Exercise for Seniors in Community and Long Term Care Settings. Nicholas Wahl, CTRS Brookcrest Rehabilitation and Life Center, Grandville, MI

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1 Exercise for Seniors in Community and Long Term Care Settings Nicholas Wahl, CTRS Brookcrest Rehabilitation and Life Center, Grandville, MI

2 Identify 2 benefits of physical activity in Geriatrics from Evidence Based Literature. Identify a current trend in fitness for seniors based on data from surveys conducted. Identify at least 1 community resource to implement with seniors in community setting. Provide an example of intervention to use for fitness in SNF

GVSU graduate in Therapeutic Recreation in 213. I love to stay active!

3 Currently Employed at Brookcrest Rehabilitation and Life Center as CTRS of Sub Acute Rehab and LTC Unit, as well as Volunteer Coordinator. GVSU graduate in Therapeutic Recreation in 213. I love to stay active! I enjoy going on hikes, camping, fishing, playing sports (soccer, tennis, golf and disc golf) to name a few. I have a 7 month old niece who I love to spoil.

5 Strength Training improves functional fitness and decrease falls (Mobily et al 24) Falls Statistics among older adults Collected data from Strength training program participants, and a control group (other programs offered at Senior Center), to measure hand-eye coor, arm strength, balance and leg strength using specific tests. Participants also answered follow up questionnaire addressing falls (self reported by participants), health and physical activity over past year. Results showed significant improvements in the above areas, as well as decreased falls after 6 weeks of strength training. Hand Eye coordination (task completed 2 sec faster) Arm strength (participants doing 5+ more reps than at baseline) Leg Strength (took 3.5 sec less to stand up/down 1x) Balance (took 1 sec less to stand up, walk 3 meters and return to seated position) Falls decreased by 5% in Strength Training Group Study involved CTRS leading the strength training in group format.

6 Correlation between exercise and brain functioning.(kirk-sanchez and McGough 214) Cardiovascular risk factors and cognitive impairments Resistance training and neuron growth/maintenance Exercise in rats to performance in maze Exercise and brain volume Effects of Goal Based Activities on persons with Parkinson s Disease (Petzinger et al 213) Improvements physically (Nied and Franklin, 22) Increase aerobic capacity Increase Life Expectancy Maintain muscle mass or slow rate of decline May improve or limit decline in conditions such as osteoporosis, osteoarthritis, diabetes Provide Activity Pyramid/Exercise Prescription as general baseline for fitness in Seniors.

7 Pyramid should serve as a guideline; choose activities you/patients will enjoy. Try to include activities from each section, or create your own! CUT DOWN ON Sitting more than 3 min at a time (TV, computer, etc.) THROUGHOUT THE WEEK Aerobic & Recreation Activities: 3-5x/wk, for at least 2-3 min per time. Low impact fitness classes, water exercise, walking, moderate sports (such as tennis) and dancing. Flexibility activities: 3+/wk. Include stretching throughout day, yoga, tai chi. Flexibility & balance Recreational & Aerobic Act. Muscle Strengthening EVERYDAY (AT LEAST 3 MIN A DAY) Walking, leisure activity (like golf, bowling), taking stairs, yardwork, household chores, parking farther away to walk in, etc. Muscle Strengthening: 3x/wk. Weight machines, or hand weights (at least 1-2 lbs)

8 Self Efficacy Attitude Discomfort Disability Poor Balance/Fear of Injury Not a habit/routine Subjective Norms Limited/Fixed Income Environmental Factors Cognitive Decline Illness/Fatigue

9 What Physical Activities are Older Adults Doing? (Fitzhaugh, Klein, & Hayes 28) Their sample showed most common Leisure Time Physical Activities overall are Walking (64%), Yardwork (13.9) and Cycling (13.7). Others include golf, treadmill, gardening, stretching, aerobics, swimming, dancing and weightlifting. Also examined how leisure patterns changed with age, gender, race, education level, and with/without activity partner. Cited biggest barriers to exercise were personal (temperament, time, discomfort, fear of injury, inertia, isolation and misconceptions), Environmental (access to facilities, equipment, climate) and exercise specific (readiness for exercise, enjoyment of activity, speed of progression, learning curve)

10 Fitness Surveys handed out to residents of Sunset Communities facilities, as well as Salvation Army Kroc Center participating in Senior Programming. Goal was to gather data on what Seniors are doing for fitness, what they would like to do for fitness, as well as their perceptions of their current fitness levels. Anonymous and optional survey Kroc Center: 34 people responses ( 25 women, 9 men) Sunset Communities: 49 responses (36 women, 13 men) For Charts coming up, Kroc Center (Community) on left, and Sunset Communities (SNF) is on the right

11 or younger or younger

12 Once a Week 2-4 days/wk 5-7 days/wk When Int/No Set Once a Week 2-4 days/wk 5-7 days/wk When Int/No Set

15 Easy Moderate High Easy Moderate High

16 By Myself In a Group By Myself In a Group

17 Below Average Average Above Average Below Average Average Above Average

18 Worse than Last Year Same as Last Year Better than Last Year Worse than Last Year Same as Last Year Better than Last Year

21 Overtime Therapy (or as I m sure some of my resident s call it behind my back, Nick s House of Pain) Acts as a supplemental exercise to Therapy for Rehab patients. Also serves for LTC residents as more of a high intensive exercise program for those who want to get stronger Includes interventions such as Seated Yoga, Tai Chi and Zumba Restorative Nurses: conduct treatment plans for specific goals of resident. Care plans and treatment made with collaboration with PT Nurses trained specifically for conducting physical activity with residents. Walking and resistance training. LTC Exercise group 2-3x weekly for passive ROM and stretching Led by RTA in group. No weights are typically used.

23 Overtime Therapy (or as I m sure some of my resident s call it behind my back, Nick s House of Pain) Acts as a supplemental exercise to Therapy for rehab patients. Also serves for LTC residents as more of a high intensive exercise program for those who want to get stronger Includes interventions such as Seated Yoga, Tai Chi, Boxing and Zumba Restorative Nurses: conduct treatment plans for specific goals of resident. Care plans and treatment made with collaboration with PT Walking and resistance training primary interventions. LTC Exercise group 2-3x weekly for passive ROM and stretching Led by RTA in group format. No weights are used.

24 Popular workout sets we use at Brookcrest come from Darebee s 1 Office Workouts and adding hand weights/ankle weights when appropriate. 1 office workouts is free.pdf document, found on their website Boxing Workout Boxing for Seniors becoming very popular now, with publicity of Rock Steady Reason being: Goal Based Exercise (such as boxing) and aerobic training improved motor skill performance and cognitive motor control in persons with PD (Petzinger et al 213) Workout consists of punching exercises/combos, as well as seated agility for cardio. Other resources we use/adapt for use: Tai Chi in a Chair: Easy 15 Minute Routines for Beginners by Cynthia Quarta Daily Yoga Postures for Office and Workplace app - gives set of poses for Yoga routine, also on a timer. Works great as a group activity! Daily Senior Fitness app given to folks discharging back home from rehab; easy exercises to do as they get stronger from home

26 Popular workout sets we use at Brookcrest come from Darebee s 1 Office Workouts and adding hand weights/ankle weights when appropriate. 1 office workouts is free.pdf document, found on their website Boxing Workout Boxing for Seniors becoming very popular now, with publicity of Rock Steady Workout consists of various punching exercises/combos, as well as seated agility Other resources we use/adapt for use: Tai Chi in a Chair: Easy 15 Minute Routines for Beginners by Cynthia Quarta Daily Yoga Postures for Office and Workplace app - gives set of poses for Yoga routine, also on a timer. Works great as a group activity! Daily Senior Fitness app given to folks discharging back home from rehab; easy exercises to do as they get stronger from home

28 Popular workout sets we use at Brookcrest come from Darebee s 1 Office Workouts and adding hand weights/ankle weights when appropriate. 1 office workouts is free.pdf document, found on their website Boxing Workout Boxing for Seniors becoming very popular now, with publicity of Rock Steady Workout consists of various punching exercises/combos, as well as seated agility Other resources we use/adapt for use: Tai Chi in a Chair: Easy 15 Minute Routines for Beginners by Cynthia Quarta Daily Yoga Postures for Office and Workplace app - gives set of poses for Yoga routine, also on a timer. Works great as a group activity! Daily Senior Fitness app given to folks discharging back home from rehab; easy exercises to do as they get stronger from home

30 Senior Centers Salvation Army Kroc Center/YMCA Gyms/Fitness Centers (such as Snap Fitness) Silver Sneakers/Silver and Fit Sit and Be Fit - Enhance Fitness

31 Be Barrier Eliminators; less barriers = less excuses Make it individual. If we meet their needs, they will be more invested. Recruit support around them, (members of class, family, etc) and being a support to them as well Set up/find an environment that sets them up for success (in community setting, well lit/sidewalks for walking, etc) Consider becoming certified as a Senior Fitness Instructor or Senior Fitness Specialist Implement a variety of interventions to meet individual needs, as well as to keep programs fresh and not repetitive. Be intentional when creating a workout and make it goal based. Don t just wing it but be intentional

32 Self Efficacy start slow with obtainable goals; advance slowly with encouragement Attitude promote positive personal benefits to fitness; use/find enjoyable activities to them Discomfort vary intensity and range; cross train; start slow and avoid overdoing Disability specialized exercises to meet their needs Poor Balance/Fear of Injury assistive devices; balance/strength fitness to start; start slowly and ensure proper equipment. Not a habit/routine promote lifestyle, set up schedule, encouragement Subjective Norms find/seek role models; educate them along with influential persons for them Limited/Fixed Income simple exercises, use of items at home, community resources Environmental Factors provide/seek resources for alternative fitness outside of norm Cognitive Decline establish routine, simple exercises Illness/Fatigue range of exercises/intensities to use based on level for that time

33 Personally, I would love to see more apps/technology specific to Seniors to help with fitness. (If you know anyone techy let me know!) as there is not much available to them today. Let s challenge each other to have similar/same programs being offered in both community and SNF. We have very active Seniors in the community, and they may expect similar programs as they continue to age. If interest is there, I would love to continue this research on Senior Fitness Habits/Challenges and see how fitness continues to change for this population, as Baby Boomers continue to grow older.

34 Fitzhugh, E. C., Klein, D., & Hayes, G. (28). Leisure-Time Physical Activity Participation Among Older Adults: Implications for Therapeutic Recreation Specialists. Annual in Therapeutic Recreation, 16, Mobily, K. E., Mobily, P. R., Raimondi, R. M., Walter, K. L., & Rebenstein, L. M. (24). Strength training and falls among older adults: a community-based TR intervention. Annual in Therapeutic Recreation, 13, 1-11 Nied, R. J., & Franklin, B. (22, February 1). Promoting and Prescribing Exercise for the Elderly. American Family Physician, 65(3), Petzinger, G. M., Fisher, B. E., McEwen, S., Beeler, J. A., Walsh, J. P., & Jakowec, M. W. (213, July). Exercise-enhanced Neuroplasticity Targeting Motor and Cognitive Circuitry in Parkinson s Disease. Lancet Neurol, 12(7), Kirk-Sanchez, N. J., & McGough, E. L. (214). Physical exercise and cognitive performance in the elderly: current perspectives. Clinical Interventions in Aging, 9,

35 My Contact Info if you have any questions or need assistance with resources: x224

Implementing Exercise Routines for Seniors in Community and Long-term Care Settings. Nicholas Wahl, CTRS Brookcrest Rehabilitation and Life Center

Implementing Exercise Routines for Seniors in Community and Long-term Care Settings Nicholas Wahl, CTRS Brookcrest Rehabilitation and Life Center Participants will be able to identify 3 physical or mental