New York Physical Therapy Ebook Continuing Education

increments (2018). There is also a connection between the body and mood, suggesting that the practitioner should continue to assess how exercise affects how a client feels (Bordoni & Marelli, 2017). Such connections have helped expand recommendations from the American College of Sports Medicine related to Parkinson’s disease, cerebral palsy, and intellectual disability. Also, a new chapter on brain health and brain-related disorders provides added coverage related to conditions such as attention-deficit/hyperactivity disorder, Alzheimer’s disease, anxiety and depression, and autism spectrum disorder (Liguori & American College of Sports Medicine, 2020). To successfully intervene with older adults, practitioners must be aware of relevant new research and know how to implement the recommendations. Occupational therapists and occupational therapy assistants utilize therapeutic exercise as an intervention approach to support therapeutic outcomes for individuals, groups, and populations as they relate to engagement in occupations, including activities of daily living (ADL), instrumental activities of daily living (IADL), health management, rest and sleep, education, work, play, leisure, and social participation (AOTA, 2020). Exercise is also considered an occupation of physical activity related to health management, and is defined as activities related to developing, managing, and maintaining health and wellness routines (AOTA, 2020). If a client has difficulty engaging in the occupation of exercise, an occupational therapist can address the context of environmental and personal factors that support or hinder performance patterns of exercise, as well as performance skills that are required to engage in the exercise (AOTA, 2020). Prior to utilizing exercise as a therapeutic approach, occupational therapists need to understand both the positive and negative effects participation in exercise may have on personal factors such as other health conditions and fitness (AOTA, 2020). This intermediate-level course is designed to educate occupational therapists and occupational therapy assistants about the implementation of exercise prescriptions in older adults. This course will review the multiple age-related systemic changes that take place in the cardiovascular, respiratory, endocrine, musculoskeletal, and interstitial systems and describe how exercise may mitigate these changes. This course will also provide recommended exercise programs according to the most recent American College of Sports Medicine guidelines for older adults and discuss common barriers to exercise participation in older adults. In addition, it will describe how changes after an exercise intervention can be measured by providing several clinical measures that can routinely and easily be implemented in clinical practice. Finally, this course will discuss special concerns, such as the need for medical screening prior to establishing a new exercise program, and special considerations when recommending exercise for individuals with comorbid conditions common in older populations such as osteoarthritis, diabetes, dementia, and obesity. At the end of this course, practitioners should be able to comfortably recommend, implement, and evaluate a comprehensive exercise program for older adults.

interviewing, and individual tailoring of self-managed health programs (AOTA, 2017). These movement- and exercise-inclusive interventions help older adults effectively maintain health gains, as do occupational therapists’ other skills such as the use of visual, tactile, auditory, and other multisensory and cognitive cueing strategies to improve client performance and participation in activities such as functional mobility, exercise, functional transfers, environmental modification to enhance motor performance, and other multifactorial interventions to help with functional performance of exercises (AOTA, 2017). OTs can also, of course, work with physical therapy practitioners to treat clients. These interventions have provided clinically significant results in the areas of instrumental activities of daily living (IADL), fall reduction, driving performance, and dynamic and functional movement in clients who have motor coordination deficits (e.g., Parkinson’s, Alzheimer’s, and poststroke; AOTA, 2017). Both APTA and AOTA emphasize the importance of movement and exercise. Physical therapists define and promote the movement system as the foundation for optimizing movement to improve the health of society. Recognition and validation of the movement system is essential to understanding the structure, function, and potential of the human body. The physical therapist is responsible for evaluating and managing an individual’s movement system across the life span to promote optimal development; diagnose impairments, activity limitations, and participation restrictions; and provide interventions targeted at preventing or ameliorating activity limitations and participation restrictions. The movement system is the core of physical therapy practice, education, and research (American Physical Therapy Association, 2019). Physical exercise is considered a health management occupation in the fourth edition of the Occupational Therapy Practice Framework (OTPF-IV), with the following example description, “Completing cardiovascular exercise, strength training, and balance training to improve or maintain health and decrease risk of health episodes, such as by incorporating walks into daily routine” (AOTA, 2020). Because America’s population is aging, most physical therapists, physical therapist assistants, occupational therapists, and occupational therapy assistants will engage with older adults in routine practice. These practitioners are ideally placed to recommend and manage exercise to counteract a sedentary lifestyle and problems associated with aging. Older adults experience a host of physiological changes that these practitioners need to be aware of when working with and recommending exercise for this population. The American College of Sports Medicine has new guidelines for recommending exercise for older adults, suggesting a move away from the maximum heart rate (HR max ) calculation (220 – age) and toward other methods such as the Gellish method (207 – [0.7 × age]) (Liguori & The American College of Sports Medicine, 2020). The U.S. Department of Health and Human Services (HHS) also has revised guidelines, such as starting the Move Your Way adult exercise dosage (see figure 1) and eliminating the recommendation that physical activity occur in 10-minute

PHYSICAL INACTIVITY AND AMERICA’S AGING POPULATION

expectancy was approximately 46 years. Today, improvements in housing and hygiene, along with medical advances, have raised the average life expectancy of men and women to more than 75 years, and those who survive to age 65 are expected to live an average of 19 more years (Federal Interagency Forum on Aging-Related Statistics, 2020). The increase in life expectancy seen in the past century has brought a new urgency to the task of developing programs dedicated to helping older adults stay fit and active for as long as possible. Aging is a complex interaction of biomedical and psychosocial factors that leads to a progressive deterioration in the physical structure and biological functions of the body. It is universally characterized by a decrease in the body’s ability to maintain

The demographics of the American population are undergoing a major change. Every day more than 10,000 people in the U.S. turn 65. By the year 2030, all baby boomers (those born between 1946 and 1964) will be over age 65, and by the year 2050, more than one fifth of the U.S. population will be over age 65 (Federal Interagency Forum on Aging-Related Statistics, 2020). In 2020, one in six Americans were age 65 or older (Federal Interagency Forum on Aging-Related Statistics, 2020). It is expected by the year 2060, over 20 million adults will be over age 85 in the U.S. alone (Federal Interagency Forum on Aging- Related Statistics, 2020). The past 100 years have seen not only an increase in the number of older adults but also an increase in general life expectancy. At the turn of the last century, life

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