BY KAREN KATZENBACH
February 21st, 2018
A terrible fate awaits those who ignore their fitness and fall victim to a sedentary lifestyle.
In the CrossFit Specialty Course: Masters, instructors talk about how a victim of sedentary aging will have not only a weaker and less flexible body but also a weaker and less flexible mind. I contend that this second effect is the more challenging for a CrossFit trainer.
We’ve all worked with people, young and old, who have less-than-optimal strength and flexibility. That’s why they come to us in the first place, right?
Working with an athlete with a fixed and inflexible thought pattern or a lack of mental agility and coordination might not be so familiar.
I took on just such a client in October 2017 and faced the biggest challenge of my CrossFit career. This athlete was recently diagnosed with Alzheimer’s disease. She is also my mother.
Alzheimer’s disease robs its sufferers of their memories, their reasoning, and eventually their personalities and relationships. The Centers for Disease Control and Prevention predicts that 13.8 million Americans will have Alzheimer’s disease by the year 2050.
Though my mother’s diagnosis was recent, the signs and symptoms had been there for some time. My siblings and I had been guilty of chuckling about how scatterbrained mom could be. It was funny, we thought. But we should have known better.
When we did confront her, she fell into the common response: “It’s normal to forget things as you get older.”
We nodded. But we could have done better.
That’s the danger of the myths of aging. Muscle loss, forgetfulness, aching joints—you rationalize symptoms that should be addressed by lifestyle changes as “just what happens” when you are over 40, 50, 65, etc. Or, as a wise woman once told me and I’ve told many people since, “Age is not a disease.” Loss of capacity, physical or cognitive, is not inevitable. Don’t accept it as such. Ever.
Training an athlete with cognitive impairment is a challenge in and of itself. When the impairment includes a memory issue as with Alzheimer's disease, the challenge for the coach increases exponentially. And when it’s your mother, well, here’s my story.
When a person is diagnosed with Alzheimer's, the burden of care often falls on family members. (iStockimage.com/Pablo_K)
Off the Carbs, Off the Couch
In October I traveled from Florida to Ohio. For a month I stayed in the house I grew up in, and I spent nearly every moment with mom.
I learned a lot to say the least. I now understand how scary this disease is and how 13.8 million diagnoses in 2050 will affect billions of loved ones, caregivers and health-care professionals.
I also reaffirmed how good coaching can be adapted to any client in any environment.
I kept things as simple as possible. My goal for mom: Get off the carbs and get off the couch.
I was able to control her nutrition from the moment I arrived. I was with her basically 24/7. We cooked together. We ate together. We went to the grocery together. I definitely felt the grip of karma on those shopping trips as she tried to sneak cookies and chips and ice cream into the cart. I regretted every sugar-induced tantrum I ever threw as a little girl.
These food choices were a product of her rigid thinking. This is how she’s always eaten. She was a housewife of the late 20th century—the high-carb, low-fat age. We had bread and some sort of starch at every meal. Butter was bad. Margarine was healthier. There was always soda and dessert.
With Alzheimer’s, her sugar cravings are much more frequent and urgent than I remember. My prescription? Meat and vegetables. Lots of vegetables.
I threw out the chips, the cookies, the canola oil.
During my time in Ohio—four weeks—mom’s blood glucose fell from diabetic levels into the normal range.
Her workouts needed to be as simple as possible. I concentrated on just four movements: deadlifts, squats, ring rows and push-ups with her hands on the wall. I called none of these movements by its proper name, and I didn’t use traditional equipment. I was limited by what I had on hand but also by mom’s reluctance to “exercise.” Functional and recognizable were the keys. We know these movements have a place in everyday life, and that was how I described them to her. This simple familiarity also helped ensure she’d be able to continue after I returned to Florida.
After all, what is a deadlift? Picking something up off the ground. A squat is sitting down and standing back up. It’s easy to see the practicality of those movements. I didn’t stop there. I was specific about what mom might be picking up off the ground. A bag? A purse? A piece of firewood? Get to know your athletes and how they spend their time, then make these movements meaningful. Even better, pass on a barbell or dumbbells and use the objects they will pick up daily. That will help them connect to the movement and understand why they should learn to do it in the first place.
Just say, “Today we are going to pick up this bucket of rocks and carry it across the yard” or “Today we are going to sit down in this chair and stand up.”
We need to know the correct terms for the movements, and we want most of our athletes to learn them as well, but someone who is battling dementia really has no need for a vocabulary test every time he or she comes to you. Don’t overwhelm these clients with new and unique movements every time, and don’t confuse them with complicated rep schemes.
We use benchmarks in CrossFit to test fitness improvements, and this applies to the cognitively impaired athlete as well. But repetition of benchmarks should be done with these athletes not only to reassure them that they’re gaining fitness but also to increase their comfort level with the activities. Perhaps it’s not quite “constantly varied,” but it’s appropriate “scaling” for an athlete with a cognitive disorder, and you can still program enough variety to improve fitness. Routine is not the enemy for these athletes. In fact, the repetition over days, weeks and months for a cognitively impaired athlete will lead to greater achievement, which will lead to greater confidence. In the end, those are the results we are looking for.
When training people with cognitive disorders, Katzenbach said it's even more important to use functional movements seen in daily life. (iStockphoto.com/Neustockimages)
Couplets and triplets are at the heart of what we do in CrossFit. Nowhere are they more important than when working with an athlete who has trouble following basic instructions. Squats and push-ups. Ring rows and deadlifts. Fast walking. These movements in various combinations are extremely effective. Interestingly enough, CrossFit Kids programming is designed to keep youngsters with short attention spans stimulated and on task, and many Kids techniques can be used when training older people with cognitive disorders. But, whereas a coach can have a relatively high expectation that the kids will remember and progress in the movements from session to session, a coach working with a dementia patient will have to temper those expectations.
Teaching the movements was trying. I relied more on tactile cues than verbal or visual instruction. I quickly realized that I needed to physically move mom into the correct position. Rather than telling her to move her hips back, I gently guided them back. I spotted her during most if not all movements even if I knew she was strong enough. I got creative and tied my tactile cues to a verbal cue that drew on a familiar activity. But I knew the likelihood that she would remember the movement or the cue from session to session was low.
I went into this experience with realistic expectations. At least that’s what I told myself. My goal was to teach mom and my sister who is her primary caregiver some good habits that will help my mother maintain her quality of life and independence for as long as possible. I’ll admit that I held onto a glimmer of hope that a radical change of diet and regular exercise would lead to regained cognition.
There were improvements in her mood and slight improvements in her clarity. I remain hopeful that her new habits will help her feel happier over the time she has left even if it doesn’t increase her life expectancy.
Alzheimer’s disease is a fatal diagnosis, and I will lose my mom to it in one way or another. It could be in the next year or the next 10 years. Minimizing the suffering that comes with this disease might be all a coach can hope for a client.
But when the client is your mom, that’s a big deal.
About the Author: Karen Katzenbach and her husband, Tony Young, operate 30A CrossFit in Santa Rosa Beach, Florida. She has a passion for developing athletes with strong and flexible minds.
Cover image: iStockphoto.com/wildpixel