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PAX e presentation
Transcript of PAX e presentation
Community-dwelling elderly 60-75 years old
Able to ambulate 20m nil aid independently
Approval or referral from GP/PT (nil safety concerns)
Successfully passed the pre-class screening tool
days per week
Borg RPE 12-30 moderate to somewhat hard intensity (Nelson et al., 2007)
7min warm up, 30min exercises, 8 min cool down
alance, Neuromotor, Cardiorespiratory, Resistance & Strengthening, Flexibility
3 mins of marching, 9 laps of walking, 12 reps x 2 sets strength training, 30s hold for stretching, 3 min for dynamic balance exercises, 5 repeated sequences for neuromotor and coordination practice
increase speed/reps/resistance/depth of movement, BOS and addition of upper limb (dual task) movements for balance
Falls prevention for community-dwelling elderly
Elderly Falls Prevention Exercise Group
Improve reaction times
Reduce unplanned hospitalization
Improve quality of life
Reduce fear of falling
Maintain bone strength to reduce fracture risk
Attenuate cognitive decline
Improve planning and executive function
By: Radha Bilgi, Vicky He, Maisie Kamal, Sharon Li, Jenny Shing, XiaoYan Zhang, Xiaoyang Zheng
Coincides with current evidence of physical activity and falls prevention for elderly (Barnet et al, 2003)
Facilitates social interaction
Designed for NESB population, using clear simple instructions and visual demonstrations
Use of functional exercises which are practical and transferable to daily life tasks
Use of class evaluation feedback form
Only for participants without gait aid who are functioning well in the community
Supervisor to participant ratio entails that exercises are more cautious rather than challenging for balance components
The Physiotherapist should :
Include pre screening and ongoing outcome measure monitoring
Follow FITT-VP guidelines
Emphasize safety and be cautious with progression
Use simple language and gestures for demonstration
Use appropriate music to set the pace of class
Key Learning Ideas
The most useful outcome measures for monitoring functional performance include:
10MW, TUG, SF-36, DEMMI, CTSIB
The application of FITT-VP principles for elderly in community
The characteristics of a successful balance training class require a variety of types of exercise
A good balance exercise program should be both safe and challenging
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Introduction to Falls
Approximately 30% of community-dwelling elderly aged over 65 have at least one fall each year (Lord, Ward, Williams, & Anstey, 1993)
Falls lead to many serious consequences including:
fear of falling
loss of independence
reduced confidence in activities and community participation
Comfortable clothing & well-fitting shoes
Closed-ended shoes with a slip-resistant hard sole & low heel height, as is recommended to prevent falls in elderly (Menant et al., 2008).
water or light snacks for hydration & comfort
Environment & Description
Our exercise program is designed to run at the local community centre
Duration of 45 minutes
Class offered twice daily
Aim for participants to attend 3-5 times per week in order to receive benefit (Garber et al, 2011)
The class will be taught and supervised by a physiotherapist and allied health assistant, and would accommodate on average 6 to 12 participants per session
The class will be accompanied with songs set at 120-126 BPM during the warm up and main exercise components, and with songs of 60-90 BPM for the cool down component
Monitoring Effects of Intervention
During the Class:
the intensity of the class aimed at a moderate level will be measured with the Borg RPE scale.
assesses static balance and sensory integration
established normative values in elderly fallers as well as good psychometric data (Bulat et al., 2007; Ricci et al., 2009).
: assesses functional dynamic balance
established normative values in community dwelling elderly with a cut off score that indicates increased falls risk. The BBS and CTSIB are appropriate, easy to administer and have been used by previous studies (Bulat et al., 2007).
self-reported measure of fear of falling
established reliability and validity for measure of participation restriction due to fear of falling (Huang & Wang, 2009)
good correlation to the ABC, DGI and gait speed (Morgan et al., 2013)
several translations available for linguistically diverse older adults.
Exercise & Falls
Exercise as an Intervention
There is currently Level 1 evidence supporting that exercise targets modifiable risk factors that contribute to falls such as poor balance & muscle weakness (Liu & Latham, 2009; Howe et al., 2011)
Exercise is strongly recommended to effectively prevent falls in community-dwelling elderly (Gillespie et al., 2012)
A routine comprising of strength, balance & flexibility components leads to greatest reduction in fall rates