New York Physical Therapy Ebook Continuing Education

FITT for flexibility exercise recommendations As it relates to optimizing flexibility, the FITT principle of flexibility exercise prescription can be viewed in Table 9. Table 9: Flexibility Exercise Recommendations FITT Recommendations F requency • Minimum of 2 times per week. I ntensity • Enough of a stretch to maintain the normal range of motion required to perform daily activities. T ime

• Typically of brief duration as a warm-up or cool-down activity accompanying aerobic or muscle strengthening activities.

T ype

• Any exercises that maintain or increase flexibility. • Sustained stretches for each major muscle group.

○ Examples: Neck stretch, shoulder stretch, shoulder and upper arm raise, upper body stretch, chest stretch, back stretch, ankle stretch, back of leg stretch, ankle stretch, thigh stretch, hip stretch, lower back stretch, calf stretch.

Note : From Mora & Valencia (2022); HHS (2018). Balance exercise benefits and prescription

75–79, 21.7% were ages 80–84, and 39.7% were over age 85 (Liguori & American College of Sports Medicine, 2020). This finding is consistent with the age-related changes of increased bone fragility, loss of cartilage resilience, reduced ligament elasticity, and loss of muscular strength—which in turn lead to osteoarthritis, osteoporosis, and soft tissue infections (Liguori & American College of Sports Medicine, 2020). Of older adult falls, 75.9% resulted in moderate to majorly severe loss of function (Liguori & American College of Sports Medicine, 2020). Although falls are a complex and multicomponent issue, balance difficulties are a major risk factor for falls, and balance activities are part of the recommended physical activity guidelines for older adults (HHS, 2018). The American College of Sports Medicine also recommends the use of balance exercise in older adults, recommending balance training for fall prevention (Liguori & American College of Sports Medicine, 2020).

Balance is the ability to maintain a desired position and is divided into two subcategories: Static and dynamic balance (Liguori & American College of Sports Medicine, 2020). Balance is increasingly becoming a component of health- related fitness and fall prevention programs for older adults (Liguori & American College of Sports Medicine, 2020). Fall incidence and recidivism have strong correlations between age, comorbid musculoskeletal disorders, and the propensity to have a hospital admission related to a fall (Prabakaran et al., 2020) The Agency for Healthcare Research and Quality (AHRQ) found that of the 40,437,581 hospital admissions in 2010, there were 926,283.2 related to falls in people over age 65 (Liguori & American College of Sports Medicine, 2020). Of the fall-related admissions, age was a considerable factor: 10.3% were ages 65– a69, 12.1% were ages 70–74, 16.2% were ages

FITT for balance exercise recommendations As it relates to optimizing balance, the FITT principle of balance exercise prescription can be viewed in Table 10. Table 10: Balance Exercise Recommendations FITT Recommendations F requency • At least 3 days a week for healthy older adults.

• Older adults at risk for falls should do 3 or more days of balance activities as part of standardized exercise program. • Progressively difficult postures that challenge but do not compromise balance. • Intensity is personal preference; for higher intensity use another adult as a spotter. • The exercises can increase in difficulty by progressing from holding onto a stable support (like furniture) w exercises to doing them without support.

I ntensity

T ime

• 90 minutes a week as part of moderate-intensity muscle strengthening activities. • Plus 60 minutes of moderate-intensity walking.

T ype

• Progressively difficult postures that gradually reduce base of support. • Dynamic movements that perturb the center of gravity. • Focus on postural muscle groups/core: ○ Examples: Backward walking, sideways walking, heel walking, toe walking, tai chi, and standing from position.

Note : From Mora & Valencia (2022); HHS (2018); WHO (2020) The inclusion of balance training in an exercise program is an essential approach to fall prevention, as falls are a frequent and dangerous phenomenon for older adults (Fountouki et al., 2021). Balance exercises should challenge participants by reducing their base of support, moving their center of gravity, and reducing the need for upper limb support. Participants should aim to increase the duration of a sustained or dynamic position gradually. For example, individuals may practice standing while reaching. While they are reaching, they should be focused on extending their reach and gradually relying less on upper extremity support

to maintain their balance. A simple exercise program should include a combination of activities, which can include walking, cycling, aerobic drills, and other resistance exercises (Fountouki et al., 2021) A meta-analysis of 409 articles on falls and the older adult yielded the following considerations for physical activity prescription to enhance balance (Demir et al., 2022): ● Wearing personally chosen footwear significantly improves balance compared to walking barefoot. The greatest benefit

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Book Code: PTNY1024 Physical-Therapy

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