Activities of Daily Living

Activities of Daily Living (ADLs) - Heritage Creek Assisted Living

The activities of daily living, or ADLs, are self-care tasks. These tasks are:

  • Self-feeding
  • Bathing and showering
  • Dressing
  • Functional mobility, or the ability to walk, get in and out of bed, and in and out of a chair
  • Toileting
  • Continence

It goes without saying that we all want to be able to do these tasks as long as possible. It is not true that frailty is an inevitable part of aging. Frailty is the result of inactivity. Exercise is the magic pill that will keep us enjoying the activities of life that are important to us. Certain types of exercise can target ADLs. Your exercise program should include these exercises, especially after age 62 when age related slowing typically begins. But it is never too late to begin! The ADLs have been broken down into the following movement patterns:

  • Push
  • Pull
  • Rotate
  • Bend at the hips
  • Squats
  • Lunges
  • Brace (hold still) and balance
  • Pelvic floor exercises
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Push. We push a grocery cart or a stroller. We push the door shut. We push away from the table when we are finished eating. We push when we use our arms to get up from any position. We push our arms into the sleeves when we get dressed. Exercises that involve pushing include the chest press machine in the gym, dribbling a basketball, and push ups. If the traditional push ups on the floor are too difficult, place your hands on a sturdy bench or couch to perform incline push ups, or try standing push ups against a wall or counter top. In a water fitness class any action where the arm moves against the water in any direction away from the body is a push. A chest press toward the pool floor can be performed in a lunge position using buoyant dumbbells. An incline push up can be performed using a noodle.

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Pull. We pull weeds. We pull a wagon. We pull the car door shut. We pull when we pick something off the floor. We pull laundry out of the washing machine. We pull clothes out of the closet. Exercises that involve pulling include the rowing machine in the gym, biceps curls with weights, and pulling resistance bands. Wrap the band around a banister or sit on the floor with the band around the bottom of your shoes and pull the ends. In a water fitness class any action where the arm moves the water towards the body is a pull. Jogging arms with cupped hands and jumping jacks with the arms moving toward the midline are examples. You can row with drag equipment, such as paddles or Aqualogix bells.

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Rotate. Any throwing or hitting action requires torso and arm rotation. Walking and running involve torso rotation. We rotate to look behind us when we are backing the car out of the parking space, and we rotate to get out of the car. An exercise that involves rotation is to sit in a chair with both hands on one hip and then turn to look over your shoulder. Limit the range of motion if you have osteoporosis. A stretching routine called Controlled Articular Rotations (CARs) uses rotation to improve mobility. To find out more, see Dr. Larissa Armstrong-Kager’s YouTube videos. In a water fitness class you can increase the intensity of a cross-country ski or a high kick by rotating the upper body with the arm swing. Crossing the midline of the body with the arms and crossover kicks involve rotation.

Bend at the Hips. We bend at the hips when we pick something small up off the floor. We bend when we tie our shoes. We bend when we put our pet’s food on the floor. We bend when we towel off after a shower. An exercise that involves bending is a deadlift. With weights in your hands and arms down, bend forward from your hips keeping your back straight and bending your knees slightly; then return to an upright position. We also bend at the hips when doing a hamstring stretch. In a water fitness class we bend at the hips during the up action of a straight leg front kick and during the down action of a straight leg back kick. We also bend from the hips when performing suspended exercises in shallow water, and when performing exercises in the “L” position in deep water.

Squat. We squat every time we sit down in a chair, or on the toilet. The best way to lift something heavy off the floor is to squat and grab the item with both hands and then stand up using the legs. Squats are functional exercises. Stand with your chest lifted and shift your weight to your heels as you lower your hips, as if sitting in a chair. Try not to let your knees go forward past your toes. Then push through your heels to return to standing. Another version of squatting is to sit down in a chair and stand back up again. In water fitness squats do not work the same muscles because the water’s buoyancy makes it easy to return to standing. Standing on an aquatic step so that more of your body is above the water makes the squat more effective. You can work the same muscles with rebounding moves that involving jumping with both feet, such as a tuck jump, a jumping jack and a cross-country ski.

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Lunge. You lunge when you step in any direction, or transfer weight from one leg to the other. Walking and running involves lunging. You lunge when you vacuum the floor. To perform a lunge exercise, take a big step forward with your hands on your hips, and slowly lower your body. Make sure that your front knee does not extend past your toes. If your knees bother you on the lunge, you can lean forward slightly from the waist to reduce the stress on the joints. Press through your heel to bring your front foot back to the starting position. If the lunge is too difficult, take a smaller step forward, or don’t bend your knees as far. You can place one hand on a wall or chair to help you balance. In a water fitness class you work the same muscles by jogging, kicking side to side and doing a rocking horse.

14 Exercises for Seniors to Improve Strength and Balance | Philips Lifeline

Brace (hold still) and Balance. Bracing involves contracting the core muscles to maintain a position. It is important in maintaining balance. The ability to balance greatly reduces the risk of falling. For exercises to improve balance, see my previous Blog post Balance Training at Home. Many of these same exercises can be performed in the pool as well. Another pool balance exercise is the Yoga plank while holding a noodle in the hands under the shoulders.

Pelvic floor exercises. Incontinence is often a problem as we age and the solution is pelvic floor exercise. These used to be called Kegels, but research has changed the way the exercises are done. Keep your shoulders relaxed and breathe normally as you smoothly raise your pelvic floor. Hold for 10 seconds then relax for 30 seconds before performing the next pelvic floor exercise; repeat up to 10 times. Or do 10 quick pelvic floor exercises in succession. For a more detailed description of pelvic floor exercise, see my Blog post Keep Your Inner Core Strong. Pelvic floor exercises can be done in a water fitness class as well as at home.

There is a Functional Core Strength lesson plan and a Balance lesson plan for shallow water as well as a Functional Core Strength lesson plan and a Balance lesson plan for deep water in my book Water Fitness Progressions. The lesson plans demonstrate options for teaching a class focusing on maintaining the ability to perform ADLs. To order the book, click on the link. Many pools are getting ready to reopen following closures because of COVID-19. I hope to see you in the pool soon!

Chris Alexander

Chris Alexander

COVID-19 and Swimming Pools

Expert: Swimming pool facilities water unlikely to spread ...

Many states have loosened social distancing restrictions in order to get the economy going again. Now, however, we are seeing a rise in Corona virus cases. We would all like to know what to expect with this pandemic, but there is no way to know for sure how it will play out. My doctor’s practice, USMD Health System, has suggested three possible scenarios:

Scenario One — Begins with an initial wave in Spring 2020 followed by a series of smaller waves of infection that last up to two years.
Scenario Two — Begins in Spring 2020 and is followed by a second, larger wave this fall or winter and a smaller one in 2021. If this happens, communities will likely return to quarantines.
Scenario Three — Begins in Spring 2020 and is followed by what the Center for Infectious Disease Research And Policy (CIDRAP) describes as a “slow burn.” That means there’s no clear pattern. This scenario would likely not cause communities to return to quarantines, but infections and deaths would continue.

No matter the scenario, CIDRAP says we should prepare for another 18-24 months of COVID-19. That means we should continue to practice social distancing, wear face masks in public, and wash our hands often.

Our swimming pools have reopened. Lap swimming, swim lessons and water fitness classes are resuming. What should we know about the safety of returning to the pool and what kind of cautious response should we make? Sara Kooperman (the owner of SCW Mania Fitness conventions) and John Spannuth (the president of the US Water Fitness Association) have both asserted that chlorine used to disinfect pool water kills COVID-19. Craig Lord, the Swimming World Editor-in-Chief, agrees that disinfectants, including chlorine, act on viruses and it is reasonable to expect that would include COVID-19. He adds that pool operators also need to observe strict hygiene protocols, including correct maintenance of pool water and air in the facility, as well as heightened levels of cleaning of adjacent surfaces and environments, since the fundamental mode of transmission of COVID-19 is air and not water.

It is likely that if your favorite pool is reopening, the pool operator is aware of the necessary protocols and has trained the staff properly. Those of us who will be using the pool to teach or participate in a water fitness class also need to do our part. Yes Fitness Music has made the following suggestions:

  1. Outdoor pools are safer because air circulation outdoors is better than indoor air circulation.
  2. Our Texas sun and heat often makes an indoor pool preferable. Ask about the air ventilation. Fresh air is better. If the air is recycled, it should go through a filtration system.
  3. Wear a mask.
  4. Maintain social distancing, 6 feet away from the other swimmers or class participants.
  5. Wash your clothing, towels and masks directly after class.

We can all do our part to protect ourselves and those around us. Enjoy the pool safely!

Chris Alexander

How to Deal with Disruptive Class Participants

This is an article written by Angie Miller and well worth reading:

We’ve all been there. We’ve come to class prepared and eager to lead, only to discover that there’s that one person- the one who won’t stop talking to the people around them, who answers their cell during class, who takes our yoga, step, or strength training class, but does his/her own workout, or the one who wears headphones during cycle class and rides as if no one else is in the room. Unfortunately, there are a multitude of ways that members can be disruptive, some unknowingly, and some seemingly for attention, but either way, disruptive members disrupt the flow of the class. They compromise safety, hijack our concentration, suck up positive energy, and ironically, they often stand right in the front row ensuring that we couldn’t ignore them if we tried.

So, what do we do? Everyone has their own ideas on what works, based on their comfort zone and the members they teach. Some clubs even have policies to address disruptive members. After decades of teaching I feel like I’ve seen it all (though I know I haven’t), and here are a few things I’ve personally implemented, to manage a member who is disruptive.

  1. Ignore them. I know, I just said that they’re nearly impossible to ignore, but I try this as my first line of defense. If it is attention seeking behavior, as opposed to total oblivion, then I don’t want to reward negative behavior with attention. That’s the educator in me. If that doesn’t work, move on to number two.
  2. Make eye contact. If at all possible, try to make eye contact with them. Not in a confrontational manner, with a smile on your face and a professional demeanor. Eye contact can be a gentle reminder that you’re watching, and you’re reminding them to stay engaged. Ideally, we’re making eye contact with everyone in the room at least once throughout the workout, so this shouldn’t seem unusual. If that doesn’t work, move on to number three.
  3. Address the class as a whole. The key is to not target anyone individually, especially on a live mic. We’re better served to address the class as a whole and remind them: “We don’t have breath for conversation, we’re using our energy for the workout.” “Lets not chat, lets challenge each other to go the extra mile.” You’re addressing everyone in a professional, non-confrontational manner, hoping the culprit of the crime gets the message. If that doesn’t work, move on to number four.
  4. Proximity is key. Often all that’s needed is for us to move about the room as we always do, checking form and alignment, then proximally stand close to where they are and teach from there (only in the moment, not the whole class of course). Proximity is all about presence, which promotes accountability, and it’s a great way to motivate. When we move about the room, most members will step up their game. If that doesn’t work, move on to number five.
  5. Speak to them after class. Mic off, gently, with a professional tone we can ask, “Do you have a minute?” That’s when we say, “I noticed that you seem distracted and I’m wondering how you’re enjoying the workout?” From there, we can guide the conversation to behaviors that promote quality exercise and we can offer guidance on appropriate group fitness etiquette.

One Final Note: One of the best ways to ensure healthy group fitness etiquette is to talk about it at the beginning of class, during our introduction. It’s when I get ahead of any behaviors I’ve witnessed in the past, and I address them before they have potential to compromise my class. It’s when I remind all members: Safety is key, and that means we want to be considerate to those around us: Cell phones off. Save conversations for after class. We’re here to build energy, be engaged, and make the most of every moment.

Keep doing what you love and loving what you do.

About Angie:

Angie Miller, M.S., is a health and fitness educator, speaker, and licensed counselor. She teaches at Northern Illinois University in the Department of Kinesiology and Physical Education and presents at mental health and fitness conferences worldwide. Angie owns her own fitness company, Angie Miller Fitness, and she is a Master Instructor for NASM, AFAA, and Kettlebell Concepts. She writes for fitness journals and digital communities and publishes a weekly blog where she covers fitness and lifestyle topics. You can learn more about Angie on her website,

Thanks, Angie! See you in the pool!

Chris Alexander

Holiday Ideas for Your Class


There is a lot to do during the holiday season: shopping, wrapping presents, decorating, baking, holiday parties and more. You know your water fitness class participants need to maintain their exercise routine to help them manage the holiday stress, but sometimes exercise moves near the bottom of their priority list. Try some of the following ideas to make your water fitness class more festive and encourage everyone to keep coming:

Holiday Music. Break out some holiday music to get everyone in a festive mood. All the fitness music companies have Christmas music playlists for sale. Check out:

(1) Super Happy Xmas Step (128-130 BPM) and Xmas Buzz (135 BPM) at Yes Fitness Music

(2) Tis The Season – Best of Christmas Hits Remixed (130 BPM) and Christmas Hits Remixed (135 BPM) at Power Music

(3) Core Christmas Volume 2 (128 BPM) and Christmas in Motion 3 (135 BPM) at Muscle Mixes

Holiday Themed Games and Activities. Add fun activities at the end of your fitness routine to have everyone laughing and looking forward to the next class. Here are two ideas:

(1) Holiday Obstacle Course – Create an obstacle course with the pool equipment you have on hand, giving it a holiday theme. Station One: Have a participant begin by cross-country skiing to the North Pole, using either drag equipment or foam dumbbells. Station Two: Tie 3 noodles in a triangle to serve as a Christmas tree and have a bucket of small balls nearby. The participant throws the balls into the triangle to “decorate the tree.” Station Three: The participant picks up a paddle or a foam dumbbell and uses it to “stir up the Christmas cookie dough.” Station Four: The participant runs to 3 “elves” who are holding 3 balls. The participant helps in the toy shop by tossing the balls a set number of times back and forth to each elf. Station Five: The participant picks up 2 noodles and puts the ends of each noodle under an arm with the opposite ends sticking out in back. “Santa grabs the free ends and takes a seated position. The participant now takes the place of Rudolph the Red-Nosed Reindeer and pulls Santa’s sleigh to the finish line. If your class is large, half of the participants can man the stations while the other half runs through the obstacle course; then the two groups
change places. If your class is small, have all your participants (but one) man the stations while the “contestant” runs the course. Then that person will take the place of another participant who will take a turn running the course.

(2) Sleigh Races – Have your class members partner up. One partner can be Rudolph and the other Santa. Rudolph then pulls the sleigh as in the obstacle course above, racing with all the other sleighs in the class. After one team wins the race, Rudolph will take a turn being Santa, and Santa will become Rudolph, and the teams race again.

Costumes. This is the perfect time to wear your red swim suit, a Santa hat, a Frosty the Snowman top hat, a red nose or a hat with reindeer antlers.

Holiday Gifts. Show your appreciation for your class by giving them each a small gift. If you are an H20 Wear AquaPRO, you can get coupons for your participants worth 10% off their first purchase of a swim suit. Contact them at to request coupons or to become an AquaPRO member. Some other gift ideas include a Clementine tangerine, a tree ornament, a peppermint candy cane, a Christmas cookie, a package of hot cocoa mix or some kind of homemade goodie. Here is an easy recipe if you would like to make your own treats:

Peppermint Crunch Puppy Chow

Ingredients: 5 cups Rice Chex, 10 ounces melting white chocolate, 1 cup crushed candy canes, 1 cup confectioners’ sugar

Pour the cereal into a large bowl. Melt white chocolate according to the package directions. Pour melted chocolate over cereal, stirring and folding until the cereal is completely covered. Fold in crushed candy canes.

Pour the confectioners’ sugar into a zipped-top bag. Pour the cereal mix in next. Seal the bag and shake until all the cereal is coated with the confectioners’ sugar. Discard excess powdered sugar.

Divide the puppy chow into individual bags and tie with a ribbon.

Merry Christmas!


Chris Alexander

Buoyant Equipment: Dumbbells

markgrevelding_mug   Foam dumbbells

Nearly every pool has foam dumbbells and participants love to use them! In some places they use dumbbells for every class. Often they grab the largest dumbbells available. Is this a good thing?

The Metroplex Association of Aquatic Professionals hosted Mark Grevelding at a Continuing Education Training on April 21. One of his workshops was a Noodle & Buoy Circuit.  Mark discussed exercise safety with dumbbells. He says that the main thing people do with dumbbells is push them forward and plunge them down.

Every time you submerge foam dumbbells under water, your shoulder stabilizers contract. When you push dumbbells forward you are using them like drag equipment. Your latissimus dorsi and lower trapezius contract isometrically to hold the dumbbells under the water. You get some work for the targeted muscle groups (chest and triceps), but these are not the muscle groups that get most of the work. Plunging the dumbbells down uses the shoulder stabilizers and works the triceps. It is easy to see that too much of this will put undue stress on the shoulders, which can lead to a shoulder injury.

Not only do some people use the dumbbells for every workout, but they also select the largest dumbbells available. They may not be able to keep the shoulders neutral with equipment this buoyant, so the shoulders are elevated. They may not be able to control the dumbbells without throwing their body weight into the exercise. They may have to reduce the range of motion as a result of this loss of control. It is easy to see that too much of this will put undue stress on the shoulders, which can lead to a shoulder injury.

So what are foam dumbbells good for? Well, I’d love to show you some pictures of exercises with the dumbbells, but when I Googled pictures of water exercises with foam dumbbells, all they had were pictures of pushing them forward and plunging them down! So you’ll have to use your imagination. Choose a size that you can manipulate while keeping the shoulders relaxed and the spine in neutral alignment. Relax your shoulders and fingers between each set. Use the dumbbells for only part of a class.

  1. Chest. In a lunge position, lean forward 45 degrees and perform a chest fly, like clapping your hands, or a chest press, pushing at an angle toward the floor.
  2. Lats. In an upright lunge position, perform a lat pull-down, like jumping jacks arms.
  3. Triceps. In a squat or lunge position, with elbows by the waist, perform a triceps extension. Or plunge the dumbbells down at the sides.
  4. Squats and lunges. Hold the dumbbells down at your sides while you perform these exercises to add resistance as you lower the body toward the floor.
  5. Calf raises. Hold the dumbbells down at your sides while you rise up on your toes to add resistance as you lower your heels back to the floor.
  6. Plank and side plank. Hold both dumbbells directly under the shoulders for the plank and one dumbbell directly under the shoulder for a side plank.

There are a lot of muscle groups missing from this list, like the upper back, shoulders and biceps. That’s because foam dumbbells only add resistance when you are pushing them toward the pool floor. The buoyant dumbbells want to float to the surface of the water, which means there is no resistance for any exercise that involves lifting them. Another thing missing from this list is using the buoyant dumbbells for support in a suspended position. When the body is suspended from dumbbells held in the hands or placed under the arms, the shoulders are unacceptably loaded, the tendons are pinched, and nerve damage may occur in the arm pits (Ivens and Holder, Do No Harm, 2011).

The bottom line is that foam dumbbells are a lot of fun and they offer some good resistance for a limited number of exercises. For more information on using dumbbells, including a chart showing which muscles are being trained with various exercises using buoyant equipment, see my new book Water Fitness Progressions. The book also contains lesson plans using dumbbells for both shallow water and deep water classes. The book can be ordered from Human Kinetics (the publisher) or from Just click on whichever source you wish to order from and the link will take you there.

Mark Grevelding wrote about my book in his Blog. Check out his post at

See you in the pool!


Chris Alexander