Resistance bands/tubing, weights

UE: Shoulders and elbows

LE: hips and knees

Strengthening5-10 min.

AFEP Manual, 2009

Variety of movements such as:• Walking in place• Dance type steps, sports themes

Cardiovascular1-20 min.

AFEP Manual, 2009

• Interspersed throughout

• Use of chair as support if needed

• Examples: heel raises, toe raises, tandem standing, weight shifts, single leg stand, leg swings, side steps, tandem walking

Balance/Coordination

AFEP Manual, 2009

• Reduce soreness

• Transition to next segment

• Lower injury risk

Jt. Check/Cool down5-10 min.

AFEP Manual, 2009

• Progressive relaxation

• Guided imagery

• Slow, deep breathing

Relaxation/Breathing1-5 min.

AFEP Manual, 2009

AFEP Forms

• Participant release form

• Ongoing assessment of participant reach

NCOA, 2012

AFEP Leader Training

• Required instructor certification

• 8 hour training

• Typically leaders are health care professionals or fitness professionals

• CPR required; first aide recommended

• One instructor per classNCOA, 2012

AFEP Other Costs & Equipment

• Weights (optional)

• Guidebooks

• Other materials

• No licensing fee

NCOA, 2012

Examples of an AFEP Class

• http://www.arthritistoday.org/what-you-can-do/staying-active/exercise-videos/two-minute-exercises/head-neck-stretch.php

• http://www.arthritistoday.org/what-you-can-do/staying-active/exercise-videos/two-minute-exercises/arms-and-elbows.php

• http://www.arthritistoday.org/what-you-can-do/staying-active/exercise-videos/two-minute-exercises/hips-knees-and-legs.php

Arthritis Foundation, 2006a; 2006b, 2006c

AFEP Evidence Example

Hinchman, 2001

178 Participants

Less health care utilization (ER visits), Improved overall health

AFEP Evidence Example

Arthritis Foundation, NY Chapter, 2001

551 Participants; pre-post testing, control group

Results indicted:• Reduced depression, pain, stiffness• Improved self-efficacy and functioning• Improved education on self-mgt

AFEP Evidence Example

• 347 participants (Schoster, Callahan, Meier, Mielenz, & DiMartino. (2005). Results indicated

AFEP program provided social support for participants and increased self-efficacy

Improved arthritis self management

AFEP Evidence Example

• 174 participants; RCT, pre-post test design study; 8 week, 16 week, & 6 month follow up (Minor, 2007)

Reduced pain; improved endurance

Improved self care behavior

AFEP Evidence Example

• 346 participants with arthritis, RCT, 8 week follow up and six month follow up (Callahan, et al., 2008)

Less pain

Improved self-mgt, arthritis

Less stiffnessBetter endurance

Improved strength

AFEP CMS Review

• Participants in this program had estimated total healthcare savings of over $750.

• Savings in inpatient unplanned stays ~$670

• Savings in SNF stay ~$200

• Less unplanned hospitalizations; more MD visits

CMS, 2013

Group Activity

Talk with one or two people near you and answer the following question. Please be ready to share your answers afterwards.

• Group Activity: What are some strategies to make it feasible to offer evidence-based health promotion classes in your community?

• What role(s), if any would you like to take in this process?

Tai Chi for Arthritis

• Tai Chi for Health Institute was founded by Dr. Paul Lam in 2009

• Empower people to improve their health and wellness

• Recommended by CDC for fall prevention

Principles of Tai Chi Arthritis

• Improved flexibility• Improved muscular strength• Improved fitness• Decrease pain and falls

Program

• 6-8 weeks• 45-60 min 2x per week• Led by certified instructor

Session Includes

• Warm-up• 6 basic core movements• 6 advance movements• Breathing techniques• Cool-down

Tai Chi Arthritis Example

• http://www.arthritistoday.org/what-you-can-do/staying-active/exercise-videos/tai-chi-exercises/tai-chi-video-spine-stretches.php

Chronic Disease Self-Management Program (CDSMP)

• Enable to build self-confidence to take part in maintaining their health and managing chronic conditions

• Hypertension• Arthritis• Heart disease• Stroke• Lung disease• Diabetes

Program

• 6 weeks• 2.5 hours per week• Program provides information and teaches practical

skills on managing chronic health problems• 2 trained leaders

Assessments

• STEADI – Stop Elderly Accidents, Death & Injury• Timed Up and Go• 30 Second Chair Rise• 4 – Stage Balance Test

STEADI

• 12 item self assessment• Printed by CDC• Environmental checklist• Safety tips

Timed Up And Go (TUG)

• Easy, reliable, and valid indicator of functional mobility and falls risk

• Predictive or morbidity, mortality, functional status (Studenski, 2011)

Timed Up And Go

• Rise from a standard height chair– May use arms– May use assistive device

• Walk 3 meters (@10’)• Cross a visible line or around a visible pylon• Turn 180• Walk to chair• Turn & sit down

What it Tells Us

• Does the person have difficulty performing the task?• Is the person slow?

– 7-9 sec: low risk, typically a fit & active older adult– 10-12 sec: moderate risk, an ‘average’ older adult– ≥ 13.5 sec: high risk for future falls

– (Bohannon, 2005)

What it Tells Us

• Best reliability and validity with independently mobile, healthy older adults

• Poor reliability in hospital settings• Timing task can provide baseline measure of performance• KEY – Does the person have difficulty performing????

30 Second Chair Rise

• Indicator of strength and endurance• Poor performance associated with increased falls risk

30 Second Chair Rise

• Sit in middle of chair• Cross arms, hands on shoulders• Feet flat on floor• On go, rise to full standing and sit• Repeat for 30 seconds

30 Second Chair Rise

• Begin timing on go• Count number of times the patient comes to full standing in

30 seconds• Record number of repetitions

• http://www.cdc.gov/homeandrecreationalsafety/Falls/steadi/videos.html

Resources

National Council on Aging, Center for Healthy Aging

www.ncoa.org/improve-health/center-for-healthy-aging/online-training-modules/series-1-intro-to-health.html

http://www.ncoa.org/improve-health/center-for-healthy-aging/about-evidence-based-programs.html

http://www.ncoa.org/improve-health/center-for-healthy-aging/where-to-find-evidence-based.html

• http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-Evidence-FINAL.pdf

http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-Evidence-FINAL.pdf