Exercise Assessment and Program Design for Preventing Falls

Transcription

1 Exercise Assessment and Program Design for Preventing Falls Christian J. Thompson, Ph.D. Thompson Fitness Solutions, LLC Department of Kinesiology, University of San Francisco

2 Objectives Describe the prevalence of falls and falls-related injuries and the costs associated with them Identify intrinsic and extrinsic risk factors associated with falls Understand age-related changes in the body s physiological mechanisms relating to falls prevention Describe the elements of a multifactorial fall prevention program and the importance of exercise in fall risk reduction Learn 3 valid functional assessments for evaluating fall risk Utilize assessment results to design the key elements of a fall prevention exercise program Employ progression and regression strategies to modify exercises

3 Introduction to Falls in Older Adults & Risk Factors for Falls

4 Falls Data Almost 1/3 of people aged 65+ fall annually In 2016, over 2.8M seniors visited ERs for fall-related injuries resulting in 800K+ hospitalizations and $31B in cost Over 400K fractures annually ~20% of hip fractures fatal within 1 year Over 50% of hip fracture survivors never regain full function Mama Thompson Wrist Fracture 2009 Source:

5 Factors Affecting Falls Extrinsic Factors Weather & Outdoor Conditions House Clutter & Obstacles Poor Lighting Lack of Adaptive Devices Inappropriate Footwear/Clothing Intrinsic Factors History of Falling Chronic & Acute Medical Conditions Sensory &/or Vestibular Impairments Medication Effects Poor Nutrition Functional Level (Joint Mobility, Muscle Function, Balance & Gait)

6 Age-Related Physiological Changes & Effects on Fall Risk

7 Our Falls Defense Systems (Which Get Worse With Age ) Vision Thickened cornea & night vision Clouding & stiffening of the lens Loss of rods & cones Pathological eye conditions Vestibular Loss of cilia & bloodflow reduces sensory input & increases postural sway Vertigo and vestibular neuritis Somatosensory Skin & joint receptors sensitive to pressure and movement Loss of sensitivity and stiffer joint structures Diabetic neuropathy & ataxia

8 Neuromuscular System Muscle Mass & Sarcopenia SARCOPENIA Defined 2 SDs below average adult MCSA Relationship between muscle mass and muscle performance Weaker in older adults vs. younger adults Factors that affect muscle mass and muscle quality Fat and collagen infiltration Mitochondria & cell death

9 Neuromuscular System Motor Units Loss of Type II motor units Higher activation threshold Loss of myelination Type I fibers can rescue denervated Type II fibers Take on slower & weaker characteristics Loss of muscle power = Dynapenia Reduced recoverability More predictive of M&M than Sarcopenia

10 Age-Related Changes in Gait Gait cycle has STANCE and SWING phases Requires mobility and stability Gait changes with age: Decreased stride length Decreased gait velocity Increased stance time Widened stance Biomechanical alterations increase fall risk

11 Factors That Reduce Risk of Falls & General Exercise Recommendations

12 U.S. Preventative Services Task Force Report JAMA 2018 Analyzed fall prevention studies with a total of over 15K participants as to what elements are essential in a multi-factorial falls prevention program Exercise is the most important component in a fall prevention intervention showing a 11% reduction in falls occurrence. Nutritional intervention with Vitamin D and calcium supplementation is NOT EFFECTIVE in reducing falls in older adults who are not osteoporotic or Vitamin D deficient

13 Non-Exercise Elements of Multifactorial FP Programs Make Sure Your Clients Know! Behavior Change: Peer support, fall risk education, success stories Home Hazard Reduction: Improved lighting, installation of grab bars/railings, floor modifications, Universal Design elements Medication Management: Overmedication, psychotropic medications, Brown Paper Bag Checkup, Beers Criteria Sensory System Diagnosis/Prescription: Optometry and audiology

14 Essential Exercise Elements Accumulation of 50 hours of exercise to reduce OCCURRENCE but only 2 weeks to reduce RISK Sherrington, 2011 NSWPHB Must choose correct exercise components!! NO EVIDENCE Cardiovascular Yoga/Pilates Stretching EVIDENCE Joint Mobility Sensory Stimulation Muscle Strength/Power Static/Dynamic Balance Gait Enhancement

15 Exercise Prescription Recommendation Exercise Domain Joint Mobility Sensory Stimulation Muscle Strength Muscle Power Static Balance Dynamic Balance Gait Enhancement Time or Sets & Reps 60 seconds (total and/or each side) 2 sets of seconds (total and/or each side) 2-4 sets of 8-12 repetitions 2-4 sets of seconds (total and/or each side) 2 sets of seconds (total and/or each side) 2 sets of seconds (total and/or each side) 2 sets of seconds (total and/or each side)

16 Exercise Programming Recommendations If your client reports falling regularly (>1 fall/mo) recommend for evaluation by physician/physical therapist Exercise selection should be challenging but not impossible Use the 75% Rule as it relates to sensory, balance and gait exercises Progression of the different components may (and probably will) occur at different rates Always include at-home exercises to supplement the training program

17 Mobility Matters New Online Subscription Exercise Program Design Platform

18 Physical Functional Assessment of Fall Risk

19 Fall Prevention Assessment Strategy There are many assessments available which are appropriate and within your Scope of Practice?? Functional Reach Test Quantifies Static Balance and Joint Mobility Timed Up-and-Go Test Quantifies Dynamic Balance and Gait Enhancement 30-Second Chair Stand Test Quantifies Muscle Strength/Power

20 Functional Reach Test Developed by Duncan (JOG 1990) Measures sagittal plane Limits of Stability Requires both mobility and stability of the kinetic chain during reach/hold/return Outcome measurement is anterior reach distance (±0.25 )

21 Timed Up-and-Go Test Developed by Podsiadlo & Richardson (JAGS 1991) Measures several aspects of function including ambulation & postural control Modify by increasing walking speed to fast but safe Outcome measurement is time (±0.01sec)

22 30-Second Chair Stand Test Developed by Rikli & Jones (JAPA 1999) Measures lower body muscle strength and power Outcome measurement is # of repetitions in 30 sec If standing at 30 sec, count the rep

23 Developing Exercise Program from Assessment Results

24 Assessment to Program Design Matrix ASSESSMENT NORMS

25 Exercise Difficulty Poor Score = Level 1 Exercise Below Average Score = Level 2 Exercise Average Score = Level 3 Exercise Above Average Score = Level 4 Exercise Excellent Score = Level 5 Exercise

26 Suggestions for Basic Progression/Regression Joint Mobility Seated, Standing, Single Leg, Multijoint, Balance Challenge Sensory Stimulation Stationary, Moving, Direction, Strength Challenge Muscle Strength/Power External Assistance, Loading, Body Positioning Static Balance External Assistance, Displacement, Direction Dynamic Balance External Assistance, Displacement, Direction, Speed Gait Enhancement External Assistance, Step Complexity, Strength Challenge

27 Not-So-Basic Progression!!!

28 Sample Program

29 Sample Program

30 Thank You! Christian J. Thompson, Ph.D. Thompson Fitness Solutions, LLC Department of Kinesiology, University of San Francisco youtube.com/thompsonfitnesssolut