1. 1 1 EFFECTIVE EXERCISE FOR SENIORS Ming Leung, Physiotherapist Regional Coordinator, Seniors Falls and Injury Prevention Fraser Health Authority Debbie Cheong Provincial Coordinator, BC Women’s Hospital & Health Centre Do not duplicate these slides without the permission of the presenters.

2. 2 Current Practice Give us feedback on your exercise class  What are the principles in conducting your exercise class?  Warm up?  Strength?  Stretches?  Agility?  What are your exercises targeting? – just exercising  What are precautions?

3. 3 Current Practice What we have seen:  Sequence – Head to toe  General range without focus on movement required in activities of daily living  Mixture of warm up, range and strength

4. 4 Objectives for physical activity programs  Safe, effective, simple  Fall prevention  Improve posture and strength  Progressive  Maintain mobility and independence  Improve quality of life  Adherence

5. 5 GOALS Improve participant’s functional ability, quality of life, and reduce the risk of falls Increase independence, confidence and dignity

6. 6 FRASER HEALTH INITIATIVE  Appropriate program to meet the objectives and goals  Program that can change the practice of delivering exercises  Program that is sustainable

7. 7 What is OSTEOFIT? Evidence-based Exercise intervention program designed for people with osteoporosis who are at high risk for falls and fractures Developed by BC Women’s Osteoporosis Program

8. 8 Carter et al. (2002). Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. CMAJ; 167 (9). OSTEOFIT Works! -4 -2 0 2 4 6 8 10 12 Control Intervention +5% +13% Dynamic Static Knee balance balance extension

9. 9 OSTEOFIT Safe, gentle, effective Not a regular aerobic program Unique Low impact Warm up, agility, resistance, stretching FUN!

10. 10 PRIORITIES IN OSTEOFIT Posture Strength Balance, coordination and agility Activities of daily function Fall prevention Improve confidence Mental stimulation Progressive

11. 11 TYPICAL POSTURE OF OLDER PERSON Lower trapezius Neck flexors Forward head Middle and lower trapezius External shoulder rotators Rounded upper back Deltoid External shoulder rotators Limited shoulder range Triceps Forearm and Finger extensors Poor elbow and finger extension Spine muscles Flat low back Abductors Extensors (butt muscles) Limited Hip range Quadriceps Poor knee extensors Feet muscles Limited ankle range

12. 12 EXERCISES TO IMPROVE POSTURE Sit tall, chest lifted Create more double chins (gently!) Forward head Sit tall and Big Breath in Open arms with thumbs up Rounded upper back Raise arms singly to front, side External shoulder rotators Limited shoulder range Full straightening of the arm and fingers Poor elbow and finger extension Sit tall Just imagine creating a gap at lumbar spine Flat low back Challenging to do seated! Side sitting knee drop may be safe for some. Limited Hip range Sit tall and extend knee fully Poor knee extensors Ankle ROM; seated or standing if safe to do. Toe actions really help also. Limited ankle range

13. 13 EXERCISES TO IMPROVE FUNCTION Medial deltoids, strengthen shoulders Lift and Carry Mobility of the shoulder Triceps, straighten arm. Reach and Retrieve Hip flexor strength, core strength Quadriceps, glutes, hamstrings, ankles Step Up and Over Quads, glutes, hamstrings, core Sit to Stand Hip mobility, lower body strength, balance Ankle flexibility, agility, movement of toes Walking Joint ROM Maintain flexibility. Personal care

14. 14 EXERCISES FOR FALL PREVENTION All muscles of lower body especially the hip abductors, quads, glutes, gastrocs Lower body strength All muscles of the trunk Core Weight shifting Quadriceps, glutes, hamstrings, ankles Balance Quads, glutes, hamstrings, core Joint mobility Joint mobility, directional changes Upper and Lower body strength, coordination Agility Quickness of movement in the upper arm, flexibility Speed and Reaction

15. 15 GENERAL GUIDELINES Start with small range of movement 4 to 6 repetition Take joints through all planes of movement Alternate upper and lower muscle groups All strength exercises will be alternated Initial exercises are un-resisted, low repetition, target primarily range and posture

16. 16 APPLICATION OF RESISTANCE  Is exercise equipment (handheld weights and resistance bands) being applied effectively and safely?  Do you understand the principles of strength training and loading of muscles?

17. 17 MODIFICATIONS & PROGRESSIONS  Are modifications being made for those with chronic conditions?  Is warm up effective and includes all joints in full range of motion in all planes of movement?  Do the exercises result in improved strength, function and ability?  Is there monitoring of progressions?  Has there been a decrease in falls?

18. 18 SUMMARY  Improve knowledge and skill of the Activity Coordinator in application of safe and effective physical activity.  Objectives include increasing strength, improve functional ability, thereby maintaining independence of the residents.  Reduction in falls and injury  Mentally stimulate  Improve quality of life