Where can Older Adults Exercise: An overview of exercise programs available for Older Adults in Victoria

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1 Where can Older Adults Exercise: An overview of exercise programs available for Older Adults in Victoria Karla Gallagher, Physiotherapist Seniors Outpatient Clinic, Victoria

2 Overview: Exercise options in Victoria: Health Authority funded programs Outpatient programs Home and Community care Seniors At Risk Integrated Network (SARIN) Community Programs Recreation Centres Seniors Centres Private Physiotherapy Services Community Groups How to choose where to send a client: Factors that will determine where to refer a client

3 Health Authority funded programs Outpatient Services: Outpatient Neuro-Rehabilitation Program, VGH Short term treatment for adults who have acquired significant neurological impairments that impact their ability to function. See attached sheet for referral criteria Outpatient Musculo-Skeletal Rehabilitation Program, RJH Physiotherapy services for people who have had recent orthopaedic or breast cancer surgeries See attached sheet for referral criteria

4 Health Authority funded programs Seniors Outpatient Clinic, Main Floor Memorial Pavilion Interdisciplinary assessment and treatment for older adults in the community with complex medical issues. Includes 8 week physiotherapy exercise program focusing on balance, strength and gait training. Options for specific classes for high level balance training, low level activation program and Parkinson s specific exercise class based on large amplitude training Unable to refer directly to exercise programs See attached sheet for referral criteria

5 Health Authority funded programs Home and community care (HCC) services: HCC can do an assessment and set up treatment program. Due to limited resources they are not able to provide ongoing services. Physiotherapist can delegate the task to the home support workers Home support workers can direct clients to do exercises or go for walk but cannot physically help client

6 Health Authority funded programs Seniors At Risk Integrated Network (SARIN) General Practitioners with special interest in treating older adults Additional resources are available to help with the management of the their older adult clients Older adults at risk for falls can be referred to the falls clinic Falls clinics Evolving model over past couple years. Current model is a comprehensive balance and mobility assessment by physiotherapist at the SOPC Referral to community or outpatient exercise programs as appropriate Recommendations sent to doctor

7 Health Authority funded programs SARIN team on Saanich Peninsula Assessment by Physiotherapist to determine appropriateness for the exercise class vs. home SAIL exercise program SARIN Balance class runs 2x/week for 12 weeks at the Panorama Recreation Center. Patients are charged $2.00 / session user fee that is paid to the recreation center. Private Public Partnership.

8 Community Programs Direct referral Clients can register themselves Program are designed to meet different needs Exercise for Seniors can mean may different things. For example a program may be geared towards fit person in their 60 s versus a frail person in their 80 s Specific programs are constantly changing and evolving due to demands and scheduling

9 Community Programs Recreation Centres Equipment: bikes, weight machines etc, Pool Range of functional abilities from seated programs to high level balance and movement classes. Programs include: strength training in gym, pool programs, exercise and balance classes Range of customized specific programs designed for each person to general group programs Ratio of instructor to client: range from 1:1 treatment with personal trainer to 1:15 in group exercise classes Cost range ~$6-90/session

10 Community Programs Seniors Centres: Minimal equipment (free weights, theraband, balls etc Range of functional abilities from seated programs to high level balance and movement classes Programs include: group exercise programs, walking groups Access to other programs/activities (lunch after class, games etc.) Ratio of instructor to client: 1:10-35 (average ~ 1:15). Some programs also have volunteers Cost: yearly membership, classes included or small drop in free. Some program are pre-register for time period.

11 Home Programs Low physical function Leaving the home may be too much exercise SAIL home exercises Higher function and self motivated Home strength and aerobic exercise program Prescription for exercise and way to monitor progress (calendar, journal)

12 Other options: Physiotherapy Clinics Some clinics offer assessment, set-up of exercise program and drop-in rates to use the exercise equipment at the clinic Assisted living facilities Most offer exercise programs Tai Chi Centre Mall walking groups??other ideas

13 Specific programs for different conditions: OSTEOFIT- BC Women s Hospital & Health Centre certified exercise, education and falls prevention program for individuals with osteoporosis, low bone density or who are at risk of fractures and fall Parkinson s Disease: Exercise Classes through VEPC Arthritis: Arthritis centre, JointWorks and WaterWorks Cardiac Rehab programs Alzheimer's disease or another dementia: Minds in Motion exercise for body and brain Classes are offered at many recreation and seniors centres

14 Get Up and Go collaboration between the Fraser Health Falls and Injury Prevention and Osteofit entry level exercise program for seniors with balance and mobility impairment who would otherwise be unable to attend a community based exercise class safe exercise program specially designed to improve strength, balance and coordination as well as functional ability independence and quality of life Subsidy for this program may be available through a referral from the Fraser Health Fall and Injury Prevention Program Some recreation centres are looking at potentially bringing this program to Victoria id=121&program_id=13777

15 Barriers to participation Transportation Handydart Volunteer drivers in some areas Family/friends Cost L.I.F.E. subsidy is available for recreation centres Motivation Cognition May need family member for assistance Cueing Timing Time of program

16 How to choose where to send a client The CSHA Clinical Frailty Scale 1 Very Fit Robust, active, energetic, well motivated and fit; these people commonly exercise regularly and are in the most group for their age. 2 Well Without active disease, but less fit than people in category 1 3 Well, with treated comorbid disease Disease symptoms are well controlled compared with those in category 4 4. Apparently vulnerable Although not frankly dependent, these people commonly complain of being slowed up or have disease symptoms 5. Mildly Frail With limited dependence on other for instrumental activities of daily living 6. Moderately frail Help is needed with both instrumental and noninstrumental activities of daily living 7. Severely Frail Completely dependent on others for the activities of daily living or terminally ill.

17 How to choose where to send a client Recent deconditioning due to hospitalization, fall, change in medical status Specific rehab needs Requires medical supervision -Outpatient Programs See document for goals, criteria and referral process for each program

18 How to choose where to send a client Unable to attend a community program Home Exercises Frail (Stages 5, 6, 7) Compromised physical function Able to get out to community program (able to walk to transportation and into facility) Low level/ seated exercise class Benefits for leaving the home for socialization, mood etc

19 How to choose where to send a client At risk for functional decline Determine main goal: Strength training Balance Socialization Community programs Rec centre, Seniors centre etc Encourage client to try a community program, can observe the first session/ have a family member attend to decrease anxiety Choose a program they enjoy weight training versus aerobic class (Stages 3 + 4) Home program if motivated

20 How to choose where to send a client High function (Stages 1 + 2) Goal to keep high level of function, increase fitness and decrease future fall risk High level community balance and mobility programs, Tai Chi, nordic walking Need a program that addresses all areas of physical function Aerobic strength flexibility Balance *Can target a specific area as needed.

21 Summary: Strong evidence that exercise is an effective treatment for physical function and cognition in older adults. Older Adults need to continue regular exercise for the rest of their lives Exercise program needs to be: appropriate to their level of function increased or decreased with changes in physical function something that can be done a couple times/week something that is sustainable Additional benefit of group programs for social interactions and stimulation and adherence (Estabrooks, Harden, & Burke, 2012).

22 References: Everard, K. M., Lach, H. W., Fisher, E. B., & Baum, M. C. (2000). Relationship of Activity and Social Support to the Functional Health of Older Adults, 55(4), Estabrooks, P. a., Harden, S. M., & Burke, S. M. (2012). Group Dynamics in Physical Activity Promotion: What works? Social and Personality Psychology Compass, 6(1), Estabrooks, P. a., Harden, S. M., & Burke, S. M. (2012). Group Dynamics in Physical Activity Promotion: What works? Social and Personality Psychology Compass, 6(1),