Transcript Active for Later Life in Scotland

Strength & Balance for Older People
Session Aims
•
•
•
•
•
•
•
Importance of Active Ageing
Silent epidemic of sedentary behaviour
Physical Activity Guidelines for older people
Different approaches for different people
Evidence for strength and balance exercise
Collaboration with Paths for All Walk Leaders
Introducing you to the selected strength &
balance exercises
• You having a “go” at teaching the exercises
Policy Agendas Galore!!
• WHO Active Ageing Policy (2002)
• Lets Make Scotland More Active
(2003)
• Five year review of Lets Make Scotland
More Active (2008)
• On your Marks: A Games Legacy Plan
for Scotland (2009)
• Scottish Charter for Physical Activity
(2011)
• CMO Guidelines for physical activity
for health (2011)
• Path to Active Ageing (2012)
Being independent and connected
Being Active enables.....
• Social contact, interaction and
others
• Access to people and places
• To choose to do things
where and when we want
Getting to
the GP
Working
Caring
Home
Walk in
the
woods
Visiting
the
library
Bus stop
to visit
friends
Volunteering
Connect... Take notice...Keep learning... Give...
“Life in your years”
- requires more than just stamina and energy, requires
strength and balance to feel confident in all other
activities you go on to do....
3 Dimensions of Human Frailty
TIME
HUMAN
FRAILTY
DISEASE
DISUSE
Spirduso, 1995
Ageing affects all of us!
1-2%
in functional ability p.a.
– Strength
– Power
– Bone density
– Flexibility
– Endurance
– Balance and co-ordination
– Mobility and transfer skills
Sedentary behaviour accelerates the loss of performance...
A Vicious cycle of inactivity
Social /
psychological
ageing
Increasing
age
Further
decrease in
physical activity
Physical
deterioration
-
Less
exercise
Heart disease
High blood pressure
Aches and pains
Osteoporosis
-
Feeling ‘old’
‘Acting’ one’s age
Increased stress
Anxiety, depression
Low self-esteem
Fear of falling
Decreased
physical abilities
- Increased body fat
- Sagging muscles
- Decreased energy
Making activity choices…..
• >3 hrs per week targeted exercise
– Heart Attack - 3 x less likely
– Osteoporosis - 2 x less likely
– Hip fracture - 2 x less likely
• Also reduces risk of high blood pressure, obesity, stroke and diabetes
• >3 hrs per week on your feet
– Reduced risk of falls and fractures
• New PA Recommendations highlight the need for additional strength
and balance training activities over and above the moderate physical
activity messages
ACSM 2007; CDC 1996,2002; Sesso
2000; Nicholl 1994; WHO 1997; NIA
1998; BHF 2010.
Physical Activity benefits….
• Psychological
– Reduce Anxiety, depression, fear of falling; Improve
sleep
• Physiological
– Maintain bone density, ability to perform everyday
activities, reduce breathlessness and stiffness;
reduce effects of disease and falls
• Psychosocial
– Reduce Isolation, Increase self efficacy, social
contacts, peer support, playing with grandchildren,
using the bath
• Even the very frail
– DVT, constipation, transfer skills
Acute effects of exercise
• 24-48 hr period after
exercise
– Glucose tolerance
– Insulin sensitivity
– Circulating growth
hormone (requires
strength exercise)
– Reduced cortisol
(requires strength
exercise)
– Cerebral circulation and
function
Sedentary Behaviour
Active bone and strength loss

No standing activity leads to active
loss of bone and muscle
– 1 wk bed rest  leg strength by ~ 20%
– 1 wk bed rest  spine BMD by ~1%

Sedentary behaviour = worse balance

Nursing home residents spend 8090% of their time seated or lying
down
(Krolner 1983; Tinetti 1988;
Skelton 2001; Beyer 2002)
Ageing and Sedentary Behaviour
14
TV
12
Hours Daily
10
Sitting
8
Accelerometry
6
4
2
0
60-64
65-69
70-74
75-79 80-84
Age Group
85-89
90-94
> 95
With thanks to Juliet Harvey, Seb Chastin
Prevalence of Sitting
in Older Adults
100
N = 661,125
% Population
80
60
40
compared to < 2hrs,
> 4hrs TV viewing
= 46%  risk of all
cause mortality
= 80%  increased
risk with CVD
mortality
(Dunstan, et al.,
2010).
20
0
>3
>4
>5
>6
>7
>8
>9
>11
Hours
With thanks to Juliet Harvey, Seb Chastin
Achieving the guidelines
Increased benefits
Moving More
Often
Moving
regularly and
frequently
Meeting the
guidelines
Moving
Increased physical activity
Sedentary
Older adults – Moderate intensity –
accumulating 150 minutes per week
OLDER ADULTS (65 + )
• Older adults should aim to be active daily.
• Over a week, activity should add up to at
least 150 minutes (2 ½ hrs) of moderate
intensity activity in bouts of 10 minutes or
more.
• For those who are already regularly active
at moderate intensity comparable benefits
can be achieved through 75 minutes of
vigorous intensity activity spread across
the week or combinations of moderate and
vigorous activity.
CMO, Start Active Stay
16
Active, 2011
Older Adults – Sedentary,
Strength and Balance
• All Older adults should minimise the
amount of time spent being sedentary
(sitting) for extended periods.
• Older adults should also undertake
physical activity to improve muscle
strength on at least two days a week.
• Older adults at risk of falls should
incorporate physical activity to improve
balance and co-ordination on at least
two days a week.
CMO, Start Active Stay
Active, 2011
The Guidelines apply to all older people 65+
The Actives - Those who are already active,
either through daily walking, an active job
and/or who are engaging in regular
recreational or sporting activity..
Functional decline -Those whose function is
declining due to low levels of activity, too
much sedentary time, and who may have
lost muscle strength, and/or are
overweight but otherwise remain
reasonably healthy.
Frail elderly - Those who are frail or have very
low physical or cognitive function perhaps
as a result of chronic disease such as
arthritis, dementia, or very old age itself.
Interpretation
www.bhfactive.org/
Interpreting the guidelines
BHFNC Resources
The Actives
In Transitions
Frailer, older
people
How do we “Get Up and Go “?
• Strength to rise from a chair
• Balance to remain upright
• Then we can go Walking
(shopping, go to church, into
the garden, see our friends)
The key to independence and health in later life
Wide range of abilities and needs
Barriers to walking
• Intrinsic barriers e.g.
what I think/believe, eg,
– Fear of falling and other ideas of
“harm”
– Too late to have any effect
– Too much of a challenge (selfefficacy)
– No point
• Extrinsic barriers e.g.
open or outdoor spaces
– Toilets
– Views of other people (friends
and family?)
– Unsafe physical environment, eg,
traffic, pavements
– No-where good to go
Reported daily physical
symptoms
•
•
•
•
•
•
•
•
Trouble with ears and hearing - 56%
Aches and pains in legs - 45%
Trouble with eyes or vision - 43%
Aches and pains in hands and feet - 35%
Backaches - 33%
Fatigue and tiredness - 32 %
Swelling of upper/lower extremities - 22%
Difficulty breathing - 17%
(Cooper K 2001)
Items in blue represent perceptions
associated with reduced strength and
balance....
Enough strength and
balance to COPE with a
risky environment?
Exercise to Prevent Falls
Exercise does help fallers in a number of
ways:
• Reducing Falls (or injurious falls)
• Reducing known Risk Factors for Falls
• Reducing Fractures ? (or changing the
site of fracture)
• Increasing Quality of Life & Social
Activities
• Improving bone density
• Reducing Fear
• Reducing Institutionalisation
Gardner 2000; Skelton &
Dinan 1999; NICE 2004
Strength, balance and walking
• Guidelines state addition of strength and
balance on top of moderate physical activity
• BUT Brisk walking may increase risk of falls in
those who are frail or who do not walk
regularly
• However, brisk walking in pre-frail older people
increases bone density...dilemma?
• Strength and balance exercises should be
incorporated into walking programmes
(Campbell 1997; Robertson 2001; Campbell 2005; Sherrington 2011; Ebrahim 1997)
Falls prevention in the UK
•
•
Otago Home Exercise Programme (OEP)
– 1 yr; 3 x p/w; standing strength and balance; graded
walking programme; 6 home visits (physiotherapist,
nurse) to progress and tailor exercise but otherwise
unsupervised
Falls
Injuries
Cost effective >80s
Cost neutral >65s
– 6 mths; 3 x p/w (1 p/w group, 2 p/w home) exercise
instructor
Cognitive Function
Falls Management Exercise Programme (FaME/PSI)
Falls
Quality of Life
– 9 mths; 3 x p/w (one group, two home); standing
Bone Mineral Density
strength and balance plus floorwork; specialist exercise
Change of residence
instructor to progress and tailor exercise
Coping strategies
Long lies
(Campbell 1997; Robertson 2001; Campbell 2005; Liu_Ambrose 2008;
Skelton 2005, 2008; RCP 2012, DoH Prevention Package 2009)
NEW! Cue cards with walking
advice plus 10 Strength and
Balance exercises
NEW! Leaflet for older adults
containing the same exercises
and simplified information
Functional
Fitness
MOTs
• For older people
• Awareness raising on
components of fitness
• Comparison to
“norms” and practical
advice
Why Fitness MOTs?
• Highlight the new Physical Activity
Guidelines with older people
• Highlight the importance of the
components of fitness, particularly
strength and balance
• Use as a motivational tool to
engage older people in
programmes and activities
Personalised take home information
Active Ageing Events
• Celebrating participation in
events and festivals
• Active Ageing Challenges in
– Games and sports competitions
– Walking and dance challenges
– Ideas for action
• Potential for wider
involvement by Community
Sports Hubs,
intergenerational activity,
cycling and active travel and
outdoor places
Public Engagement Activities
• Glasgow Life Physical Activity Programmes
– Vitality Festival
– Active Ageing Week
envisage
Passive and
not exciting
Repetitions
from memory
No feedback
on
performance
Maximum therapeutic
benefit of exercise is not
assured
Chance to play
favourite
games
“It is good to see
what you are
doing”
“This could give
me the
confidence and
discipline that I
need”
Instructions
with reminders
The users made
important
contributions to the
design
Stephen Uzor, Prof. Lynne Baillie
Limitations of the
booklet can be
addressed
“I only hope I’ll
be able to stop
playing because
it is fun”
“I like the music.
That’s one thing I
liked about the
classes”
Will these technologies encourage
adherence over an extended
period of time?
•
•
•
•
We ALL need to Get Up and
Go and we ALL need to
encourage all older people
to do strength and balance
exercise as well as walking to
….
Maintain independence
Maintain physical and
psychological health
Connect, notice and give
Do the things we want to in
later life
Age successfully!
Questions
[email protected]