Balancing Your Fitness Program
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Presented for the International Council for Active Aging,December 2010: It will give you many ways to add balance to everyday fitness programming for older adults
Balancing Your Fitness Program
- 1. Balancing Your Fitness ProgramAdding Balance to Everyday Fitness for Older AdultsI Blame ABLE Bodies for this
- 2. Achieve Better Living with ExerciseWith permission: ABLE Bodies Balance Training, 2008; Human KineticsRenewable Fitness, LLC
- 4. Randomized Control Trial Robert Wood Johnson Foundation
- 5. Study Sites & Participants 84 Adults70+ yrs old
- 6. Mean age = 83.5 yrsCCRCsContinuing Care Retirement facilities, Independent - Assisted Living Study Demographics Medical Conditions Diabetes 12 Heart Disease 19High BP 46 Stroke 13Arthritis 40 Osteoporosis 13 Joint Pain 27 Hip Surgery 8GenderFemale 69Male 15Prescribed MedsNone3 1 to 3 294 to 9 32> 9 838% used Walkers
- 7. ResultsSignificantly ImprovedBalance & Mobility
- 9. Strength
- 10. FlexibilityPublishedMedicine and Science in Sports & Exercise, 2005PresentedACSM, ICAA, APHA, IAHSA, IDEA World
- 11. Add Balance to Your Programs
- 12. Exercise ScienceProtocolsPeer reviewed, publishedMode, Intensity, Frequency, DurationSpecific to GoalsSpecific to Systems
- 13. Exercise PrescriptionRecipe . . . written to address certaingoals, systemsMode activity choices (active ingredient)
- 14. Intensity challenge (dose)
- 15. Frequency how often
- 16. Duration how longAddress Specific Goals Get out of chairsUpright posture Reach & Turn Gait & Mobility Climb stairs Get up from floorConfidence
- 17. ACSM Protocols for Balance in ElderlyConform to accepted theories for balance controlMulti ModalAddress all systems & components of balanceEngaging, challenging, complex, layered, functionalProgressively difficult postures, gradually reduce Sensory inputBase of supportDynamic movements disturb Center of GravityStrengthen leg and postural musclesBuild strength before endurance A Walk in the Park
- 18. Multi-modal: Address allSystems & Components for BalancePostureFlexibilityStrengthEndurance Sensory SystemsVisionVestibularSomatosensoryAutomatic, Central, NM & IntegrativeCognitionExperiencesSkills & Learning
- 19. Sensory SystemsIncoming information about our environment
- 20. Sensory Systems for BalanceVisionSomatosensory (touch, proprioception)Vestibular
- 21. How Sensory Systems Function for BalanceSource: Fay Horak, PhD; NSI Balance Disorder Laboratory, Hillsboro Oregon; used with permission
- 22. Sensory WeightingFirm Surface70% Somatosensory20% Vestibular10% VisionUnstable, Compliant Surface10% Somatosensory60% Vestibular30% VisionTall StandHorak, Fay B; OHSU, NSI Balance Disorders Lab; Hillsboro, OR; used w/permissionBalance Mat w/head turns
- 23. Manipulate VisionEnhance visionOptimal lightingExternal CuesVisual TargetsEyes on the PrizeVertical linesMirrorsModeling Reduce visionLess optimal lightingDim the lightsSun glassesNo-body glassesFewer external cuesEyes on the PrizeKayaking thru poles w/ no-body glassesMirrorsH-Lines
- 24. Visual Tool: Follow the LightVisual TargetsLaser Lightin well-lit roomFlashlight in reduced light
- 25. Visualization Enhance Vision w/Minds EyeVisualize event Make a planSee themselves doing itLook ahead (next turn or goal)Look Ahead, next turn
- 26. Somatic Awareness Inside-Out LearningListen to their BodiesIncrease Self AwarenessCue/Focus on proprioceptive sensationsSensational Somatic cues Feel, notice, lift, pushTie Breath to movementReduce vision
- 27. Somatic Learning ToolComing to Our Senses
- 28. Somatic Learning ToolThe Ball GameThe Ball Game
- 29. Somatic Learning ToolSupple SpineTake Home MessageEven gentle stretching improves functionSupple Spine(Based on Feldenkrais)
- 30. Somatic Learning ToolBelly Button TrainingSways, circles, rockingOne foot standingStepsBelly Button Training
- 31. Somatic Learning ToolsTai ChiSelf Awareness Tie Breath to MovementWeight ShiftsUpright postureYogaPilates
- 32. Somatic SummaryEnhance Somatic Inside-out Learning Supple Spine Belly Button Training Tai Chi Reduce visual input Reduce SomaticCompliant surfacesDyna discsStability ballsBalance pads/matsBelly Button TrainingSeated on compliant surfaceSupple SpineBalance Mat- WalkingOver the Moon Ball StretchThe Ball Game
- 34. Slowly, carefully, to adapt
- 35. Progressively
- 36. Seated
- 37. Standing
- 38. WalkingWords on the Wall in the HallMaking WavesHead Turns
- 39. More Tools to Enhance/Engage Vestibular SystemReduce Vision (engage other sensory input)Dim room
- 40. Sun or no-body glasses
- 41. Distracting busy patternsReduce Somatic Input (w/compliant surfaces) Mats, Dyna-Discs, Stability balls
- 42. Outside: Grass, sand, gravelUse Caution Fitness cant fix, just help adapt
- 43. Do activities seated, first
- 44. Dizziness, peripheral neuropathyFollow the LightStand/Walk on Foam
- 45. Sensory Training SummarySensory SystemsOne part of Multi-modal programTheir Job: Incoming info about environmentHow to Use Sensory input for balance:Manipulate or vary environmentEngage the systemEnhance inputReduce inputASCM protocol: gradually reduce Sensory inputBase of Support
- 46. <Base Of Support (BOS)Examples of <BOS for Tall SitSit back in chair, use arm restEdge of chairEdge, arms liftedHeels upFeet tandemKnee liftedOn dyna-discOn Ball w/holderOn Ball
- 47. BOS Standing / MovingStandingWide stanceNarrow stanceOff-setTandemOne footBalance beamDynamicNormal stepsLong steps (lunges)Skipping?On LinesOn BeamsH-LinesLadder for Stride Length
- 48. <BOS: Walk the LineWalk and WaddleLadder for Stride LengthThe Straight & NarrowH-LinesSquiggly LinesBalance Beam or Narrow Path
- 49. Review ACSM ProtocolMulti-modalAll systems, components of balanceSensory systemsIntegrative/Automatic componentsGradually reduce:Sensory inputBOSDynamic motions that challenge CoG
- 50. Integrative Aspects of Balance in Real Life Multiple systems used simultaneouslyAutomatically & continually integrate results w/feedback and goalsMovement goal-directed, centrally drivenSensori-motor feedback loops
- 51. NeuromuscularWhole skillsComplex motor patternsAutomaticity of balance
- 52. Exercise provides Neuroprotection in Parkinsonian Rats Aerobic (Treadmill) vs: Medication (Dopamine)More neural transmitter
- 54. Aerobic or Strength vs: Balance & Agilitytraining
- 55. Larger improvements in motor function
- 56. Morenew synapses Renewable Fitness & ABLE Bodies
- 57. SM Agility Training for RatsSensori-motor tasks are largely controlled by basal ganglia, master coordinator of goal-directed movementSensori-Motoragility courses drive neuro-plasticity and >improvements in motor skills Renewable Fitness & ABLE Bodies
- 58. Sensori-Motor & AgilityVariety of TasksADLs, FunctionalEngaging, fun, novelVary the TaskMultiple directionsBOSAdapt for obstaclesAdd resistanceIncrease timeVary EnvironmentSurfaceVisionLocationBalance Mats: Arm SwingsFigure 8 Walking thru doors & chairs
- 59. Sensori-Motor SkillsVary Tasks & EnvironmentActivitiesTraffic SchoolOpposing CirclesHigh FivesA Walk in the ParkGamesOpposing Circles & High Fives
- 60. Momentum ControlPuddle JumpingPuddle Jumping
- 61. Obstacle Courses for Agility
- 62. Agility & MusicMusic &Transitions TrainingImproves anticipatory skillsHelps initiate movementImproves quality of movementSymmetry, size, cadence, coordination Whole body responseKeeps movement flowingw/ rhythm & momentum Waltzing MatildaMusic can enhance mind-body connections & SM skills
- 63. Dual Tasks for Auto-BalanceDual Tasks enhance automatic balanceMulti-tasking - no such thing!We switch. Former task left on auto-pilotDistraction from established motor task with a secondary task . . . Requires automaticity of balanceTraining improves automatic balance!
- 64. Using Dual TaskingMaster base skill first Functional, ADLsAdd complexity in layers >resistance, reps Vary task Vary environment Add dual task
- 65. Progressing Dual TasksTo established motor skill, add:Simple recitationCounting, ABCs, nursery rhymes, sing Motor taskArm swings, kayaking, Snap claps, carry, toss or catch a ballCognitive taskCount backwards, tongue twisters, word winks, re-arrange numbers or wordsFunctional: Cell phones, keep track of time
- 66. Attention TrainingMy pizza is cold4 31 19 7T__ L__ S__ B____ F__V __G __RRenewable Fitness . . . imagine the possibilities
- 67. Word Winks for Mental AgilityTT TTThinkfry fryRenewable Fitness . . .imagine the possibilitiesRenewable Fitness . . .imagine the possibilities
- 68. Distractions
- 69. Tongue TwistersWhat noise annoys an oyster most? Noisy noise annoys an oyster most(Google has gazillions)Require concentration and improves verbal skills (PD patients ) Renewable Fitness . . .imagine the possibilities
- 70. ReviewPostureFlexibilityStrengthEndurance Sensory SystemsAutomatic, central, NM & IntegrativeCognitionExperiencesSkills & Learning
- 71. FlexibilityReduce BOSSeated positionsStanding positionsManipulate Sensory InputReduce Vision by dimming lightsEnhance Vision by using mirrors, modelingEnhance somatic awarenessFacilitate Vestibular
- 72. FlexibilityUse Dynamic movements that disturb cogLean and reach Dynamic StretchesWhole Body StretchesMind and Body / Engaging / Fun / Layers /ComplexityUse Rhythm/MusicThink BIG, stretch BIGEducate Its the ultimate mind body toolUse Conceptual physical activities as learning toolsSupple Spine Even gentle stretching improves functionVenus Di Milo Arms Explores ROM in arms and trunkMeasure, re-test periodicallyCarry the Baby
- 73. Posture & Core StabilityManipulate Sensory Input Increase somatic awarenessUpright, centered over base of supportCue with proprioceptive cues feel, lift, noticeEnhance Vision Mirrors, ModelReduce Somatic Input & Facilitate VestibularBalance mat with good posture and core stabilityHead turns, tilts while maintaining good posture
- 74. Posture & Core StabilityReduce BOSSeated positionsStanding positionsChallenge w/Dynamic MovementsAdd Arm Swings to upright postures Add Reaches, perturbations, turns Practice Transitions with trunk stabilityTall Sit to Tall StandRise to toes w/upright postureTai Chi, Yoga, Pilates
- 75. Posture & Core StabilityMind & Body/Engaging/Fun/LayerEducate: Discuss value Use hands-on Conceptual learningTorso as a Cylinder - Trunk StabilityWhen Push comes to Shove Trunk stabilityParts of the Whole Segmental alignmentBreathe Easy Posture affects function When Push Comes to Shove
- 76. Strength TargetsADLsAnti-gravity musclesGetting out of ChairsStairsTurnReachUp from floorTeeter Totter Chair Stands
- 77. Strength Targets for BalanceUpright postureBack & Hip extensorsCore muscles Scapular retractorsLegsLower legs Transitions Anti-gravity
- 78. StrengthDynamic movements that disturb cogDynamic ActivitiesProgress from w/In-place w/MovementWhole Body ExercisesVary environmentVary task, BOSMind and Body / Engaging / Fun / Layers /ComplexUse Music, rhythmThink BIG VisualizeDual TasksEducate, show value Measure & re-test
- 79. EnduranceDynamic movements that disturb cogRequire balanceElliptical vs recumbent bike> movement size whole body workUpper/lower body ie: add Arm Swings Mind and Body / Engaging / Fun /ComplexityUse Rhythm/MusicDual TasksThink BIGEducate: Talk about its value Measure results, re-test over time
- 80. Exercise ScienceProtocolsEvidence-basedPeer-reviewedPublishedExercise SpecificitySystemsTasksOverloadChallenge EngageChange Task/Environment
- 81. Whats in your tool box? Did you find a few new tools here?
- 82. The Tools Youll Use You cant possibly do it all. Your talents & choices that will make a differencePick your favorites Visualize Make a plan ObserveKeep learning
- 83. PhilosophyIf its physical,its therapyPhysical Activity . . .The Tools of our Trade
- 84. Thank you for coming!I THINK MY WORK HERE IS DONECartoonstock.com
Editor's Notes
- Sue Scott, BS MSIn 2003 developed AB. Significant improve balance, strength, flexibility and everyday activity.
- ABLE Bodies Balance Training Techniques were originally validated with results of a RCT conducted in 2004. project was selected byNational Blue Print/ Active Aging Partnership, whose committees, a coalition of national organizations,. Including the NIA, CDC and the ACSM Robert Wood Johnson Foundation funded our programWhich was selected bythe ACSMLocal support came from OHSU who did statistics and analysis, TP provided facilities and accounting and renewable fitness who directed the programs, interns and instructors in 4 sites
- Todays program is based on ABLE Bodies Balance Training, whose techniques were shown to significantly improveBalanceAgilityPhysical activityGait speedFlexibility BalanceIn 84 adults the vast majority of which took multiple medications and reported a myriad of medical conditions
- Robert Butler, Pulitzer prize winning physician and gerontologist
- Enhance how they use visionReduce vision Participants will have to facilitate other sensory input
- Enhance
- Tai ChiUpright postureMovements tied to breathSensation of weight transfers Sequential, coordinatedPractice transitions
- Deductive reasoning
- How do we put it all those parts together in everyday life
- Motor skills and Learning
- Neural protection in animal studiesAbove & beyond the expected improvements in CV statusMore blood supplyLess cell deathRemaining cells function betterincrease in dopamine synthesis and releaseBetter motor function increased running speed & distance was a result of decreased cell death, preservation of cell bodies & terminals Conversely non-use of a limb, in casted rats resulted in increased motor deficits and losses of dopaminergic terminalsAgility- trained rats showed greater improvements in motor deficits Attributed to significantly greater number of new synaptic connections neuroplasticityAnd in other studies Neurogenesis, cell proliferation, was demonstrated (8)
- Task-specific training drives neuro-plasticity and greater improvements in motor skillsAGILITY TRAIING StudiesTask specific, environmental enrichment types of courses; require agility of mind and body, changes in techniques, decisions, set switching, reprogramming of tasksAgility training for PD rats is Task specific agility training (environmental enrichment, acrobatic, high-beam balance courses that require changes in techniques - set switching, reprogramming of tasks) . . . Tasks that are largely sensori motor and controlled by basal ganglia
- Sensori motor skillsLocation: outside insideWalkingAdd arm swings; use different locations, different directions, Crowds,
- Form before functionDr Seuss used just 57 words when he wrote the Cat in the Hat. He did it on a bet actually. That he could design something engaging and educational with just 57 words
- Available through speech therapy at OHSUSustainedAlternatingSelectivedividied
- What noise annoys an oyster most? Noisy noise annoys an oyster mostGoogleA tree-toad loved a she-toadWho lived up in a tree.He was a two-toed tree-toad,But a three-toed toad was she.The two-toed tree-toad tried to winThe three-toed she-toad's heart,For the two-toed tree-toad loved the groundThat the three-toed tree-toad trod.But the two-toed tree-toad tried in vain;He couldn't please her whim.From her tree-toad bower,With her three-toed power,The she-toad vetoed him
- MIND bodyUltimate mind & bodySafe and Effective
- Posture mechanical efficiency Core Stability helps w/perturbations
- Posture mechanical efficiency Core Stability helps w/perturbations
- Protocol - professional credibilitySpecificity Specific to the tasks and to the systems and components used to achieve those tasksExercises and activities we assign help them achieve desired specific goals and should be similar to goal tasks. Activities should mimic difficult tasks either in part or wholly, when possible. If having trouble getting out of a chair, strengthening legs and arms is helpful in general, but the practice itself of getting out of chair is even more specific. Chair Stands would be a better choice than a squat, as a leg exercise. And triceps presses back and down (see activity called flag salutes)probably better than o/head.Overload get focus and best effort