HEALTHY AGING! Preventing falls in people with R.A.

Transcription

1 HEALTHY AGING! Preventing falls in people with R.A. Annual European Congress of Rheumatology EULAR Paris June 2014 Costas Ioulianos Physiotherapist President of Cosmos Rheuma +

2 AGING Aging is a multi-factorial process that ultimately induces a decline in our physiological functioning, causing a decreased health-span, quality of life and independence for older adults COULD EXERCISE HELP?????

3 Physiological changes with aging Decreased Muscle mass Muscle strength Muscle power Muscle endurance Muscle contraction velocity Muscle mitochondrial function Muscle oxidative enzyme capacity (Montero-Fernadez, Serra-Rexach 2013)

4 Physiological changes with aging Decreased Maximal and submaximal aerobic capacity Cardiac contractility Maximal heart rate Stroke volume and cardiac output Nerve conduction velocity Balance (Concannon et al. 2012)

5 Physiological changes with aging Decreased Proprioception Gait velocity Gait stability Insulin sensitivity Glucose tolerance Immune function Bone mass/strength/density Collagen cross-linkage, thinning cartilage, tissue elasticity (Park, Yeo, 2013)

6 Physiological changes with aging Increased Arterial stiffness Myocardial stiffness Systolic blood pressure Diastolic blood pressure Visceral fat mass Total body fat Intramuscular lipid accumulation (Chrysant, 2013)

7 Use It or Lose It Sedentary people lose large amounts of muscle mass (20-40%) 6% per decade loss of Lean Body Mass (LBM) Aerobic activity not sufficient to stop this loss Only resistance training can overcome this loss of mass and strength Balance and flexibility training contributes to exercise capacity

8 Use It and Lose Less of It Resistance training improves strength by a range of % Lean body mass increases 1-3 kg Muscle fiber area 10-30%

9 Vicious Cycle of Instability Joint Dysfunction Altered motor program Impaired proprioception Abnormal Movement pattern Loss of muscle activation / stabilization

10 Why is the study of falls important? The human costs of falls (e.g. Loss of mobility, independence, dignity and confidence) Large numbers of older people are falling (one-third of people aged 65+ and 50% of over-80s living in the community will fall) Impact on local services Costs to the health services ($ 2 billion + in medical costs annually) Prof. Dr. Nadja Schott

11 Falls-related injuries fractures contusions/abrasions 29 26,5 27,5 38,4 lacerations strains/sprains 9 8,6 internal injuries 6 7,6 men women others 6,9 8, AGE percentage Prof. Dr. Nadja Schott Treatment rates in US emergencies 2001 (Stevens & Sogolow, 2005)

12 R.A. and falls 10-54% of people with R.A. fall annually (Davis 2013) One in three people suffering from R.A. will fall < 1+ in a year, regardless of their age R.A. patients are at greater risk of falling after their first fall, due to previous injury and fear of falling (Stanmore et al., 2013)

13 Suggested reasons of risk falls Impaired muscle strength Postural instability Fatique (associated with pain rather than the disease activity) Joint pain Swollen joint count Pain in lower extremities Pain intensity Reduced functioning (Pollard et al., 2013)

14 Suggested reasons of risk falls Low levels of physical activity Use of antidepressants Impaired vision and balance Impairment in both walking and rising (Stanmore et al., 2013, )

15 Assessing algorithm in patient with falls (Ungar et al. 2013)

16 Fall risk consequences Increased risk of hip fracture ( per year U.S.A.) Hospital admission Admission to care home Fear of falling Reduced quality of life (Latham NK, et al.,2014)

17 Role of exercise in aging and prevention of fall risks Exercise programmes are designed to prevent falls in older adults, prevent injuries caused by falls Exercise programs exist for the age related changes, including programs that target resistance and strength training and programs that incorporate coordinated movement of the body's center of gravity and limbs, balance, proprioception and promotion of functionality and ADL

18 What is exercise? Lifestyle choices Organized sports Unstructured play Household and Occupational tasks

19 Sensorimotor Training Progression Rogers N, et al J Orthop Sports Phys Ther. 36(1):A Firm Green Blue Black Wobble 140 Eyes open first through progression, then eyes closed 120 Textured black had less sway than non-textured Postural Sway Firm EO Firm EC Foam EO Air+Text EO Air EO Wobble EO Foam EC Air+Text EC Air EC Wobble EC 2008 The Hygenic Corporation

20 Sensorimotor Training MAXIMIZE proprioception Joint FUNCTION FACILITATE muscle activation / stabilization RE-PROGRAM motor program RESTORE movement pattern 2008 The Hygenic Corporation

21 Functional Exercise Progression SENSORIMOTOR TRAINING Skill Fundament al Movements Functional Synergies Muscle Performance Gait, Balance & Locomotion Motor Function Sensory & Reflex Integrity ROM & Muscle Length Joint Integrity & Mobility Posture Pain & Inflammation 2008 The Hygenic Corporation

22 Preparation for SMT 1. Restore normal joint proprioception & movement patterns Control pain & inflammation Facilitate proprioceptive posture Restore normal joint biomechanics 2. Increase sensory input Conscious awareness of movement & position Stimulation of proprioceptors 3. Address muscle imbalances 2008 The Hygenic Corporation

23 SMT Prescription FREQUENCY : perform daily INTENSITY : less resistance, higher repetitions DURATION : 6 weeks for neural adaptation QUALITY: Control eccentric movements 2008 The Hygenic Corporation

24 Sensorimotor Training Progression 1. Static Maintain balance on progressively unstable surfaces (Stability Trainers & Balance Boards) Progress by shifting weight, perturbations, closing eyes, adding head movements Progress to unilateral stance 2008 The Hygenic Corporation

25 Sensorimotor Training Progression 2. Dynamic Add arm & leg movements while balancing on progressively unstable surfaces Use exercise bands, FlexBars, or Soft Weights 2008 The Hygenic Corporation

26 Sensorimotor Training Progression 3. Functional: Perform functional movements (squat, lunge, step, push, pull, etc) on progressively unstable surfaces The Hygenic Corporation

27 Key Points Functional stability is a result of both local and global stabilization The Sensorimotor system controls functional stability Neuromusucular reflexive activation is more important than strength Sensorimotor training is a scientifically-based progression for stabilization training Used for injury rehab and prevention 2008 The Hygenic Corporation

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32 Johanna Quaas, the world s oldest gymnast (here, aged 86)

33 Conclusions Exercise participation is seen as a way to reduce the impact of aging through maintenance of physiological parameters. Exercise to prevent falls in older adults are effective in Reducing both the risk of falling and the monthly rate of falling. Understanding the biologic changes that occur with age and their social implications is essential for a practitioner working to maximize an aging patient s Quality of life and functional Independence!!!! With the appropriate guidance and personally tailored exercise program based on a patient s goals and abilities, persons of all levels can Achieve improvements in performance and general well being!!!!

34 HEALTHY AGING = QUALITY OF LIFE