How to Strengthen Leg Muscles in the Elderly [Pt. 1]

As with any age, the term “strong” or “strength” depends on what you’re goal is or what specific problem a person may be having. In the case of the older population, there may be some who have a real problem walking distances in the community. Then there may be others who find it a challenge to simply stand up from a chair or toilet.

So, in this blog post we’ll look at how to strengthen weak legs in the elderly who have been sedentary for a while and have difficulty with simple, routine, home mobility. We can consider these “basic” or “beginner” exercises because, if a person is very weak, they need to start simply and slowly to build up to more advanced (or those with more resistance) exercises.

Before we jump right into the exercises, there are basically 3 things that the elderly and their caregivers need to understand up front about what it takes for muscles to “get stronger”. First, the muscles need to be “challenged”. This means that there needs to be a level of resistance to the movement that makes it challenging to do. Second, the exercises need to be done consistently over time. It will take weeks of consistent, committed, performance to see changes take place. And, thirdly, “patience”. This builds on the consistency thing. You need to be patient when working with the elderly because being too aggressive may cause a lot more discomfort, which will give them and excuse to stop exercising. And, going “too hard and too fast” may actually cause an injury which could set them back even further.

You may find other online sources that address weak leg muscles in the elderly and give you a list of exercises to do. But they don’t tell you why those particular exercises should be done and what the benefit will be. I will address those points when we get to the exercises. I’ll also address the importance of proper positioning to make the movements safe and easier.

With seniors who may be significantly weak or been inactive for a while, it’s a good idea to start with “body weight” exercises. In this case you’re literally just “going through the motions” of the exercise movements. I use this approach to teach the correct form so that when we add resistance to the movements they will know what they’re supposed to do with it. By using the body weight approach you can also see if the movement itself is something they should do. If any exercise still causes pain (as opposed to discomfort) or swelling, after doing it for a week or so, it should be stopped and another approach considered.

If a person has been sedentary for a while a couple of things happen. Certain muscles get weak, because they haven’t been used. Other muscles get shortened and tight because they stay in their “shortened” position when a person in sitting or reclining for long periods. The exercises need to strengthen and stretch the muscle groups in general.

Leg Exercises For Seniors

Sit to Stand Squats

Sit to stand squats are a “functional” version of the squat exercise. It targets the majority of the leg muscles and the movement is essential for allowing someone to stand up from a seated position.

When you’re starting out, the movement should be done from a seat that puts the level of a person’s hips higher than that of their knees. This means from a dining type chair or edge of their bed, rather than a soft sofa or easy chair. Some people do it from their elevating recliner with the seat elevated to the proper height.

For the squat exercise, the proper positioning will be 1. hips higher than knees, 2. Feet shoulder width apart, 3. Ankles behind the knees, 4. Shoulders over knees.-These last 2 points are essential as no human being can stand up if those 2 positions aren’t met.

Once you’re in the right position, the effort to stand will be pushing forward and not straight up as most people do. Going straight up causes the person to struggle and fall backwards back into the seat. Then they use up a lot more of their energy trying to “throw themselves forward” in an effort to get out of their chair. When you lean/push forward, this transfers the body’s weight onto the legs which carry it into standing.

Although a person may need or want to use their hands to help when doing the sit to stand squat, it’s important to remember that it’s meant to strengthen the legs of the elderly. This means the goal is to get to the point of doing the exercise with as little help from the upper body as is safely possible.

When in the standing part of the exercise, make sure you stand up as straight and erect as your body allows and try to tighten your legs and hips before you begin the trip back to sitting.

Remember the importance of positioning and form? So, on the way back down to the seat the first thing you’ll do is bend forward at the hip as if to take a bow after a musical performance, then reach backward for your chair/seat, then bend your legs and slowly lower yourself down to the seat. Lightly touch the chair with your rear end and then push forward back into standing. Rinse and repeat.

I usually recommend 5 repetitions when first starting out and perform 2 sessions every other day.

Heel Raise in Standing

The heel raise in standing is underappreciated for it’s benefits and an under emphasized exercise for seniors, in my opinion, because it seems boring and too simple. The heel raise exercise targets the muscles of foot and the calf. These muscles are essential for good balance, stopping a person from falling forward, helping a person climb stairs and walk efficiently and gracefully.

If a person has been sedentary or in the bed for a long period, the muscles of the calves and feet tend to shorten into what is called plantar flexion. This is when the toes are pointed away from the body. When the muscles are shortened into plantar flexion, it’s more difficult for a person to stand up straight and they may feel as if they are falling backwards.

These muscles also get weak when a person doesn’t spend a lot of time on their feet. This means walking and stair climbing will be more challenging and tiring.

Many physical therapists to my dismay will have people perform heel raise exercises while their patient is sitting. While this may help “pump” the muscles and “warm up” the tissues, it really doesn’t do anything to strengthen the lower leg muscles. This is because there is really no resistance on the lower legs in the sitting position.

When you do the heel raise in standing, you’re lifting your body weight as the resistance. And isn’t the whole point of doing leg strengthening exercises for seniors is to get them to be able to walk better and carry their bodyweight better? Another advantage of doing this movement while standing is that it helps improve a person’s balance by teaching them to control the forward and backward weight shift through their feet.

So again, remember, this is a leg exercise and the goal is to use as little assistance from the arms as is safely needed to do the work. While a person could use their walker for support, it usually have a person lightly hold onto a kitchen counter, or other fairly stationary object for support as they learn to do this movement.

So, to do the heel raise a person stands with their feet about shoulder width apart. Then, with a light hand hold on a stationary object, they slowly shift their weight forward onto their forefeet and raise their heels as high as safely possible and then slowly shift their weight back to what’s called “foot flat”. Avoid rocking back onto the heels with the toes up in their air as some therapists teach. Doing this only reinforces the common habit of standing on their heels and may cause them to fall backwards.

(As an aside, our bodies are designed to prevent a forward fall and not a backwards fall. So, in my opinion, rocking back on the heels with the toes up in the air is not the safest thing to teach our elderly. If a person starts to fall backwards, there’s nothing that is going to prevent them from hitting the floor.)

Again, rinse and repeat. The goal is to get to the point that very little support from the hands and arms are needed to maintain balance.

I usually have people who are starting out to perform 10 repetitions and again, 2 sessions every other day.

Standing Hip Abduction

This is another movement that I think is underappreciated and seldom done correctly but has a lot of benefits and will help the elderly walk better and feel stronger.

Hip abduction targets the smaller gluteal muscles and another important muscle called the Tensor Fasciae Latae. Combined these muscles are responsible for keeping the pelvis stable when a person is standing on one foot as in walking. When a person has been sitting (either in a recliner, in a car, or at a desk) for long periods, these muscles get shortened and weakened because they are typically called into action when a person is standing but not when sitting.

Tight and weak hip abductors are also a frequent cause of lower back pain and can cause people to shuffle when they walk because they feel unsteady when they lift one foot too high off the ground. Also, tight and weak abductors can also slow the reaction time for lateral movements needed to prevent falls to the side.

To do the hip abduction in standing, you again want to help the elder hold onto something that’s relatively stable and stationary and that will allow them to swing either leg out to the side. And, as with the previous exercises, you want to perform this exercise while standing as erect as possible with the rear end tucked in and the chest up and out. This trains the muscle to work when the person is standing rather than stooping.

When in the proper position, the elder gently shifts their weight to their “stance” foot and swings the opposite leg out to the side. It’s important to keep the foot of the “swing” leg pointed forward rather than rotating it in the direction of the swing.

Now don’t look at this as a “Bruce Lee Kung Fu Kick”, the foot doesn’t have to go that high off the ground. If your elder tries to lift too high, it may require too much effort and cause a loss of balance. The point is to “activate” these dormant muscles and wake them up. You can always add more effort once the movement is learned and doesn’t cause them any trouble.

Again, I usually start people out doing 10 repetitions, 2 sessions every other day.

Daily Walking Program

Being able to walk is essential for seniors and the elderly. Maintaining their ability to get around their home and to their appointments is what will help keep them in their homes and also reduce the amount of physical care that family caregivers need to provide.

So, starting a walking program to keep the legs strong and improve endurance is a no brainer. This can be done inside the home initially and then transferred outside when weather and fitness permits.

While a lot of seniors will say that “I walk a lot because I have to go back an forth to the bathroom”, this is not the type of walking program needed. A progressive home walking program is when you set aside a dedicated amount of time on a daily basis to improve your ability to walk. That may include focusing on posture, weight shift, breathing, etc.

This is how it works. Have the senior begin walking in the home. You’re going to use a timer one your smart phone or tablet to see how long they walk before “they have to” stop for a rest. This will be your “baseline”. If it’s only 2 minutes and 30 seconds, then this is the amount of time they walk continuously at least once daily.

As their tolerance and quality of their movement improves, you increase the amount of time they’re walking weekly, not daily. When they are tolerating walking well, you can add another “session” of walking during the day. Each session should be spread out as to not cause fatigue and “unsteadiness”.

Have an Exercise Schedule for Seniors

Having a routine is a great tool to keep people on track and help them work exercise into their day to day activities. Having specific times and days that exercises are performed will help with adopting them into the overall lifestyle. So, have your seniors pick the times they will perform their exercises and walking program. There is plenty of time in the day for retirees to work things in. Plus, they know when they feel they have the energy and most motivation to do them. Naturally, you’ll have to make allowances for medical appointments and such. But don’t let them be an excuse to miss an exercise session.

Having a “Master calendar” is a good tool because you can “star” your “exercise days” and add medical appointment times. This will let you get your exercises in before or after your appointment times. In reality, there will be days that things happen that are not in your control. It’s to be expected. But if you want your legs to get stronger, you’ll have to make exercising a priority. Once it’s become part of your daily routine, it will be a lot easier.