stay on your feet! prevent falls with exercise aahperd national convention 2011 christian thompson,...
TRANSCRIPT
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Stay On Your Feet!Prevent Falls With Exercise
AAHPERD National Convention 2011
Christian Thompson, Ph.D.
Department of Exercise & Sport Science
University of San Francisco
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Objectivesn Describe the prevalence of falls and falls-related injuries
and the costs associated with themn Identify intrinsic and extrinsic risk factors for fallsn Explain the balance control mechanisms in the body and
how they work together to reduce falls riskn Learn about 3 simple screening protocols to identify falls
risk in older clientsn Develop a comprehensive falls prevention exercise
program consisting of exercises for mobility, strength, balance, and gait enhancement
n Identify appropriate exercise progression and regression strategies to use with older clients to reduce falls risk
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The Older Adult Continuum
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This Can Happen to Both of Them!
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Too Bad It’s Not Funny…n Over 1/3 of people aged of 65+ fall each year
n In 2004, over 1.8 million seniors were treated for fall-related injuries at emergency rooms
n Approx. 400,000 fractures per year due to falls
n Over 20% of hip fractures result in death in 1 yr
n Problem will only continue to increase with the “Graying of America” and its changing demographicsSources: CDC, 2007; Kannus et al., 2005; Ngyuen et al., 2007
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Golden Years in the Golden State?
•Almost 12% of older Californians fell more than once & 34% fell at least once in 2007
•Diagnosed diabetes increased from 15% in 2001 to 17.5% in 2008
•Diagnosed hypertension increased from 53% in 2001 to 60% in 2008
•A coincidence…PROBABLY NOT!!!
• Source: UCLA Center for Health Policy Research, 2008
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Factors Affecting Falls
Extrinsic FactorsExternal Issues– Weather or outdoor
conditions– House clutter and
obstacles– Poor lighting– Lack of adaptive
devices in the home– Inappropriate
footwear/clothing
Intrinsic FactorsInternal Issues
– History of Falling– Chronic Diseases &
Medical Conditions– Sensory/Vestibular
Impairments– Medication Effects– Functional Level
(Strength, Posture, Gait)
Sources: (Rose, 2003; Tinetti et al., 1988; Carter, 2001; Lehtola et al., 2006)
Risk linearly with number of risk factors present
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Our Falls Defense Mechanisms
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What To Do About It??
• IDENTIFY the Balance Control Deficit(s)
•CONSTRUCT Corrective Strategies
•MODIFY Based on Functional Capabilities
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IDENTIFY Multifactorial Interventions – 6 Studies
Three simple, validated assessments
• Functional Reach Test
• Timed Up and Go Test
• 30 Second Chair Stand Test
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Functional Reach Test Duncan & Colleagues, 1990
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Timed Up and Go TestPodsiadlo & Richardson, 1990
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Chair Stand TestRikli & Jones, 1999
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CONSTRUCT & MODIFYMobilizations
•The ANKLE & HIP are KEY!!!–Subconscious utilization of ankle “strategy” during quiet
standing–Reactive utilization of hip “strategy” during movement
• Isolated non-loaded mobilizations–Ankle Circles–Hip Circles
•Loaded integrated mobilizations–TADAs
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CONSTRUCT & MODIFYMuscle Strengthening
• More than just gaining strength…– Enhance neural recruitment & increase lean tissue mass
– Challenge postural control and improve stabilization capacity
– Emphasize eccentric control during movement – deceleration of gravitational forces is essential for falls prevention
• Selected exercise– Chair squats
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CONSTRUCT & MODIFYGait Enhancement
• WHY do older people walk the way they do???– Reduced mobility of ankle & hip joint (reduced sensory input)
– Gravity is winning the battle
– FEAR!!!! (contracts the sphere of function)
– Pathological conditions (only in a small % of OAs)
• Gait Enhancement– Enhancing the proprioceptive input
– Increasing awareness at long distance
• Selected Exercise– Side Stepping
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Recommendations for the Fitness or Activity Professional
n Understand your older clients
n Recommend clients to undergo multifactorial risk assessment
n Progress clients safely but steadily
n Include multiple modes of exercise to address modifiable physical characteristics
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Dr. Christian ThompsonDepartment of Exercise & Sport Science
University of San Francisco2130 Fulton Street
San Francisco, CA 94117
(415) 422-5270