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Cynthia Rockey & Terri Stewart
Chapter 3A
Increased risk for falls
Reduced functional independence
Impaired Balance:
What are the consequences?
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1) Motor systems
2) Sensory systems
3) Cognitive systems
Balance Changes Due to Increasing Age
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Controls all voluntary movements
Part of our Nervous System
As we age:
↓ muscle response
↓ ability to adjust to responses
↑ uncertainty of responses
↑ dependence on arms
Motor Systems
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Knowing where the body is in space and the direction of motion
Also part of our nervous system
↓ function in vision, hearing and touching
↓ taste and smell
Sensory Systems
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Balance requires your attention
↓ overall attention capacity
↓ ability to allot required attention when performing multiple tasks
Cognitive Systems
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Warm Up
Aerobics
Balance exercises (Mandatory)
Strength exercises (Mandatory)
Stretching and Education
WABSS
Components of a SAIL class
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Gradually increases circulation
Gradually increases heart rate
Prepares the body for more vigorous exercise
Reduces the risk of injury
(In older adults, sudden vigorous work can strain the heart)
Warm-Up
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Increases the heart rate and breathing rate for an extended period of time.
“Cardiovascular” because it makes the heart and blood system work harder.
Recommendations:
30 minutes, moderate intensity, 5 days/week
Or
20 minutes, vigorous intensity, 3 days/week
Aerobics
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Dynamic balance exercises followed by static balance exercises
Allows heart rate to gradually decrease
(abrupt ending of strenuous exercise can strain the heart)
Reduces risk of injury due to falls
Maintains independence
Balance Exercises (Mandatory)
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Muscle strength and endurance decline significantly with advancing age.
Slows bone loss; delays onset of osteoporosis
Decreases likelihood of fractures due to osteoporosis
Decreased risk of falling
(stronger muscles = improved balance)
Strength Exercises (Mandatory)
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Increased activity level
(stronger muscles = increased energy)
Improves flexibility
(weight training uses full range of movement)
Controls weight
(exercise burns calories)
Lose inches
(tighter muscles = trimmer body)
Strength Exercises (Mandatory), cont.
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Changes in elasticity and compliance of connective tissue as we age, lead to decreased flexibility and
range of motion.
Maintaining good flexibility is an important part of remaining independent
Helps to reduce chronic pain in joints and muscles
Recommendation: 10-30 seconds for each stretch and 3-4 repetitions for each stretch
Stretching and Education
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Older adults actually read written information
Older adults need general health, health care, and falls prevention information
Falls prevention information can be difficult to find
79% of older adults will make changes to reduce their risk of falling if given the correct information from a professional
Stretching and Education, cont.
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Any questions?
The S.A.I.L. Class Mandatory Exercises and Adaptations
& Strength and Balance
Cynthia Rockey & Terri Stewart
Chapter 3B
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All classes have 5 S.A.I.L. components
Some mandatory exercises
A mandatory balance component
Then – the rest is up to you
and your imagination !
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The Components: WABSS
Warm-up (3-5 mins)
Aerobics (18-20 mins)
Balance exercises (Mandatory) (10 mins)
Strength exercises (Mandatory) (15-18 mins)
Stretching and education (8-10 mins)
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Warm-up (3-5 mins) Slow pace music: approx 115 bpm*
Examples:
Marching in place
Knee lifts
Side steps L+R
Heel tap
Toe tap: front, back and side
Hamstring curl
Walk around edge of classroom
Squats over chair
Shoulder shrugs
Shoulder rolls
Neck exercises
19 *BPM = Beats per minute
Warm Up - Sitting
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Warm up -Standing
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Walk briskly around classroom
Step-touch: include arms, side swings, reach up, etc…
Knee raise : touch with elbow
Step-kick : include arms
Walking backwards/forwards + arms
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Aerobics (18-20 mins) Faster music – approx 125 bpm
Examples:
*BPM = Beats per minute
The Borg Scale When exercising, you can rate your:
Perception of Exertion
Example: How hard do you think you are working on a scale from 6-20?
Do not focus on any one factor for example leg pain or shortness of breath.
Your own feeling of effort and exertion is important, not how it compares to other people’s.
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6 No exertion at all 9. For a healthy person, it is like walking slowly, at your own pace, for some minutes
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8 Extremely light
9 Very light 10
11 Light 13. Somewhat hard, but still feels OK to continue.
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13 Somewhat hard
14 17. Very strenuous –
you can continue but you have to really push yourself.
15 Hard (heavy)
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17 Very hard
18 19. The most strenuous exercise you have ever done.
19 Extremely hard
20 Maximal exertion
Borg Scale of Perceived Exertion
Talk Test
Ask each of your participants to say their name out loud during aerobic exercises, or “what did you have for breakfast ?” etc
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“If you can’t talk while you’re exercising, the exercise is too difficult. If you can sing, it’s too easy !” Ask simple questions like: “What did you have for breakfast today?” or “What is your favorite color?”
Balance exercises (10 mins) *MANDATORY*
Music – approx 115 bpm
Dynamic Balance
1. Walk slowly with head turns 2. Walking and stepping over “obstacles” 3. Heel-to-toe walk, forwards and
backwards 4. Turn small circle in each direction (by
chair) 5. Sit-to-stand for 30 seconds
26 *BPM = Beats per minute
Heel-toe Walk Sit-to-Stand Figure 1 Figure 2 & 3
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Balance exercises (10 mins) *MANDATORY*
Static Balance
1. Clock sway (feet close together)
2. Head turns and/or trunk turns
3. Heel-to-toe stand (hold 15 t0 30 seconds)
4. Reaches (forwards, sideways, etc)
5. Single-leg stance
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Clock Sway
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Head Turns Trunk Turns
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Reaches Single Leg Stance
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Additional exercises using a ball:
Throw and catch standing still
Throw and catch walking up and down
Bounce standing still
Bounce against wall
Bounce standing on one leg
Bounce walking around the circle
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Strength exercises (15-18 mins) *MANDATORY*
Music – approx 120 bpm
Guidelines Start with no weights – allows muscle tissues to adapt to new
movements
Then use minimum weight – too much too soon can lead to injury
2 sets of 8-10 reps, with a short rest between sets
SLOWLY ! 3 secs to lift/push, hold position for I second, 3 secs to lower
33 *BPM = Beats per minute
Guidelines, continued
Should feel hard/very hard (15-17 Borg)
Too heavy: cannot do 8 reps
Too light: can do 15 easily
PARTICIPANTS SHOULD NEVER HOLD THEIR BREATH! Breathe out with effort eg lift, push…Breathe in as you relax
All movements should be smooth and steady
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Note:
Normal: muscle soreness and slight fatigue
Abnormal: exhaustion, sore joints, unpleasant muscle pulling
There should be NO PAIN during exercise.
35
Progression and Adaptation Allow the first few sessions to feel easy
Increasing the amount of weight is necessary for increasing strength
When 10-15 reps is easy, it’s time to increase the weight
Increase weight in approximately 10% increments
36
Exercise Adaptations What do we mean ?
Participants who are unable to stand in order to take part in the class can participate while sitting.
- Mostly arm movements, but can also move their feet in varying directions.
Goal: progress to standing version
*We have adapted some mandatory exercises to be done while sitting.
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When will you decide that a participant needs to use adapted exercises ?
1. On initial assessment 2. Performance during class 3. Temporary change in status
Specific co-morbidities:
Diabetes Osteoporosis Glaucoma Balance/mobility deficits
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Other reasons for participants to use adapted exercises:
History of falls/fear of falling
Unable to get out of chair without use of arms
Poor performance on Timed Up and Go
(takes longer than 15 seconds)
Uses walker or other assistive device
Pain which restricts activity levels
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Strength exercises – Upper Body
*MANDATORY*
1. Biceps curl
2. Triceps extension
3. Arm raise to side
4. Shoulder flexion
5. Overhead press
6. Seated crunches (this is the only exercise that has to be
done seated, otherwise participants can choose which way they prefer).
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Bicep Curl Triceps Extension
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Side arm raise Shoulder flexion
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Overhead Press
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Seated Crunches
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Bicep Curl
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Strength Exercises – Lower Body *MANDATORY*
1. Knee extension
2. Knee flexion
3. Hip flexion
4. Hip extension
5. Side-leg raise
6. Plantar flexion (toe stand)
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Knee Extension Sitting vs. Standing
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Knee Flexion Sitting vs. Standing
Hip Flexion Sitting vs. Standing
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Hip Extension Sitting vs. Standing
Side Leg Raise Sitting vs. Standing
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Toe Stand/Calf Raise Sitting vs. Standing
Other Strength Training Examples
Wall push-ups
Upright row
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54
Squat over chair Lunges
Stretching and Education
Loss of function and increased fall risk in adults over the age of 70 are directly related to decreased flexibility in the shoulders, the neck and the spine.
Flexibility exercises increase range of movement in participants suffering from musculoskeletal and neuromuscular diseases.
Regular gentle stretching helps to decrease chronic pain.
The list goes on…. Stretching is KEY to independence!
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Stretching and Education (8-10 mins) *MANDATORY* Upper Body
Neck:
side-to-side flexion+extension
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Scratch between Shoulder Blades From Above From Below
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Clasp In front Clasp Behind
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Scapular Retraction
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“Praying” “Fist and Fling”
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Quadriceps
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Hamstrings
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Inner Thigh
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Calves
Stretching and Education
Don’t forget to include an education piece during the stretches: one bullet
point from the SAIL Guide
Other educational material may be shared if it is from a reliable source
(.gov, .edu, .org)
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Check Your Knowledge – 1 Name 3 mandatory SAIL balance exercises
Walk slowly with head turns
Walking and stepping over “obstacles”
Heel-to-toe walk, forwards and backwards
Turn small circle in each direction (by chair)
Sit-to-stand for 30 seconds
Clock sway (feet close together)
Head turns and/or trunk turns
Heel-to-toe stand (hold 15 t0 30 seconds)
Reaches (forwards, sideways, etc)
Single-leg stance
Check Your Knowledge - 2 Name 3 mandatory SAIL strength exercises
Biceps curl
Triceps extension
Arm raise to side
Shoulder flexion
Overhead press
Seated crunches Knee extension
Knee flexion
Hip flexion
Hip extension
Side-leg raise
Plantar flexion (toe stand)
Check Your Knowledge – 3 What is the purpose of a Warm-Up?
Gradually increases circulation
Gradually increases heart rate
Prepares the body for more vigorous exercise
Reduces the risk of injury
(In older adults, sudden vigorous work can strain the heart)
Check Your Knowledge - 4 What are the consequences of impaired balance?
Increased risk for falls
Reduced functional independence
THANK YOU
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