Mo-Bility: Walking Your Way Into Forces and Motion Linda Pruski MaryAnne Toepperwein Cheryl Blalock Olivia Lemelle National Science Teachers Association March 31 to April 3, 2005

Positively Aging®/M.O.R.E. Choices and Changes Project SEPA & MKITS funding from National Institutes of Health: National Center for Research Resources, National Institute on Aging, National Heart, Lung, & Blood Institute Michael J. Lichtenstein, Principle Investigator Carolyn Marshall, Project Director Linda Pruski, Education Specialist MaryAnne Toepperwein, Education Specialist Cheryl Blalock, Research Associate Yan Liu, Programmer Analyst Olivia Lemelle, Graphics Designer Kathleen Boehme, Administrator Steve Owen, Statistician Kacy Vandewalle, Research Intern Michelle Wang, Teacher Intern

Positively Aging ®/ M.O.R.E. Collaborative Curriculum Development Secondary Teachers UTHSCSA Researchers

To help teachers... prepare and implement research- based curricular materials that explore interdisciplinary opportunities in health science, physiology, and gerontology prepare students to make critical health decisions for extending and enhancing their lives Positively Aging®/ M.O.R.E. Goals

To help teachers... develop sensitivity to the needs and concerns of the aging population foster an enduring interest in health science research and medical careers Positively Aging®/ M.O.R.E. Goals

National Institutes of Health National Center for Research Resources – Science Education Partnership Award National Institute on Aging National Heart Lung and Blood Institute National Institute of Dental and Craniofacial Research

Walking Much of the study of walking has its roots in the early 1800s and in early cinematography Walking was once defined as “a movement of falling forward, arrested by the weight of the body thrown on the limb as it is advanced forward.” Weber brothers, 1836

Walking Benefits Strengthen the heart and lungs Control weight Prevent osteoporosis Increase stamina Improve sleep Strengthen/Loosen joints/connective tissue Tone/Strengthen muscles Relieve stress & improve mood Lower blood pressure, blood lipids

Walking “Prescription” 30 to 45 minutes 3 to 5 times a week –May take months to work up to maximum minutes and days per week Swing arms forcefully Comfortable rate and consistent rhythm –3 to 4 mph; 140 strides/minute Can talk with companion while walking Do not fatigue Can be repeated the next day without pain –Take pulse; mind target heart rate

To Begin Walking Consider personal fitness level and goals Get a good pair of walking shoes Learn to take pulse; determine target heart rate Plan what you are going to do –How far, where, keep a record (time/miles) –Progress at steady pace with specific goal in mind –Gradually introduce wrist/ankle weights, gentle inclines or hills Warm up and cool down! Talk with physician (need medical exam before starting walking program?)

Target Heart Rate The rate at which exercise is the safest yet most beneficial for you Between 70% and 85% of your maximum heart rate

Warm Up – Cool Down Warm Up –5 to 10 minutes Slow walk and simple stretches –Get heart ready for exercise –Limber up muscles, ligaments, tendons Cool Down –5 to 10 minutes Easy, slow, relaxed stroll and stretching –Body adjusts back to resting state

Balance, Mobility, and Gait Why? –Components of walking - an excellent exercise promoting CV fitness –Lower limb function related to health, disability, and mortality –Look for causes of gait change and impaired balance –Determine proneness to falls –Determine specific treatments, exercises, precautions, or interventions to improve gait and balance

Balance, Mobility, and Gait Why? –Lower limb function related to health, disability, and mortality Under reporting of illness – “due to age” –Non-specific presentation of illness – confusion, anorexia, falls Masking by co-morbidity –arthritis may mask angina –back pain may mask kidney disease “Polypharmacology” –too many meds, interactions unclear

Informal Assessment Tools from Everyday Materials? Difficult for seniors to come in for regular assessments –Uncomfortable in exam room Need quiet and adequate furnishings Need adequate TIME to talk with provider –Cost –Mobility –Location –Fearful “White Coat Syndrome”

Informal Assessment Tools from Everyday Materials? Informal geriatric assessments conducted by caregivers, friends, and family facilitate early intervention in elder care and in maintaining a good quality of life –Medication control –Environmental adaptations –Promoting interaction/Reducing isolation –Preventing falls –Comfort & dignity

Falls Among Older Adults Falls are the most common cause of injuries –1 out of 3 adults 65+ fall each year Falls are most common reason for traumatic hospital admissions among older adults –1 in 20 requiring emergency treatment Falls translate into fractures, spinal cord and brain injury

Falls and Fractures About 3% of all falls cause fractures –pelvis –femur –vertebrae –humerus –hand/wrist –forearm –ankle –hip joint

Impact of Hip Fractures Half of all older adults with hip fractures cannot return to normal life or live independently Hip fractures in an aging population will increase over next four decades –By 2040, hip fractures may exceed 500,000 Lead to severe health problems and cause the greatest number of deaths

Falls and Deaths Falls are leading cause of injury deaths among people 65+ years Fall-related deaths are more common among men (particularly white) than women

Where do people fall? For adults 65+ years: –10% occur in health care institutions –30% occur in public places –60% of fatal falls occur at home

What Examine Elderly “You can observe a lot just by watching.” Yogi Berra

Activities of Daily Living Physical (BASIC) ADLs (ex. bathing, dressing, toileting, mobility) Instrumental ADLs (ex. telephone, shopping, food prep, housekeeping, taking medications, transportation, finances) Discretionary ADLs (ex. hobbies, social functions, golf)

Assessing Mobility “Get Up and Go” Test Hands Behind Head Pick up Coin Gait –feet touching each other? –wider base between feet to compensate for balance compromises? Waddle –weakness in muscles need protein, good nutrition, and regular exercise

Balance & Gait Stations “Mobile Marvin” “Gauge Your Gait” “A Well-Turned Ankle” “Could You Please Stand Still?” “Gymnastic Joints”

Locomotion Describe & determine –Stance –Posture –Stride –Pace –Gait –Balance –Strike –Cadence

Station 1 A Well-Turned Ankle See-saws, fee-faws! Walking is just losing and regaining the center of gravity over your feet! Use a homemade balance board test endurance and see how quickly your center of gravity shifts. Role assignments: PT (Timer), Test Subject, Technician (Referee)

Station 2 Could You Please Stand Still?! Feel out of balance? Then use your head – get a bicycle helmet and homemade “stabilometer” to check your sway! Estimate area from a “stabilogrid” to compare changes in balance & sway Role assignments: Measurer, Balancer, Timekeeper, Reader

Station 3: Get Up & Go, Whoopee! How fast can you get up and go from one place/position to another? Use your height and “speed” to examine your muscle response, coordination, and energy output. Role assignments: PT (Timer), Test Subject, Technician (Recorder)

Station 4 Gymnastic Joints ROM on you; not a computer! Use your homemade goniometer (gonia = angle; metron = measure) to assess flexibility of useful joints Stationary Arm – on part that doesn’t move Movable Arm – on part that moves Role assignments: PT, Test Subject, Technician

Station 5 Carry My Books, Please Overdoing? Muscles will punish you with pain if you exceed their limits! Isokinetic strength – force required to keep muscles and bones moving at a steady rate Isometric strength – force required to hold your muscles and bones in one place Role assignments: PT, Test Subject, Technician

Station 6: Gauge Your Gait Tickle your toes with talcum then step out on the “blue carpet” to analyze your gait Apply mathematical formulae to interpret gait information – cadence, stride length, and velocity Possible application of Tenetti Rubric Role assignments: Walker, Reader, Measure Master, Timekeeper

Frailty – Recognize & Label It Markers include –Extreme old age (85+) –Disabilities (Interference w/ ADL’S) –Multiple diseases (2+) –Multiple medications –Geriatric symptoms – dementia, incontinence, hip fractures

Fighting Frailty as You Age Nutrition –Wide variety of plant foods – cereals/grains, vegetable & fruit –Vitamins, minerals, fiber –Healthy snacks & small meals

Fighting Frailty as You Age Physical Activity –Begin gradually; build up –Get going and enjoy doing! –Reduce risk of injury by lifting correctly! –Reduce osteoporosis to reduce risk of fractures –Stronger cardiovascular system

Fighting Frailty as You Age Physical Activity for Mobility Challenged –Sit & be Fit –Tai Chi –Yoga –Physical Therapy –Design of replacement limbs

Fighting Frailty as You Age Vision/Hearing –Use ear plugs around loud noises to avoid damage –Wear protective lenses when in sunlight to avoid damage to eyes –Adaptive devices to compensate for vision or hearing loss

Fighting Frailty as You Age Education across the early years can develop early intervention awareness and skills helping to improve the quality of life throughout the life span The Positively Aging®/M.O.R.E. Curricular Projects

How to Measure Cane Height Research Dr. Margaret Wylde showed that 2/3s of regular cane users risk developing back pain due to incorrect cane height At minimum height, a cane should reach the user's wrist when the arm is hanging to the side The cane can be 2-3" higher than “wrist to floor” measurement and still be correct The cane should usually be held on the side opposite the leg or foot that is injured or weakened A rubber tip is preferable to avoid skidding on waxed or slippery floors