1. Health benefits of walking Decreases immobility which can cause: Gravitational oedema Leg ulcers Skin ulcers Constipation Joint stiffness Muscular wastage DVT

2. OEP Walking Health benefits of walking Increases mobility which can help improve: Increases mobility which can help improve: –Circulation –Local muscle endurance –Range of movement –Balance, gait rhythm –Social interaction –Awareness of others and surroundings

3. OEP Walking There are different ways of walking! Health walking Health walking Fitness walking Fitness walking Assisted walking Assisted walking Speed/race walking Speed/race walking Orienteering Orienteering Rambling Rambling Pole walking Pole walking

4. OEP Walking OEP walking plan Advise the person to include walking to help increase physical capacity Advise the person to include walking to help increase physical capacity Note that walking on its own will not result in a reduction in falls Note that walking on its own will not result in a reduction in falls Aim for 30 minutes at usual pace (not “briskly”) at least twice a week Aim for 30 minutes at usual pace (not “briskly”) at least twice a week Can be broken up into shorter sessions e.g. three 10-minute walks Can be broken up into shorter sessions e.g. three 10-minute walks Suggest strategies e.g. off bus 1 block early Suggest strategies e.g. off bus 1 block early Usual walking aid Usual walking aid

5. OEP Walking Short & long term goals S pecific S pecific M easurable M easurable A greed A greed R ealistic R ealistic T ime-framed T ime-framed

6. OEP Walking Normal patterns of gait Stance phase Stance phase –Initial contact (heel strike) –Load response (foot flat) –Mid stance –Terminal stance (heel off) –Pre-swing (toe off) Swing phase Swing phase –Initial –Mid –Terminal

7. OEP Walking Muscle analysis What muscle groups are involved? What muscle groups are involved?

8. OEP Walking Altered gait examples Painful hip Painful hip Trendelenburg gait Trendelenburg gait Foot ‘catching’ Foot ‘catching’

9. OEP Walking Frail older people Stride length short Stride length short Stooped posture Stooped posture Rigid trunk (no rotation) Rigid trunk (no rotation) Increased base of support Increased base of support Increased lateral sway Increased lateral sway SOLUTIONS? SOLUTIONS?

10. OEP Walking Walking technique Upright posture Upright posture Heel toe foot-strike Heel toe foot-strike Natural stride length Natural stride length Foot placement – foot turnout approx 10° from midline Foot placement – foot turnout approx 10° from midline Spine rotation Spine rotation Arm swing in opposition to the legs Arm swing in opposition to the legs

11. OEP Walking Progression Start with 5-10 minute activity snacks Start with 5-10 minute activity snacks Build up time Build up time Increase pace by striding out Increase pace by striding out Swing arms through a bigger range Swing arms through a bigger range

12. OEP Walking Walking – safety check list Environmental factors Environmental factors Appropriate clothing Appropriate clothing Psychological safety Psychological safety Emergency action plan Emergency action plan

13. OEP Walking Assisted walking Gentle to low moderate walking pace on even ground with frequent opportunities to rest, refresh, take in the surroundings Gentle to low moderate walking pace on even ground with frequent opportunities to rest, refresh, take in the surroundings Appropriate for deconditioned individuals and those with additional health problems Appropriate for deconditioned individuals and those with additional health problems With frail older people assisted walking can be a good way to begin With frail older people assisted walking can be a good way to begin

14. OEP Walking Progression Independent walking Supervised walking Assisted walking

15. OEP Walking Progressive techniques for assisted walking One arm link One arm link One arm placement One arm placement One elbow support One elbow support One hand to back One hand to back Independent walking in close proximity Independent walking in close proximity Independent walking with supervision Independent walking with supervision Five point turns Five point turns Progression, support and negotiation are required to achieve success Progression, support and negotiation are required to achieve success

16. OEP Walking Assisted walking strategies Explore opportunities Explore opportunities –Times of day e.g. mealtimes –Linked to specific events and activities –Specific opportunities e.g. corridors, wards and gardens –Specific programmes e.g. walk the block, walk from Lands End to John O’Groats, Walk the Great Wall of China