level 3 award in adapting exercise for...

Level 3 Award in

Adapting Exercise for Independently

Active, Older People

LESSON 2: Skeletal System

Previous Lesson

In lesson 1 you covered:

• Older population classifications

• Inclusion and exclusion criteria

• Terms and definitions for ageing

• Statistics for ageing population

• Inactivity in the older population

• You completed a quiz which

tested your understanding so far…

COPYRIGHT © PURE TRAINING AND DEVELOPMENT


Effects of Ageing and Inactivity

Skeletal System

Lesson 2 Learning Objectives

• Know the effects of ageing and inactivity on the skeletal

system

• Describe the skeletal changes within the bones and

joints

• Identify osteoporosis as a condition which affects the

bones

• Examine the differences between osteoarthritis and

rheumatoid arthritis

• Discuss the effects of a total hip replacement

• Recognise the ACSM guidelines to adhere to for each

condition


Ageing and Inactivity

Skeletal System

• Bone constantly changes

• Calcium deposited and reabsorbed in a cycle throughout life

• Osteoblast = laying down calcium and mineral salts

• Osteoclast = removes old bone by replacing a new framework of collagen fibres

• Activity is equal until ~35 years of age

• Osteoclast activity exceeds osteoblast and decreased bone mineral density & mass occurs


• Women lose more calcium than men

• Women lose ~ 1% of bone mass per year

• Men lose ~ 0.5% of bone mass per year

• Following menopause, 3-5% losses can

occur per year



Skeletal System

• Cause of calcium loss is unknown

• Reduced vitamin D affects absorption of

calcium (especially most menopausal)

• Increased reliance on skeleton to maintain

circulating calcium levels



Skeletal System

• Decrease is bone density

• Reduced mineral content

• Joints become less flexible

• Increased risk of osteoporosis

• Increased risk of arthritis

• Increased risk of fractures



Skeletal System

• Skeleton changes occur

• Risk of spinal curvatures

• Poor posture

• Potential pain in joints

• Temporary ischaemic attacks



Skeletal System

• Degenerative changes affect intervertebral discs

and vertebrae

• Loss in height & become dehydrated

• Facet irritation, spondylytic changes and

stenosis formenal gaps reduce neural

impingement

• Watch the recommended

video to reinforce

understanding



Skeletal System

Sourced from http://cnx.org

• Common bone disease

• Means ‘porous bones’

• Common fracture sites are spine, wrist & hips

• Due to high trabecular bone

• Compression or wedge fractures are

common

• Causing kyphotic posture or ‘dowagers hump’


P14


Skeletal System - Osteoporosis


P14



"722 Feature Osteoprosis of Spine" by Anatomy & Physiology, Connexions Web site.

http://cnx.org/content/col11496/1.6/, Jun 19, 2013. - OpenStax College. Licensed under CC BY 3.0

via Wikimedia Commons -

http://commons.wikimedia.org/wiki/File:722_Feature_Osteoprosis_of_Spine.jpg#mediaviewer/File:

722_Feature_Osteoprosis_of_Spine.jpg


P14



Images taken from www.webmd.com 2014

http://www.webmd.com/


What do you think are

MODIFIABLE & NON

MODIFIABLE factors for

development osteoporosis?

Ageing and Inactivity Skeletal System - Osteoporosis

5 mins


P15

Modifiable Non Modifiable

Poor diet low in calcium, vitamin D Gender

Sedentary lifestyle Age

Smoking Hormone

Alcohol Intake Heredity and family history

Caffeine Body type, low body fat

Carbonated drinks Ethnicity

Long term corticosteroid use Nulliparity (number of children)

Some medical conditions



• Dietary improvements and physical activity

slow down the onset of osteoporosis

• Nearly all elderly men and women have a

degree of lowered bone mass

• Imminent risk of fractures


P14



• Various treatments and supplements

introduced – see p15 of manual


P15



• Estimated 3 million people in UK

• 1 in 2 women and 1 in 5 men over 50 will

break a bone

• Cost of hospital and social care for hip

fractures is more than 2.3 billion per year

in the UK

The National Osteoporosis Society (2013) and NICE

(2010)


P15



• Weight bearing activity can maintain bone

mineral density


P16 Ageing and Inactivity Skeletal System – Osteoporosis &

Exercise

Research suggests if women exercised

for 20 mins, 4x week over 10 years

before onset of menopause, osteoporosis

would be unlikely

1 hour of exercise a

day can reduce hip

fracture by 50%

• Jogging, tennis, biking and vigorous

walking considered relevant

• Swimming is beneficial for strength

• Golf and gardening did not reduce hip

fracture rates

• Pilates is beneficial – core stability,

strength, endurance and flexibility


P16

Ageing and Inactivity Skeletal System – Osteoporosis &

Exercise

• Functional movement patterns

• 4 point kneeling

• Standing, seated and side lying

• Spine extension movements – strengthen

back extensors

• Spinal articulation and extension through

thoracic spine


P16

Ageing and Inactivity Skeletal System – Osteoporosis &

Exercise

American College of Sports Medicine – Guidelines to exercise for people

with Osteoporosis (ACSM, 2009)

Cardiovascular Strength Flexibility Functional

Frequency 3-5 days a week 2-3 days a

week

5-7 days a

week

3-5 days a

week

Balance 2-3

days a week

Intensity 40-70% MHR

75% of 1RM

2 sets of 8-10

reps

Prolonged

holding

Time 30-60 min each

session 20-40 min 30 seconds

Type

Large muscle

activities

depending on

BMD. Walking,

cycling, elliptical,

swimming, water,

running, sports

Dumbbells,

machines,

cuff weights,

floor work,

vibration

machines

Chair based

Increase ADL,

improve

balance and

decrease risk

of falls


P17

• Exercise considerations

• These are guidelines

• Ensure you tailor specifically to your client

• Osteoporotic clients are likely to be more

deconditioned

• Progress to 75% of 1RM

• Use a whole body approach

• Be aware of postural changes

• Use pages 17 & 18 for specific exercises


P17 &

P18 Ageing and Inactivity Skeletal System – Osteoporosis &

Physical Activity

• Reduction in synovial fluid • More viscous, reducing lubrication

• Calcification of cartilage • Less water and more calcium salt deposits affect

cartilage

• Affects shock absorption of the spine

• Reduction in joint stability • Wear and tear

• Thickening of ligaments and joint capsule

• Ligament laxity


Ageing and Inactivity Skeletal System – Joints

P19

• Common condition

• More than 100 types of rheumatic diseases affecting the joints

• Inflammation or degeneration of a joint

• Cartilage, joint membrane and bones can be affected

• Most common types are: • Osteoarthritis

• Rheumatoid arthritis

• Ankylosing spondylitis

• Gout


Ageing and Inactivity Skeletal System – Arthritis

P20

• 8.5 million people in UK affected

• Chronic inflammatory condition causes articular cartilage to degenerate

• No clear cause

• Related to genetic predisposition, stress on joints, biomechanical factors, lifestyle

• Cartilage replacement slows down

• Bones are exposed causing bone spurs (osteophytes)


Ageing and Inactivity Skeletal System – Osteoarthritis

P21


Ageing and Inactivity Skeletal System – Osteoarthritis

www.interactive-biology.com Images taken for illustration purposes from: www.hightimes.com

• PA does not make the condition worse

• Strength training decreased pain by 43%

• Good for posture, functional movement

and less falls

• Tai chi and Pilates are good for balance,

stability and strength



Skeletal System – Osteoarthritis &

Exercise

P21

• Focus on protecting joint

• Low impact activities – swimming, cycling,

walking

• Gradually increase exercise intensity

• Aim to increase flexibility & increase ROM

• Avoid overstretching

• Avoid kneeling positions, impact work,

repetitive stress, flexion or extreme stretching



Skeletal System – Osteoarthritis &

Exercise

P21

&22

• Chronic inflammatory disease

• Inflammation of the synovial membrane

• Tends to affect the smaller joints i.e.

hands, feet, ankles, elbows and wrists

• Cause not fully known


Ageing and Inactivity Skeletal System – Rheumatoid

Arthritis

P22

• Triggered by bacterial or viral infection

• Commonly thought that auto-immune

disease – body attacks itself

• Synovial membrane thickens to heal itself

• Joint swells as synovial fluid accumulates



Arthritis

P22

• Inflammation erodes cartilage

• Scar tissue ossifies

• Finally bone ends fused and/or deformed.

• Remissions and flare ups

• More common between 20-40 years.

Watch the video for the difference between OA and RA



Arthritis

P22

• Non weight bearing (to start)

• Do not exercise during a flare up or feeling

unwell – hot and painful joints

• Gradually ease clients into exercises



Arthritis & Exercise

P22


P23

American College of Sports Medicine Exercise Guidelines – Osteoarthritis

and Rheumatoid Arthritis (ACSM, 2009)

Cardiovascular Musculoskeletal Flexibility

Frequency 3-5 days a week 2-3 days a week Before aerobic or

strength training

Intensity 60-80% MHR

RPE 11-16/20 Not specified

Within pain

threshold

Time

5-10 mins each

session building to 30

mins each session

1 or more sets of

2-3 reps building

to 10 reps

Not specified

Type

Large muscle

activities, walking,

cycling, swimming,

water aerobics &

dance

Circuit training,

free weights,

machines, bands,

Pilates mat and

equipment based

sessions

Increase/maintain

ROM

• Surgical procedure to replace all or part of

diseased joint

• Artificial one

• Unstable following operation, be aware of

dislocation

• Period of caution is 3 months

• Full recovery after 6 months (no

complications)


Ageing and Inactivity Skeletal System – Total Hip

Replacement

P23

• Gradually increase the strength in all the

main associated muscle groups; hip

abductors/adductors, flexors and

extensors

• Gradually increase ROM

• Create all round conditioning



Replacement & Exercise

P23

• Deep water classes are ideal

• Limit abduction initially

• Avoid adduction across centre line of body

• Avoid hip flexion beyond 90 degrees




P24

• Caution with rotation

• Avoid breaststroke

• Avoid swivelling on the spot

• Avoid side lying exercises

• Target the gluteal muscles – very

important

• Gluteal bridge and lying leg circles are

excellent for hip stability




P24

• Identified the bone building cells (osteoblasts) and bone

reabsorbing cells (osteoclasts), as well as their role in the

growth and deterioration of the skeleton

• Identified age related changes to the bones, joints and

cartilage

• Described the effects of activity and inactivity on the skeleton

• Identified common fracture sites

• Explored age associated conditions and their risk factors

• Described the benefits of activity and exercise for people with

skeletal conditions

• Identified adaptations needed for older people with and

without skeletal conditions COPYRIGHT © PURE TRAINING AND DEVELOPMENT


Skeletal System – Summary

ANY QUESTIONS?

If you need any support please do not hesitate to get in contact with your

mentor.


Activities

Pure Training and Development © 2014

• Complete the Quiz

‘Quiz Yourself from Lesson 2’

• Watch the supporting videos

• Read Section 2 of manual to support

understanding

• Download/Print out any resources

needed for Lesson 3.

• Take a 15 minute break

level 3 award in adapting exercise for...

Documents