7 - EXERCISE PRESCRIPTION FOR OLDER ADULTS

Question 1

PREVENTION

Answer 1

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Question 2

Strategies

Answer 2

Tableau

Question 3

Assessment frailty: name + description + what to assess

Answer 3

Fried’s criteria
1) Physical inactivity: less than 150 min of moderate activity per week
2) Low muscle strength: can be measured by grip strength - < 21 kg in men & < 14 kg in women
3) Slow walking speed
1) Less than 0,8 m/s with or without walking aids
2) Predictor of mortality
4) Exhaustion / fatigue: self reported
5) Weight loss: loss of 4,5 kg or more (5% of weight) in 1y
=> Scoring as follows: 0-1: not frail, 1-2: pre-frail, 3+: frail (mild, moderate & severe)

What to assess
1) Muscle function
1) Grip strength
2) Chair lift
2) Balance & walk function
1) Timed up & go
2) 6MWT
3) Tinetti
4) Unipolar balance
3) Cognitive functions
1) Mini mental state
2) CODEX (dementia)
3) Geriatric depression scale
4) Nutritional status
1) Nutritional screening initiative
5) Dependency
1) KATZ: activity of daily living
2) IADL: instrumental activity of daily living

Question 4

Fall management: rehab plan reasoning

Answer 4

• Uni-factorial interventions, with physical exercises (balance & muscle strengthening): effective in reducing number of falls & number of fallers in people living at home
• For frail subjects and/or those at high risk of falling, multifactorial approach appropriate
• Muscle strengthening = improvement of functional capacities but does not bring any improvement in balance function if used alone
  —> Key muscles: dorsal flexors of foot, triceps surae, quads, hamstrings
• Balance training = key to any falls prevention exercise program
• Physical activity, in particular balance rehabilitation, muscular reinforcement & improvement of endurance helps to maintain autonomy of elderly person
• Can should preferably be individual: targeted & adapted to each person

Question 5

Fall management in elderly: balance

Answer 5

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Question 6

Fall management: strengthening

Answer 6

• Take into account fatigue: DOMS
• Key muscles: ankle dorsiflexors, triceps, quadriceps & hamstrings
• 60-80% of RM
• Closed chain
• Eccentric with lower energy cost
• Functional gestures

Question 7

Fall management: foot

Answer 7

• Important sensory input
• Gait
• ROM: ankle & foot
• Muscle length: triceps surae
• External sensory stimulation
• Weight-bearing proprioceptive exercises

Question 8

Fall management: optimizing sensory afferents

Answer 8

• Exercises on foam cushions or mats
• Seated exercises (ball, chair + dynair cushion)
• Exercise or unstable trays
• Progression in difficulty:
• Decrease polygon sustentation
• Add head oscillations
• Closing eyes
• Exercises with balls
• Optokinetic rehab

Question 9

Optokinetic examples

Answer 9

• Cx spine ROM
• Eye-head exercise
• Egocentric & exocentric targets
• Walking + eye-head dissociation

Question 10

Exocentric: description

Answer 10

• Involve motor tasks requiring individual to focus on external objects or targets in environment, rather than own body movements
• Exercises necessitate integration of visual & spatial information to interact with external world accurately & efficiently
• Exocentric exercises rely on individual’s ability to process & integrate visual information with motor planning & execution to achieve desired outcome

1) Ball sports: throwing, catching or kicking call, which requires accurate perception of ball’s position, velocity & trajectory
2) Target-based activities: Archery or darts, where goal is to hit specific target at distance
3) Interactive activities: dance or martial arts routines that involve interacting with partner or opponent &
responding to movements

Question 11

Egocentric: description

Answer 11

• Egocentric exercises: motor tasks requiring individual to focus on own body movements, positioning & spatial orientation
• In these exercises, individual’s perception of body & its movements is central to task
• Egocentric exercises rely on person’s ability to process & integrate proprioceptive & kinesthetic information to maintain balance, control movement & coordinate body segments

1) Balance exercises: Single-leg stands, tandem walking or balance board training
2) Flexibility exercises: stretching routines that focus on individual muscle groups & joints
3) Body awareness exercises: yoga or Pilates, which emphasize body positioning, alignment & controlled
movements

Question 12

Fall management: walking rehab

Answer 12

• Footwear & adapted technical aids
• Gait symmetry (height & length of step)
• Solicitations of speed changes during walking
• Phases of walking
• Higher activities of walking
• Walking on unstable surfaces
• Catching up on balance in standing position
• Passing obstacles
• Sit-stand transfer exercises
• Walking with variations in speed, direction , changes in position
• Double-tasking
• Walking outdoors if possible

Question 13

Fall management up after falling

Answer 13

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Question 14

Fall management: roles of PT

Answer 14

To work within interdisciplinary team & investigate possible causes of falls through detailed subjective history

Goals
- Prevent future falls by ensuring living environment is safe
- Prevent future falls by working on mobility, balance & strength
- Restoring confidence to improve quality of life & reduce fear of falling
- Training patients to cope with future falls & minimize complications

Question 15

Fall management: addressing fear

Answer 15

Progressive exposure to circumstances that patient apprehends
- Desensitization process

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Question 16

Fall management: Otago home exercise program

Answer 16

Specifically designed for falls prevention
- Strengthening
- Balance exercises
- Walking

Question 17

Fall management: community exercises

Answer 17

Exercises to help improve balance & flexibility
- Dancing
- Gym sessions
- Group exercise classes
- Home exercise program
- Lawn bowling, boules, pétanque
- Pilates
- Tai chi
- Yoga
- Hydrotherapy

Question 18

Fall management: general guidelines infographic

Answer 18

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Question 19

Exercise prescription: osteoporosis

Answer 19

1) Weight-bearing exercises: encourage weight-bearing, high impact exercises such as brisk walking, dancing, stair climbing & hiking to stimulate bone formation. Aim for 30min of moderate-intensity excises at least 3 to 5 days per week
2) Resistance training: incorporate progressive resistance training exercises targeting major muscle groups, with focus on spine & hip. Include exercises such as squats, lunges & seated rows, performed at 60-80% for 8-12 reps, 2 to 3 sets & 2 to 3 times per week
3) Balance & flexibility: implement balance exercises, such as single-leg stands, tandem walking & heel-to-toe walking, to reduce risk of falls. Also include stretching exercises to improve overall flexibility & joint- mobility
4) Postural exercises: focus on postural exercises to address kyphosis & reduce risk of vertebra fractures. May include exercises that target back extensor muscles & encourage thoracic extension
5) Progression: gradually increase intensity, duration & complexity of exercises, ensuring that patient tolerating activities & monitoring for signs of discomfort or pain
6) Precautions: avoid high-impact exercises, spinal flexion & twisting movements in individuals with severe osteoporosis or history of vertebral fractures. Consult healthcare professional before starting exercise program

Question 20

Exercise prescription: sarcopenia

Answer 20

1) Resistance training: emphasize progressive resistance training exercises that target all major muscle groups. Utilize exercises such as seated rows, legs presses, chest presses & biceps curls. Perform at 60-80% of 1 RM for 8-12 reps, 2 to 3 sets & 2 to 3 times per week
2) Aerobic exercises: include moderate intensity aerobic exercises, such as brisk walking, cycling or swimming, for at least 150min per week or 75min of vigorous-intensity exercise per week
3) Balance & functional exercises: integrate balance exercises, such as single-leg stands and tandem walking, to reduce risk of falls. Also, incorporate functional exercises that stimulate activities of daily living, such as chair stands & step-ups
4) Flexibility: incorporate stretching exercises for all major muscle groups to improve flexibility & joint mobility. Aim for 2 to 3 sessions per week, holding each stretch for 15-60 sec
5) Progression: gradually increase intensity, duration & complexity of exercises, monitoring patient’s tolerance & ensuring safety
6) Precautions: obtain medical clearance before initiating exercise program for individuals with significant functional limitations or co-morbidities. Tailor exercise prescription to individual’s needs, capabilities & preferences. Regenerate response