Establishing Areas of Focus: Preparing for the Yearlong Program

Tim: Even though Ken and I had worked together many times in the past, this was the first time I had committed to total hands-on involvement, being just as responsible for the short- and long-term results as Ken. Given that, we both agreed that November—before we officially started the formal one-year program—should be directed toward establishing the fitness areas we would focus on and determining the appropriate help Ken would need from me in each area to accomplish our agreed-upon goals.

My first concern was what kind of exercise Ken should be doing at his age. I have been in the fitness industry for over 40 years and have noticed that many physiological changes occur through a normal lifetime.

My first realization of the inevitability of age-related physiological differences occurred when I was 45. A track enthusiast friend of mine convinced me that I should compete in masters-level track and field competitions. Since I was in great shape and very strong for my age, I decided to compete in the shot put. I threw well in college, and when I saw that the All American standard was only 41 feet, I got very excited. I threw so hard trying to reach that mark that I pulled a hamstring muscle. I couldn't believe that I was throwing nearly 20 feet less than I threw when I was in college. I knew age brought certain physiological changes, but how could it make such a difference?

As we get older, our bones become more brittle, our joint cartilages wear thinner, and our ligaments become looser. Sounds kind of depressing, doesn't it? The good news is that we have the same muscle cells regenerating and will for as long as we use them. What this means from a training standpoint is that we can't handle the exercise demands that we once did.

The objective of my first month working with Ken was to initially provide him with a basic orientation on the six components of a complete, age-appropriate fitness program. Then, using Situational Leadership® II, we would determine the appropriate leadership style I needed to use on each component to help him succeed.

Why all this planning? Because, unfortunately, most people have a philosophy of “ready-fire-aim” rather than “ready-aim-fire.” They want to get started before they know where they're going and how they're going to get there.

Let's take a look at the six components of a complete fitness program.

Aerobic Exercise

Aerobic exercise occurs when oxygen combines with fat and carbohydrate to form ATP (adenosine triphosphate) for muscle fuel. Aerobic exercise has numerous benefits: The heart muscle gets stronger, lung capacity improves, mitochondria (muscle cells) increase in number, circulation improves, and we can burn stored body fat. Other major benefits of a good aerobic program are increased capillaries, greater energy level, and stress relief. A number of studies show that aerobic exercise is good for the brain—particularly cognitive function and memory retention. Some studies have even indicated that it may delay the onset of Alzheimer's disease. All of these benefits will make us healthier—and aerobic exercise is relatively simple to do.

I am very familiar with Ken's capabilities and limitations because I have worked with him for so many years. When it comes to aerobic exercise, we both diagnosed him as a D2—disillusioned learner. He had some success in the past through basketball and also with jogging when he first came to California, but he was frustrated that he could not maintain a consistent aerobic routine. Given that diagnosis, I had to set up a program that was challenging yet realistic for Ken—and not boring. In coaching him in this area, I needed to take the lead in setting up his program but also seek his suggestions and involvement; an S2—Coaching leadership style.

Ken had completed his rehab from a second total hip replacement six months earlier. He had been doing about 15 minutes of aerobic exercise on his recumbent bike at home two to three times per week. This was very minimal, but at least he was getting some exercise stimulus. I knew that his aerobic exercise would be limited to cycling because of a limitation with his left knee. A basketball injury (Ken claims he hit his knee on the rim) and a subsequent knee surgery in 1961 had resulted in a knee condition that was very arthritic and lacked full extension by at least 15 degrees. This left Ken with the equivalent of a shorter left leg and was partially responsible for the “Quasimodo” look that his son Scott was concerned about. Walking any distance was not directly painful but caused other problems with spinal displacement and posture.

My objective for the first month was to have him work out on his exercise bike a minimum of 15 minutes at 100 to 115 heartbeats per minute (bpm), twice a day for at least five days per week. The goal would be to eventually combine those two 15-minute sessions into one 30-minute session at that same heart rate once a day. Ken could continue to do this at home on his own, with me monitoring him closely and cheering his progress.

Strength Training

Strength training has always been my favorite component of fitness. Muscle tissue is one of the only body tissues that continues to regenerate over a lifetime. However, you are only as strong as you need to be to do your daily activities.

When muscle tissue grows, the term is hypertrophy. When muscle tissue shrinks, it is called atrophy. Both conditions can occur rather quickly. If you have ever had a limb in a cast for six weeks, you've probably observed how quickly tissues shrink when they are immobilized. When people retire, they often spend too much time sitting around and rapidly lose the strength of their stabilizer muscles. This is why many older adults have trouble with balance. Some people worry that strength training will develop large bulky muscles. The reality is that they should worry more about losing too much muscle. Numerous studies have cited that adults who don't engage in strength training will lose an average of one-half pound of lean muscle tissue per year after age 25.

In terms of strength training, Ken was a D1—enthusiastic beginner. He never really had done any strength training but was excited about becoming a little buff—at least enough to get a “You're looking good” from Margie. Given his lack of experience in strength training along with his enthusiasm to give it a try, I needed to provide an S1—Directing leadership style. My job was to design a program for Ken and closely supervise him to avoid any potential injury. His job was to do what I said.

Ken started to come to my facility two to three times per week to do strength training. Initially, we worked for about 45 minutes each session. I divided his strength training program into upper-body, lower-body, and trunk exercises. Most of the upper-body exercises were done initially on a cable-driven multi-gym machine from a sitting position. It was easier for him to do these exercises as they did not require a lot of body stabilizing and balance. Also, the cables operate independently, which allows the limbs to work together to correct any bilateral deficiency. Ken's legs were exercised on a Pilates Reformer, and his trunk was exercised on a massage table. I placed a lot of emphasis on proper form, correct breathing, and doing the full range of motion. The goal for each exercise was to achieve muscular fatigue at 15 reps for upper body, 20 to 25 reps for the leg muscles, and as many as 40 reps for the torso exercises.

Flexibility

This is my least favorite component of the exercise regime. However, it is as important as the others. A flexibility program can be completed in 10 to 15 minutes and ideally should be done daily or at least every time after you work out. As we get older and spend less time actively moving around, the muscles become tighter and shorter, thus restricting our ability to move around and increasing the chance of injury.

In terms of flexibility, Ken was a D2—disillusioned learner. Periodically he would go to his local Egoscue clinic and see Pete Egoscue or one of his staff. Pete was a Vietnam veteran who had trouble standing up straight after returning from his tour of duty. So he decided to learn about the body, resulting in the Egoscue Method®, which specializes in alignment. But like Weight Watchers, Ken would start a program with the Egoscue folks with great enthusiasm and then get too busy to follow through. As a result, I decided to do flexibility work with Ken along with his strength training at my facility, where I could direct his efforts and encourage his progress: an S2—Coaching leadership style.

It became clear to me that flexibility was an area where Ken would need a lot of work. Years of poor postural alignment, mostly related to his knee condition, had resulted in him having very tight muscles. Most of the strength training exercises were done with as much range of motion as possible to help free up the movement of the joints. Strength training work was done first, since warm muscles move better than cold muscles. The majority of the stretching exercises were done by me manually moving his limbs. One of the objectives was to make Ken capable of eventually doing his own stretching.

Balance Training

Balance begins to decline in your late 20s and gets progressively worse from age 60 on. For most people, this is of little consequence until the later years, when it can result in falls as well as hip and arm fractures. A lot of this balance deficiency is the result of weaker stabilizer muscles from less activity, and some is due to loss of proprioception.

Proprioception is the body's ability to compensate for gravity and that third plane of movement. It is a coordinated effort among the brain, muscles, and joints to react to movement that might cause us to fall. A simple example is what occurs when we walk or step off a curb. We do not consciously have to think about where we need to place our foot to maintain balance, as our body does that automatically.

Another system that affects our balance is the vestibular system. This mostly involves the fluid in our inner ear and is largely responsible for maintaining our equilibrium. A number of things can cause problems with the vestibular system, and most require medical intervention. The other two balance factors mentioned—weak stabilizer muscles and gradual loss of proprioception—can be improved by training.

When it came to balance training, again Ken was a D1— enthusiastic beginner. He hadn't thought much about the importance of balance but was quick to get excited about it when I convinced him of the consequences of lack of balance when we age. Using an S1—Directing leadership style, I had Ken attempt to balance himself standing on one foot while he was looking straight ahead—first his left foot and then his right. I also had him stand on a BOSU® ball—a quarter-round ball with a flat bottom—with me not holding on, but close enough to catch him when he lost his balance. Showing improvement with these activities I knew would go a long way in building up Ken's balance.

Nutrition and Weight Control

We've all heard the expression “You are what you eat.” If you mainly eat fat, you are generally fat. If you eat starches and simple sugars—much of which are converted to fat—you are usually fat. If you eat what your body requires with the correct amounts and types of proteins, carbohydrates, and fats, you can become a “lean, mean (not necessarily) fighting machine.”

When it comes to nutrition and weight control, I'm sure by now you could diagnose Ken's development level yourself. Given his yo-yo history and in-and-out forays with the Weight Watchers program, he was definitely a D2—disillusioned learner.

Ken and I discussed several weight loss options. His first thought was to rejoin Weight Watchers, where he had achieved some success in the past. While I wanted to support him here, I did remind him of how often he had gained weight back after he stopped attending the meetings. As a result, I directed him first to consult with Sabrina Zaslov, the nutrition advisor in Dr. Rice's office, on an eating and nutrition program. After that, the Weight Watchers program and the cheering of the fellow participants at the meetings could complement and support any progress made and hopefully provide the S2—Coaching leadership style he needed.

Rest and Sleep

Most adults are sleep deprived, causing marked reduction in their productivity, concentration, and quality of work. Several leading Fortune 500 companies and professional associations, as well as professional sports teams, are learning that it is neither macho nor smart to operate on less than the required amount of sleep.

This was one area where Ken didn't really need any help. In fact, he told me that Dr. James B. Maas, an expert on sleep and performance and a personal friend of Ken's since graduate school, had made an appointment for him at the sleep clinic at UCSD Medical School to do a routine test, which Ken passed with flying colors. According to the attending physician, Ken broke the record as the person who fell asleep most quickly! Ken was certainly a D4—self-reliant achiever in terms of rest and sleep. This was one part of his health and fitness program where an S4—Delegating leadership style worked just fine.