Cynthia Rockey & Terri Stewart

Chapter 3A

Increased risk for falls

Reduced functional independence

Impaired Balance:

What are the consequences?

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1) Motor systems

2) Sensory systems

3) Cognitive systems

Balance Changes Due to Increasing Age

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Controls all voluntary movements

Part of our Nervous System

As we age:

↓ muscle response

↓ ability to adjust to responses

↑ uncertainty of responses

↑ dependence on arms

Motor Systems

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Knowing where the body is in space and the direction of motion

Also part of our nervous system

↓ function in vision, hearing and touching

↓ taste and smell

Sensory Systems

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Balance requires your attention

↓ overall attention capacity

↓ ability to allot required attention when performing multiple tasks

Cognitive Systems

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Warm Up

Aerobics

Balance exercises (Mandatory)

Strength exercises (Mandatory)

Stretching and Education

WABSS

Components of a SAIL class

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Gradually increases circulation

Gradually increases heart rate

Prepares the body for more vigorous exercise

Reduces the risk of injury

(In older adults, sudden vigorous work can strain the heart)

Warm-Up

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Increases the heart rate and breathing rate for an extended period of time.

“Cardiovascular” because it makes the heart and blood system work harder.

Recommendations:

30 minutes, moderate intensity, 5 days/week

Or

20 minutes, vigorous intensity, 3 days/week

Aerobics

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Dynamic balance exercises followed by static balance exercises

Allows heart rate to gradually decrease

(abrupt ending of strenuous exercise can strain the heart)

Reduces risk of injury due to falls

Maintains independence

Balance Exercises (Mandatory)

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Muscle strength and endurance decline significantly with advancing age.

Slows bone loss; delays onset of osteoporosis

Decreases likelihood of fractures due to osteoporosis

Decreased risk of falling

(stronger muscles = improved balance)

Strength Exercises (Mandatory)

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Increased activity level

(stronger muscles = increased energy)

Improves flexibility

(weight training uses full range of movement)

Controls weight

(exercise burns calories)

Lose inches

(tighter muscles = trimmer body)

Strength Exercises (Mandatory), cont.

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Changes in elasticity and compliance of connective tissue as we age, lead to decreased flexibility and

range of motion.

Maintaining good flexibility is an important part of remaining independent

Helps to reduce chronic pain in joints and muscles

Recommendation: 10-30 seconds for each stretch and 3-4 repetitions for each stretch

Stretching and Education

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Older adults actually read written information

Older adults need general health, health care, and falls prevention information

Falls prevention information can be difficult to find

79% of older adults will make changes to reduce their risk of falling if given the correct information from a professional

Stretching and Education, cont.

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Any questions?

The S.A.I.L. Class Mandatory Exercises and Adaptations

& Strength and Balance

Cynthia Rockey & Terri Stewart

Chapter 3B

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All classes have 5 S.A.I.L. components

Some mandatory exercises

A mandatory balance component

Then – the rest is up to you

and your imagination !

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The Components: WABSS

Warm-up (3-5 mins)

Aerobics (18-20 mins)

Balance exercises (Mandatory) (10 mins)

Strength exercises (Mandatory) (15-18 mins)

Stretching and education (8-10 mins)

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Warm-up (3-5 mins) Slow pace music: approx 115 bpm*

Examples:

Marching in place

Knee lifts

Side steps L+R

Heel tap

Toe tap: front, back and side

Hamstring curl

Walk around edge of classroom

Squats over chair

Shoulder shrugs

Shoulder rolls

Neck exercises

19 *BPM = Beats per minute

Warm Up - Sitting

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Warm up -Standing

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Walk briskly around classroom

Step-touch: include arms, side swings, reach up, etc…

Knee raise : touch with elbow

Step-kick : include arms

Walking backwards/forwards + arms

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Aerobics (18-20 mins) Faster music – approx 125 bpm

Examples:

*BPM = Beats per minute

The Borg Scale When exercising, you can rate your:

Perception of Exertion

Example: How hard do you think you are working on a scale from 6-20?

Do not focus on any one factor for example leg pain or shortness of breath.

Your own feeling of effort and exertion is important, not how it compares to other people’s.

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6 No exertion at all 9. For a healthy person, it is like walking slowly, at your own pace, for some minutes

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8 Extremely light

9 Very light 10

11 Light 13. Somewhat hard, but still feels OK to continue.

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13 Somewhat hard

14 17. Very strenuous –

you can continue but you have to really push yourself.

15 Hard (heavy)

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17 Very hard

18 19. The most strenuous exercise you have ever done.

19 Extremely hard

20 Maximal exertion

Borg Scale of Perceived Exertion

Talk Test

Ask each of your participants to say their name out loud during aerobic exercises, or “what did you have for breakfast ?” etc

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“If you can’t talk while you’re exercising, the exercise is too difficult. If you can sing, it’s too easy !” Ask simple questions like: “What did you have for breakfast today?” or “What is your favorite color?”

Balance exercises (10 mins) *MANDATORY*

Music – approx 115 bpm

Dynamic Balance

1. Walk slowly with head turns 2. Walking and stepping over “obstacles” 3. Heel-to-toe walk, forwards and

backwards 4. Turn small circle in each direction (by

chair) 5. Sit-to-stand for 30 seconds

26 *BPM = Beats per minute

Heel-toe Walk Sit-to-Stand Figure 1 Figure 2 & 3

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Balance exercises (10 mins) *MANDATORY*

Static Balance

1. Clock sway (feet close together)

2. Head turns and/or trunk turns

3. Heel-to-toe stand (hold 15 t0 30 seconds)

4. Reaches (forwards, sideways, etc)

5. Single-leg stance

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Clock Sway

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Head Turns Trunk Turns

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Reaches Single Leg Stance

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Additional exercises using a ball:

Throw and catch standing still

Throw and catch walking up and down

Bounce standing still

Bounce against wall

Bounce standing on one leg

Bounce walking around the circle

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Strength exercises (15-18 mins) *MANDATORY*

Music – approx 120 bpm

Guidelines Start with no weights – allows muscle tissues to adapt to new

movements

Then use minimum weight – too much too soon can lead to injury

2 sets of 8-10 reps, with a short rest between sets

SLOWLY ! 3 secs to lift/push, hold position for I second, 3 secs to lower

33 *BPM = Beats per minute

Guidelines, continued

Should feel hard/very hard (15-17 Borg)

Too heavy: cannot do 8 reps

Too light: can do 15 easily

PARTICIPANTS SHOULD NEVER HOLD THEIR BREATH! Breathe out with effort eg lift, push…Breathe in as you relax

All movements should be smooth and steady

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Note:

Normal: muscle soreness and slight fatigue

Abnormal: exhaustion, sore joints, unpleasant muscle pulling

There should be NO PAIN during exercise.

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Progression and Adaptation Allow the first few sessions to feel easy

Increasing the amount of weight is necessary for increasing strength

When 10-15 reps is easy, it’s time to increase the weight

Increase weight in approximately 10% increments

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Exercise Adaptations What do we mean ?

Participants who are unable to stand in order to take part in the class can participate while sitting.

- Mostly arm movements, but can also move their feet in varying directions.

Goal: progress to standing version

*We have adapted some mandatory exercises to be done while sitting.

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When will you decide that a participant needs to use adapted exercises ?

1. On initial assessment 2. Performance during class 3. Temporary change in status

Specific co-morbidities:

Diabetes Osteoporosis Glaucoma Balance/mobility deficits

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Other reasons for participants to use adapted exercises:

History of falls/fear of falling

Unable to get out of chair without use of arms

Poor performance on Timed Up and Go

(takes longer than 15 seconds)

Uses walker or other assistive device

Pain which restricts activity levels

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Strength exercises – Upper Body

*MANDATORY*

1. Biceps curl

2. Triceps extension

3. Arm raise to side

4. Shoulder flexion

5. Overhead press

6. Seated crunches (this is the only exercise that has to be

done seated, otherwise participants can choose which way they prefer).

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Bicep Curl Triceps Extension

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Side arm raise Shoulder flexion

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Overhead Press

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Seated Crunches

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Bicep Curl

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Strength Exercises – Lower Body *MANDATORY*

1. Knee extension

2. Knee flexion

3. Hip flexion

4. Hip extension

5. Side-leg raise

6. Plantar flexion (toe stand)

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Knee Extension Sitting vs. Standing

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Knee Flexion Sitting vs. Standing

Hip Flexion Sitting vs. Standing

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Hip Extension Sitting vs. Standing

Side Leg Raise Sitting vs. Standing

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Toe Stand/Calf Raise Sitting vs. Standing

Other Strength Training Examples

Wall push-ups

Upright row

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Squat over chair Lunges

Stretching and Education

Loss of function and increased fall risk in adults over the age of 70 are directly related to decreased flexibility in the shoulders, the neck and the spine.

Flexibility exercises increase range of movement in participants suffering from musculoskeletal and neuromuscular diseases.

Regular gentle stretching helps to decrease chronic pain.

The list goes on…. Stretching is KEY to independence!

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Stretching and Education (8-10 mins) *MANDATORY* Upper Body

Neck:

side-to-side flexion+extension

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Scratch between Shoulder Blades From Above From Below

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Clasp In front Clasp Behind

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Scapular Retraction

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“Praying” “Fist and Fling”

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Quadriceps

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Hamstrings

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Inner Thigh

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Calves

Stretching and Education

Don’t forget to include an education piece during the stretches: one bullet

point from the SAIL Guide

Other educational material may be shared if it is from a reliable source

(.gov, .edu, .org)

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Check Your Knowledge – 1 Name 3 mandatory SAIL balance exercises

Walk slowly with head turns

Walking and stepping over “obstacles”

Heel-to-toe walk, forwards and backwards

Turn small circle in each direction (by chair)

Sit-to-stand for 30 seconds

Clock sway (feet close together)

Head turns and/or trunk turns

Heel-to-toe stand (hold 15 t0 30 seconds)

Reaches (forwards, sideways, etc)

Single-leg stance

Check Your Knowledge - 2 Name 3 mandatory SAIL strength exercises

Biceps curl

Triceps extension

Arm raise to side

Shoulder flexion

Overhead press

Seated crunches Knee extension

Knee flexion

Hip flexion

Hip extension

Side-leg raise

Plantar flexion (toe stand)

Check Your Knowledge – 3 What is the purpose of a Warm-Up?

Gradually increases circulation

Gradually increases heart rate

Prepares the body for more vigorous exercise

Reduces the risk of injury

(In older adults, sudden vigorous work can strain the heart)

Check Your Knowledge - 4 What are the consequences of impaired balance?

Increased risk for falls

Reduced functional independence

THANK YOU

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