recommended performing the strength training portion of the program at a moderate to high intensity, or 60 to 80 percent of a one rep max (1RM) and at a moderate volume of two to three sets per exercise. (Cadore et al., 2014). The same study recommended performing endurance training at a moderate to high intensity, or 60 to 85 percent of VO2 max, and at a moderate volume of 25- to 40-minute duration. The study stated that when strength and endurance training are performed on the same day, patients should complete the strength training first to see the most gains. Individuals should participate in muscle power training, or exercises that are considered high-velocity strength training, in order to improve muscle power output, which is associated with the functional capacity ability of the elderly population (Cadore et al., 2014). One study by Krist et al., 2013, found that performing a progressive resistance- training program just two times per week for eight weeks seemed beneficial in improving mobility and muscle strength in nursing home residents up to 97 years old. This study shows that strength gains can be made at any age and it is important to incorporate strengthening into any exercise program for older adults. Aerobic activities can include aerobic exercise classes, bicycle riding, dancing, golfing without a cart, yard work, gardening, swimming, water aerobics, tennis, racquetball, vacuuming, walking or jogging (Elsawy et al., 2010). Aerobic activities should include at least 10 minutes of activity at a time and should be performed at a moderate-vigorous intensity (Elsawy et al., 2010). Activity performed at least three days a week can reduce the risk of injury and excessive fatigue while providing health benefits (Elsawy et al., 2010). Muscle-strengthening activities can include callisthenic exercises; carrying exercises; exercises using exercise bands, weight machines, hand-held weights; Pilates; yard work/gardening including lifting, digging and carrying; yoga; tai chi; and household chores (Elsawy et al., 2010). Muscle strengthening should involve all major muscle groups and exercises should consist of eight to 12 repetitions per activity, or should continue until it would be difficult to do another repetition without help (Elsawy et al., 2010). Stretching exercises may be necessary for the older adult population in order to maintain flexibility needed to continue with regular activity (Elsawy et al., 2010). Older adults should perform activities to maintain or increase flexibility at least two days per week and perform exercises for 10 minutes per day (Elsawy et al., 2010). Proprioception and neuromuscular re-education are necessary exercise interventions when improving the functional ability of older adults. Lower torque and power production on elderly fallers is associated with an increase in co-activation of muscles around the knee and ankle (Periera & Goncalves, 2012). Co- activation is defined as the simultaneous muscle contraction around a joint and may be responsible for reduced walking speed and an increased fall risk in the elderly population (Periera & Goncalves, 2012). Proprioceptive neuromuscular facilitation, or PNF, technique can help improve coordination and proprioception in the elderly population and reduce the risk of falls (Periera & Goncalves, 2012). During PNF movement patterns, the muscles are briefly stretched before contracting, which excites neuromuscular endings and produces a higher level of force (Periera & Goncalves, 2012). PNF movement patterns are performed on diagonals and not just in straight planes, which incorporates more functional movement patterns and reproduces physiological movements and gait patterns (Periera & Goncalves, 2012). The main result of a study by
Periera and Goncalves, 2012, showed a 20 percent greater improvement in balance in a group that performed 90 minutes of eight different PNF patterns three times per week when compared to the control group (Periera & Goncalves, 2012). Knee extension strength also improved with PNF training, which can decrease the risk of falls (Periera & Goncalves, 2012). PNF training was more impactful on balance perturbation performance than on strength performance, so it is important to continue focusing on strengthening as well as incorporating PNF neuromuscular facilitation into exercise programs for the elderly population. The older adult population can use Pilates exercises to improve function and decrease the risk of falls. Developed by Joseph Pilates in the 1940s, the Pilates Method strengthens the mind and body using several fundamental principles to achieve well- being and total-body conditioning (Stivala & Hartely, 2014). The original fundamentals of the Pilates Method included whole body movement, breathing, balanced muscle development, concentration, control, centering, precision and rhythm (Stivala & Hartely, 2014). Pilates has become a popular form of exercise to enhance strength and endurance for people of all ages and can be used as a supplemental adjunct to traditional rehabilitation (Stivala & Hartely, 2014). Pilates-based rehabilitation is a modified version of the traditional Pilates Method that is appropriate for patients of all levels and abilities. The Pilates Method includes exercises that focus on core strengthening and stability which can contribute to proper spinal alignment, enhanced breathing biomechanics, and greater balance and coordination of the extremities (Stivala & Hartely, 2014). Pilates Method exercises not only help healthy older adults but can also help adults who have disease processes due to improved breathing techniques, which may help patients with pulmonary decline or disease. Utilizing the Pilates Method for older adults can lead to improvements in static and dynamic balance (Stivala & Hartely, 2014). Improving lower extremity and trunk muscle endurance can help to improve balance and the performance of functional tasks, which can significantly impact an elderly person’s ability to perform their daily activities (Stivala & Hartely, 2014). Martial arts or other forms Tai Chi or Tai Ji Quan have been well researched as a mode of exercise for the older adult population that can not only reduce the risk of falls but can also promote exercise participation. Tai ji quan is a balance-training exercise based on martial arts movements and has been proven effective at reducing the risk of falling in community-dwelling older adults with postural instability (Li F et al., 2013). Tai ji quan has also been effective in decreasing the risk of falls in patients with Parkinson’s disease who experience postural instability (Li et al., 2013). Li et al. conducted a study in which subjects performed two one-hour sessions per week for 24 weeks. Each session consisted of warm-up exercises; core practices, which include a mix of practice of forms, variations of forms, and mini-therapeutic movements; and brief cool-down exercises (Li et al., 2013). The study encouraged, but did not monitor, home practice. Li et al. looked at the dissemination potential of a Tai Ji Quan program through outpatient clinical settings and results showed that health-care providers can successfully implement a protocol to refer individuals at risk for falls to a Tai Ji Quan exercise program. This type of exercise program is successful in reducing falls, so physicians as well as physical and occupational therapists should consider such a program for individuals who are identified as at-risk for falls. (Ishigaki et al., 2014). Extrinsic factors can include the patient’s environment, such as rugs, stairs and poor lighting, while intrinsic factors include impairments in balance or gait, muscle weakness, decreased visual acuity, cognitive deficits, chronic disease, postural hypotension, or the use of psychotropic medication (Ishigaki et al., 2014).
Balance exercises to decrease risk of falls in the elderly population Balance exercises are important because they reduce the risk of falls and decrease the risk of injury (Elsawy et al., 2010). Fall-related injuries, which may include head injuries and fractures, can cause serious problems for the elderly population (Kawanabe et al., 2007). Falls are considered a geriatric syndrome that is associated with extrinsic and intrinsic factors
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Book Code: PTNY3622B
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