How to measure changes after balance exercises Historically, balance has not been included in clinical testing, but the Berg is a widely accepted static and dynamic balance assessment tool. The Berg Balance The Berg Balance scale is a 14-item performance measure that assesses static and dynamic balance in adults. While it takes a bit longer to administer than other balance assessments, it does not require any special equipment and the standard error of measurement is low (Shirley Ryan Ability Lab, 2022). It is available in the public domain for free. Supplemental assessments are highly recommended for clients with neurological conditions. The test items are static and dynamic balance activities of varying difficulty, such as standing on one foot or with one foot in front of the Special concerns The benefits of both aerobic and resistance exercise for older adults are clear. Exercise is generally considered to be a relatively safe activity, but good clinical judgment is still necessary when evaluating and prescribing both aerobic and resistance exercise for older adults. Despite its benefits for a majority of older adults, exercise is contraindicated for a minority of individuals due to health concerns (WHO, 2020). When not able to engage in the typical activity recommendations, adults with chronic conditions should aim to engage in physical activity according to their abilities, starting with small amounts of physical activity and gradually increasing the frequency, intensity, and duration over time (WHO, 2020). When not contraindicated, older adults with Contraindications and screening prior to exercise For a minority of individuals, exercise may be contraindicated. As practitioners increasingly participate in direct access patient care, they must have knowledge of the absolute and relative contraindications to exercise. Generally, absolute contraindications result from severe or uncontrolled cardiac disorders that place an individual at an increased risk for sudden cardiac death or other cardiac complications. Absolute contraindications suggest that it is currently unsafe for individuals with these disorders to exercise, and exercise should be postponed until such time as these conditions are brought under better medical control. In some cases, the patient may require surgical intervention before starting an appropriate exercise program. Patients with any of these absolute contraindications who are seeking to participate in an exercise program should always be referred to their physician for further follow-up and care (Fletcher et al., 2013; Williams et al., 2007; WHO, 2020). Relative contraindications suggest that a patient may still benefit from aerobic and resistive exercise but that further testing or screening by a physician prior to starting an exercise program may be necessary to ensure the safety of the patient. Generally, relative contraindications suggest that an individual has comorbid conditions that place them at higher risk for potential cardiac complications with exercise and that an exercise stress test may be necessary before starting to exercise. To ensure their safety, individuals with relative contraindications may also benefit from close monitoring of their vital signs during the initial stages of participating in an exercise program (Liguori & American College of Sports Medicine, 2020). For individuals with relative contraindications, the advice of their physician should be sought prior to initiating an exercise program. A list of both absolute and relative contraindications to exercise can be found in Table 14.
other. Scoring items depends on whether the test subject needed to touch something for support or how long they could keep one foot off of the ground. Item-level scores are determined by the ability to perform each assessed activity. Items are scored and then summed to a maximum score of 56. The test takes 15 to 20 minutes to administer, and no training is required. Minimal clinically important difference is seen at a score change of between 3.3 and 6.9, depending on initial score, and between 8 and 10.5 for older adults who are living in nursing homes or institutionalized. Scores of less than 45 indicate a greater risk of falling, and less than 40 indicates an almost 100% fall risk (Shirley Ryan Ability Lab, 2022). and without chronic conditions can increase moderate- intensity aerobic physical activity to more than 300 minutes or do more than 150 minutes of vigorous-intensity aerobic physical activity or an equivalent amount of moderate- and vigorous- intensity aerobic exercise throughout the week (WHO, 2020). Many older adults, however, experience certain comorbid conditions, such as diabetes, arthritis, and/or dementia, that may warrant special considerations before and after exercise prescription. While exercise is not contraindicated in these conditions, practitioners working with older adults should be aware of the various concerns that may arise. Table 14: Absolute and Relative Contraindications to Exercise Absolute Contraindications • Unstable chronic heart disease. • Unstable angina (chest pain). • Uncontrolled heart arrhythmias such as ventricular tachycardia. • Worsening congestive heart failure. • Acute myocardial infarction. • Severe pulmonary hypertension. • Severe aortic stenosis. • Acute infection of the heart. • Aortic dissection. • Unstable eye disease such as advanced diabetic retinopathy. • Acute severe infection. • Pulmonary embolism. Relative Contraindications • Moderate aortic stenosis. • Hypertrophic cardiomyopathy (enlarged heart). • Coronary artery disease. • Diabetes. • Uncontrolled hypertension with systolic above 200 mm Hg or diastolic above 110 mm Hg. • Stable congestive heart failure. • Recurrent or chronic infection. • Uncontrolled metabolic disorders such as uncontrolled thyroid disorders. • Implanted pacemakers or defibrillators. • Very low functional capacity. • Recent blood clot. • Acute illness. • Recent fracture. • Metastatic cancer. Note : Adapted from Fletcher et al. (2013); Williams et al. (2007).
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