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

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

The Older Adult Continuum

This Can Happen to Both of Them!

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

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

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

Our Falls Defense Mechanisms

What To Do About It??

• IDENTIFY the Balance Control Deficit(s)

•CONSTRUCT Corrective Strategies

•MODIFY Based on Functional Capabilities

IDENTIFY Multifactorial Interventions – 6 Studies

Three simple, validated assessments

• Functional Reach Test

• Timed Up and Go Test

• 30 Second Chair Stand Test

Functional Reach Test Duncan & Colleagues, 1990

Timed Up and Go TestPodsiadlo & Richardson, 1990

Chair Stand TestRikli & Jones, 1999

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

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

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

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

Dr. Christian ThompsonDepartment of Exercise & Sport Science

University of San Francisco2130 Fulton Street

San Francisco, CA 94117

cjthompson@usfca.edu

(415) 422-5270