Early 2015 it was suggested to me by a Geriatric Care Manager(GCM) to prepare a proposal to speak at the Western Regional Geriatric Care Manager's Conference November 5-7, 2015 for the first time offered in Portland Oregon. The GCM mentioned that the targeted exercise training that I had provided for her father in law provided him with the opportunity to stay at home with the strength and mobility to live out his life at home longer rather than having to move to a care facility. The in-home exercise service beyond physical therapy has not been widely recognized as a choice for older adults not only to restore function, improve fitness and health, but also as a palliative exercise choice so that the individual can maintain function or slow down functional declines due to the disease process.
I decided to develop the proposal and enlisted the additional expertise of our PT Bayla O'Brien as well. The topic name "Aging in Place: Long-Term Solutions to Independence and Fall Risk Reduction".
Falls are the main reason older adults lose their independence, one out of three older adults fall annually and most falls occur at home. GCMs are continually weighing risk/benefit of aging in place for a given individual. This session provides assessment tools the GCM can integrate into client care plans to minimize fall risk and improve balance, mobility and strength- all keys to independence and quality of life. The Medicare Annual Wellness Visit provides valuable information the GCM can use to strengthen care plans and collaborate with client’s family and healthcare providers for simple, practical interventions. This session will broaden the GCM’s resource base for health and fitness professionals who help clients develop and practice basic safety and ADLS in their own home –decreasing falls in the location of highest risk.
I am very happy to report that every seat was taken in the room and that this topic was very important to GCM's who's main interest is to maximize their clients functional potential and quality of life.
Lifestyle Medicine is a branch of medicine dealing with research, prevention and treatment of disorders caused by lifestyle factors such as nutrition, physical inactivity, and chronic stress. The leading causes of mortality and healthcare costs worldwide are chronic diseases, resulting from lifestyle and environmental factors. The economic burden of poor lifestyle choices is no longer sustainable and impossible to ignore. Most chronic diseases are preventable!
To treat the causes of these diseases and to be successful in prevention, a strong focus must be placed on lifestyle medicine aspects. Lifestyle Medicine encompasses research, prevention, diagnosis and treatment of dysfunctions caused by a non-physiological lifestyle (lifestyle-related diseases, LRDs) and morbidogenic environments conducive to promoting such lifestyles.
Primary goal of lifestyle medicine: The ultimate goal and primary focus of Lifestyle Medicine is to promote healthier lives through salutary environments and healthier lifestyle choices. Treatment of LRDs includes nutritional, exercise, psychological, social, economic and environmental interventions.
To successfully do this requires education, training and communication about Lifestyle Medicine at the professional and general public level, while avoiding the trap of ‘victim blaming’ of individuals whose lifestyles are influenced by circumstances beyond their control.
EXERCISE IS MEDICINE: In 2007, the American Medical Association (AMA) and the American College of Sports Medicine (ACSM) co-launched Exercise is Medicine (EIM) - a United States-based health initiative that has since been coordinated by ACSM. The initial purpose of EIM was to make the scientifically proven benefits of physical activity the standard in the U.S. healthcare system. The new world of healthcare is focused on at-risk population groups that require interventions to slow, stop and reverse the progression of chronic diseases. In any particular community, healthcare stakeholders will depend on trusted EIM exercise professionals, as part of their community care team, to meet the demand for engagement in interventions
Physical activity (PA) is a powerful complement to traditional medical intervention and, in many instances, allows a physician to significantly reduce a patient's drug dosage or eliminate the need for medicine altogether. A great example of this is that targeted exercise has the same effect on reducing blood sugar as many diabetes drugs, and thus reduced medication or dosage is expected. Medications often have a large number of undesireble side effects for which patients take addiinal mediation which often all can be eliminated with targeted exercise.
Exercise professionals serve a continuum of client needs: Some clients wish to optimize their athletic performance; some wish to improve their fitness; and, increasingly, many wish to elevate their physical actiity levels to prevent or manage chronic disease. Exercise professionals play an integral role in educating clients about the benefits of becoming more active and in communicating how clients can speak with their primary care physicians about ways to increase their physical activity.
Exercise professionals are extensions of a healthcare “team” -- working with the clinical care team on the other side of the healthcare system-to-community bridge. Organizations and locations that are designated as EIM Places are also becoming a part of this shift.
American College of Sports Medicine Fitness professionals are EIM credentialed and are trained to work with patient populations that have been stratified by chronic diseases, levels of risk, motivational readiness and personal preferences. The ACE Medical Exercise Specialist holds similar credentials and are also powerful extension to their clients' healthcare team.
Jacqueline Sinke and her team of health fitness professionals have the required certifications, qualifications and have the experience and expertise to optimize your function, health, fitness and performance, enhance quality of life with targeted and beneficial exercise training. Best of all; We Come To YOU with IN-HOME Exercise Training.
Active Aging Week celebrates aging and active living. Active Aging was initiated and is a product of the International Council on Active Aging (www.ICAA.cc). The week promotes the benefits of a healthy lifestyle on a national scale by giving older adults the opportunity to experience activities and exercise in a safe, friendly and fun atmosphere. This year's theme LIVE YOUR ADVENTURE.
To STAY Independent Longer, LIVE Strong with Better Function, Health, Fitness and Performance physical activity and targeted exercise are a MUST. When you are older, and have a medical condition or conditions, your exercise program needs to be more targeted to be able to deliver the benefits you are looking for. Just participating in a well-rounded program may not provide you with the results you are looking for.
There are guidelines that have been developed to help older adults start an exercise program. These guidelines have been developed by the American College of Sports Medicine (ACSM) and the American Heart Association (AHA). For more information on the guidelines and specific recommendations, please visit www.Exerciseismedicine.org
When you have been diagnosed with a or multiple medical conditions a more targeted exercise program can help you better manage and also treat the condition. The ACSM Exercise Physiologist, ACSM Cancer Exercise Trainer and ACE Medical Exercise Specialist are qualified to develop and deliver specific and complementary clinical exercise programs and can work in conjunction with your healthcare team to establish the most effective health and fitness plan. Be active and live your adventure!
As we get older we may come to realize that we don’t bounce back or recover as quickly from an injury, or that the ‘spring in our step’ is not there any longer. Regular exercise definitely has a lot to do with how fast we recover, how vital we feel, and how we perform all those daily tasks and recreational activities. Just like financial planning for retirement, planning for a strong healthy body that can pull us through old age, living independent with a high quality of life also takes planning. And we need to be SMART about it. We don’t want to waste our time and effort and want to get the biggest bang for our buck!
First: to achieve and maintain health there are guidelines, thank goodness!
The American College of Sports Medicine and the American Heart Association have set guidelines for health care professionals and fitness professionals for your safety, effectiveness and benefit.
Here is the your guideline to develop YOUR DECLARATION OF INDEPENDENCE
Guidelines for healthy adults under age 65 with no apparent chronic disease or condition:
STEP 1 - Set aside time each day to exercise. Getting started can often be the most difficult part of any exercise routine. Scheduling exercise into your day and making it a priority will increase the chance of being successful.
STEP 2 - Choose cardiovascular activities you enjoy, such as swimming, biking, or playing basketball with friends to get your daily physical activity. If you need a variety of activities to stay motivated, combine a few that appeal to you. Physical activity can be accumulated through a variety of activities, not just running. Walking is a great way to do moderate-intensity physical activity. Moderate-intensity physical activity means working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation.
STEP 3 - Start with 10 to 15 minutes of cardiovascular exercise daily. Each week, add five minutes to your exercise routine until you reach 30 minutes of moderate intensity for a minimum of five days per week. Alternately, you may do 20 minutes of vigorous-intensity exercise three days per week. The 30-minute recommendation is for the average healthy adult to maintain health and reduce the risk for chronic disease. It should be noted that to lose weight or maintain weight loss, 60 to 90 minutes of physical activity may be necessary.
STEP 4 - Incorporate strength training into your routine. Do eight to 10 strength training exercises, eight to 12 repetitions of each exercise twice a week. This can be accomplished by using dumbbells, resistance bands or your own body weight. If you are unsure how to perform the exercises correctly, seek the advice of an exercise professional
Guidelines for adults over age 65 (or adults 50-64 with chronic conditions, such as arthritis)
STEP 1 – Begin by following the four steps listed above. Both aerobic and muscle strengthening activity is critical for healthy aging.
STEP 2 - If you are at risk of falling, perform balance exercises. If you are unsure how to perform the exercises correctly, seek the advice of an exercise professional. Choose a professional who has the qualifications to assess your balance and provide targeted balance and mobility training (FallProof Balance an Mobility Specialist Instructor).
STEP 3 - Have a physical activity plan. Older adults or adults with chronic conditions should develop an activity plan with a health professional to manage risks and take therapeutic needs into account. This will maximize the benefits of physical activity and ensure your safety.
An ACSM Exercise Physiologist (ACSM EP-C), ACSM Clinical Exercise Specialist (ACSM CES), or ACSM Cancer Exercise Trainer (ACSM CET), ACE Medical Exercise Specialist (ACE CMES) are qualified to do just that.
Exercise recommendations to achive a higher level of fitness or sport perfomance:
Whe your goal is enhanced fitness or exercise to maintain or maximize athletic perfomnce you needto exceed the minimal recommended guidelines. You need to invest more time and effort into your workout program andpay strict attention to nutriion.
For more information visit: www.exerciseismedicine.org
Dr. Wayne Westcott Ph.D. states that it is important to realize that muscles are the engines of our bodie . He explains that our muscles are where combustion occurs, where energy is released, where power is produced, and where movement originates.
Muscles have long been recognized as key factors in physical performance and athletic achievement, however strength training has a much greater application by having a major influence on both our physical and mental health.
Adults who do not perform resistance exercise lose almost 5 pounds of muscle every decade before age 50 and up to 10 pounds of muscle every decade after age 50.
Research shows that much of the declines of aging are associated with inactive aging. Dr. Westcott explains that one aspect of aging is a reduction in mitochondrial content and function.
Strength training or resistance training has been shown to increase both muscle tissue mitochondrial content and oxidative capacity. A study of older adults participating in a standard resistance training program experienced favorable changes in 179 genes associated with age and exercise performance. After the strength training program the older adult mitochondrial gene expression was similar to that of moderately active young adult(24 years).
Resistance training reverses specific age factors in skeletal muscle. Muscle tissue can be increased in adults of all ages, including individuals in their 90s. In a study of nursing home residents 28 brief sessions in resistance exercise (twice weekly, 14 weeks) resulted in almost 4lb increase in lean weight (includes muscle and bone), 3lb reduction in body fat, 60% increase in muscle strength, and a 14% improvement in functional independence.
Additional evidence based benefits associated with aging due to resistance training:
- Improved bone mineral density in both pre-menopausal and post-menopausal women between 1% and 3% in a 1 to 2 year resistance training programs
- Prevent falls and fractures. Please note that 1 out 3 older adults over the age of 65 falls each year and a large percentage will not be returning to their home.
- Reduced risk for diabetes: resistance training increases insulin sensitivity and optimized blood sugar uptake.
- Resistance training can also be an effective intervention for counteracting age associated changes in insulin sensitivity and for preventing Type 2 diabetes in middle-aged and older adults.
- Significant reduction in blood pressure
- Improved cholesterol levels
- Decrease in body fat
- Resistance training is effective treatment therapy in obesity and is recommended in the management of obesity and related metabolic disorders, including resting blood pressure, cholesterol, high blood sugar, high waist circumference-- all these are associated with development of Type 2 diabetes and heart disease.
Whether your goal is to stay healthy or improve your physical function, or staying independent at advanced age; resistance training must be part of your exercise regimen to receive these benefits.
Fitness & Function specializes in improving health and physical function of people 40 to ageless 90+ years of age.
When you are 60 or older or have a medical condition we need a medical release from your health care provider. A completed health medcial activity history, most recent blood tests and bone density if available allow us to develop the most beneficial exercise program.
When you are a healthy adult or older adult with no apparent health problems a standard resistance training program can prevent development of chronic illness and help you you fit and functional well in to your 90s and beyond.
I recently read a fantastic book: “BALANCE In Search of the Lost Sense” by Scott McCredie which reinforces my believe that our body is an amazing machine, a super computer that is capable for making adaptations to the challenges we place upon it even at advanced age(90+ years)!
This book shows that the type of physical activities performed on regular basis affect how well we can live and how efficiently our bodies can function even at advanced age. This books goes into detail about our vestibular system; THE NEXT BIG THING IN FITNESS, how its function affects anyone from a fetus in the womb to older adults with balance problems to pilots, athletes, that it relates to our cognitive function, fear of heights and fear of crowds and most of all that it can improve and that we can maintain its function with appropriate training. You have probably said once or twice in your life that you are “out of shape “, which really is not possible because you are in the shape you have adapted to as a result lifestyle habits and challenges placed upon it. Our function (physical function, cognitive function, optimize our use of vision, proprioception and vestibular) will improve when we challenge it and do it regular and consistently. Even while we are aging we can maintain function to the end.
I was excited to read another article this month by Wayne Westcott, Ph.D., in the 2nd. Quarter issue of ACSM Certified News about the benefits of resistance exercise for older adults and elderly individuals.
An enormous amount of research has been done since the 1980's on the benefits of muscle strengthening exercise and the aging body. Some of you reader may remember that I worked as a research instructor for doctor Westcott in Massachusetts and was involved in exercise training various populations including older adults and how resistance training effects the body.
Older adults participating in regular strength training benefit from a gene expression reversal (179 genes associated with age and exercise) that resulted in muscle mitochondria characteristics similar to those in moderately active younger adults(average age 24 years).
Now this may not mean very much to you, however, when you are able to:
- boost metabolism and reduce body fat
- increase strength and flexibility that improves your functional fitness and balance
- increase gastrointestinal and as a result are able to avoid developing colon cancer
- improve your cholesterol levels and reduce your blood pressure
- reduce blood sugar and thus are able to prevent development of diabetes
- are able to increase your bone mineral density and avoid osteoporosis and fracture risk
- do not have to take any medication and not have to deal with side effects of medication
All these are benefits of resistance training and directly affect your quality of life and, may be more important, can help you stay independent as you age.
Dr. Westcott's answer to the question why relatively few older adults and elderly perform regular resistance training was that "there is low participation rate due to motivation or believe that successful strength training requires long, laborious and frequent exercise which fortunately is not the case.
ACSM training recommendations for older adults are 8-10 exercises that involve major muscle groups, performed for 1 or more sets of 10-15 repetitions each, 2 or more days per week.
When 2 hours of training per week can keep you independent, healthy and functionally independent doesn't this beat the alternative?
Fitness & Function specializes in targeted exercise training for mature and aging adults with the goal of achieving a high quality of life, functional health and fitness and long-term independent living.
When you have difficulty getting out of your chair, need a walker for mobility and have had several falls you maybe considering assisted living care, right? This is a decision that should not be made too fast before exploring other options. The other option is targeted exercise and exercise specifically in falls risk reduction.
At age 92 our client X was facing this dilemma, a comprehensive pre-exercise screening determined s/he was at high risk of falling by scoring 2% on the chair stand test and 20% on the 8-foot up and go test with a 38 out of a max 56 score on Berg Balance Scale.
We implemented the multidimensional and multisensory FallProof Balance and Mobility program-training regimen twice a week. Lower body strength improved by 58% bringing our client up to the 60th percentile which is the cut-point score best associated with having the fitness level needed to perform the types of activities required to remain physically independent until late life, with late life defined as age 90 and beyond. Additional improvements experienced: 8-foot up and go test from 20% to 45% and Berg Balance Scale improved from a 36 score to a whopping score of 51(max score is 56).
During the last 3 years client X had a stroke causing a temporary loss of vision, mobility and strength, however with continued multisensory and multi dimensional exercise training client X is in better shape now than before the stroke.
Now 3 years later and 95 years of age, client X is still going strong and is planning again his annual trip to the East Coast.
Falls are the main reason why oldder adults lose independence. Balance problems are often a subject that is ignored for too long to the point that injuries happen.
Question(1) Do you have balance problems, but no falls and do not use a cane or walker or other person to keep you up? If your answer is Yes, a community balance and mobility program may provide benefits.
Question (2) have you had 1 or 2 falls with or without injury? If your answer is yes, a targeted and individualized balance and mobility program and/ or physical therapy may provide best results.
However, speaking with your doctor is important. Also prepare for your Annual Medical Wellness Visit and request a fall risk assessment, this includes:
- Physical exam
- Medication review(CDC STEADY Recommendations)
- Eliminating medication that places you at high risk for falling. For example psychoactive drugs and over the counter drugs such as Tylenol PM(which contains Benadryl and Benadryl
- Reducing doses of medications (e.g. , anti hypertensives) to the lowest effective dose
- Avoiding prescribing medications where the side effect outweighs the benefit(e.g., skeletal muscle relaxants)
- As your doctor to check the following risk factors: Postural dizziness(dizzy standing from seated or lying position)
- Feet and footwear
- Use of mobility aids (cane, walker, another person)
- Visual acuity check
- Vitamin D ( is testing due)
- Calcium, do you need additional supplemention
The following are modifiable risk factors for falling that you can do something about:
- Lower body weakness
- Previous falls
- Muscle weakness
- Gait and balance problems
- Poor vision
- Postural hypotension
- Chronic conditions (e.g., arthritis, stroke, Parkinson's, incontinence, dementia, osteoporosis) Fear of falling
Remember that there are numerous risk factors for falling and these vary between each person. But falls remain the main reason older people lose independence and therefor should be the #1 reason to talk to your doctor about.
The most beneficial balance and mobility programs that provide the best benefits are those that include comprehensive assessments and are individualized, preferably One-on-one and are with a certified balance and mobility specialist (best program is FallProof) or Physical Therapist who specializes in balance and mobility disorders.