Session # 199 ACE IFT - Integrated Fitness Training for Active Aging (Part 1 of 3) Fabio Comana, MA., MS., ACE CPT & LWMC, ACSM HFS, CSCS, CISSN American Council on Exercise Fabio.comana@acefitness.org Physical Inactivity Disorder (pathology) Impairments (anatomical / structural) Disability Functional Limitations (physical / cognitive) Modified Disability Model (adapted from Nagi, 1991) Aging Process Less Physical Activity Inability to Sustain Physical Function Loss of Physical Function / Impairment Less Ability to be Physical Active Outcomes of this effect? Need to compress the period in which one lives in a state of morbidity (below functional limitation or disability stage). Functional Capacity Early Life (Growth and Development) Adulthood (Maintenance) Older Adult (Maintain Independence and Prevent Disability) Disability Threshold Age Developed by Fabio Comana MA., MS. All Rights Reserved Page 1
The Challenge: Getting older adults to be active is challenging. General trend towards becoming more sedentary, becoming physically unfit and experiencing disability from chronic medical conditions. While recognizing benefits of physical activity, resistance to change given tenure of hypo-activity and excuses: It doesn't feel good, it makes my arthritic joints hurt. It takes too much time, it's boring. Don t know what to do. Overall: Medication review ADL and IADL assessment Orthostatic blood pressure measurement Vision assessment Gait and balance evaluation Cognitive evaluation Assessment of environmental hazards Static Postural: Head forward Thoracic kyphosis (head tilt) Loss of lumbar lordosis Posterior pelvic tilt External femoral rotation Movement Screens (Primary Movement Patterns) Walking (Trendelenburg Gait) o Gait changes and contributing reasons Bend-and-lift Single-leg stand Push Pull Trunk Rotation Assessments Glenohumeral = Mobility Scapulo-thoracic = Stability Thoracic Spine = Mobility Lumbar Spine = Stability Hip = Mobility Knee = Stability Ankle = Mobility Foot = Stability Senior Fitness Tests (Fullerton Functional Fitness Tests) Rikli & Jones Chair Stand Arm Curl Test 6-minute Walk Test 2-minute Step Test Chair Sit-and-Reach Test Back Scratch Test 8-foot Get Up-and-Go Test Elite Sports Competition Fit Moderate Physical Work Functional Classification Independent Very Light Physical Work, Some AADL s Modified Berg Scale Fullerton Advanced Balance Scale Tinetti Balance and Gait Evaluation AAPHERD Functional Fitness Tests Frail Some IADL s, All BADL s Dependent Cannot do some BADL s Basic Activities of Daily Living: Feeding Continence Transference Toileti ng Dressi ng Disabled Developed by Fabio Comana MA., MS. All Rights Reserved Page 2
Developed by Fabio Comana MA., MS. All Rights Reserved Page 3
1. AADL s advanced ADL s (sports, vacation travel, gardening) 2. IADL s instrumental ADL s (cleaning, washing clothes, shopping) 3. BADL s Basic ADL s (dressing, washing, toileting, feeding) Fall Statistics and National Fall Prevention Strategy Types of Falls: Slipping, tripping or stumbling... 57.0 % Loss of balance, dizziness, fainting, seizure... 26.7 % Other (collision, pushing, shoving; jumping, etc.,)... 16.3 % Location of Falls: Inside the house 49.9 % Outside the house (but in close proximity - yard, etc.) 23.7 % Street, highway, or parking lot (away from home) 6.3 % Residential institution, health care facility, or public building 10.1 % Other (playground; park or recreation area, etc.) 10.0 % How big is this problem? In older adults, falls are leading cause of: Injury deaths and non-fatal injuries. Injury rate from falls: Adults > 65 years: 76 per 1,000 people. Adults < 65 years: 36 per 1,000 people. Medical costs (2000) (Stevens, et al., Injury Prevention, 2006): Fatal falls - $179 million Non-fatal injuries - $19 billion National Fall Prevention Strategy 4 Key Areas to Address: 1. Medication management. Review all medications - high risk for falls when taking 4 medications. Psychotropics (sedatives) and anti-hypertensives (cause postural hypotension) are key concerns. 2. Home safety engineering and administrative controls, personal protective equipment. 3. Environmental safety we have limited control in this area. 4. Physical abilities. Steps for NFPS Domains: Step One: Thoroughly review / have a health care provider review all medications. Step Two: Begin a regular exercise program Step Three: Check vision on a regular basis. Step Four: Make the home environment safer (engineering controls, administrative controls behaviors, personal protective equipment) Programming Functional Strength Training to mimic ADL s at real movement speed and complexity Fundamental Strength Free weights core engagement, basic movement patterns (motor learning & integration training) Foundational Strength Machines - stabilize body, fixed patterns; muscleisolation training (weak links) Reference: Wescott, W., 2010 Developed by Fabio Comana MA., MS. All Rights Reserved Page 4
ACE s IFT Model for Functional Movement and Resistance Training 1. Foundational Strength: Muscle isolation machines (lower extremity) Introduction to Stability-Mobility Training Core functional Segmental Stability 2. Fundamental Strength: Postural control Stability-mobility Balance Integrated Stability static Dynamic Balance Gait 3. Functional Strength: Movement Training Load Load Training Frequency: 2-3 x / week with a minimum of 48 hours recovery between sessions. Department of HHS recommendations: 2x / week. 1x / week = appropriate initial frequency Intensity: RPE 3 5 (on the Borg 1 10 Category-ratio scale). While 60 90 % 1RM (max effort) is generally optimal for all populations, utilize 40 60 % 1RM for older / frail individuals initially, then progress to 70 80 % 1RM (8-12 rep range). Reps and Sets: Minimum 1 set x 8 12 reps targeting 8 10 major muscle groups. 1 set x 12 15 repetitions at lower intensities for frail, de-conditioned, or adults > 50 years - provides sufficient stimulus to increase muscle. More conditioned and/or experienced older adults can follow programs for muscular endurance and strength similar to younger adults. DOMS Amount of muscle work (TUT, volume sets x reps). 1 set = less eccentric time under tension = reduced DOM 1 set vs. 2-3 sets (no significant differences during first 4 months of training, but demonstrates differences beyond 4 months. For individuals > 50 years of age (after 12 weeks of training) Strength Gains 1x 2x 3x Training Frequency / week Developed by Fabio Comana MA., MS. All Rights Reserved Page 5
Personal Attributes (Belief systems, age, experiences, etc.) Environmental Factors (Convenience, support, etc.) Physical Activity Factors (Injury, tolerance, etc.) Cognitive (Thinking) Associative (Feeling) Decisions and Choices Engage the older adult empower them to self-reliance by building self-efficacy and give them a positive, memorable experience Engage Ignite Innovate Instruct Empower Developed by Fabio Comana MA., MS. All Rights Reserved Page 6