A toolkit for frontline caregivers to help maintain healthy
and active aging in seniors
With the goal of sustaining adequate IADLs to allow seniors
to remain as autonomous as possible for as long as possible
Relaxation exercises, physical exercises
and suggestions for cognitive activities for the home setting
Table of contents
Introduction
A healthy mind in a healthy body at any age!
2
Facts and Tips
Facts about frailty
3
Some false myths about exercising
3
Benefits of Exercising
4
Good Pain versus Bad Pain : How to Tell the Difference?
6
Appropriate Level of Effort
7
Functional Fitness Assessments
8
Physical Tests (TUG et STS)
9
Confidence Test
11
Functional Fitness Score
12
The Physical Exercise Program
Exercise Categories
13
Start with Relaxation (Listen to the audio monologue instructions!)
14
The Aerobic Exercises
15
The Muscle Strengthening Exercises
16
The Flexibility Exercises
17
The Balance-building Exercises
18
End with Relaxation (Listen to the audio monologue instructions!)
19
Client’s Exercise Calendar
20
Suggestions for Intellectual Activities
21
Client’s Functional Fitness Progress Report
22
And of course….EAT RIGHT!
23
1
Introduction
A healthy mind in a healthy body at any age!
Everyone wants to live independently with a good quality of life for the rest of their days. What
can help make this possible? The secret according to scientific research is maintaining an active
lifestyle. Contrary to popular belief, old age is definitely not the time to rest - if living
independently with good health and an alert mind is the goal.
With age, our physiological reserves and biological resilience declines. This can lead to frailty,
and it is easy to spot in some seniors. These seniors appear weak, look fragile, and move slowly
and without confidence. They often complain of low energy and have no interest in doing much.
But frailty is not the norm. Old age does not necessarily mean limited mobility, reduced zest for
life, and bad health. Nor does it always mean memory loss and cognitive decline. Frailty and
dementia need not always be a part of normal aging – at the very least their onset can be
postponed according to scientists. Indications are that all it takes is a commitment to moderate
daily physical and cognitive exercise, even from really senior seniors! The goal is long term
autonomy not long term care!
In the past, we would encourage our seniors to reduce their activities, get someone to do their
chores for them, and advise them to rest. Research has since shown that this approach to caring for
seniors has adverse effects – in fact is the opposite of what we should be doing for them. For this
reason, the Ontario government has implemented Ontario’s Action Plan for Seniors featuring the
theme "Independence, Activity and Good Health". It encourages seniors to stay active and
engaged in order to prolong a good quality of life with the goal of living at home independently
for as long as possible, which is the cherished wish of the overwhelming majority of seniors.
So let’s get started on the road towards maintaining independence and an active and healthy
lifestyle for our seniors! This manual contains everything you will need to help your clients
succeed in this new action plan. It contains facts about the benefits of an active lifestyle and
counterarguments to dispel harmful myths about seniors and exercise; it contains simple physical
and cognitive exercises, a progress report template, and tips on how to accompany them in their
new life routine.
The exercises proposed here meet the Canadian guidelines for physical activity for adults aged 65
and over and are supported by the Canadian Centre for Activity and Aging of Western University
and the Department of Physical Therapy of the University of Toronto. The cognitive activities are
endorsed by the Centre for Cognitive Health of York University.
2
Facts and Tips
Facts about frailty
What does it mean to be frail? It means that there is a decrease in functional mobility and overall
physical resiliency. Frailty is caused by a reduction in aerobic capacity, a loss of balance control
and a reduction in bone density. Physical frailty can also be associated with declining cognitive
functional capacity making seniors more vulnerable to stress, risk of falls, and depression.
Frailty is caused in part by the cumulative effects of a sedentary lifestyle and loss of physical
fitness and tone. Disuse and lack of physical conditioning reduces functional mobility which leads
to frailty and a loss of independence. But clients should not be discouraged because physical
activity can prevent frailty.
Some false myths about exercise
I am too old to do exercise.
No one is too old! And every little bit helps.
http://www.csep.ca/en/guidelines/get-the-guidelines
Exercise is bad for people with varicose veins problems.
Actually exercise is good as gets blood moving!
http://www.veinspecialists.com/blog/exercise-and-varicose-veins/
Exercise is bad for people with arthritis.
Actually exercise is good and will improve symptoms!
http://www.health.harvard.edu/blog/exercise-is-good-not-bad-for-arthritis-201305086202
Exercise is bad for people with asthma.
Often, exercise can help control the frequency and severity of asthma
attacks.
http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-and-chronicdisease/art-20046049
Puttering around the house and walking to the store is enough.
This is not enough; the older we get the more we need to do a mix of
more formal functional exercises (aerobic, strength-building,
flexibility and balance).
http://www.health.harvard.edu/newsletter_article/how-much-exercise-do-you-need
3
Benefits of Exercising : Let Your Clients Know That…
Exercise helps prevent falls
Did you know that 20-30% of people over 65 years of age will fall this year?
Did you know that 80% of these falls occur in the home?
Did you know that the main cause of hospitalization in people over 65 years of age is due to
falls (77% for men and 88% for women)?
Did you know that 95% of all hip fractures are due to a fall?
Did you know that 40% of all falls result in the person being hospitalized or sent to long-term
care?
Did you know that 39% of deaths in Canada are related to a fall?
Did you know that in 2004 the cost of falls to the health system in Ontario was $2 billion?
Don’t let your client be one of these statistics!!
All it takes is 10- 30 minutes of daily exercise.
While many falls do not result in
serious injuries, they cause discomfort
and often result in prolonged periods
of inactivity, which can have a
negative impact on the body.
But - for seniors who exercise and who
fall, they end up incurring fewer and
less serious injuries because their
bodies are a more resilient and they are
more relaxed..
https://www.stayonyourfeet.com.au/everyone/order-free-brochures-and-booklets/
4
Exercise helps us
digest better
sleep better
control their weight better
improve their mood
reduce the risk of memory problems
boost the immune system
increase their bone density
feel less anxious and less stressed
reduce the risk of cardiovascular problems
feel more confidence in themselves
DON’T FORGET TO CHECK OUT YOUR CLIENTS’ PROGRESS
by using the “Function Fitness Progress Report”.
There is nothing more motivating for you and for your client
than proof of progress! It makes it all worth it!
5
Good Pain versus Bad Pain : How to Tell the Difference?
Good Pain gets the thumbs up!
Good normal pain feels like stiffness or burning and can cause some discomfort, but it doesn’t
hurt when the person is at rest. Good pain is a good thing as it a sign that means that the muscles
are becoming stronger.
It normally occurs within 24-72 hours after the exercise session, and then it begins to disappear.
http://www.hopkinsmedicine.org/orthopaedic-surgery/about-us/ask-the-experts/pain.htmlx
Bad Pain gets the thumbs down!
Bad pain is not normal. It is often a sharp pain, usually not located in a part of the body that you
were actually deliberately exercising. Often the pain is present even while the person is at rest.
This kind of pain persists after 72 hours.
http://www.hopkinsmedicine.org/orthopaedic-surgery/about-us/ask-the-experts/pain.html
If your clients are reticent about exercising because they already have some pain, try to get them
do some a couple of repetitions of an exercise anyway. After a couple of repetitions, ask them if
the pain is worse. If the pain isn’t worse, then it means that the exercise is not aggravating the
situation. They should feel free to exercise. Simply continue to ask them if the pain is worsening
as they continue to exercise. If the pain level does not increase, then the client can proceed with
their exercise program. If the pain is increased by the exercise, they should stop.
Quand ne pas continuer avec les exercices!
• If the pain persists longer than72 hours.
• If the person has an injury.
• If the client has a severe medical condition such as a heart condition.
• If the client is at risk of falling.
• If the environment is not safe for exercising.
Wait until a doctor says
it is fine to start to
exercise again!
6
Appropriate Level of Effort
The client should always be able to talk without being too out of breath during exercise. Engage
the client in a bit of a conversation from time to time throughout the exercise session. If the client
cannot talk without significant breathlessness, stop and rest for a while before proceeding and
select a less strenuous regime of exercise.
Ideal
level of
exertion
for your
clients.
https://www.google.ca/search?q=modified+borg+scale+of+perceived+exertion&rlz=1T4MXGB_enCA584CA585&
biw=1536&bih=762&tbm=isch&imgil=rWnLw5tfKmLWlM%253A
7
Functional Fitness Assessments
Tiered Exercise Program Participant Guide, Canadian Centre for Activity and Aging, Western University, 2016
The purpose of assessments:
To provide a baseline measurement so can compare future performance so as to be able to
measure changes;
To provide information as to the physical fitness of the client in order to design an
appropriate individualized exercise program for the client;
To help motivate clients through a record of their performance;
To help identify a risk of frailty and falls due to inactivity.
When To Assess:
An initial assessment should be done before the client begins the Dr Actif program.
Reassessments can be done every 3 to 6 months.
Take your time with the assessments so that the client does not feel stressed by them.
The Three Assessments:
1. TUG Test (Timed Up-and-Go) measures general mobility by assessing ability to rise
from a chair and to walk with good speed.
2. 5 Rep Sit to Stand (STS) measures lower body muscular strength and balance by
assessing stamina in raising and lowering into a chair.
Together these two assessments are good predictors of risk of falls and of frailty.
http://www.medscape.com/viewarticle/578505_4; Podsiadlo D, Richardson S. The Time “Up & Go”: A Test of Basic
Functional Mobility for Frail Elderly Persons. Journal of the American Geriatrics Society 1991; 39(2):142148
3. The Functional Fitness Confidence Scale (FFC) assesses the client’s confidence level in
performing the activities of daily living, reflecting the client’s perceived judgment as to
their physical stamina, muscular strength and flexibility.
Confidence tests are important to administer because clients who are worried about falling
tend to be less active, which in turn feeds the cycle of inactivity and disuse leading to
higher risks of frailty and falls. A.M. Myers. Department of Health Studies and Gerontology, University of
Waterloo, Ontario, Canada, N2L 3G1. Funded by Searle Canada Inc. and Health Canada.
8
1.
TUG (Timed Up-and-Go) Test
Instructions
Have client sit in a standard chair, like a dining room chair, that has a back and arm rests (about
46 cm or 16” high). Ask them to sit back in the chair with their back against the back of the
chair and arms resting on the chair’s arms.
On the word “go”, the client is to get up and walk at a comfortable and safe pace in a straight
line for 3 meters (10 feet), turn and return and sit down again in the chair. The client can use a
walking aid if the individual normally uses one.
Time the number of seconds it takes for the client to complete the task.
Allow the client can take a practice walk before being timed.
TUG Scoring Scale
# Seconds to Complete Task
Less than 7
7.1 - 8
8.1 - 9
9.1 - 10
10.1 - 11
11.1 - 12
12.1 - 13
13.1 - 14
14.1 - 15
More than 15
Level
1
2
3
4
5
6
7
8
9
10
Client’s Score (Test 1): ____
9
2.
STS (Sit-to-Stand) Test
Instructions
Have the client sit a standard chair, like a dining room chair, that has a back and arm rests
(about 46 cm or 16” high). The chair should be placed against a wall to prevent slipping.
On the word “go”, the client is to get up as quickly as possible to a fully erect position and sit
back down in the chair 5 times without stopping without using the arm rests if possible.
Allow the client to practice one sit-stand cycle before being timed.
Time the number of seconds it takes for the client to complete the task. Counting aloud can
keep the client oriented. Stop the watch when the standing position is achieved on the 5th
repetition. Do not mention it if they use their hands. Record the time in seconds that it takes for
the client to complete the task.
STS Scoring Scale
# Seconds to Complete Task
Less than 9
9.1 – 10.0
10.1 – 11.0
11.1 – 12.0
12.1 – 13.0
13.1 – 14.0
14.1 – 15.0
15.1 – 16.0
16.1 – 17.0
More than 17
Score
1
2
3
4
5
6
7
8
9
10
Client’s Score (Test 2): ____
10
3.
0%
10%
20%
Not at all confident
FFC (Functional Fitness Confidence) Test
30%
40%
50%
60%
Moderately confident
70%
80%
90%
100%
Completely confident
(1)
Get up from a low chair without using the chair arms? ______%
(2)
Cut and file your toenails? ______%
(3)
Hold your arms above your head (for instance when doing your hair)? ______%
(4)
Bend down to tie up your shoes without having to sit down? ______%
(5)
Reach your arm back over your shoulder to touch the middle of your back (for instance, to pull up a
zipper)? ______%
(6)
Do 15 minutes of light house work? (such as cleaning bathrooms, washing or vacuuming floors)
______%
(7)
Climb up one flight of stairs ______%
(8)
Climb up three flights of stairs ______%
(9)
Lift a bag of sugar (1 kg) from the counter to an overhead cupboard ______%
(10)
Lift a bag of potatoes (5 kg) from the floor to the counter ______%
(11)
Walk an hour around a shopping mall ______%
(12)
Run quickly (about 50 feet) to catch a bus or cross a busy street when the light is changing ______%
Functional Fitness Confidence (FFC) Scoring Scale
Overall confidence
Add all scores and divide by 12 then code
the score
91-100%
81-90%
71-80%
61-70%
51-60%
41-50%
31-40%
21-30%
11-20%
Less than 20%
Score
1
2
3
4
5
6
7
8
9
10
Client’s Score (3): ____
11
Overall Functional Fitness Level
Score 1 (TUG) + Score 2 (STS) + Score 3 (FFC) = TOTAL = Overall FFL Score
_____ out of 30 (__/30)
Client’s score record and calculation of FFL Score:
Name of client:
Follow-up
Dates
TUG in
seconds
TUG
Score
STS in
seconds
STS
Score
Start Date:
Total
FFL
Score
Comments
Legend pour FFL:
Score
Description of Functional Fitness Level
0–9
Good physical condition
10 – 18
Weakened physical condition
19 – 30
Compromised physical condition
12
The Exercice Program
Exercise Categories
 To promote health and improve functional capacity, your client should do at least 150
minutes or 2 1/2 hours of physical activity per week. Start your client off with 10-minute
sessions 5 times a week. Gradually increase the duration of their exercise sessions to 30
minutes 5 times a week.
 All seniors, including those with reduced mobility, should do physical exercises
belonging to the 4 following categories of exercise:
Exercise categories
Reasons for doing them
 Aerobic
To improve heart function, breathing,
digestion and sleep.
 Muscles Strengthening
To increase mobility and strengthen bones,
and reduce joint pain
 Flexibility
To improve mobility et achieve a larger range
of movement
 Balance-building
To prevent falls and encourage mobility
 Cognitive
To maintain intellectual performance –
requiring the learning of something new every
day
 Memory
To maintain this crucial aspect of intellectual
capacity
“Every man desires to live long, but no man would be old”
Jonathan Swift
13
ALWAYS begin with la
relaxation
Put on some comfortable clothing.
Spend the next 30 minutes giving yourself
permission to take time for yourself, for your
body and your well-being.
Make yourself as comfortable as possible, whether you are sitting or lying down.
Uncross your legs and arms.
Do not think about your worries – convince yourself that you do not need to do anything right
now.
If you wish, close your eyes for less distraction thus promoting an atmosphere of relaxation.
Breathe deeply through your nose allowing the abdomen to expand so the lungs can fill
completely, then slowly and fully exhale to release tension. Think only of your breathing.
Give yourself time to calm your body and mind.
Identify an intention for your exercise program and remember this intention throughout your
exercise session. Take for example the commitment to have a positive attitude today or to make a
special effort to do the exercises so you can get out for more walks this summer.
Whenever you start thinking of other things, bring your awareness gently to the present moment
and your breathing.
14
The Fitness Plan
Aerobic Exercises
Some examples…
Check the “Objectives Column” with your Case Manager.
Exercises
Instructions
Walking
Walk from room to room taking rest
periods when needed.
Chair Walking
In a seated position, go through the
motions of walking.
Chair Squats
Bend your knees and squat down as
far as you can as before sitting in the
chair with or without using the arms
of the chair for support; then stand up
again.
Leg Lifts
From a standing position and with
hands resting on the back of a chair,
raise your left leg backwards,
forwards and sideways and then
replace it. Repeat with the right leg.
Toe Taps
From a seated or standing position,
tap the toes of one foot and then the
other.
Heel Raises
From a standing or seated position,
raise yourself up on your toes.
Images
Objectives
(# of repetitions or
# of minutes)
15
Muscle-Strengthening Exercises
Some examples…
Check the “Objectives Column” with your Case Manager.
Exercises
Instructions
Arm Circles
In a standing or seated position, with arms
extended straight out from the side body, make
circles with arms clockwise and then counterclockwise.
Lunges
Stand with feet apart about the width of the
pelvis, back straight, step forward with left foot,
bending both legs until your right knee almost
touches the ground. Straighten up. Repeat with
the other leg.
Strengthening
the Glutes
While sitting, place a ball under the arch of your
foot, then and push down with your foot while
flexing or working the buttocks muscles. Repeat
with the opposite foot.
Strengthening
the Deltoids and
Pectorals
From a standing or sitting position, place a ball
under your arm. Lower your arm towards your
body while squeezing the ball against you, then
release. Repeat with the other arm.
Wall Push-ups
Standing or sitting upright in front of a wall,
push against the wall with your arms.
Images
Objectives
(# of
repetitions or
# of minutes)
16
Flexibility Training Exercises
Some examples…
Check the “Objectives Column” with your Case Manager.
Exercises
Instructions
Runners’
Stretch
Stand facing a wall with your arms straight in front
of you and your hands flat against the wall. Extend
your left leg straight back, with your heel flat on
the floor. Lean into the wall without bending your
back knee until you feel the stretch in the back leg.
Hold for 15 seconds.
In a seated position, stretch one leg straight in front
and rest it on the floor, then hinging at the hips, not
the waist. Stop when you feel a stretch at the back
of your thigh. Hold for 20 seconds. Repeat with
other leg.
Back of Leg
Stretch
Arm Stretches
Reach your arms above your head, out to the side
and then in front of you.
Back Stretch
From a seated position, curve your back and point
your head towards your chest, then sit back up
straight.
Shrugs
In a seated position, shrug your shoulders, holding
for 15 seconds before releasing.
Images
Objectives
(# of
repetitions or
# of minutes)
17
Balance-building Exercises
Some examples…
Check the “Objectives Column” with your Case Manager.
Exercises
Instructions
Marching Band
Walk
With arms outstretched on either side, walk forward
while looking ahead and lifting one leg and keeping
it raised for 1 second each time before advancing.
Head Dance
Walking
Walk slowly across the room while slowing turning
your head as far to the right as you can. Walk back
to your starting point while slowly turning your
head as far to the left as you can.
Rock Around the
Clock Circles
Stand straight with your feet together and make
your body rigid as a board. Begin to sway in a circle
with your body. Sway for one minute in each
direction.
Heel to Toe
Walking
Place the heel of one foot just in front of the toes of
the other foot. Your heel and toes should touch or
almost. Look ahead. Walk forward.
Weight Transfer
With one hand on the back of a chair, shift your
weight from one foot to the other.
Images
Objectives
(# of
repetitions or
# of minutes)
18
End with Relaxation
At the end of your exercise session, give yourself time to enjoy the feeling of the benefits of your
practice and dedication to your health.
Make yourself as comfortable as possible, whether you are sitting or lying down.
Make sure that your body is perfectly supported by the surface upon which you are sitting or lying
so that your muscles can fully enjoy the feeling of rest and relaxation they deserve.
Become aware of the new sensations in your body stimulated by the healthy activity you have just
undertaken. Remember this pleasant sensation of revitalisation.
If you wish, close your eyes for a fuller relaxation and to avoid distraction and breathe slowly and
easily.
Take this time to celebrate that you have done something positive for your body.
Your body will thank you for permitting it to benefit from this time.
You can now continue your daily activities with the renewed sense of energy you feel in your
body.
19
Client’s Exercise Calendar
Create an exercise schedule for clients who want to continue the exercise program
in-between PSWs visits by using the exercise calendar provided.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Walking
Chair Walking
Chair Squats
Leg Lifts
Toe Taps
Heel Raises
Arm Circles
Lunges
Strengthening the glutes
Strengthening the
deltoids and pectorals
Wall Push-ups
Runners’ Stretch
Back of Leg Stretch
Arm Stretches
Back Stretches
Shrugs
Marching Band Walk
Head Dance Walking
Rock Around the Clock
Circles
Heel to Toe Walking
Weight Transfer
20
Suggestions for Intellectual Activities
A good memory and good overall brain function is the result of strong connections between brain
cells. What is the best way to strengthen these links? In other words, what is the best way to “exercise”
your brain? The answer is to perform one challenging intellectual activity per day.
Whether you prefer to read a book, do crossword puzzles, play a good game of chess or cards, attend
workshops, take part in social gatherings, attend a good show, play a musical instrument or sing in a
choir, it is important to focus on at least one intellectual activity every day.
Below are some cognitive activities to help you “exercise” your brain and keep it in shape!
I like this one!
Some Ideas
Doing some simple math problems / Undertake a numbers game like a Sudoku / Count
up from 0 by twos, by threes...
Make a list of items or words and then try to remember at least 12 of them.
Play a game of strategy such as Bridge or Chess.
Play a word game or complete a crossword puzzle.
Start and complete a difficult jigsaw puzzle.
Read a book, newspaper or magazine and then try to remember as many details as
possible.
Write a paragraph a keep or keep a daily diary or write a poem a day.
Name the streets to the east, west, north and south of your own address; expand your
geography as you learn the names.
Travel to a new place.
Further suggestions:
21
Functional Fitness
Progress Report
N AME
OF CLIENT :
F UNCTIONAL F ITNESS S CORE
30
20
10
0
B AS EL IN E
A F T ER 3
M ON T HS
A F T ER 6
MON T HS
A F T ER 1 2
MON T HS
M ONTHS
22
And of And of course …… EAT RIGHT !!!
Canadian Food Guide
23