“Sit Tall, Stand Strong”

Chair-Based Exercise Coursefor

Frailer, Older Adults & Disabled Adults

Welcome to Day 2

Any Questions?Any Questions?

Recap of class structure:Warm-up Circulation Boosting 1MobilityCirculation Boosting 2StretchesCirculation Boosting 3

EnduranceStrengthCool down

How ageing, inactivity, disease, functional impairment and

disability affect bones, joints, muscles, nerves, heart and

lungs….

BonesBones

Functions of the Functions of the SkeletonSkeleton

ShapeProtectionStorage of mineralsProduction of blood cellsMovement through joints

Knowledge

Base

Page 43

Possible changes to Bone Possible changes to Bone associated with ageing, disability associated with ageing, disability

and inactivity:and inactivity: Reduced bone mineral density

Increased risk of osteoporosis

Loss in height

Postural problems

What is Osteoporosis?What is Osteoporosis?

Skeletal disorder characterised

by low bone mass and

deterioration of bone

with increase in bone

fragility and susceptibility to fracture(Consensus Department Conference 1993)

Bone becomes thinner and more fragile

OsteoporosisOsteoporosis

OsteoporosisOsteoporosis

40 years 60 years 70 years

JOINTS

Structure of a synovial joint

Knowledge

Base

Page 48

Possible changes to joints Possible changes to joints associated with ageing, disability associated with ageing, disability and inactivity:and inactivity:

• Less synovial fluid• Synovial fluid more viscous• Cartilage wear and tear• Reduced joint stability• Reduced range of movement• Ligament less flexible• Joints more stiff

MUSCLESMUSCLES

Structure of Skeletal Structure of Skeletal MuscleMuscle

Possible changes to Muscles Possible changes to Muscles associated with ageing, disability associated with ageing, disability

and inactivity:and inactivity:

Reduction in muscle massReduction in number of muscle fibresIncreased connective tissueIncreased size of motor unitsReduced elasticity of tendons

The same size difference is seen between 30 yr old and 80 yr old

Active, strength-trained 70 yr old female

Sedentary

(Adapted from Sipilä & SuominenMuscle Nerve 1993;16:294)

Potential consequences

• Reduced:– Power– Strength– Endurance– Fine control– Heat production– Immune function

Nervous SystemNervous System

Knowledge

Base

Page 59

Nervous System Nervous System

Possible changes to Nerves Possible changes to Nerves associated with ageing, disability associated with ageing, disability

and inactivity:and inactivity:

• Reduces number of nerves

• Reduced speed of transmission

• Slower information processing

Potential consequences:Potential consequences:Slower movement speedImpaired short term memory Reduced reaction timeSlower pace of learningReduced balanceIncreased fallsSlower response to instructionsPoorer coordinationReduced sight and hearing

HEART AND HEART AND LUNGS AND LUNGS AND

BLOOD VESSELSBLOOD VESSELS

The LungsThe Lungs

Knowledge

Base

Page 56

Gaseous Exchange in the Gaseous Exchange in the AlveoliAlveoli

Diaphragm and Diaphragm and Intercostals MusclesIntercostals Muscles

Possible changes to the lungs Possible changes to the lungs associated with ageing, disability associated with ageing, disability

and inactivity:and inactivity:

Decreased elasticity of the lungs Weaker breathing muscles Less flexible rib cage Reduced gaseous exchange Increased breathlessness Reduced maximal inspiration and reduced expiration

Blood Vessels….

ArteriesArteries

Veins Veins

CapillariesCapillaries

Possible changes to the blood Possible changes to the blood vessels associated with ageing, vessels associated with ageing,

disability and inactivity:disability and inactivity:

• Increased furring and hardening of the arteries• Increased blood pressure and risk of hypertension • Reduced number of capillaries in muscles• Reduced oxygen delivery to muscles, reduced ability to sustain activity

ATHEROMA

The heart ….

Possible changes to the heart Possible changes to the heart associated with ageing, disability associated with ageing, disability

and inactivity:and inactivity:

• Decreased cardiac muscle • Decreased blood pumped out• Decreased maximal heart rate

Consequences…• Reduced ability to work at high intensity•Tasks require greater percentage of max heart rate• Reduced ability to sustain activity

Leading WorkshopLeading Workshop

Warm-up CB1MobilityCB2Stretches

Warm-Up Component Warm-Up Component CB11. Alternate heel raises, Arm Swings, Leg Marches, Tap & ClapMobility2. Shoulder Lifts and Circles3. Side Bends4. Ankle Activators5. Trunk TwistsCB2Stretches6. Back of Thigh Stretch7. Chest Stretch8. Calf Stretch9. Upward Side Stretch

The Functional Model

Practice Workshop…….

Safety First…

• This session will cover:– PARQ screening– Contraindications to exercise– Exercise cautions– Medication effects on safe exercise

participation

PARQ…

See pages 5 & 6 of your learner file

Absolute contraindications• Unstable and uncontrolled health conditions as follows:

– Uncontrolled pain or feeling unwell on arrival– Lasting, increased pain following previous session– Suspected acute injury– Recent injurious fall without medical assessment– Severe breathlessness or dizziness– Recently diagnosed cardiovascular events– Recent medication changes– Uncontrolled pulmonary problems– Inability to follow simple instructions placing themselves or

others at risk of injury– RA flare up or acute systemic illness/infection– Unexplained lethargy

Cautions• Known current injury/wound that is

identified and/or protected

• Observable pain of known origin

• Problems understanding instructions

• Unable to safely maintain balance while seated

• Infection control

• Latex allergy

Common effects of medication

• Reduced alertness• Postural hypotension• Reduced balance• Reduced proprioception• Difficulties with exercise intensity monitoring• Urinary urgency/frequency• Slowed reaction time• Poor coordination

Session PlansSession Plans

Why?

They will assist you in your exercise session

What should it contain?

Include relevant information to deliver a safe and effective exercise session!

Session PlansSession Plans

Name of exercise and planned rests Repetitions and/or Time How to perform the exercise safely and

effectively (teaching points/key safety considerations)

Purpose of the exercise Alternatives and adaptations

See page 23 of your learner file

SAMPLE SESSION PLANSAMPLE SESSION PLANPosture/Teaching Points/or Instructions?

Exercise Name & Planned Rest

Exercise purpose &

ADL’s

Reps and/or Time

Teaching Points

(Key safety considerations)

Adaptations and/or

Alternatives

Shoulder Lifts

Shoulder Rolls

• Sit tall, feet flat on floor• Knees hip width apart• Knees above ankles• Smooth continuous movements• Lower with control• Lift shoulders up • Avoid poking chin• Roll shoulders back• Avoid arching the back• Breathe normally• Keep tummy in

What makes a COMPETENT and What makes a COMPETENT and SUCCESSFUL Chair-Based SUCCESSFUL Chair-Based

Exercise Leader?Exercise Leader?

Prepare to lead a small group on day 3 Use the “how to be even better” info sheet

to help with the leading sequenceComplete all 3 worksheets ready to hand in on day 3 for marking