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To your “Sit Tall, Stand Strong”Chair-Based Exercise Course
forFrailer, Older Adults & Disabled Adults
Welcome
INTRODUCTIONINTRODUCTIONan opportunity to get to know each
other
The Course ManualsThe Course Manuals
1 The Knowledge Base Manual
2 The Practical Manual
3 Open Book Worksheets
4 Learner File
Aims of the Chair-Based Aims of the Chair-Based Exercise CourseExercise Course
• To provide underpinning knowledge about the ageing process, disability and functional impairment and about adapted exercise programming related to leading ‘Sit Tall, Stand Strong’, the Later Life Training (LLT) chair-based exercise programme.
• To provide opportunities to apply this knowledge in the safe and effective practice of leading the 22 ‘Sit Tall, Stand Strong’ chair-based exercises.
• To develop competence in leading the specific ‘Sit Tall, Stand Strong’ chair exercises for frailer, older adults or disabled adults.
• To provide information on how to access appropriate local resources to help set up ‘Sit Tall, Stand Strong’ chair-based exercise sessions in a range of community settings.
By the end of the course the By the end of the course the Learner should be able to:Learner should be able to:
• Identify the main functional impairments affecting frailer, older adults and/or disabled adults
• Describe the key approaches to adapting the 22 ‘Sit Tall, Stand Strong’ exercises accordingly
• Describe and demonstrate how to communicate with older or disabled individuals to encourage, motivate and give feedback to improve performance.
Links with NVQ’sLinks with NVQ’s
NVQ Level 2 Instructing Exercise and Fitness (Gym-Based Exercise) D417 Support Participants in Developing and Maintaining Fitness (D417.1, D417.2, D417.3) D410 Plan and Prepare a Gym Based Exercise Session D411 Instruct a gym based session Level 2 & 3 NVQ in Promoting Independence (within the Care Sector) Level 2 NVQ in Sport Recreation & Allied Occupations: Activity
Leadership Level 2 Care Level 3 Promoting Independence Z6 Links with Key Skills Communication: Levels 1, 2 & 3 Improving Own Learning & Performance: Levels 1, 2 & 3 Working with Others: Levels 1, 2 & 3 Problem Solving: Levels 1, 2 & 3
AssessmentAssessment
You will be expected to: Provide a written Health & Safety Plan Provide a full written plan of the Exercise
Session, covering all 22 exercises Lead 5 of the 22 chair-based exercises Provide a written self evaluation of the
session you lead
Page 12
Learner File
During the course you will complete 3 worksheetsrelating to the ageing process and exercise
OK – so here we goOK – so here we go
Physical Activity, Ageing & Disability
Page 31
Knowledge Base
Components of Total Fitness
• Physical
• Mental
• Social
• Emotional
• Medical
What is Physical Fitness?
“Physical fitness is the ability to meet the
demands of everyday life with vigour and alertness – without undue fatigue and
with enough energy in reserve to enjoy
leisure time pursuits”(The Presidents Council on Physical Fitness and Sport)
Page 36
Knowledge
Base
Components of Physical Components of Physical FitnessFitness
Muscular Strength and Power
Cardiorespiratory (aerobic fitness)
Flexibility (Suppleness)
Motor Skills
Muscular Endurance
Physical Fitness
Body Composition
What’s the difference?
• Physical Activity– Any muscular movement occurring above
resting levels
• Exercise– Planned/structured physical activity which has
an aim (Buckley, 2008)
• Examples….
Exercise for Older/Disabled Exercise for Older/Disabled PeoplePeople
General health & fitnessFunctional fitnessADLsStrength & PowerJoint range of
movementManagement of medical
conditions
Exercise helps to:
Feeling of well-being
Independence
Socialisation
Body image
Enjoyment
Mood
AActivitiesctivities ofof DDailyaily LLivingiving
BADL’s
BasicBasic activities of daily living such as eating,
bathing and dressing
IADL’s
InstrumentalInstrumental activities of daily living that are
required for independent living such as
housework, shopping and stair climbing
Exercise for Older/Disabled Exercise for Older/Disabled PeoplePeople
General health & fitness
Physical Activity helps to:
Feeling of well-being
Independence
Socialisation
Body image
Enjoyment
Absence of DiseaseAbsence of Disease
Physical activity helps to prevent:
OsteoporosisNon-insulin dependant diabetesHypertensionHeart diseaseStrokeColon cancerHigh cholesterol
Sedentary vs. Sedentary vs. active lifestylesactive lifestyles
>3 hrs per week targeted exercise♥ Myocardial infarct
- 3 x less likely
Osteoporosis
- 2 x less likely
Fall-related injuries
- 2 x less likely
Hip fracture
- 2 x less likely
Psychological Function
Physical activity improves:
DepressionAnxietyAlertnessSleep
YOUNG AND DINAN (2000)
Benefits to individuals
Frailer older adults Disabled adults
•Maintain function•Maintain independence•Manage medical condition(s)•Psychological benefits
•Maintain function•Maintain independence•Manage disability•Psychological benefits
AgeingAgeing
AgeingAgeingEverybody does it
Everybody does it differently
Ageing population
• 10 million people in the UK are over 65 years old • 5½ million more older people in 20 years’ time • 19 million by 2050• 3 million people aged more than 80 years • 6 million by 2030 and 8 million by 2050. • 1 in 6 of the UK population is currently aged 65
and over• by 2050 this will be 1 in 4
Disability
Disability includes…
• Neurological • Arthritic• Cardiac • Metabolic (obesity, diabetes) • Anxiety and depression • Hearing and vision impaired• Learning disabilities • Spinal injuries
Disabled UK population
• Wheelchair users make up only 8% of the disabled population
• Obesity accounts for 40%• Only 17% of disabled people born with impairments • 1 million people in England have a learning disability • 9 million in UK - deaf/hard of hearing• 2 million in UK - sight problems• 78% of over 85s are disabled • 7% of disabled people (compared to 31% of non-
disabled) do enough physical activity to improve health and prevent disease
A different “spin” on A different “spin” on fitness?fitness?
Strength to lift household objects
or to get up from the floor
Flexibility to wash hair, tie shoes
Balance and agility to climb
stairs
Co-ordination and dexterity to
open a door with a key or get
dressed
Stamina to walk to the shops
Keeping up with the Keeping up with the grandchildrengrandchildren
Meeting FriendsMeeting Friends
Mental StimulationMental Stimulation
Exercise for Exercise for Older/Disabled PeopleOlder/Disabled People
Target functional muscles Practice functional movements Target postural muscles Provide opportunities for socialisation Improve body composition Bone loading activity
Physical Activity Over Physical Activity Over HealthHealth
Disease
Prevention
Age
Maintenance of Independence
How much is enough?How much is enough?
Page 40
Knowledge
Base
How much is enough?How much is enough?
Dept Health, 2011 :
Guidelines for older adults
• 150 minutes a week, moderate intensity, bouts of 10 minutes or more
• Muscle strength exercise - 2 days a week
• Older adults at risk of falls – balance exercise - 2 days a week
• Minimise sitting for extended periods
How much is enough?How much is enough?
Dept Health, 2011 :
Guidelines for disabled adults • “Most disabled people would benefit from
physical activity according to their capacity”• “The general guidelines are applicable to
disabled people (so long as safety is addressed/ activities may need to be adapted)”
• “The guidelines for older adults can be applied to older adults with disabilities”
So what's stopping youSo what's stopping you??
Not at my age Not with my
disability Not fit enough It’s not for me It’s a fad I might fall It’s too painful Can’t get there Too busy
I do enoughCan’t afford itNot the sporty typeIt’s too late for meYou can get
obsessedI’ve been told not to??
If I’d known I was going to live this long, I’d have taken better care of myself
Dubey Blake
“Man does not cease to play because he grows old. Man grows old because he ceases to play”
George Bernard Shaw
Introduction to The Functional Model
The LLT 4 Step Guide to Normal Function and Functional Impairment
Page 65KnowledgeBase
• A ‘model’ is a template, a way to approach something, a model to follow
• This is beneficial in the context of exercise because with this model, all exercise leaders can apply the same thought process in order to come up with solutions, regardless of the problem
• A ‘model’ is a tool for thinking, and solution finding. It has a start point, and then follows a path towards decisions….so;
What is The Functional Model?
Several body systems work together to produce ‘normal’ functional movement needed for
everyday activities
Several body systems work together to produce ‘normal’ functional movement needed for everyday activities
Normal function movement requires:
Healthy Bones & joints Healthy Muscular systemHealthy Heart and lungs Healthy Nervous system Healthy Endocrine system
Several body systems work together to produce ‘normal’ functional movement needed for everyday activities
Normal function movement requires:
Healthy Bones & joints Healthy Muscular systemHealthy Heart and lungs Healthy Nervous system Healthy Endocrine system
Functional movement is impaired when something goes wrong as a result of processes such as:
Ageing,DeconditioningDisease/clinical conditionsTrauma and injuryHereditary/congenital
Several body systems work together to produce ‘normal’ functional movement needed for everyday activities
Normal function movement requires:
Healthy Bones & joints Healthy Muscular systemHealthy Heart and lungs Healthy Nervous system Healthy Endocrine system
Functional movement is impaired when something goes wrong as a result of processes such as:
Ageing,DeconditioningDisease/clinical conditionsTrauma and injuryHereditary/congenital
Resulting in:
Discomfort, pain, poor posture, early fatigue, injury, demotivation, low mood/depression, isolation, reduced activity levels, further deconditioning & further impaired functional movement
Several body systems work together to produce ‘normal’ functional movement needed for everyday activities
Normal function movement requires:
Healthy Bones & joints Healthy Muscular systemHealthy Heart and lungs Healthy Nervous system Healthy Endocrine system
Functional movement is impaired when something goes wrong as a result of processes such as:
Ageing,DeconditioningDisease/clinical conditionsTrauma and injuryHereditary/congenital
Resulting in:
Discomfort, pain, poor posture, early fatigue, injury, demotivation, low mood/depression, isolation, reduced activity levels, further deconditioning & further impaired functional movement
Commonly leading to: *Reduced range and control of movement*Asymmetry*Impaired base of support, *poor balance and co-ordination*Sensory impairment*Abnormal movement patterns (compensatory)*Painful movement *Impaired communication
Movements must be ADAPTED to suit the individual in order to achieve safe, effective, comfortable function, motivation and enjoyment for people with functional movement
impairment
The LLT ‘4 step guide’ to adapting exercise and maximising CBE delivery for people with functional impairments are;
Several body systems work together to produce ‘normal’ functional movement needed for everyday activities
Normal function movement requires:
Healthy Bones & joints Healthy Muscular systemHealthy Heart and lungs Healthy Nervous system Healthy Endocrine system
Functional movement is impaired when something goes wrong as a result of processes such as:
Ageing,DeconditioningDisease/clinical conditionsTrauma and injuryHereditary/congenital
Resulting in:
Discomfort, pain, poor posture, early fatigue, injury, demotivation, low mood/depression, isolation, reduced activity levels, further deconditioning & further impaired functional movement
Commonly leading to: *Reduced range and control of movement*Asymmetry*Impaired base of support, *poor balance and co-
ordination*Sensory impairment*Abnormal movement patterns (compensatory)*Painful movement *Impaired communication
Movements must be ADAPTED to suit the individual in order to achieve safe, effective, comfortable function, motivation and enjoyment for people with functional movement impairment
The LLT ‘4 step guide’ to adapting exercise and maximising CBE delivery for people with functional impairments are;
Listen to your
participant; they are the experts on adapting to their disability 1
Observe the impairment/ how are range, control and comfort of movement affected? Then focus on a ‘Can Do’ approach 2
Understand the exercise, what range of movement and functional activity is it aiming to achieve?
3
‘Instruct, and communicate with the participant’ to keep joint (s) and other body systems safe and to train functional movement, prevent pain and strain, and maximise gain. 4
Class StructureClass Structure
Warm up Circulation Booster 1
Mobility
Circulation Booster 2
Stretches
Main Workout
CV Endurance Exercises
Strength Exercises
Cool down Circulation Lowering
Pelvic Floor (strengthening exercise)
Flexibility
Relaxation
Revitaliser Page 85
Practical
Handbook
MODEL PRACTICAL MODEL PRACTICAL CLASSCLASS
The Warm-UpThe Warm-UpAims: To prevent injury To promote circulation, generate heat and warm the
muscles To mobilise the joints in order to improve joint
function & ROM in the performance of everyday activities
To stretch the muscles To stimulate the nervous system to enable more skilful
performance To enhance enjoyment and motivation by providing a
relaxed, fun atmosphere at the beginning of the classPage 16
Practical Handbo
ok
Warm up structure
1. Circulation booster 1 (2-3 minutes)
2. Joint mobility exercises (4 reps each)
3. Circulation booster 2 (2-3 minutes)
4. Warm up stretches (perform once, hold 8-10 seconds)
Warm-Up Content Warm-Up Content CB11. Alternate heel raises, Arm Swings, Leg Marches, Tap & ClapMobility2. Shoulder Lifts and Circles3. Side Bends4. Ankle Activators5. Trunk TwistsCB2Stretches6. Back of Thigh7. Chest8. Calf9. Upward Side Stretch
Guidelines to Leading Guidelines to Leading Warm-UpWarm-Up
Correct posture
Starting position
Gradual build up
Keep it simple and achievable
Page 19
Practical
Handbook
Cool Down Component Cool Down Component
Page 68
Practical
Handbook
Cool Down ComponentCool Down ComponentAIMS
To allow the body’s systems to recover from the exercises gradually
Maintain and increase flexibility and posture Reduce the likelihood of post exercise
stiffness Strengthen pelvic floor muscles To promote relaxation To refresh and revitalise, following relaxation
Guidelines to Leading Guidelines to Leading The Cool DownThe Cool Down
CIRCULATION LOWERING
Progressively reduce the intensity of the
Circulation Boosting exercises
Guidelines to Leading Guidelines to Leading the Cool Downthe Cool Down
STRETCHES:
Repeat the warm up stretches,
holding for a little longer, to develop
flexibility and increase the range of
movement (up to 20 seconds, if possible)
Progression - repeat each stretch 2/3 times
Guidelines to Leading Cool DownGuidelines to Leading Cool Down
PELVIC FLOOR: Ensure in a relaxed,
supported position
RELAXATION
REVITALISER: Mild circulation exercises
Adult Social Care
• Values and principles:– Individuality– Choice– Rights– Dignity– Independence– Partnership– Confidentiality– Empowerment– Privacy– Respect for the individual
Reasons for upholding values & principles:
• Care needs met• Quality of experience• Appropriate service delivery• Consistent approach• Promotion of overall well-being• Value people as individuals• Meet legal requirements – human rights,
anti-discrimination
Possible areas of conflict between own values and adult social care values?
• Culture• Religion• Morals• Ethnicity• Politics• Confidentiality v ‘right to know’• Balancing needs of family/needs of individual• Organisational policy
Importance of supporting diversity
• Self-esteem of person
• Important to them
• Recognition of individual
• Supporting choice
• Quality of experience
• Promotion of overall well-being
• Legal/organisational requirements
Importance of gathering information
• What?– History – Needs – Wishes– Likes/dislikes
• Why?– Person feels valued– Tailored support– Person-centred approach– Avoid negative experience– Promotion of choice
Task
• What questions might you ask relating to exercise/physical activity?
– history
– needs
– wishes
– likes/dislikes
Endurance Theory
• What is endurance training?– uses the large muscle groups of the legs
and arms– can be continued for a prolonged period– is rhythmical– is aerobic (‘with oxygen’) – ‘huff and puff’– e.g. walking, running, swimming and
dancing
Endurance component structure
How much?
• 150 minutes a week • Can be in bouts of 10 minutes• Moderate intensity (breathing more heavily but can still
talk)
What exercises in CBE programme?• 10 minutes of:
– Marching– Arm swings– Pat and clap– Standing up and sitting down– Rowing
PRACTICAL CLASSPRACTICAL CLASSStrength Component
Page 47
Practical
Handbook
Muscular Strength - Muscular Strength - Endurance ContinuumEndurance ContinuumFast/Explosive
Powerful
Fast to Fatigue
High Resistance
Low Repetitions
Slow
Stamina
Slow to fatigue
Low Resistance
High Repetitions
Muscular Strength - Muscular Strength - Endurance ContinuumEndurance Continuum
Muscular Strength
Muscular Endurance
1 RM 15+ RM8-12 RM
Strength - Endurance Strength - Endurance ContinuumContinuum
Muscular Strength
Muscular Endurance
1 RM 15+ RM8-12 RM
Age related loss
Strength TrainingStrength Traininghow much is enough?how much is enough?
ACSM Guidelines for Health ACSM Guidelines for Health Related gains in Strength Related gains in Strength
2 x per week8 – 10 exercisesModerate Intensity (80% of 1RM) 10-15 reps1 set training initially
American College of Sports Medicine, 2007
Strength GuidelinesStrength Guidelines
Start between 5 - 8 reps Aiming to progress to 8 - 12 reps When easier, increase resistance Slow Controlled repetitions (6-9 seconds) Hold (up to 5 seconds) at peak contraction
Progress cautiously but ambitiously
Strength WorkoutStrength Workout
AIMS Improve and maintain muscular strength and
also improve posture and muscle mass To improve skill and control of movement To reduce the risk of injury, strain and
fatigue doing every day activities To improve bone density To improve self-esteem and confidence
Page 47
Practical
Handbook
Guidelines to Leading Chair Based Guidelines to Leading Chair Based ExerciseExercise
Tell them what they are going to do (name the exercise)
What it works (body system/part)
Why they are doing it (mobility, flexibility or strength & ADL’s)
Demonstrate (show
front view or side view)
Give key leading points Ask questions to check
understanding Group perform Observe (get up, walk
amongst the group)
Reinforce key leading points
Praise, correct and reassure
The Functional Model in Practice
Adapting the Sit Tall, Stand Strong Exercises
Bones, Joints & Muscles
Adapting the Sit Tall, Stand Strong Exercises
Where do we start ?
Listen to your participant; they are the experts on adapting to their disability 1
Observe the impairment/ how are range, control and comfort of movement affected? Then focus on a ‘Can Do’ approach 2
The Functional Model in Practice - Steps 1&2
Understand the exercise, what range of movement and functional activity is it aiming to achieve? 3
‘Instruct, and communicate with the participant’ to keep joint (s) and other body systems safe and to train functional movement, prevent pain and strain, and maximise gain. 4
The Functional Model in Practice - Steps 3&4
The Functional Model in Practice : Example 1, Optimum Sitting Posture
Mrs P tells you that she has;- hip discomfort on walking and in sitting- some low back discomfort- able sit-to-stand but requires use of her arms
You observe; she sits in her chair always leaning to one side. The chair is such that her hips are set lower than her knees causing her spine to be permanently curved
How Can Mrs P’s sitting position be improved ?
1. Where do you want her joints to be/how do you want her sit/what could you do to make more comfortable ?
2. What joint actions/movements will you need to observe/look out for things going wrong?
3. What STST exercises would benefit from her better sitting posture position? And Why?
Optimum Seated Posture – Learner Led Practical
What exercises are most affected by poor posture, And why?
1. Show us your exercise/s with correct technique
2. Show us what would happen to the exercise if sitting posture was poor/alignment not correct
Refer to the Solutions chart on page 66 of knowledgeBase manual to help you with this task.
Summary - Optimum Seated Posture
• All seated exercises will be affected by a poor sitting
posture
• Alignment of ankles, knees, hips, shoulders and head
will support freer movement at the joints
• Poor alignment will lead to movement restriction
• This alignment may not be possible for all, so joints
may need to be supported with cushions etc.
One Day Instructor Course OnlyOne Day Instructor Course Only
PLANNING FOR YOUR PLANNING FOR YOUR ASSESSMENT DAYASSESSMENT DAY
Page 13
Student File
ASSESSMENT ASSESSMENT INSTRUCTIONSINSTRUCTIONS
AAHHH
Assessment Instructions – Assessment Instructions –
PlanningPlanningYou must produce a session plan, which youwill bring with you on the assessment date.
Your plan will include -
a) Health and Safety document (Page 14 in Student File)
b) All 22 exercises and full session structure
c) Give specific and relevant teaching and safety points for each exercise (not instructions)
d) Give appropriate adaptations and progressions
Session PlanSession Plan
Remember to bring the completed session plan to the assessment
Check that you have named, initialled, dated and numbered every page of your plan and that they are secured
(please DO NOT put each page in a separate plastic folder)
Assessment Instructions – Assessment Instructions –
PracticalPractical
You will be asked to lead FIVE exercises. These are from your planned and practiced session
plan and will include:
2 warm up exercises 1 endurance exercise 2 strength exercises
1 endurance exercise
Circulation Booster 1 PLUS
one mobility exercise
Circulation Booster 2 PLUS
one stretch exercise
OR
2 strength exercises
Assessment Instructions - Assessment Instructions -
Self EvaluationSelf EvaluationAfter you have taught each of your exercises
you will be encouraged to make notes on
your teaching skills based on:
Feedback gained from the groupHow you feel the group performed What you didHow you felt about itWhat will you do differently next time
Student File
Page 19
Assessment Instructions – Assessment Instructions –
PlanningPlanning
You MUST bring
All 3 completed worksheets (even if marked and passed already, you still need to submit)
Your session plan (including the Health
and Safety Planning Document)
Your exercise band
PracticePracticePlease don’t put everything away until the
day before the assessment! Practice on ‘anyone’ you can find!
LAST BIT!LAST BIT!
Course EvaluationsCourse Evaluations
Thank you Thank you for your timefor your time
Your comments do make a difference Your comments do make a difference