As personal trainers, we are at a tremendous advantage working one on one with the older adult. It's most important for all of us involved with this population to share information. Then and only then can older adults count on real-life fitness programming.

Case Study
The Client:
Billie S. is a 74-year-old with Parkinson's disease.

During the interview, I ascertained that Billie's current category of function was between BADL and IADL. Parkinson's disease obviously furthered her already sedentary lifestyle. She was also contending with mild hypertension and osteoporosis.

However, the most important information I acquired in our initial discussion was that Billie was afraid. She had a fear of walking outside and of climbing stairs. As with many older adults, her real fear was of falling. Plus, the fatigue and muscular rigidly of Parkinson's decreased her hip and knee flexion and ankle dorsiflexion, making it difficult for her to climb stairs.

The Evaluation:
Physical assessment with Billie began with mobility testing. By giving her various verbal cues, such as, "Reach for the sky" and "Cover up your ears with your arms," I could begin to identify limitations in voluntary function. Further investigation revealed stiffness in the shoulder girdle, the appearance of a frozen right shoulder, and severe weakness throughout her body.

Billie's gait pattern indicated severe impairment: Stride length was 25 percent of normal. Step width was greater than normal, which suggested weakness in stabilization of the weight-bearing leg. Step initiation was visibly cautious and resembled a shuffle..

Billie exhibited virtually no arm swing at the shoulder joint, and her elbows remained at approximately 90 degrees of flexion, with her arms drawn close to her torso. Verbal reminders were not sufficient to elicit a correction in arm swing.

Designing the Program:
Billie began a circuit weight training program. The variety of activities in circuit training is very specific to real life. In addition to accommodating a large volume of work in a short period of time, circuit training often allows muscular and metabolic fatigue to occur simultaneously.

Our first goal was strength training to build up Billie's conditioning level so she could perform cardiovascular training. A secondary goal was to improve her confidence in her ability to move safely.

Billie exercised twice a week for approximately 30 minutes per session.

The circuit program was modified to exclude prone or supine positioning from the floor-or even from a bench- because of her fear of falling when getting up and down. Legs were the predominant focus. Upper-body work was generally performed from a seated position.

We placed a great deal of emphasis on stabilization. Body weight and dumbbells were chosen for this purpose. Balance training was used, progressing to balancing on one leg, and eventually to using the proprioception board. Multi-hip maneuvers (abduction, adduction, flexion and extension) led to a variety of gait patterning.

Billie wore a Polar heart monitor at all times during her workout. (I find the "at-a-glance" reading of the heart rate helpful to track progress as fitness level improves.)

Six-Month Evaluation:
Billie is able to climb three flights of stairs without stopping. This was a primary goal because the walking track is on the third floor. The walking track offers an environment free of obstacles and weather, so she can increase the aerobics component of her program. Her confidence has increased, and she now takes regular strolls outside in the evening with her husband.