Mobility and Activity Exercise for Health Promotion PDF

MOBILITY AND ACTIVITY EXERCISE FOR HEALTH PROMOTION Prepared By: ARNELLE L. BALINAO, MAN INSTRUCTOR LEARNING OBJECTIVES: Discuss principles and techniques for activity and exercise in older person Apply skills in health promotion on the area of activity and exercise WHY T...

MOBILITY AND ACTIVITY EXERCISE FOR HEALTH PROMOTION Prepared By: ARNELLE L. BALINAO, MAN INSTRUCTOR LEARNING OBJECTIVES: Discuss principles and techniques for activity and exercise in older person Apply skills in health promotion on the area of activity and exercise WHY THE ELDERLY? 1. Chronological age is a poor indicator of physical and cognitive function 2. Wide range o rehabilitation services for varying needs of the aged Immobilization due to: Environment Cognitive impairments Acute illnesses Chronic illnesses Affective Physical Activity Guidelines for older adults (2010) - Physical inactivity contributes to chronic diseases - Increased Physical activity reduces disease and disability Goals: Prevention Combating, minimizing accumulative disabling effects of physical illness associated with the aging process Hastening convalescence Reducing institutionalization Education of the patients and caregivers Contributing to comfort and well – being of Patients Assist the patient to return to optimal living within their capabilities Why physical activity and Exercise? Each year an estimated 646,000 individuals die from falls glbally of which over 80% are in low- and middle income countries (WHO 2017)  Physical inactivity (lack of physical activity) has been identified as the 4th leading risk factor for global mortality( 6% of deaths globally (WHO 2017) Approach to the elderly Patient with Gait Disturbance (2012) Accident injuries are the 5th most common cause of death in the US accounting to 118,000 deaths in 2009 Falls account for two- thirds of the deaths attributed to accident injury While only about 13% of the population is 65 or older , ¾’s of the fatal falls in the US with this age group Frequent 911 calls in older adults: Opportunity for injury prevention Over 10-year period, 37,324 EMS call data were recorded 11% (N=4,8084) identified as related calls that occurred for individuals aged 60 and older  15% (N=107) of repeat callers called 5 or more times for falls and these individuals were transported to the hospital. Only 21% of the time (versus 75% of the first time callers)  29%(N=685) of individuals who called for a fall at least one or more time within the study period. Time between calls substantially decreased the more frequently an individual called PHYSICAL ACTIVITY AND EXERCISE: Seven systematic reviews concluded that physical activity intervention programs provide benefits for reducing falls in older people.  14th of seventeen articles on PA and the elderly concluded that PA is beneficial for physical functioning aspects including mobility, physical activity, strength , flexibility and balance in older people.  Physical activity defined Any bodily movement produced by skeletal muscles that requires energy expenditure – however, it should be planned, structured, repetitive and intentional movement to improve or maintain physical fitness. Forms of Physical Activity: Leisure Transportation Occupational Work Household chores Sports 1. Incidental activities – or Activities of daily living  Carried out as part of usual of daily living They help older people to stay mobile; can help protect against and manage certain health conditions and can help to maintain independence  What is incidental exercise? Taking the stairs instead of the lift/escalator. Walking to the shops/bus stop/train station. Choosing to park the car further away. Playing with mates/your kids at a park. Short bursts of gardening. Cleaning around the house. Standing up and moving around the office whilst at work. Occupational activities: Activities that are part of work They can help prevent health conditions and enhanced general health Here are examples of the tasks and skills OTs might focus on: Self-care routines like getting dressed (fine motor skills and motor planning) Writing and copying notes (fine motor skills, hand-eye coordination) Holding and controlling a pencil, using scissors (fine motor skills, motor planning) Recreational Activities: Important for maintaining social and physical independence  Includes walking, sports and dancing Transportation PA by using a mode of transport from one destination to another.  It includes walking to places and cycling Structured Activities Five of the best senior social activities that can help older people stay physically, mentally and emotionally healthy. 1. Walking. One of the most beneficial senior social activities is walking with friends.... 2. Exercise Classes 3. Swimming and Water Aerobics Classes. 4. Dancing.... 5. Board Games.  Are organized by club or individual, such as group exercise activities, taichi, aqua aerobics and competitive sports  Supervised Activities May occur as part of rehabilitation program by a trained health practitioner following injury or surgery, or as a training program to manage long-term condition Supervised training programs such can help older people have fewer falls Categories of PA Aerobic endurance activities Resistance activities Flexibility Activities Balance activities Benefits O Physical Activity for Adults Exhibit higher levels of functional health, a lower risk of falling, having reduced risk od moderate and severe functional limitation and role limitations Have lower rates of all cause mortality and other diseases  A higher level of cardiorespiratory and muscular fitness, healthier body mass and composition  Physical Activities - is excellent for increasing social interaction which is particularly important for older people. Cognitive benefits of PA There is an evidence that mental well being can be improved by undertaking 60 minutes of PA per day, and that a lower level of good quality PA can still have positive effects onmental health (Ministry of Health 2012) Consequences of Physical Activity Older physically inactive people particularly those aged over 85 years, are at an increased risk of fall Sedentary behaviour or physical inactivity in older people an contribute to obesity Risks of Physical Activity for older adults PA may aggravate some pre- existing conditions and injuries (Mazzeo and Tanaka 2001) Older people are at an increased risk of injury when they are physically active outside the home  Dimensions of Physical Activity How do we classify Activity: The physically inactive group reported doing less than 30 minutes of PA per week. The partially active group reported doing some PA per week but less than 30 minutes of moderate to vigoruous- intensity activity on most days of the week  The physically active group reported doing a minimum of 30 minutes of moderate to vigorous intensity physical activity on most days of the week. Considerations in exercise Education, cost, environment, time, physical and medical limitations Lack of motivation or interest, psychological factors including fears of falling  Lack of cultural appropriateness - Sensitivity to other cultures the awareness of how other ethnic, racial, and/or linguistic groups differ from one's own.  Safety in performing exercise - use of protective equipment -Warm up and cool down Doing a variety of activities Resuming activity after an illness or injury Flexibility  Choose appropriate types and amounts of activity Increase physical activity gradually over time Age Level of fitness Prior experience General Assessment Timed up and Go test Assesses mobility, balance, walking ability, and fall risk in older adults  How to do: The patient should walk to a line that is 3 meters (9.8 feet) away, turn around at the line, walk back to the chair, and sit down. The test ends when the patient's buttocks touch the seat. Patients should be instructed to use a comfortable and safe walking speed. Age group Average Time 60-69 years 8.1 (7.1-9.0) 70-79 years 9.2 (8.2-10.2) 80-89 yeas 11.3- (10.0-12.7) The 30 second Chair Stand Test Measurement to assess functional lower extremity strength in older adults To test the leg strength and endurance  The 30-second chair stand involves recording the number of stands a person can complete in 30 seconds rather then the amount of time it takes to complete a pre-determined number of repetitions  Count the number of times the patient comes to a full standing position in 30 seconds and record it in the box below. If the patient is over halfway to a standing position when 30 seconds have elapsed, count it as a stand.  Step Test The step test measures dynamic balance an activity requiring weight shift and movement while in a single leg stance Step Test results correlate well with lower limb, muscle strength, walking speed, lwer limb motor coordination, and balance. (Hong et al 2012)  The 2 minute step test indicates the level of aerobic endurance of the participant. It is associated with the ability to perform lifestyle tasks such as walking and climbing stairs. This is an alternative test if there is not sufficient space to conduct the 6 minute walk test.  The 2-Minute Step in Place test is part of the Senior Fitness Test Protocol, and is designed to test the functional fitness of seniors. This test is performed as an alternative to the 6- minute walk test for people who use orthopedic devices when walking, as well as in the case of people who have difficulty balancing. Fear of falls The activities- specific Balance Confidence(ABC) scale -a self-report measure of balance confidence in performing various activities without losing balance or experiencing a sense of unsteadiness.  The modified Survey of Activities and Fear of Falling (SAFFE) scale  Falls Efficacy Scale International (FESI-I) General Interventions: Patient and Family Education (safety education) Awareness on risk of falling Allow plenty of time for functional activities Caregivers can remind the person the need for added precaution Environmental Modification: Stairs To and from the bathroom In the bedroom Carpets/ surface  Obstacles Lighting at night Adaptive equipment (, tub seats, showerhead, bedside commode- urinary urgency, evening fatigue, disorientation in the night)  Fear of falling Intervention by other health professionals (e.g nurses, psychiatrist or psychologist) may be required  Aerobic. Strength and balance interventions Evidence from 3 systematic reviews of older people found mixed activity programs with gait, balance, coordination, resistance and other physical activity components have positive outcomes for balance and physical functioning. (howe et al 2007: Orr et al 2008, Forster et al 2010)  WHO Recommendations Adults should do: At least 150 minutes of moderate – intensity aerobic physical activity throughout the week At least 75 minutes of vigorous – intensity aerobic physical activity throughout thr week An equivalent combination of moderate – and vigorous- intensity activity  For added Health Benefit: Older adults should increased their moderate- intensity aerobic physical activity to 300 minutes per week Engage in 150 minutes of vigorous – intensity aerobic physical activity per week An equivalent combination of moderate- intensity activity  Muscle- strengthening activities, involving major muscle groups, should be done on 2 or more days a week.  For older adults with poor mobility: Should perform physical activity to enhance balance and prevent falls on 3 or more days per week  When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be a physically active as their abilities and conditions allow.  Aerobic activity How do you know if you’re doing a moderate vigorous aerobic activity On a 10 point scale, where sitting is 0 and working as hard as you can is 10, moderate – intensity aerobic activity is a 5 or 6 Vigorous – intensity activity is 7 or 8 on this scale  Aerobic activity - Effectiveness of a combined exercise training an compared home- based walking program on physical activity compared with standard medical care in Moderate COPD; a randomised controlled trial  Strengthening Activity - impaired strength is a strong predictor of falls in most studies and may also increased the risk of injury from a fall Mostly isometric exercises - impact of a motivational resistance – training program on adherence and body composition in the elderly  Isometric exercises are contractions of a particular muscle or group of muscles. During isometric exercises, the muscle doesn't noticeably change length and the affected joint doesn't move. Isometric exercises help maintain strength. They can also build strength, but not effectively.  Motivational resistance- training program in the elderly gave rise to positive significant changes at the physical, psychological and social levels Examples of Aerobic and Strengthening Activity Walking Dancing Swimming Water aerobics Jogging  Aerobic exercise classes Bicycle riding(stationary) Some activities like gardening, raking and pushing a lawn mower Tennis Golf without a cart - Identify moderate and vigorous activities  Balance Activities Examples: Backward walking, sideways walking, heel walking, toe walking and standing from a position  Reduction of falls is seen for participants in program that include balance and moderate- intensity muscle training activities for 90 minutes a week plus moderate – intensity walking for about 1 hour.  1. Stand up and look ahead 2. slowly turn your head as far as you can to the right- vice versa 3. Repeat 5 times each side Stand up tall beside a table Stand up and facing a table ahead Hold on to the table and look ahead Your head should be shoulder width apart Come up into your toes Then lower your heels to the ground. Repeat the exercise 10 times  Stand up from the chair and stay behind the chair Holding on to the chair with one hand Other hand will Grab ankle and lift. Muscle stretching Seated on a chair with cross hands on your shoulder Slowly Slide your butt at the center of your seat to the edge of the chair Stand with raised arms then back to your seat  Modified Tai chi Focuses on improving lower limb strength and balance  The effectiveness of functional task exercise and physical therapy as prevention of functional decline in community dwelling older people with complex health problems (2018) An exercise intervention may slow down decline in self reported daily functioning in older persons with daily activity limitations  Effects of a task- specific Exercise program on balance and mobility and muscle strength in elderly - The task- specific program has a positive effect on balance ability and muscle strength related to falls in elderly  FREQUENCY AND TIME Aerobic physical activity should be spread throughout the week Episodes of aerobic performed at least 10 minutes at a vigorous intensity should be divided throughout the week If Older person is on medication - Tell them to observe proper biomechanics - Lift with your muscles of the lower extremities not with your back. - Make sure that object being carried is close to you - Before lifting make sure to count off - Avoid holding your breath when lifting (valsalva Maneuver) - Use momentum to your advantage (Start where you are, use what you can and do what you can.) - Always ask for assistance if needed  What to keep in mind Assist patient, family, caregivers to maximize the individual’s functional abilities and slow physical declines Change and simplify environment to maintain function Assist caregivers in providing functional meaningful, pleasant , safe activities  Being physically active among the elderly can be simple as walking, dancing, performing ADL’s. gardening, sports or calisthenics Fall prevention is a priority in management