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PAX e presentation

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Simon Zheng

on 23 October 2016

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Transcript of PAX e presentation

Participants
Eligibility Criteria:
Community-dwelling elderly 60-75 years old
Able to ambulate 20m nil aid independently
Approval or referral from GP/PT (nil safety concerns)
Informed consent
Successfully passed the pre-class screening tool
FITT-VP Principles
Frequency: 3-5
days per week

Intensity:
Borg RPE 12-30 moderate to somewhat hard intensity (Nelson et al., 2007)

Time:
7min warm up, 30min exercises, 8 min cool down

Type: B
alance, Neuromotor, Cardiorespiratory, Resistance & Strengthening, Flexibility

Volume:
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

Progress:
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
Class goals
Prevent falls!
Improve strength
Improve balance
Improve reaction times
Reduce unplanned hospitalization
Improve quality of life
Social connection
Reduce fear of falling
Maximize independence
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
Appraisal
Strengths
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

Limitations
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
Recommendations for
Implementation
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

References

American College of Sports Medicine. (2013). ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins.

Anacker, S. L., & Di Fabio, R. P. (1992). Influence of sensory inputs on standing balance in community-dwelling elders with a recent history of falling.Physical Therapy, 72(8), 575-581.

Arent, S., Landers, M., & Etnier, J. (2000). The effects of exercise on mood in older adults: a meta-analytic. J. Ageing Phys. Act, 8, 407-430.

Barnett, A., Smith, B., Lord, S. R., Williams, M., & Baumand, A. (2003). Community‐based group exercise improves balance and reduces falls in at‐risk older people: a randomised controlled trial. Age and ageing, 32(4), 407-414.

Bherer, L., Erickson, K. I., & Liu-Ambrose, T. (2013). A review of the effects of physical activity and exercise on cognitive and brain functions in older adults.Journal of aging research, 2013.

Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology.

Bulat, T., Hart-Hughes, S., Ahmed, S., Quigley, P., Palacios, P., Werner, D. C., & Foulis, P. (2007). Effect of a group-based exercise program on balance in elderly. Clinical interventions in aging, 2007, 655.

Cadore, E. L., Rodríguez-Mañas, L., Sinclair, A., & Izquierdo, M. (2013). Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation research, 16(2), 105-114.

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., ... & Swain, D. P. (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and science in sports and exercise, 43(7), 1334-1359.

Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev, 9(11).

Godi, M., Franchignoni, F., Caligari, M., Giordano, A., Turcato, A. M., & Nardone, A. (2013). Comparison of reliability, validity, and responsiveness of the mini-BESTest and Berg Balance Scale in patients with balance disorders.Physical therapy, 93(2), 158-167.

Howe, T. E., Rochester, L., Neil, F., Skelton, D. A., & Ballinger, C. (2011). Exercise for improving balance in older people. The Cochrane Library.

Huang, T. T., & Wang, W. S. (2009). Comparison of three established measures of fear of falling in community-dwelling older adults: psychometric testing. International journal of nursing studies, 46(10), 1313-1319.

Liu, C. J., & Latham, N. K. (2009). Progressive resistance strength training for improving physical function in older adults. The Cochrane Library.

Lord, S. R., Ward, J. A., Williams, P., & Anstey, K. J. (1993). An epidemiological study of falls in older community‐dwelling women: the Randwick falls and fractures study. Australian journal of public health, 17(3), 240-245.

Menant, J., Steele, J., Menz, H., Munro, B., & Lord, S. (2008). Optimizing footwear for older people at risk of falls. Journal Of Rehabilitation Research & Development, 45(8), 1167-1181.

Montero-Fernandez, N., & Serra-Rexach, J. A. (2013). Role of exercise on sarcopenia in the elderly. European journal of physical and rehabilitation medicine, 49(1), 131-143.

Morgan, M. T., Friscia, L. A., Whitney, S. L., Furman, J. M., & Sparto, P. J. (2013). Reliability and validity of the Falls Efficacy Scale-International (FES-I) in individuals with dizziness and imbalance. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 34(6), 1104.

Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., King, A. C., ... & Castaneda-Sceppa, C. (2007). Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), 1094.

Podsiadlo, D., & Richardson, S. (1991). The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. Journal of the American geriatrics Society, 39(2), 142-148.

Ricci, N. A., de Faria Figueiredo Gonçalves, D., Coimbra, A. M. V., & Coimbra, I. B. (2009). Sensory interaction on static balance: A comparison concerning the history of falls of community‐dwelling elderly. Geriatrics & gerontology international, 9(2), 165-171.

Sequin, R., & Nelson, M. (2003). The benefits of strength training for older adults. Aijn’V Med, 25(3 Suppl 2), l4l-l49.

Sherrington, C., & Tiedemann, A. (2015). Physiotherapy in the prevention of falls in older people. Journal of physiotherapy, 61(2), 54-60.

Steffen, T. M., Hacker, T. A., & Mollinger, L. (2002). Age-and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Physical therapy,82(2), 128-137.

Tinetti, M. E., Richman, D., & Powell, L. (1990). Falls efficacy as a measure of fear of falling. Journal of gerontology, 45(6), P239-P243.



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:
pain
fractures
impaired function
fear of falling
loss of independence
reduced confidence in activities and community participation
Participant
Preparation
Participants should
Wear
:
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).

Bring:
water or light snacks for hydration & comfort
positive attitude!
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.

Participant Evaluation:
CTSIB:
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).
BBS
: 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).
FES:
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.
Warm up
Main Exercises
Cool down
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
Full transcript