Program Design and Exercise Prescription
Build the program around function
Design for older adults follows the FITT-VP framework (Frequency, Intensity, Time, Type, Volume, Progression) with an emphasis on safety and function.
- Aerobic: most days, moderate intensity (talk test, RPE ~11–13/20), progressing from short bouts. Low-impact options (walking, cycling, water exercise) reduce joint stress.
- Resistance: 2+ days/week, major muscle groups, starting light (e.g., RPE 5–6/10 or ~40–50% 1RM) and progressing. Emphasize power (speed of movement) cautiously for fall prevention.
- Balance: for those at fall risk, incorporate progressive balance work (e.g., single-leg stance, tandem stance, dynamic stepping) near support.
- Flexibility/mobility: regular stretching and joint mobility, especially for ADL tasks.
Progression and safety
- Progress one variable at a time (e.g., load OR volume).
- Warm up and cool down; monitor for dizziness, chest pain, or unusual fatigue.
- Respect recovery - older adults may need more time between intense sessions.
- Regress to progress: modify range, load, or support before abandoning an exercise.
Traps
Common wrong answers include: prescribing high-impact plyometrics for frail clients, skipping resistance training because of age, or progressing intensity too aggressively. Also watch for confusing aerobic and resistance FITT parameters.
Rule of thumb
If a client can perform a movement safely but with difficulty, that's the right progression point - not the point to stop.