Tiered Exercise
Program – TEP
3-Tiered Exercise
BALL Program
EXERCISES
Welcome
Welcome
Sign in
Balls, Bands & Balance
WELCOME
Single most important thing we can help older people to do is
become engaged in a physical activity in a simple and easy way
as part of their lifestyle to help them maintain their overall
functional mobility to age in place.
The only way to maintain function is to engage in movements
that keep the body moving – no pill gives such benefits.
After the age of 25 we all start to loose about 1% of our S, B, F
and CR fitness – this loss is per year and has significant
functional implications. But through PA and exercise we can
maintain or help restore functional potential
Clara Fitzgerald 2015
Fast Facts:
85% of people over 85 spend 85% of their time sitting.
70% of the negative effects of aging are due to lifestyle choices.
Exercise is SO good for you that it’s benefits almost always outweigh
any risks.
We need to move towards a Movement-based lifestyle.
http://www.youtube.com/watch?v=Qo6QNU8kHxI
Dr. Mike Evans – Canada
231/2 hours
http://www.youtube.com/watch?v=aUaInS6HIGo
Page 5
WHAT IS TEP
•
An effective, evidence-based, multi-level,
PREPARED exercise program for older adults with
mobility challenges, that is READY TO PUT INTO
PRACTICE, and includes an ASSESSMENT TOOL
to determine the most appropriate level for each
individual
•
Promotes follow through programing and outcome
based programing
Key Points
Three prepared exercise programs for people with mobility
challenges – ready to put into practice!
Level 3 - Ambulation potential (HSEP)
Level 2 - Transfer ability potential
Level 1 - Sitting balance and chair bound clients
Includes Assessment tools to determine starting level
Each Level is based on 10 simple yet progressive exercises
and comes with a picture package
Need – History of HSEP
•
Home Support Exercise Program developed
in 1996 to meet needs of frail, isolated and
home-bound
•
Promotes functional ability, mobility and
increases independence
•
10 simple, progressive exercises
•
Translated in over 20 languages
•
Disseminated in every province and territory
Need – Tiered Exercise
•
Time is limited for staff to develop programs
•
Need programs for those who cannot ambulate
•
Variety of assessment tools available – which one(s)
to use?
•
Programs need to be geared to ability and not age
and target specific outcomes
•
Programs that can be followed through in a cost
effective manner and simple to disseminate
Journal of Aging and Physical Activity, 2000, 8, 59-75
TEP Objectives
(page iv in manual)
Promote the philosophy of
physical activity as an integral
part of healthy aging:
a. Recognize and clarify common myths of aging,
societal values with respect to aging, and the
impact of population aging in Canada.
b. Support physical activity as a positive health
intervention for the frail.
Assess the older adult for a
fitness program:
a. Review the care plan for functional goals.
b. Identify functional mobility problems in relation
to maintaining independence.
c. Identify factors affecting adherence to physical
activity.
Use assessment findings to
provide individualized fitness:
a. Work with the older adult and family/significant
others and appropriate health care providers to
maintain the older adult’s present level of functional
independence.
b. Provide ambulatory and non-ambulatory older
adults with the exercise program.
c. Encourage a consistent progression of exercises.
d. Encourage the older adult to complete the exercise
calendar daily.
Provide a safe environment:
a. Demonstrate and adapt exercises to individual
needs.
b. Provide advice on proper footwear and clothing
for participation.
c. Encourage a clear path and area during the
exercises
Provide instruction and assist
with monitoring program
Ongoing demonstration and feedback on
performance
Ongoing evaluation of exercise program and
need for progression
Fitness, Activity, Health and
Independence
Getting the Words Straight
Active Living is a way of life in which physical activity is valued and integrated into daily life.
Physical Activityis any body movement produced by skeletal muscles resulting in energy expenditure.
Exercise is a subset of physical activity. It is a planned and repetitive body movement which improves or maintains
one or more components of physical fitness.
Physical Fitnessis a set of attributes that people have or achieve that relate to the ability to perform physical
activity.
Functional Fitness – The level of fitness necessary to take care of personal, household, social, and daily living
needs.
THINK ABOUT IT: Why might physical activities
Components of Functional
Mobility
•
cardiorespiratory endurance
•
anaerobic capacity
•
muscular strength
•
muscular endurance
•
flexibility
•
balance
•
coordination
•
body composition
Learned Helplessness
Refers to the declines beyond what is warranted
by actual physical problems
Older adults relinquish control over routine
activities which can lead to physical, psychological
and social decline
Attitudes of health care workers play a significant
role in the development of learned helplessness
Frailty
reduced capacity to cope with stressors
vulnerability, a lack of resilience, or fragility
loss of aerobic power, balance, strength, bone density and
cognitive changes - all contribute to reduced functional mobility
caused in part by the accumulative effects of a sedentary lifestyle
chronic diseases accelerate the loss of functional mobility
Why do Falls
Matter?
Post Fall Syndrome
Individual Falls
Loses Confidence..
Restricts their Activity..
Loses Mobility..
Independence decreases..
Can be a vicious cycle! Think of all the people one fall can effect...
HSEP Video
•
20 min to watch the video and answer
questions
Purpose of Assessments
•
Assessing fitness and/or function is a logical first step toward promoting changes in
lifestyle activity choices.
•
An assessment can:
•
provide a baseline measurement to be repeated and compared at a later date
•
be used as an indicator of program effectiveness
•
serve as a motivator of the older adult
•
be used for educating the older adult
•
help categorize functional level, indicate appropriate exercise program for the older
adult
•
can help identify older adults at risk of frailty due to inactivity
5 REP Sit to Stand
The Sit-to-Stand test is used to assess lower body muscular strength, transitional
movements and balance of older adults, which can help determine an appropriate
physical activity program for the individual to participate in.
Start position:
Make sure individual is wearing everyday footwear. Begin with individual sitting in a standard
armchair (seat height 46 cm or 16”, arm height approximately 65 cm) with their back against the
back of the chair. The chair should be placed against a wall to prevent slipping.
Instructions:
(Individual) On the word “go”, stand up as quickly as possible to a fully erect position and sit back
down in the chair. Do this 5 times without stopping, with as little hand assistance as possible.
(Assessor) Counting aloud can keep the individual oriented. Stop the watch when the standing
position is achieved on the 5th repetition. No instructions are given regarding hand position. This is
helpful to establish the initial or spontaneous category of hand assistance.
Record:
Time in seconds required to complete the task. Allow individual to practice one time (sit-to-stand
movement) before being timed. As individual completes 5 repetitions, note any difficulties
experienced.
Scoring
Sit-to-Stand Scoring Scale
Recommend further assessment of fall risk if score is > 12 sec. 1
Individual is at risk of recurrent falls if score is > 15 sec. 2
Seconds To Complete
Score (A)
Less than 9
1
9.1 – 10.0
2
10.1 – 11.0
3
11.1 – 12.0
4
12.1 – 13.0
5
13.1 – 14.0
6
14.1 – 15.0
7
15.1 – 16.0
8
16.1 – 17.0
9
More than 17
10
Timed Up and Go
Timed Up-and-Go (TUG) Test
Described below is a simple field assessment to measure agility/dynamic
balance. It is simple to administer, safe, sensitive to change with activity, and
can provide a “snapshot” description of functional mobility.
Start position:
In everyday footwear, the individual sits in a standard armchair (seat height 46 cm, or 16”, arm
height approximately 65 cm) with back against the back of the chair, and arms resting on the
chair’s arms. Use a walking aid during the test if the individual normally uses one.
Instructions:
On the word “go”, get up and walk at a comfortable and safe pace to the line on the floor 3 metres
away, turn around, return to chair and sit down again.
Record:
Time in seconds required to complete the task; one practice walk allowed before being timed; note
difficulties in getting out of the chair, walking, turning and/or sitting down.
TUG scoring – score sheet
pg 34
Timed up-and-go (TUG) Scoring Scale
Seconds To Complete Test
Score (B)
Less than 7
1
7.1-8.0
2
8.1-9.0
3
9.1-10.0
4
10.1-11.0
5
11.1-12.0
6
12.1-13.0
7
13.1-14.0
8
14.1-15.0
9
More than 15
10
Functional Fitness
Confidence Scale (FFC)
•
Pg 36
Overall Confidence Recoded
(Add up all %’s and divide
by 12)
Score (C)
91-100%
1
81-90%
2
71-80%
3
61-70%
4
51-60%
5
41-50%
6
31-40%
7
21-30%
8
11-20%
9
Less than 20%
10
Combined Scores
Total Points
Functional Fitness Level
0 – 9 Points
Level 3 for Ambulatory Participants
10 – 18 Points
Level 2 for those with Transfer Ability
19 – 30 Points
Level 1 for Chair Bound Participants
Learning the Exercises
Demonstration each exercise. Narrative
accompanies each exercise graphic.
Pair up and practise after each demonstrated
exercise. Respond to questions as they come up.
Observe and assist.
Review safety precautions especially proper form
and positioning (pg 33)
Tier 1 Exercises
1.
Chair marching
2.
Chest press
3.
Chair push-ups
4.
Finger press
5.
Adductor strengthening
6.
Abductor strengthening
7.
Seated toe taps
8.
Isometric abdominals
9.
Seated reaching
10.
Seated hamstring stretch
Tier 2 Exercises
1.
Seated march with arms
2.
Seated walks
3.
Sit to stand
4.
Toe taps/heel raise
5.
Chair push-ups
6.
Reverse seated sit up
7.
Propelling with leg
8.
Standing weight shift
9.
Seated reach
10.
Seated hamstring stretch
Tier 3 Exercises (HSEP)
1.
Walking from room to room
2.
Wall push-ups
3.
Rising up on toes
4.
Toe taps
5.
Seat walk
6.
Getting up from a chair
7.
Leg lifts: front, back, and side
8.
Reach up, front, to the side
9.
Standing stretch (lower leg stretch)
10.
Seated stretch (back of leg stretch)
Exercise Adherence
pg 102
Adoption of, and adherence to regular physical activity is a
multifaceted problem at every age. Behaviour modification
is an important part of any program designed to enhance
older adults’ functional mobility.
The acquisition of habits related to the increase of physical
activity is believed to be a process with three stages:
the decision to start exercising,
the early stages of behaviour change,
the maintenance of the new behaviour,
Exercise Motivation
The WIFM factor
What are key motivators for you?
What are key motivators for our clients?
What are ways to ‘sell exercise’?
Stress simplicity – one area of improvement
ie posture, lifting feet while walking
Audio clips
Managing Aches and Pains
Start slow and progress gradually
Do not work through sharp pain in joints or muscles
Soreness is normal for beginners but it should go
away after 1-2 days
Physical exertion can be uncomfortable at first. It is
necessary to meet such challenges in order to improve
functional abilities
Other tips?
Keeping Exercise a Priority
As an individual
As a team
As an organization
How will we maintain momentum?
Review
What is Functional Mobility?
What it TEP?
What are the Assessment Tools?
Tips to Motivate a client?
Tips to Manage Aches and Pains?
Now what?
Brainstorm catchy name for our exercise program?
Job shadowing to further learn exercises with
clients in their home
Roll out TEP for client in Killaloe and Barry’s Bay
assessments – consents – exercise plan
Thank you
If you are interested in participating and receiving the 4 hour training, please
contact:
Kathy Blomquist, RN
Care Coordinator - Assisted Living Program
Barry's Bay and Area Senior Citizens Home Support Services
613 717 2754 (cell)
http://www.bbahs.org