Active IQ Level 3 Award in Designing Exercise Programmes for Older Adults (sample manual)

Manual 

Level 3 Award in Designing 

Exercise Programmes for 

Older Adults 

Version AIQ004804

Physical activity and health 

Unit 

considerations for the older 

1adult 

Aim 

This unit covers a broad range of topics associated with ageing. It includes a comprehensive overview 

of population demographics, social and economic challenges of an ageing population and highlights 

opportunities for meeting the needs of this growing market. A thorough explanation of the physiological 

changes and medical implications of the ageing process is included, which will serve to inform programme 

design. Finally some practical considerations are addressed with regard to communicating effectively, 

building professional relationships and encouraging adherence to physical activity. 

Learning outcomes 

At the end of this unit you will: 

• Understand the effects of ageing on the UK population. 

• Understand the physiological and biomechanical changes associated with ageing and their 

implications for physical activity. 

• Understand the medical conditions commonly associated with old age and their implications for 

physical activity. 

• Understand the key considerations for older adults participating in physical activity. 

• Understand the communication skills required to engage with older adults. 

Copyright © 2017 Active IQ Ltd. Not for resale | 3

It can be seen that there are more people in all age groups over 50 in 2010 than in 1991. 

This is reflective of an ageing population and primarily represents advances in medicine and healthcare, 

in particular surgery and pharmaceutical management of non-communicable diseases. 


Bone Mass 

Attainment of peak bone mass Consolidation Age-related bone loss 

menopause 

MALES 

FEMALES 

01 02 03 04 05 0 60 70 

Age (years) 

Figure 2.1: Changes in bone mass through the lifespan 

(Needs to be redrawn by designer as copyright image example) 

• The bone cells responsible for laying down new bone mineral are called osteoblasts (builders). 

• The bone cells responsible for clearing away old bone mineral and cells are known as osteoclasts 

(cleaners). 

• In childhood, and in young adults, the osteoblasts are more active than the osteoclasts resulting in 

more bone mass overall. 

• From middle age onwards the osteoclasts are more active than the osteoblasts leading to a reduction 

in total bone mass. 

• Activities that load bones sufficiently (e.g. resistance work with loads heavier than 10RM and highimpact 

running or jumping) have the effect of increasing osteoblast activity. 

• Physical inactivity reduces osteoblast activity, as there is no stimulus for the bone to adapt. 

With age, or physical inactivity, bones become, thinner, lighter, less effective at absorbing impact and more 

prone to fracture. The appropriate loading of bones can slow or reverse this effect by stimulating the laying 

down of more bone minerals. The most effective time for this is during teenage and young adult years, in order 

to achieve a high peak bone mass in middle age. After this time bone loading is still a valuable way to maintain 

bone mass but is unlikely to increase it. 

Ageing joints 

One of the effects of ageing on all connective tissue in the body (bone, cartilage, ligament, tendon, muscle, 

fascia, skin) is a reduction in the amount of elastin fibres and relative increase in the amount of collagen. 

Elastin is only present in small quantities in young adults, so the effect of a decrease is a marked change in 

the mechanical properties of these tissues. The collagen fibre structure and cross-bridging also changes with 

age, partly due to cell fibroblast ageing and partly due to a lack of mechanical loading (inactivity) associated 

with increasing age (Varani, J. 2006) contributing to reduced extensibility of tissues. 


Figure 2.4: Illustration of changes to lung tissue with age 

These changes to anatomy in older adults make it harder for the lungs to expand and contract efficiently. This 

affects physiological measures, for example: 

• Reduced vital capacity and maximum voluntary ventilation. 

• Reduced forced expiratory volume in one minute (FEV1). 

• Increased residual volume and functional residual capacity. 

• Reduction in the amount of gas exchange that can occur across the alveolar surface. 

• Reduced clearing of lungs through coughing. 

Figure 2.5: Change in FEV1 throughout the life course 

Receptors in the airways become less sensitive with increasing age; this makes drugs used to treat respiratory 

disorders less effective in older adults compared to young adults. Combined with a loss of awareness of 

dyspnoea (shortness of breath) and an inability to respond efficiently to low oxygen levels or high carbon 

dioxide levels in the blood, due to a decline in nervous system regulation of respiratory muscles, this greatly 

increases the risk of ventilatory failure during an event or illness such as heart failure or pneumonia. 


The other common form of arthritis is rheumatoid arthritis. As it is an autoimmune condition in which the 

synovial tissues are inflamed and swollen, the progressive nature of this disease is different to osteoarthritis. 

Rheumatoid arthritis is usually widespread throughout the body and often affects smaller joints in hands, 

wrists and feet before being noticed in larger joints like the cervical spine and knees. 

People with inflammatory conditions may go through periods where there are few symptoms and exercise is 

able to progress comfortably. There are other times when, for unknown reasons, the inflammation will flare 

up. During flare-ups vigorous exercise is not recommended and can cause serious damage to tissues. Outside 

flare-ups people with rheumatoid arthritis can exercise following similar guidance to that for osteoarthritis. 

An additional consideration for those with rheumatoid arthritis is to avoid morning exercise due to morning 

stiffness of joints. As for osteoarthritis, this condition is covered in greater detail along with full guidelines for 

exercise within the level 3 exercise referral instructor qualification. 

Osteoporosis 

Osteoporosis is a condition of the skeleton characterised by a loss of bone mass and bone mineral density to 

an extent that makes bones susceptible to fracture. Bone mass loss is a normal feature of the ageing process; 

it is the severity and consequences in terms of fracture that indicate osteoporosis. Low bone mass that is 

not clinically significant is referred to as osteopaenia; almost all older women and many older men have 

osteopaenia. The reasons women are thought to be more susceptible to the condition are: 

• Lower peak bone mass is attained. 

• Bone mass loss begins at a younger age for women. 

• Bone mass loss is accelerated for a period of around five years during and after menopause. 

Figure 3.2: Bone mass changes through the lifespan 

28 | Copyright © 2017 Active IQ Ltd. Not for resale

Frailty 

The classification of frailty as a metabolic condition combines a number of the effects of the ageing process 

and the impact these have on function. Conditions including sarcopaenia and osteopaenia contribute to 

frailty. Frailty may be diagnosed as a loss of functional capacity, identified by tests such as the Short Physical 

Performance Battery (SPPB) (Appendix 1) devised by Guralnik et al. (2004). A more holistic definition of 

frailty used by Bales, Chan and Robare (Durstine and Moore, 2009) is: “…an increased vulnerability to 

stressors that results from decreased physiological reserves and multisystem dysregulation, as well as limited 

capacity to maintain homeostasis and to respond to internal and external stresses.” 

In most cases of frailty at least one chronic medical condition will be present. If not, it is clear that exercise 

will need to be modified significantly for people with this condition and medical consent to exercise should 

be obtained before a routine starts. The scope of this qualification does not include training frail older adults 

and additional qualifications and training, such as the level 3 exercise referral instructor, level 3 chair-based 

exercise and potentially level 4 qualifications in falls prevention may be required depending on the environment 

in which these clients are being trained. 

Neurological and psychological conditions 

Stroke and Transient Ischaemic Attacks (TIAs) 

Stroke is most common in people over 60 years of age. Older adults that have experienced a stroke or ‘ministroke’ 

(TIA) are at an increased risk of having a subsequent stroke. Exercise is beneficial and reduces the 

risk of a subsequent stroke by around 20%. Providing exercise programmes for people that have had a stroke 

is a specialised area requiring the level 4 specialist exercise instructor qualification in long-term neurological 

conditions. 

It is important to be aware of the signs of a stroke and react quickly in the event of a suspected stroke as 

urgent medical treatment is required to limit the extent of damage to the brain. Remember the acronym FAST 

to identify the signs. 

Figure 3.3: FAST 


Section 2: Identifying goals with older adults 

Long-, medium- and short-term goal setting 

In the coaching and psychology professions it is widely accepted that setting goals, monitoring progress and 

regular reviews are valuable for supporting behaviour change. Having support to implement this process is 

valuable and it could be argued that this is particularly true for older adults who may have been following a 

certain lifestyle for a long time. 

Making lifestyle changes can be challenging and goal setting is only valuable if the goals are truly owned and 

inspired by the person who has to make the changes. This is why goals can never be set for someone if they 

are to be effective. They should set goals by themselves, but often guidance from someone else is needed to 

design meaningful goals. 

Many people start an exercise programme with no particular goal. Sometimes they are very clear about 

what they don’t want, e.g. “I just don’t want to feel like this anymore” or “I don’t want to get diabetes”. The 

fitness professional can help the client identify some meaningful goals that are phrased positively and use 

commitment language (e.g. ‘I will’) or even better express the goal in the present tense as if it has already been 

achieved (e.g. ‘I am’). 

Often a balance has to be struck between maintaining optimism for the client and building their motivation 

and self-efficacy versus being realistic and guiding them towards achievable goals. Some people believe that 

goals should be enormous, inspiring and dramatic, but most research on goal setting indicates that goals are 

more effective if they are easily achievable as success builds upon success, so achieving one goal provides 

motivation to achieve another. By using goals with different timeframes, a combination of both approaches can 

be adopted to provide clients with the benefit of the inspiration of a big goal and the frequent feeling of success 

from lots of little achievements. An overview of the goal setting process is illustrated in figure 2.1. 

Figure 2.1: Overview of the goal setting process

Active IQ Level 3 Award in Designing Exercise Programmes for Older Adults (sample manual)

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