance exercise. . . . . . . . . . . . . 30
in strength exercise . . . . . . . . . . . . . . 34
in balance exercise . . . . . . . . . . . . . . 41
in flexibility exercise . . . . . . . . . . . . . 45

Pulse rate . . . . . . . . . . . . . . . . . . . . 69-70

Rowing . . . . . . . . . . . . . . . . . . . . . . . . 31
Safety . . . . . . . . . . . . . . . . . . . . 15-17, 25
in endurance exercise . . . . . . . . . . 29-30
in strength exercise . . . . . . . . . . . . . . 33
in balance exercise . . . . . . . . . . . . . . 41
in flexibility exercise . . . . . . . . . . . . . 45
Sarcopenia . . . . . . . . . . . . . . . . . . . . . . 34
Skiing . . . . . . . . . . . . . . . . . . . . . . . . . 31
Stair climbing. . . . . . . . . . . . . . . . . . . . 31
Strength exercises . . . . . . . . . . . . . . 35-40
Stretching exercises . . . see Flexibility exercises
Supplements, dietary . . . . . . . . . . . . . . . 64
Swimming . . . . . . . . . . . . . . . . . . . 29, 31
Tennis . . . . . . . . . . . . . . . . . . . . . . . . . 31
Tests, measuring progress . . . . . . . . . 57-58
Vigorous
exercise . . . . . . . . 11, 16, 27, 28, 29, 31
Volleyball. . . . . . . . . . . . . . . . . . . . . . . 31
Walking. . . . . . . . . . . . . . . . . 3, 29, 30, 31

Designed by Levine and Associates, Washington DC

E X E R C I S E : A G u i d e f rom t h e N a t i o n a l I n s t i t u t e o n Ag i n g

Exercises

Motivation

Safety

Exercise:
A Guide from
the National
Institute
on Aging

U.S. Department of Health and Human Services

Public Health Service
National Institutes of Health
National Institute on Aging
800-222-2225
www.nia.nih.gov
NIH Publication No. 01-4258
Reprinted September 2006

S e l f - Te s t s

Benefits

Nutrition