Week Five Session 1 Session 5.1: Standing Balance Purpose Objectives Improve balance in general Improve balance while performing daily activities By the end of the session, elders will: Materials 1. Review WISE goal from session (4.1) and create new WISE goal. 2. Participate, as able, in Standing Balance Activities. Agenda Step or mat for each elder Chairs for balance for those that wish to use them (elders who use a cane/walker can use the cane/walker for balance) Small objects such as gloves or balls for reaching exercise Activity 1: Review WISE Goal 2, Set new WISE Goal 3 Form 3.1.1 Activity 2: Checking Your Standing Position Activity 3: Standing Balance with Different Foot Positions Activity 4: Marching with Head Movements Activity 5: Weight Changes while Standing Activity 6: Weight Changes while Stepping. WELL-Balanced Page 131
Activity 1: Discuss Goals Use WISE Goal, Form if you wish (20 minutes) Ask elders to share how they did on meeting their previous goals. You may want to ask them to share Which goals they were able to complete? What goals were the most difficult? Ask them to share ideas on how they can build on their successes. If they share obstacles that got in their way, ask the other elders for suggestions as to how to overcome those obstacles. If you are using the WISE Goal form, hand out a new one. WELL-Balanced Curriculum Page 132
Standing Balance Activities The type of support (chair, wall) elders will need for these exercises depends upon their individual abilities. Start by having all participants stand with their back to a wall with a chair in front of them. The exercises are designed to challenge the elders standing balance and, with practice to improve it. Safety Some elders may need to perform these exercises with their back about 2 feet from a wall, with a chair in front of them. Do not ask an elder to perform the next exercise until they can safely perform the task at hand. For example, do not ask elders to perform an exercise with their eyes closed if they are not able to do it safely with their eyes open. Instruct elders to open their eyes immediately if they feel they are about to lose their balance. Remind elders to perform all exercises within their comfort zone (never to a point of overexertion or beyond what feels safe), and to notify the coach if they feel any pain or experience any unusual symptoms. Elders should feel free to sit out an activity WELL-Balanced Page 133
Activity 2: Checking Your Standing Position (70 minutes for Activities 2 6) Before starting any of the standing balance activities, show your participants how to check their standing position. Show them the correct standing position. Have them practice while standing with their backs against the wall. Important Reminders STAND TALL Imagine that the top of your head is being pulled toward the ceiling by a string (imagine you are a puppet on a string). Look straight ahead. Focus on an object 5 or 10 feet in front of you. Try to hold each standing position for 15 to 20 seconds. NEVER HAVE ELDERS CLOSE THEIR EYES UNTIL THEY ARE COM- FORTABLE WITH THE EXERCISE ALWAYS HAVE A CHAIR CLOSE IN CASE THEY BEGIN TO LOOSE THEIR BALANCE WELL-Balanced Curriculum Page 134
To make sure elders are standing correctly, say to them: Stand with your back against the wall, feet flat on the floor with your heels about 6 inches from the wall. Relax your arms and let them hang by your sides. (Check to make sure the space between the arm and body is equal on both sides for each elder.) Hold your head up, look straight ahead, and focus on an object 5 to 10 feet in front of you. Gently move your head straight back until your ears are above your shoulders. STAND TALL. (Check that elders upper backs are straight and chests slightly lifted.) Pull your stomach muscles in and up so that your stomach flattens. (Check to see that their lower back has a slight curve to the front and that the hips are level, the kneecaps are facing forward, and the ankles and feet are straight.) Your body weight should be equal on each foot. Looking straight ahead with your eyes focused on an object in front of you, breathe normally, and hold this standing position for 15 seconds. IF APPROPRIATE: Now, still breathing normally, close your eyes, hold this standing position, and try to focus on the feeling of standing correctly. WELL-Balanced Page 135
Activity 3: Standing Balance with Different Foot Positions These exercises teach the elders how to keep their body steady when their feet are in different positions. They will make everyday activities such as walking, stepping into and out of the bathtub, and standing in crowded spaces easier. Elders must stand near a wall or chair to steady themselves when needed. Safety precaution: Most elders will not be able to stand with their feet together (side by side or heel to toe). Always start with feet hip distance apart. Always have a chair within reach of each elder in case they need it for balance. Only use more difficult position or eyes closed (in red) if you are certain it will be safe Changing Foot Position 1. Breath normally throughout 2. Stand with your feet hip distance apart 3. Hold the position for 15 seconds 4. Stand with feet slightly apart, one foot in front of the other 5. Hold the position for 15 seconds WELL-Balanced Curriculum Page 136
Changing Foot Position More difficult 1. Breath normally throughout 2. Stand with your feet hip distance apart -Hold the position for 15 seconds Repeat with your eyes closed MORE DIFFICULT: repeat with feet together 3. Stand with feet slightly apart, one foot in front of the other (stand with feet together, one foot in front of the other) -Hold the position for 15 seconds Repeat with your eyes closed 4. Stand with one foot in front of the other, heel to toe -Hold the position for 15 seconds -Repeat with your eyes closed 5. Stand on one foot (you may rest your raised foot on your calf) -Hold the position for 15 seconds Repeat with your eyes closed WELL-Balanced Page 137
Repeat with Actions: repeat each exercise from Changing Foot Position adding a small action such as singing a song or counting backward. 1. Stand with your feet hip distance apart -Count or sing as you hold the position for 15 seconds 2. Stand with feet slightly apart, one foot in front of the other -Count or sing as you hold the position for 15 seconds WELL-Balanced Curriculum Page 138
Repeat with Actions More Difficult 1. Stand with your feet hip distance apart -Count or sing as you hold the position for 15 seconds 2. Stand with feet together -Count or sing as you hold the position for 15 seconds 3. Repeat with your eyes closed 4. Stand with feet slightly apart, one foot in front of the other -Count or sing as you hold the position for 15 seconds 5. Stand with feet together, one foot in front of the other -Count or sing as you hold the position for 15 seconds 6. Repeat with your eyes closed 7. Stand with one foot in front of the other, heel to toe -Count or sing as you hold the position for 15 seconds 8. Repeat with your eyes closed 9. Stand on one foot (you may rest your raised foot on your calf) -Count or sing as you hold the position for 15 seconds 10. Repeat with your eyes closed WELL-Balanced Page 139
Repeat While Reaching: Repeat each exercise from Changing Foot Positions while reaching for an object. For this exercise elders will need to be in groups of 2 (have them pair up). They will take turns holding an object and reaching for an object. Use several different objects (a ruler, a book, a ball) and change the position of the object (head high, waist high, knee high) for each try. 1. Stand with your feet hip distance apart -Reach for the object your partner is holding -Continue reaching for the object as your partner changes the height of the object (3 or 4 times) 2. Stand with feet slightly apart, one foot in front of the other -Reach for the object your partner is holding -Continue reaching for the object as your partner changes the height of the object (3 or 4 times) 3. Switch places with your partner and repeat each exercise WELL-Balanced Curriculum Page 140
Repeat While Reaching More Difficult 1. Stand with your feet together -Reach for the object your partner is holding -Continue reaching for the object as your partner changes the height of the object (3 or 4 times) 2. Stand with feet together, one foot in front of the other -Reach for the object your partner is holding -Continue reaching for the object as your partner changes the height of the object (3 or 4 times) 3. Stand with one foot in front of the other, heel to toe -Reach for the object your partner is holding -Continue reaching for the object as your partner changes the height of the object (3 or 4 times) 4. Stand on one foot (you may rest your raised foot on your calf) -Hold the position for 15 seconds 5. Switch places with your partner and repeat each exercise WELL-Balanced Page 141
Activity 4: Marching with Head Movements Many elders become unsteady just going through a regular day. These marching exercises will help improve balance during daily activities that require turning your head as you walk, for example, looking for cars as you cross the road or to replying to a friend s greeting. Marching in Place 1. Stand tall, look straight ahead 2. March in place by lifting one knee after the other (knees should move straight up, and straight down) 3. Continue marching for 30 seconds Marching in Place with Head Turns 1. Stand tall, look straight ahead 2. March in place for 8 counts 3. March in place for 8 counts while turning your head to the right 4. March in place for 8 counts while turning your head back to the front 5. March in place for 8 counts while you turn your head to the left 6. Repeat this exercise 3 to 5 times WELL-Balanced Curriculum Page 142
Activity 5: Weight Changes while Standing Remember as you start each exercise: DEMONSTRATE The Rocking Steps are slow movements. The Four Corner uses full steps both feet move to a new position. Forward Right and Left Rocking Steps 1. Stand tall, looking straight ahead, feet shoulder width apart 2. Move your body weight to your left leg 3. Step forward with your right foot Your right knee should be bent as your foot meets the floor 4. Move your body weight to the right leg and hold for 3 counts 5. Move your body weight back to your left leg 6. Step your right leg back to your starting position 7. Repeat this forward step with your right foot 10 times 8. Move your body weight to your right leg and repeat the exercise with your left foot 9. After you complete the movement with both feet More difficult: Repeat the exercise with your eyes closed WELL-Balanced Page 143
Four-Corner Stepping 1. Stand tall, eyes looking forward, feet shoulder width apart 2. Take one step forward with your right foot (step, close) 3. Take one step sideways to your right with your right foot (step, close) 4. Take one step backward with your right foot (step, close) 5. Take one step to your left with your left foot (step, close) 6. You have stepped out the four corners of a box 7. Repeat in the opposite direction starting with your left foot 8. Repeat 3 to 5 times in each direction WELL-Balanced Curriculum Page 144
Activity 6: Weight Changes with Step You need a mat step for each elder; or you can mark off rectangles on the floor with tape. Toe Touches 1. Stand tall, facing your mat, feet shoulder width apart, toes about 4 inches from the mat 2. Shift your weight to your left foot and 3. Touch the mat with the toe of your right shoe 4. Return to starting position 5. Shift your weight to your right foot and 6. Touch the mat with the toe of your left shoe 7. Return to starting position 8. Repeat 8 times WELL-Balanced Page 145
Toe Touches More Difficult For the more difficult portion of these exercises, use a step (platform) for each elder. The height of the step (2, 4, or 6 inches) will depend upon the abilities of your elders. Add height to increase the difficulty of the movements. 1. Stand tall, facing your step, feet shoulder width apart, toes about 4 inches from the step 2. Shift your weight to your left foot and 3. Touch the step with the toe of your right shoe 4. Return to starting position 5. Shift your weight to your right foot and 6. Touch the step with the toe of your left shoe 7. Return to starting position 8. Repeat 8 times WELL-Balanced Curriculum Page 146
Forward Step Up 1. Stand tall, facing your mat, feet shoulder width apart, toes about 4 inches from mat 2. Shift your weight to your left foot and 3. Step forward onto the edge of the mat with your right foot (your right heel will be slightly off the edge) 4. Transfer your weight to your right foot as you move your left foot onto the edge of the mat (both heels are just off the edge of the step) 5. Hold for 2 to 5 seconds 6. Return to starting position 7. Repeat with the left foot 8. Repeat the exercise 8 times WELL-Balanced Page 147
Forward Step Up More Difficult 1. Stand tall, facing your step, feet shoulder width apart, toes about 4 inches from step 2. Shift your weight to your left foot and 3. Step forward onto the edge of the step with your right foot (your right heel will be slightly off the edge) 4. Transfer your weight to your right foot as you move your left foot onto the edge of the step (both heels are just off the edge of the step) 5. Hold for 2 to 5 seconds 6. Return to starting position 7. Repeat with the left foot 8. Repeat the exercise 8 times WELL-Balanced Curriculum Page 148
Backward Toe Touches 1. Stand tall, your mat behind you, feet shoulder width apart, heels close to the mat 2. Shift your weight to your left foot and 3. Touch the top of the mat with the toe of your right shoe 4. Return to your starting position 5. Shift your weight to your right foot and 6. Touch the top of the mat with the toe of your left shoe 7. Return to your starting position 8. Repeat 8 times with each foot Backward Toe Touches More Difficult 1. Stand tall, your step behind you, feet shoulder width apart, heels close to the step 2. Shift your weight to your left foot and 3. Touch the top of the step with the toe of your right shoe 4. Return to your starting position 5. Shift your weight to your right foot and 6. Touch the top of the step with the toe of your left shoe 7. Return to your starting position 8. Repeat 8 times with each foot WELL-Balanced Page 149
Backward Step Up 1. Stand tall, your mat behind you, feet shoulder width apart, heels close to the mat 2. Shift your weight to your left foot and 3. Step backward onto the mat with your right foot 4. Shift your weight to your right foot and step backward onto the mat with your left foot (you are standing on the step) 5. Slowly raise your heels and 6. Hold for 2 to 5 seconds 7. Return to your starting position 8. Repeat with your other foot (step back with your left foot) 9. Repeat 8 times Backward Step Up More Difficult 1. Stand tall, your step behind you, feet shoulder width apart, heels close to the step 2. Shift your weight to your left foot and 3. Step backward onto the step with your right foot 4. Shift your weight to your right foot and step backward onto the step with your left foot (you are standing on the step) 5. Slowly raise your heels and 6. Hold for 2 to 5 seconds 7. Return to your starting position 8. Repeat with your other foot (step back with your left foot) 9. Repeat 8 times WELL-Balanced Curriculum Page 150
Side Toe Touches ( Taps ) 1. Stand tall, your mat on your right, feet shoulder width apart, foot 2 3 inches from the mat 2. Shift your weight to your left foot and 3. Touch the center of the mat with the toe of your right shoe 4. Return to your starting position 5. Repeat 8 times 6. Move the mat to your left side 7. Repeat the exercise with your left foot Side Toe Touches ( Taps ) More Difficult 1. Stand tall, your step on your right, feet shoulder width apart, foot 2 3 inches from the step 2. Shift your weight to your left foot and 3. Touch the center of the step with the toe of your right shoe 4. Return to your starting position 5. Repeat 8 times 6. Move the step to your left side 7. Repeat the exercise with your left foot WELL-Balanced Page 151
Side Step Raises 1. Stand tall, your mat on your right, feet shoulder width apart, foot 2-3 inches from mat 2. Shift your weight to your left foot and 3. Step up onto your mat with your right foot 4. Shift your weight to your right foot and 5. Lift your left foot off the floor 6. Hold for 3 seconds 7. Set your left foot on the floor and 8. Step back down to your beginning position 9. Repeat 8 times on each side Side Step Raises More Difficult 1. Stand tall, your step on your right, feet shoulder width apart, foot 2-3 inches from step 2. Shift your weight to your left foot and 3. Step up onto your step with your right foot 4. Shift your weight to your right foot and 5. Lift your left foot off the floor 6. Hold for 3 seconds 7. Set your left foot on the floor and 8. Step back down to your beginning position 9. Repeat 8 times on each side WELL-Balanced Curriculum Page 152
Forward Step-Up/Step-Downs 1. Stand tall, facing your mat, feet shoulder width apart, toes about 4 inches from mat 2. Step forward onto the mat right foot first 3. Step backward down from mat right foot first 4. Repeat with your left foot stepping up first 5. Repeat 8 times Forward Step-Up/Step-Downs More Difficult 1. Stand tall, facing your step, feet shoulder width apart, toes about 4 inches from step 2. Step forward onto the step right foot first 3. Step backward down from step right foot first 4. Repeat with your left foot stepping up first 5. Repeat 8 times WELL-Balanced Page 153
Forward Step-Up/Step-Downs, Changing Sides 1. Stand tall, facing your mat, legs shoulder width apart, toes about 4 inches from the mat 2. Step forward onto the mat - right foot first 3. Step forward and down from the mat 4. Turn around and face the mat 5. Repeat, starting with your left foot 6. Repeat 8 times Forward Step-Up/Step-Downs, Changing Sides More Difficult 1. Stand tall, facing your step, legs shoulder width apart, toes about 4 inches from the step 2. Step forward onto the step - right foot first 3. Step forward and down from the step 4. Turn around and face the step 5. Repeat, starting with your left foot 6. Repeat 8 times WELL-Balanced Curriculum Page 154
Forward Swing-Through Steps Only 1 foot touches the Step 1. Stand tall, facing your mat, legs shoulder width apart, toes about 4 inches from the mat 2. Step forward onto the mat with your right foot 3. Lift your left foot up and over the mat (If you need to touch the step on the way, that is all right.) 4. Place it on the floor on the other side of your mat 5. Bring your right foot down beside the left (your mat is behind you) 6. Turn around and repeat, this time starting with your left foot 7. Repeat 8 times Forward Swing-Through Steps More Difficult Only 1 foot touches the Step 1. Stand tall, facing your step, legs shoulder width apart, toes about 4 inches from the step 2. Step forward onto the step with your right foot 3. Lift your left foot up and over the step (If you need to touch the step on the way, that is all right.) 4. Place it on the floor on the other side of your step 5. Bring your right foot down beside the left (your step is behind you) 6. Turn around and repeat, this time starting with your left foot 7. Repeat 8 times WELL-Balanced Page 155
Side Step-Up/Step-Downs, Same Side 1. Stand tall, mat on your right, legs shoulder width apart, foot 2 3 inches from mat 2. Step sideways to your right onto the mat (right foot first ) 3. You are standing on the mat 4. Step sideways to your left back onto the floor (your starting position) 5. Repeat 8 times. 6. Move to the other side of your mat (mat is on your left) 7. Repeat the exercise stepping sideways to your left Side Step-Up/Step-Downs, Same Side More Difficult 1. Stand tall, step on your right, legs shoulder width apart, foot 2 3 inches from step 2. Step sideways to your right up onto the step (right foot first ) 3. You are standing on the step 4. Step sideways to your left back onto the floor (your starting position) 5. Repeat 8 times. 6. Move to the other side of your step (step is on your left) 7. Repeat the exercise stepping sideways to your left WELL-Balanced Curriculum Page 156
Side Step-Up/Step-Downs, Opposite Side (across) 1. Stand tall, mat on your right, feet shoulder width apart, foot 2 3 inches from step 2. Step sideways to your right onto the mat (standing on the mat) 3. Step sideways to your right, off the other side of the mat 4. Repeat 8 times 5. Move the mat to your left side 6. Repeat the exercise Side Step-Up/Step-Downs, Opposite Side (across) More Difficult 1. Stand tall, step on your right, feet shoulder width apart, foot 2 3 inches from step 2. Step sideways to your right up onto the step (standing on the step) 3. Step sideways to your right, off the other side of the step 4. Repeat 8 times 5. Move the step to your left side WELL-Balanced Page 157
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Week Five- Session 2 Session 5.2: Group Movement Purpose Have elders participate in group movement Objectives By the end of the session, elders will: Materials 1. Participate, as able, in group movement 2. Describe their exertion level using the RPE scale Agenda Music and player 3 strips of resistance band for each elder (one yellow, one red, and one green each about 30 inches long) RPE Table posted where elders can see it while they exercise Activity 1: Warm-up (10 minutes) Activity 2: Endurance (5-10 minutes) Activity 3: Strengthening (15 minutes) Activity 4: Flexibility (10 minutes) Activity 5: Transition to the Day (10 minutes) Use the Activities from Week 3-Session 2 Remind elders to perform all exercises within their comfort zone (never to a point of overexertion or beyond what feels safe), and to notify the coach if they feel any pain or experience any unusual symptoms. Elders should feel free to sit out an activity. Start with Activity 1 WELL-Balanced Page 159
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