AgeingAgeing & Rehabilitation& Rehabilitation

David Rigg BSc (Hons) GSR, CSCSDavid Rigg BSc (Hons) GSR, CSCS

TODAY'S PRESENTATION

• Putting aging in to context what is it Putting aging in to context what is it • Review Rehabilitation Procedures Review Rehabilitation Procedures • Physiological Exercise Prescription and the Physiological Exercise Prescription and the

Biomedical ModelBiomedical Model• Medical Exercise Therapy and the Medical Exercise Therapy and the

Biopsychosocial Model Biopsychosocial Model • Case Study Case Study • Statistics Statistics

AGE AND TIME TO RETIRE

• Army – 40 years old • Fire and Police Service – 55 years old• National Retirement Age – 60 – 65

years old and increasing• Over 65 years

PERCEPTION OR REALITY

CATEGORIES OF AGING

• Chronological aging • Cosmetic aging • Social aging (changes in interactions with others)

• Psychological aging (age-related changes in perception and behaviour)

• Economic aging (changes in financial status with age)

Ref:1

AGE AND FUNCTIONAL LOSS

Functional losses fall into 4 categories1. Functions that are totally lost 2. Structural changes 3. Reduced efficiency4. Altered control systems or reduced

reserve capacity to respond

Ref:2

TWO TYPES OF AGING IDENTIFIED IN THE LITERATURE

1. Normal Aging - changes that are not produced by

disease. 2. Pathological Aging – changes that result form

environmental changes, genetic mutations and accidents of nature.

Ref: 2

OPTIMAL AGING

The preservation function at the highest level and the quality of life

is maintained.

• The Absence of disease and disease related disability

• High functional capacity• Active engagement with life

Ref: 3

OPTIMAL AGING INCORPORATES

• Physical health • Psychological state • Level of independence • Social relationships• Personal beliefs • Relationship to the environment

Ref :4

PHYSICAL ACTIVITY REDUCES THE RISK

• Coronary heart disease

• Diabetes mellitus• Cancer – colon and breast • Obesity• Hypertension • Bone and joint

diseases – osteoporosis and osteoarthritis

• Depression Ref: 5,6

Comprehensive Exercise Programme

• Aerobic work • Resistance training • Power training • Flexibility exercises and balance

training

BENEFITS OF RESISTANCE TRAINING

• Positive effects on Muscle Mass • Enhanced motor unit recruitment • Improved contraction coupling and

calcium handling • Relief from arthritis pain • Improved balance and reduced risk

of falls • Strengthen of bones Ref:7,8,9

REHABILITATION PROTOCOL

• Control pain • Restore Range of movement • Restore Muscular Strength,

Endurance and Power• Re-establish Neuromuscular control• Maintain cardio respiratory Fitness • Restore Function

NATIONAL STRENGTH AND CONDITIONING ASSOCIATION NEEDS ANALYSIS

1. Needs Analysis

2. Exercise Selection

3. Training Frequency

4. Exercise Order

5. Training Load and Repetitions

6. Volume

7. Rest Periods

NEEDS ANALYSIS

• Evaluation of the sport, movement, physiology, injury

• Assessment of the individual - Age, training and chronological, training status, technique experience.

• Testing and evaluation

• Set primary training goal

BUT HOW MUCH

• Hunter et al – 2-4 sets of 8-15 reps at 60-80% of 1RM, on 2-3 days per week (Ref: 10)

• ACSM – 1 set of 10 -15 reps of a moderate intensity of 8-10 exercises using all major muscle groups at least 2 days per week 48 hours apart (Ref:10,11)

PROBLEMS WITH EXERCISE PRESCRIPTION

• Causes pain • Person feels uncomfortable in the situation

• Low confidence with exercise • Poor understanding of the condition

• Believes it will cause more damage • Does not like exercise and never has • Wants a quick fix

• As the prescription for exercises vary among studies and as older adults vary considerably in health, fitness and functional status do we need to prescribe for the individual.

• Meet the person where the person is

ASSESSMENT

Treat the patient not the x-ray, the CT or MRI scan results.

Advances in diagnostic imaging do not replace the need for clinical interpretation.

• Khan KM, Tress BW, Hare WSC, Wark JD. Treat the patient not the x ray: Advances in Diagnostic Imaging Do not replace the Need for Clinical interpretation. Clinical Journal of Sports Medicine 1998;8:1-

4.

CLASSIFICATION FOR TREATMENT CONTINUUM

Type 1 Type 2 Type 3

Organic Tissue Based

Identifiable Tissue

at fault

Normal pain behaviour

Recognisable pain patterns

Reproducible signs

Chronic Pain

Abnormal Pain Behaviour

Major Psychosocial

Stressors

Non specific diffuse pain

Non reproducible

BIOPSYCHOSOCIAL MODEL OF CHRONIC PAIN AND DISABILITY

Social Environment

Illness Behaviour

Biology Sensory Condition

Thoughts and Beliefs

A COLLABORATIVE APPROACH

• Is the person ready to start a programme • Is the person confident they can do the program • Is the program important to the person

• What is their motivation

• What do they want to achieve • What do they think they can do, start with• What are they willing to try

Ref:13

• Motivational Interviewing • Cognitive Behavioural Therapy (CBT) • Cognitive Behavioural Approach

(CBA)

CBT LONGITUDINAL FORMULATION (Beck 1967)

Early Life Experiences

Formation of Schema

Conditional Beliefs

Critical Incident

Symptoms

Cognitions

Emotions Physical Symptoms

Behaviour

Situation

Thoughts

Behaviour

Feelings Physical Symptoms

5 Areas Model

The CBT 5 Areas Model

Hot Cross Bun (Ref: 12)

Situation

GOING TO THE GYM FOR AN EXERCISE REHABILITATION PROGRAMME

Thoughts

Why have I been sent to the gym

I have been told not to do to much

This is going to cause more pain

Behaviour

Does not do exercise

Keeps themselves safe

Physical Symptoms

Increased HR

Feels more Pain

Feelings

Scared

Anxious

Worried

Protective

Situation

GOING TO THE GYM FOR AN EXERCISE REHABILITATION PROGRAMME

Thoughts

I am looking forward to this

This will help me

I might make some new friends

Behaviour

Complete Exercises

Attend Regularly

Physical Symptoms

Reduced Pain

Reduced muscle tension

Reduced blood pressure

Feelings

Confident

Happy

Relaxed

MEDICAL EXERCISE THERAPY

• Founded by Oddvar Holten • Published in The Norwegian Physiotherapy Journal;Fysioterapeuten1968;Holt O.

Treningsterapi. Fysiterapeuten 35(8):236-240.

• Therapy where the patients performs exercises with specially designed apparatus without manual assistance

• Defined starting positions and graded loads • One hour of effective treatment • 7-9 exercises 2-3 sets or 20 -30 reps aiming for

close to 1000 reps.

• Must start to sweat

ADVANTAGES OF THIS TYPE OF PROGRAMME

• Positive Cognitive Experience • Blood circulation • Endorphin release • Improved endurance and strength • Improved function

↓↓Pain Pain

↓↓Anxiety Anxiety

↓↓DepressionDepression

Advantages of this type of programme

• Some evidence suggests that supervised programmes increase compliance.

• Collaboratively set goals appear to lead to higher

levels of treatment compliance than set goals • Combined exercise and motivational program can

increase compliance and reduce disability • Compliance may be directly influenced by the out

come

Ref 14,15,16,17,

CASE STUDY PRESENTATION AND DISCUSSION

Summary

• Physiological principles apply • No template for prescription for – Age or

condition

• Identify – Thoughts, Feelings, Beliefs and Motivation

• Apply the right model to the right individual

• Use a collaborative approach

A healthy mind in a healthy body

Mens sana in corpore sano

Thank You

Discussion

References :

1.Dirks AJ and Leeuwenburgh C. The role ofapoptosis in age-related skeletal muscleatrophy. Sports Med 35: 473–483, 2005.

2. Taylor A Wand Johnson MJ. Physiology of Exercise and Healthy Aging. Champaign,IL: Human Kinetics, 2008.

3. Rikli RE and Jones CJ. Senior Fitness Test Manual. Champaign, IL: Human Kinetics,2001.

4. Wolf SL, Sattin RW, Kutner M, O’Grady M, Greenspan AI, and Gregor RJ.Intense Tai Chi exercise training and fall occurrences in older, transitionally frailadults: A randomized, controlled trial.J Am Geriatr Soc 51: 1693–1701, 2003.

5. Federal Interagency Forum on Aging- Related Statistics. Older Americans2008: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office, 2008.Available at: http://www.agingstats.gov.

6. Warburton DER, Nicol CW, and Bredin SSD. Health benefits of physical activity: The evidence. CMAJ 174: 801–809, 2006.Available at http://www.cmaj.org/.doi:10.1503/cmaj.051351.

7. Dirks AJ and Leeuwenburgh C. The role ofapoptosis in age-related skeletal muscleatrophy. Sports Med 35: 473–483, 2005.

8. Centers for Disease Control andPrevention and The Merck CompanyFoundation. The State of Aging andHealth in America 2007. WhitehouseStation, NJ: The Merck CompanyFoundation, 2007. Available at:www.cdc.gov/aging andwww.merck.com/cr. Accessed March 12, 2009.

9. Federal Interagency Forum on Aging- Related Statistics. Older Americans2008: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office, 2008.Available at: http://www.agingstats.gov.

10. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testingand Prescription (8th ed). Philadelphia, PA: Wolters Kluwer/Lippincott Williams &Wilkins, 2010. pp. 153, 172–174, 192–194.

11. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, andCastaneda-Sceppa C. Physical activity and public health in older adults:Recommendations from the American College of Sports Medicine and theAmerican Heart Association. Med Sci Sports Exerc 39: 1435–1445, 2007.

12. Williams C, Garland A,. Advances in Psychiatric Treatment (2002).vol8pp.172-179.

13. Rollnick S, Mason P, Butler C. Health Behaviour Change, A Guide for Practitioners. Churchill Livingston, 1999.

14. Reilly K et al. Differences between a supervised and independent strength and conditioning program with Chronic Low Back Pain Syndromes. Journal of Occupational Medicine, June 1989, vol 31, no 6. p547-550.

15. Bassett S, Petrie K. The effect of treatment goals on patient compliance with physiotherapy exercise programmes. Physiotherapy 1999,853,p130-137.

16. Fredrich M. Compined Exercise and Motivation Program: Effect on the compliance and level of disability of patients with chronic Low Back Pain: A randomised Controlled Trial. Arch Phys. Rehabil., May 1998, vol79,p 475-487.