Abdominal strength is important for everyone, but especially for older patients.
The abdominal muscles consist of several layers of overlapping fibers: the rectus abdominus, which runs from the ribs to the pelvis, the internal and external obliques, which weave diagonally along each side of the body, and the transversalis abdominus muscles, which extend across the abdominal cavity from side to side and front to back.
With age, the disks in the back become thinner, and the abdominal wall starts pouching, so it is important to keep the stomach muscles strong. This applies especially to the oblique muscles on the sides of the midsection, because they act like a basket to hold the abdomen in place.
Strong abdominal muscles can reduce unnecessary stress on the back and even the upper legs, as they do for the rectus femoris muscle that is used to bend the hip. In addition, weak stomach muscles can contribute to a swayback, which in turn can trigger muscle spasms. Remind patients that sit-ups alone will not change the circumference of the waist—aerobic exercise and diet are still needed in order to slim down.
The once-traditional method for doing a sit-up, with the legs straight out in front and the hands behind the head, is no longer considered an optimal position because it engages the hip flexors, which take away some of the work that the abdominal muscles should be doing.
Doing sit-ups with the knees bent is a much more effective way to strengthen the muscles because it isolates them and makes them work harder. However, as with any exercises, remember that pain and strain do not add value, but only leave you stiff and sore.
As with any abdominal exercises, it is important to inhale before starting the exercise, then exhale while contracting the stomach muscles and inhale again when releasing from the contraction. It is also important to avoid placing the hands behind the head, which puts undue pressure on the neck. These exercises should be done daily. It is especially important for senior patients to do something moderate every day rather than do something excessive only a few times per week.
Encourage patients to start with 3 repetitions of each exercise daily and work their way up to 10–15 repetitions. Once they reach 10–15 repetitions, remind them that maintaining this level of exercise consistently should preserve their abdominal strength.
In next month's column, I will discuss exercises to improve posture.
Strengthening Exercises
Back Tilt Position yourself on your hands and knees with hands directly underneath the shoulders and knees directly underneath the hips. Take a breath, and as you exhale, drop your head between your arms and draw the lower belly toward the back of the body. Hold for 5 seconds. Return to the starting position and relax for 4 seconds. Start with 3–5 repetitions, and gradually work up to 10.
Oblique Sit-Up Lie on your back with your arms at your sides, legs bent, knees slightly apart, and feet flat on the floor. Take a breath, and as you exhale, raise your head, upper back, and arms off the floor, reaching your left arm across the body toward the right knee. Roll up into a half sit-up, then back to the floor and breathe in. Repeat on the other side, reaching the right arm toward the left knee. Repeat the set 3–4 times, and work up to 10–15 repetitions.
Extended-Arm Sit-Up Lie on your back with your arms at your sides and your knees bent. Take a breath, and as you exhale, raise your upper body and bring your arms forward so they extend toward your knees and beyond your knees if possible. Release and roll your body back to the starting position. Repeat 3–4 times, and work up to 15 repetitions. Try to count to six as you lift up and again as you roll down. Later, you can hold the “up” position for 5 seconds, then relax for 4 seconds.
Crossed-Arm Sit-Up When you first attempt this exercise, you may need to secure your feet under a couch or heavy chair. Lie on your back with feet secured and arms crossed in front of your chest. Raise your upper body toward your knees, then lower it back to the floor. Repeat 3–4 times, working up to 10–15 repetitions. Avoid jerking movements; they can strain your back.