Older adults who have recently sustained a fall or are having difficulty ambulating have an increased risk for future falls (Elsawy et al., 2010). As previously stated, exercise can be effective in preventing falls in the elderly population (Kawanabe et al., 2007). Balance exercises may include walking backward or sideways; heel walking; toe walking; and sit to stand (Elsawy et al., 2010). Other balance exercises include standing with one foot in front of the other; walking with one foot in front of the other; stepping over an object; bending and picking up an object off of the ground; and stair climbing (Campbell et al., 1997). To reduce falls, it is important to perform exercises that involve the major muscle groups of the lower extremities, which include hip extensor and abductor muscles; knee flexor/extensor muscles; and ankle plantar flexors/dorsiflexors (Campbell et al., 1997). Exercise that involves strengthening and balance exercises can help to decrease the risk of falls (Campbell et al., 1997). Tai chi programs are also effective in preventing fractures in the elderly and are the most effective types of exercise for decreasing the risk of falls (Kawanabe et al., 2007). Another type of exercise that helps reduce falls and improve balance is whole-body vibration (WBV) exercise. WBV improves muscle power and strength as well as muscular performance and body balance (Kawanabe et al., 2007). WBV exercise, when combined with routine exercises, significantly improved walking speed, step length, and maximum standing time on one leg, suggesting that performing both exercises can improve walking ability (Kawanabe et al., 2007). WBV is said to be safe and well-
tolerated in the elderly and should be considered as mode of exercise for this population (Kawanabe et al., 2007). While fall prevention is often thought of as an intervention primarily performed by a physical therapist, occupational therapists have an important role as well. Occupational and physical therapists can be part of a multi-discipline team to decrease the risk of falls in the elderly population. Behavioral factors, such as fear of falling, can negatively affect activity performance and lead to an increased risk of falling (Leland et al., 2012). Occupational therapists can help in behavior modification to decrease the fear of falling and, in turn, decrease the risk of falls. Occupational therapists can also help with medication management, which can be a factor in greater fall risk (Leland et al., 2012). Occupational and physical therapists can both work on functional activity training in order to decrease risk of falls and improve strength and mobility in the elderly population (Leland et al., 2012). Home-health occupational and physical therapists can help elderly patients decrease risk of falls by performing home assessments to identify factors that may increase the patient’s risk for falls. As mentioned previously, extrinsic factors such as rugs, stairs and poor lighting can increase the risk, and home health therapists can modify these factors. A therapist may suggest better lighting, moving a rug, or adding a railing to the stairs in order to decrease risk of falls. Grab-bars may also be added to the bathroom to improve stability during showering and toileting activities.
EXERCISE FOR ADULTS WITH CHRONIC ILLNESS OR DISABILITY
Older adults with chronic illnesses or disabilities can also benefit from engaging in non-strenuous physical activity (Elsawy et al., 2010). Activities must be customized to meet the patient’s needs based upon their illness or disability. If a person has been inactive for a long period of time, they may need to start out with light-intensity exercises that last less than 10 minutes; therapists can increase the duration of activity, as well as the days per week the person is active (Elsawy et al., 2010). Regular physical activity within the parameters of a person’s abilities is safe and can help improve functional capacity (Elsawy et al., Frail older adults Physical exercise training can impact cognition and quality of life in frail older adults (Langlois et al., 2012). In a study conducted by Langlois et al., 2012, researchers looked at the effects of exercise on frail older adults. This study used a physical exercise training program for a period of 12 weeks with one-hour exercise sessions three days per week. Each session included warm-up exercises for 10 minutes; 10 to 30 minutes of aerobic exercises; 10 minutes of strength training; and 10 minutes of cool down. Researchers used the modified Borg Rating of Perceived Exertion Scale to increase each individual’s intensity and duration of aerobic exercise to reach moderate to hard intensity. The control group was instructed to maintain their current level of activity during the 12-week period. The study looked at physical capacity, cognition and quality of life. The physical capacity assessment included the modified physical performance test, grip strength, physical endurance, mobility and gait speed. Chronic heart failure Exercise training programs for patients with chronic heart failure have been shown to improve exercise tolerance, quality of life and hemodynamic indices (Owen & Croucher, 2000). The prevalence of chronic heart failure increases rapidly with age and may affect as many as 10 percent of people over the age of 80 (Owen & Croucher, 2000). The study performed by Owen & Croucher, 2000 used a specific exercise training protocol that took place for 12 weeks. It is important to note that resuscitation equipment was available at all sessions. If you are going to have older adults with known medical conditions exercising it is important to be prepared for the worst case scenario and be prepared for any medical event to take place no matter what type of setting you are working in. Make sure the patient is
2010). If an illness or injury occurs, it may be necessary to take a break from physical activity; once the patient recovers, they can slowly return to light activity (Elsawy et al., 2010). When developing exercise programs for special populations, it is important to consider all factors. While it was once thought that exercise was contraindicated in patients with specific diseases and conditions, studies show that exercise can have positive effects on most individuals despite chronic illness or disability. The cognitive evaluation included the six cognitive domains and issued a questionnaire to assess quality of life. Training- related improvements were seen in functional capacity; physical endurance; executive functioning; processing speed; working memory; and self-reported quality of life in leisure activities, physical capacity, social/family relationships and health. Larger gains were observed in executive control, processing speed, and working memory, which all play a critical role in performing daily activities. This study shows that not only can exercise improve physical health and ability, it can also play a role in improving mental health and ability, which is equally important in the aging population. Frail adults are often not the first group of people you would think could benefit from exercise due to the risk involved, but when they exercise in a safe, supervised environment, there are gains to be made. cleared to exercise prior to beginning any type of program as previously discussed in the pre-exercise screening section of this course. Each therapy session included three components: 1. A warm-up phase of joint mobilization and pulse-raising exercises with muscular stretches in a seated position for about 10 minutes. 2. An active phase of six station circuits with stations that alternated between stamina- and strengthening-type exercises with 45 seconds at each station; subjects worked at a rate that was comfortable for them; if unable to participate in the circuit, a set of seated exercises was performed.
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