1 fit for life: promoting physical fitness for older adults david m. morris, pt, phd professor and...
TRANSCRIPT
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Fit for Life: Promoting Physical Fitness for Older
AdultsDavid M. Morris, PT, PhD
Professor and Vice ChairDepartment of Physical Therapy
University of Alabama at Birmingham
Session Objectives
Describe the health benefits that have been shown to be associated with exercise.
Discuss established exercise guidelines for exercise for older adults.
Describe evidenced based programs that promote physical fitness for older adults.
Locate and utilize resources that assist health care professionals to promote physical fitness with their older adult consumers.
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Plan for today
The language of physical fitness Why physical fitness is important Physical activity guidelines Are Americans meeting these guidelines? Knowing if an older adult is ready to
initiate a physical fitness program Behavior change issues Evidenced based programs Resources
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Health and Human Services: Physical Activity
Guidelines
Physical fitness includes a number of components consisting of cardiorespiratory endurance (aerobic power), skeletal muscle endurance, skeletal muscle strength, skeletal muscle power, flexibility, balance, speed of movement, reaction time, and body composition.
Physical Activity
Any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal level.
Occupational Leisure Transportation
Physical Activity Guidelines Advisory Committee Report. Washington, DC: US Department of Health and Human Services, 2008
Exercise
A subcategory of physical activity that is “planned, structured, and repetitive and purposive in the sense that the improvement or maintenance of one of more components of physical fitness is the objective.”
Benefits: Moderate Evidence
A lower risk of hip fracture Lung cancer Endometrial cancer Weight maintenance after weight loss Increased bone density Improved sleep quality
Benefits: Moderate to Strong Evidence
Better functional health (for older adults)
Reduced abdominal obesity
Benefits: Strong Evidence
A lower risk of: Early death Coronary heart disease Stroke High blood pressure Adverse blood lipid profile Type II Diabetes Metabolic syndrome
Benefits: Strong Evidence
A lower risk of: Colon Cancer Breast Cancer
In addition to: Weight loss, particularly when combined with
reduced caloric intake Improved cardiorespiratory fitness & muscular
fitness Prevention of falls Reduced depression Better cognitive function in older adults
Physical Activity Guidelines
HHS Physical Activity Guidelines
American College of Sports Medicine (ACSM)/ American Heart Association (AHA)
Australian Guidelines
World Confederation for Physical Therapy (WCPT)
World Health Organization (WHO)
APTA Physical Fitness for Special Populations (PFSP) Pocket Guides
Physical Activity Guidelines for Americans
(HHS) Methodology established first All research rated based on pre-
established methodology All recommendations rated based on
pre-established methodology
Physical Activity Guidelines for Americans
(HHS) Older adults need at least:
Aerobic exercise: 2 hrs 30 min at moderate intensity OR 1 hr 15 minutes or vigorous intensity OR An equivalent mix of moderate and
vigorous intensity AND Muscle strengthening on 2 or more
days/week that work all major muscle groups
Physical Activity Guidelines for Americans
(HHS) Older adults get even greater benefits
from: Aerobic exercise:
5 hrs at moderate intensity OR 2 hrs 30 minutes or vigorous intensity
OR An equivalent mix of moderate and
vigorous intensity AND Muscle strengthening on 2 or more
days/week that work all major muscle groups
Physical Activity Guidelines for Americans
(HHS) Intensity - How hard* is your body
working? Moderate activity = 5 or 6 Vigorous activity = 7 or 8
* On a 10-point scale – “0” is sitting AND “10” is working as hard as you can.
WHO
WHO and WCPT
Adults (18-65 years old) 30 minutes of moderate-intensity
physical activity 5 days per week; OR 20 minutes of vigorous-intensity physical
activity 3 days per week; OR An equivalent combination of moderate-
vigorous intensity physical activity; AND 8-10 muscular strengthening exercises
(8-12 repetitions) at least 2 days per week.
WHO and WCPT
Adults (65 years and older) same recommendations as described for
adults (outlined previously) with due consideration for the intensity and type of physical activity appropriate for older people; AND
exercises to maintain flexibility; AND balance exercises
How are we Doing?
Less than half (48%) of US adults meet the PA guidelines
Racial disparities Non-Hispanic white adults (22.8%) Non-Hispanic black adults (17.3%) Hispanic adults (14.4%)
Men (52.1%) more likely than women (42.6%) to meet the 2008 PAG for aerobic activity
Younger adults are more likely than older adults
Income level above poverty level more likely than below
How are we doing?: 2008 Age-Adjusted Estimates of the Percentage of Adults Who Are
Physically Inactive
Are You Ready for Exercise?
Physical Activity Readiness Questionnaire (PARQ)
• Has your doctor ever said that you have a heart condition and that you should only do PA recommended by your doctor?
• Do you feel pain in your chest when you do PA?
• In the past month, have you had chest pain when you were not doing PA?
• Do you lose your balance because of dizziness or do you ever lose consciousness
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Are You Ready for Exercise? Cont…
• Do you have a bone or joint problem that could be made worse by a change in your PA?
• Is your doctor currently prescribing drugs for your blood pressure or heart condition?
• Do you know of any other reason why you should not do PA?
If you answered yes to one or more questions, see your doctor before you start becoming more PA.
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Why do people change their behavior?
What we know and think influences our behavior.
ButKnowledge is not sufficient to produce
behavior change. People change when:
THEY have a perceived need to change. THEY are ready to change. THEY have the necessary knowledge,
skill and tools. THEY have a supportive environment.
Particularly Important for PA and Older Adults
Increasing Self-efficacy
Readiness to change
Overcoming barriers
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Self Efficacy
The level of confidence individuals have in their ability to perform a certain behavior (Bandura, 1997)
Influences: Choice of behaviors How much effort a person will expend How long they will persevere How resilient in the face of setbacks How much stress and anxiety they will
experience Motivation
Measuring Self Efficacy
Physical activity or exercise includes activities such as walking briskly, jogging, bicycling, swimming, or any other activity in which the exertion is at least as intense as these activities.
Scale1 = not at all confident, 2 = slightly confident, 3 = moderately confident, 4 = very confident
5 - extremely confident
How confident are you that you could be physically active in each of the following situations?
1. When I am tired 1 2 3 4 5
2. When I am in a bad mood 1 2 3 4 5
3. When I feel I don’t have time 1 2 3 4 5
4. When I am on vacation 1 2 3 4 5
5. When it is raining or snowing 1 2 3 4 5
Improving Self Efficacy
Strategy Example
Mastery experiences/performance accomplishments
Incremental mastery – start with low level difficulty activities and increase gradually
Modeling/vicarious experiences Watching others like you exercise
Social persuasion/credible source Enlisting a credible spokesperson; trusted health professional influencing decision
Internal feedback (psychological and physiological)
Facing barriers head on and learning that they can be managed
Stages of Change
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Physical Activity Stages of Change
B. Marcus and L. Forsyth, 2009, Motivating people to be physically active, 2nd ed. (Champaign, IL: Human Kinetics)
Instructions:a) For each of the following questions, please
circle Yes or No. Please be sure to read the questions carefully
b) Physical activity or exercise includes activities such as walking briskly, jogging, bicycling, swimming, or any other activity in which the exertion is at least as intense as these activities.
Physical Activity Stages of ChangeQuestions
No Yes
1. I am currently physically active. 0 1
2. I intend to become more physically active in the next 6 months.
0 1
For activity to be regular, it must add up to a total of 30 minutes or more per day and be done at least 5 days per week. For example, you could take one 30-minute walk or take three 10-minute walks for a daily total of 30 minutes.
No Yes
3. I currently engage in regular physical activity. 0 1
4. I have been regularly physically active for the past 6 months.
0 1From B. Marcus and L Forsyth, 2009, Motivating people to be physically active, 2nd ed. (Champaign, IL: Human Kinetics).
Physical Activity Stages of Change
Scoring Algorithm
If (question 1 = 0 and question 2 = 0) stage 1
If (question 1 = 0 and question 2 = 1) stage 2
If (question 1 = 1 and question 3 = 0) stage 3
If (quest. 1 = 1, quest. 3 = 1 & quest. 4 = 0 ) stage 4
If (quest. 1 = 1, quest. 3 = 1 & quest. 4 = 1 ) stage 5
Stages of Change
Stage of Change Patient Cognition and Behavior
Stage 1: Precontemplation • Does not think about change• Resigned or fatalistic• Does not believe in or
downplays personal susceptibility
Stage 2: Contemplation Weighs benefits vs. costs of proposed behavior change
Stage 3: Preparation Experiments with small changes
Stage 4: Action Takes definitive action to change
Stage 5: Maintenance Maintains new behavior over time
Process of Change
Cognitive strategies Examples
Increasing knowledge Encourage your client to read and think about physical activity
Being aware of risks Provide your client with the message that being inactive is very unhealthy
Caring about consequences to others
Encourage your client to recognize how his inactivity affects his family, friends, and co-workers
Comprehending benefits Help your client to understand the personal benefits of being physically active
Increasing healthy opportunities Help your client to increase her awareness of opportunities to be physically active
Process of Change
Behavioral strategies Encourage your client to…
Substituting alternatives exercise when she is tired, stressed, or unlikely to want to exercise
Enlisting social support find a family member, friend, or co-worker who is willing and able to provide support for being active
Rewarding yourself praise himself and reward himself for exercising
Committing yourself make promises, plans and commitments to exercise
Reminding yourself set up reminders to exercise such as keeping comfortable shoes in the care and at the office, ready to be used at any time.
Barriers to Exercise (Sallis and Hovell, 1990; Sallis et al., 1992; McCormack et al., 2003)
Do not have time Find it inconvenient Lack self-motivation Find exercise boring Lack confidence
(low self-efficacy) Instructors don’t
understand needs Stereotypical
images of aging Poor health
Fear of injury Lack of self-
management skills Lack of
encouragement, support, companionship
Transportation and access issues
Cost
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Selected Evidence Based Physical
Activity Programs for Older Adults
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Active Living Every Day (ALED)
Contact www.ActiveLiving.info or 800-747-4457
Program goals Behavior change program to promote physical activity (also have a Healthy Eating Every Day Program)
Participants learn to set goals, overcome barriers and find activities they enjoy
Target Audience Any adult interested in integrating physical activity into their daily lives
Program description 12-weekly class sessions (short lecture, group discussion)
Training requirements • Trained facilitators• At least 1 trained facilitator needed per
class
Program costs • Licensing costs: none• Training cost: $373 per facilitator• Participant material cost:
$37.95/participant
Programs in Alabama? None37
EnhanceFitnessContact www.projectenhance.org/
EnhanceFitness.aspx.
Program goals Improve overall functional fitness and well-being of older adults
Target Audience Sedentary older adults
Program description Ongoing 1 hour, 3 times/week; focus – stretching, low impact aerobics, strength training, balance
Training requirements • Certified fitness instructor
Program costs • Licensing costs:$6,000/site ($1,000/additional site)
• Basic Package cost: $5,000/site ($50/additional site); $200 Annual renewal fee
Programs in Alabama?
None
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Fit and Strong!
Contact www.fitandstrong.org.
Program goals Engagement in safe, balanced program to build lower extremity strength
Target Audience • Sedentary older adults with lower extremity joint pain and stiffness
• Physician clearance to participate
Program description • 90 minute sessions
Training requirements
• Certified instructor• licensed PT, PTA , COTA or student
Program costs • Licensing costs: $1,000/site in year one• Certified instructor training: $30/hr for 8
hours• Equipment costs: varied items • Instructor liability policies available
Programs in Alabama?
• None39
Geri-Fit Strength Training Workout
Contact www.gerifit.com
Program goals Increase strength, flexibility, mobility, and balance
Target Audience • Older adults age 65 and older• Medicare Advantage approved program
Program description • 45 minutes, twice weekly• Most exercises done seated with 2lb
dumbbell• Typically done in groups, can be done in
person’s home on individual basis
Training requirements
• Certified personal fitness trainer• Degrees in exer phys, kinesiology, PT, OT,
ATC, or Nursing • CPR certified
Program costs • Training costs - $2,000 plus travel
Programs in Alabama?
• None 40
Healthy Moves for Aging Well
Contact www.picf.org/landing/22,3.html
Program goals In-home PA intervention focused on maintaining health status and QOL of frail elders
Target Audience Adults 65 and older who are currently enrolled in a care management program
Program description • Movement repetitions 3-5 days per week; multiple times per day
• One 15-minute session between participant nd care manager
• 3 month follow-up period with weekly or biweekly phone calls
• Delivered by care managers and motivational volunteers
Training requirements
Varies depending on expertise
Program costs Licensing: $5,000 year 1; $2,000 renewal
Programs in Alabama?
None???41
Walk with EaseContact http://www.arthritis.org/wwe
Program goals • Reduce pain and discomfort of arthritis• Increase balance and strength• Build PA self-efficacy
Target Audience Community dwelling older adults with arthritis and other chronic conditions
Program description • Community-based group program 6 weeks, 1 hr, 3x/week• Self-directed program 30 min., 3x/week
Training requirements
• Arthritis foundation course• CPR certified (required)• First aid certification (recommended)
Program costs • Licensing cost: none• Training cost: $50-75• Participant cost: $11.95
Programs in Alabama?
Contact local Arthritis Foundation42
Helpful Resources
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Centers for Disease Control and Prevention
here Consumer information• Varied formats including videos• Selecting PA• Measuring PA
Success stories Resources for health professionals• Facts• Handouts• Social media tools
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Go4Life here
National Institute on Aging Consumer information:
Getting started Staying active Resources
Information for: Consumers Family and friends Organizations Health professionals
Success stories E-news and Twitter feed
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Exercise is Medicine here
Coordinated by the American College of Sports Medicine
Vision:• “Make physical activity and exercise a
standard part of global disease prevention and treatment medical paradigm.”
• “All health care providers consider physical activity as a vital sign in every patient”
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Lakeshore Foundation here
Available to people with physical disabilities and chronic health conditions AND
Anyone age 60 and older!
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Human Kinetics PA Intervention Series
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Your Professional Organization
American Physical Therapy Association here
Positions and Policies Podcasts and continuing educaio Physical Fitness for Special Populations Examination Strategies
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Summary
Our physical activity should not decrease as we age…we should actually do more!
Promoting physical activity is the responsibility of the entire health care team
Merely knowing that one should be physically active is not enough…they must be ready, motivated, and confident
Many great resources exist for health professionals to integrate physical fitness promotion into their clinical practice.
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