At the recent NSW Falls Prevention Network Forum, Sally Castell was immensely honoured to have been recognised by the Falls Prevention Network with a Lifetime Achievement Award.
Sally's award presentation and acceptance speech is toward the end of the program.
Focus: ”Don’t lose any more function than can be helped”
The Aged Population is on the Increase!
The fastest growing population is the older adult with the majority of them are living well and independently in their own homes. This population is getting increasingly “top heavy”. At the last Australian census 6 million people were aged between 50 and 89 years. Demographic trends over the next three decades project that the global numbers of adults aged 65 years and older will double to around two billion by 2050. These demographic trends will have an impact on the health care system
Regular physical activity is a priority health issue for all Australians. “Whilst we are young we challenge our bodies, but over time the mind and body can start become more challenged”. A fulfilling quality life is important for everyone. Anybody, no matter their condition, culture, age or ability needs exercise to remain active throughout life. The benefits of exercise are universal and span across all decades.
Everyone wants to be as active, for as long as possible to remain independent and in control of their life. Age should not be a barrier to participation in an appropriate activity program. There is a good percentage of older people who are still very capable of participating in some form of exercise and remain active and able a s result. How this is carried out is dependent on health, ability and fitness status. For an active life everyone needs sufficient energy, adequate strength, balance and functional mobility to maintain good body control and prevent any unnecessary losses occurring. Physical activity programs combining aerobic, strength and flexibility components (including a balance element) have promising results and can protect against physical and cognitive decline associated with ageing.
Functionality involves many tasks done together to achieve purposeful results throughout the day. These activities involve a combination of muscular strength (power), endurance, flexibility, balance and co-ordination as well as good cognitive skills. Optimal capacity is required to perform daily tasks and achieve purposeful and effective results. With advancing age and low activity levels, muscle strength and elasticity diminish. There is also an associated loss of reserve capacity (reduced energy supply). Flexibility and strength declines gradually from 30 years onwards with greater declines after age 40 years and beyond. The long-term implication in reduction of strength is decreased functional ability and increased risk of falls (+ fractures). Joints stiffen and the body becomes tighter which can restrict daily activity, making movement more difficult. All these factors contribute to a reduction in physical abilities, fitness and health, loss of function and reduced activity levels.
“Through effective, comprehensive functional fitness programs, older adults may be able to avoid, postpone, reduce or even reverse declines in physical performance”
Functional Fitness for Older Adults - Patricia Brill. Human Kinetics3
Ask yourself these questions……….. How Well Are You Doing Now?
· Do you have enough energy for all activities throughout the day?
· Do you feel you are coping well?
· What are you not able to do as well as before?
· Do you have any chronic conditions that limit movement?
· What exercise are you currently doing?
· Do you have any mobility problems?
· Do you have any chronic conditions that limit movement?
· How strong do you feel you are?
· How flexible are you?
· Any changes with age or condition?
· Do you have good balance?
· Have you sustained a fall (s) over the past year
· Are you walking well or slower than before?
If any of your answers to the above questions are a problem, take action to improve your overall functional abilities by doing effective and safe exercises. Seek help from appropriate health / fitness professionals concerning the exercises you need to stay active
“The weakest and oldest among us can become some kind of athlete…….but only the strongest can survive as spectator. Only the hardiest can survive the perils of inertia, inactivity and immobility" (Bland and Cooper 1985
NB. If you would like some more practical ideas concerning fundamental movement to assist maintain your functional abilities you can purchase some resources from Movement Matters. Please see www. movementmatters.info website for more information
Sources / references
1 World Health Organization. (2002). Active ageing: A policy framework
(WHO/NMH/NPH/02.8), Geneva: WHO Noncommunicable Diseases and Mental Health Cluster. Retrieved May 2015, from http://whqlibdoc.who.int/hq/2002/
2. The Gerontologist, 2016, Vol. 56, No. S2
Updating the Evidence for Physical Activity: Summative Reviews of the Epidemiological Evidence, Prevalence, and Interventions to Promote “Active Aging”
This review highlights the importance, and complexity, of promoting PA among older adults.
Adrian Bauman, MD, MPH, PhD,1,* Dafna Merom, PhD,2 Fiona C. Bull, PhD,3 David M. Buchner, MD, MPH,4 and Maria A. Fiatarone Singh, MD5
1School of Public Health, Sydney University, New South Wales, Australia. 2School of Science and Health, Western Sydney University, New South Wales, Australia. 3Centre for Built Environment and Health, The University of Western Australia, Perth, Australia. 4Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign. 5Exercise, Health and Performance, Faculty of Health Sciences, Sydney University, New South Wales, Australia.
© The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: email@example.com.
3. Functional Fitness for Older Adults - Patricia Brill. Human Kinetics
Keep Moving – Stay Mobile
Focus : Arthritis and Exercise
Fitness and health decline with age and may eventually fall below the level required to be able to undertake everyday activities easily and safely. One reason for this could be as a result of arthritis causing joints stiffening and muscles to weaken. The body becomes less easy to move and joints become stiffer restricting effective daily activity. Inactivity is associated with
· 400% increased risk of disability which restricts the ability to perform of daily activities
· 300% increase in risk of balance disorders and increased risk of fall related injuries;
· 200% increase in risk of gait abnormalities
There are many reasons why it becomes harder to move. Some of the following are the causes and limitations that may reduce and change activity
· Changes in fundamental function occur due to reduced little / limited activity (being sedentary)
· Changes in overall fitness and body control such as endurance, strength and flexibility.
· Changes in the physiology of the body occur in the musculo-skeletal, neuromuscular and neurological systems
· Multiple chronic conditions such as osteoarthritis, osteoporosis, sarcopenia (muscle weakening) diabetes, heart disease etc. can alter the bodies ability to move effectively and efficiently.
· Changes in mental states, for example depression and dementia, can reduce an individuals’ motivation and ability to stay active
· Changes in balance and walking patterns increases the fear of falling which in turn also reduces the motivation to move more than necessary
These factors all correlate and contribute to a reduction in physical abilities, fitness and health, loss of function and reduced activity levels.
It is vital that the body is kept as flexible as possible.
Ask yourself these questions.
· Are you flexible enough to carry out all activities throughout the day easily?
· Do you feel you are doing activities well as you always have?
· What are you not able to do as well?
If any of your answers to the above questions are a problem, take action to improve your overall mobility by undertaking appropriate exercises. Seek help from appropriate health / fitness professionals concerning the exercises you need do to stay mobile
Arthritis is one major condition that can restrict movement. It is important however to keep the joints moving and working as best as possible to keep them from stiffening up and limiting movement further. Some important facts and considerations need to be taken into account prior to participation in an exercise program.
There are over 120 conditions that fit under the umbrella of arthritis but the major ones being Osteoarthritis and Rheumatoid Arthritis. It is a condition which affects joints and the surrounding tissue and is often associated with joint pain, stiffness, swelling, fatigue, reduced mobility and reduced muscle strength. It is not wear and tear, degenerative changes occur within the structure and composition of the cartilage resulting in structural weakness and damage. This degeneration limits movement, causing pain and swelling within and around the joint structure. Cartilage is designed for load bearing; absorbing impact; sustaining shear forces. The major potential problems associated with arthritis are functional limitations and lifestyle restrictions. Exercise is one important way of keeping joints as healthy as possible and preventing the muscles surrounding the joints from weakening
Osteoarthritis – generally affecting a few joints. Hallmark signs and symptoms: Joint pain; Stiffness; Muscle weakness; Instability; (inflammation)
Rheumatoid Arthritis - affects the entire body systems. Hallmark signs and symptoms: More swelling although intermittent
Arthritis and Exercise
Exercise is an important part of the management of arthritis and its associated complications. It is not contraindicated for either condition and will assist maintain functional activities necessary for daily living.
Overall Aims with Exercise
· Mobilise joints - move the joints as far as possible.
· Relieve pain (not exacerbate it)
· Stabilise joints by strengthening surrounding muscles.
· Work on improved functional activities.
· Protect joints to prevent deformity (good form and alignment needed).
· Work to improve posture and gait patterns. Improve general fitness.
· Maintain a healthy weight
NB. If you would like some more practical ideas concerning fundamental movement to assist maintain your functional abilities you can purchase some resources from Movement Matters. Please see www. movementmatters.info website for more information
Stretching -Not Straining …the basics
The body becomes resistant to stretching but it is an important component of an exercise program (as is strengthening)
Keeping flexible is an important component of an exercise program especially for people who are inactive and have arthritis. Muscle elasticity diminishes with age with increased muscle stiffness that results in joint restriction and the body becomes tighter. Increased stiffness can occur in all joints of the body and surrounding soft tissue e.g. tendons, ligaments, joint capsule, fascia. Restricted movement is directly linked to reduction in functional abilities and there is a marked increased susceptibility to falls and associated injuries.
· Always consider and apply correct starting position and body alignment for all movements
· Avoid bouncing or jerky movements (especially with arthritic joints changes)
· Only stretch as far as is comfortable (there is no such thing as no pain no gain)
· Try to hold the stretch for at least between 15- 20 seconds at a time to allow the tissues to stretch as far as they are able
· Be aware of any AGGRAVATING exercises or movements and change your exercise regime accordingly.
· Keep movements as smooth as possible.
· Avoid weight bearing exercises for long periods of time.
· Care needs to be taken to prevent getting overtired.
· Any inflammatory response may require rest and limited excess movements
· Little and often is often a good way to start exercising and then build up the level and degree of activity
When to be Cautious
ü Consider that inflammatory responses may require APPROPRIATE rest. Be aware of possible AGGRAVATING exercises or movements
ü After joint replacement surgery follow the guidelines and instructions carefully
When Not to exercise!
ü If there is a flare up of the condition, (hot and swollen joints) with very limited movement and extreme pain is present.
ü Remember the 2 hour pain rule ……..Reduce the program if the pain in the joints persists longer than two hours immediately following an exercise session and does not settle for a couple of days.
NB. Exercise in warm water as an alternate type of exercise (it can make movements easier to manage and provide some pain relief).
Like the rest of the body the foot can alter as it gets older. Consider for a moment how long it has being supporting you and carrying your weight? In a lifetime it is estimated that people walk 128,000 kms. Research has identified that there is a 60 to 85 % increase in foot problems with people aged 65 +.
The role of the foot
The foot provides a very stable base from which many activities literally spring. Walking is considered as a series of moving/ stepping from one foot to the other. The foot is made up of many bones, ligaments and muscles which are needed to support the entire body weight which in turn assists the body keep well balanced when stationary or when moving.
There are many age changes that occur in the foot area which may compromise and alter the gait pattern thereby becoming less safe. Feet play an important part in the functional ability of an individual to assist efficient and effective movement to occur in all situations and environments that may be presented to them. Efficient movement reduces the risk of injuries, some of which may result from a fall, when gait may be challenged or compromised.Functions of the feet
Projecting the body forward when walking
Feeling the ground to provide body position sense
Assist with alignment of the whole body
Conditions of the feet and foot problems associated with the older adult
Foot problems examples.......
Bunions & corns
ArthritisDropped arches or flat feet
Neuropathies such as Diabetes
The 3 major foot issues identified that increase the risk of falls are
1. Foot problems. Problems may change walking patterns mainly due to the pain and stiffness associated with the conditions (hallux valgus) NB. From Tinetti research
2.Pain - Incidence of foot pain is 22 - 59 % and greater increases in women
3.Numbness/ reduced sensation/vascular issues
If there are problems with the feet then there is an increased risk of fall and associated injuries. Falls and related injuries are a major issue which can be associated with aging and inactivity. If an older person has had a fall, there is an increased risk of falling again.
66% of people who fall will experience another fall within six months.50% of falls will result in injury.
Serious injury occurs in 10% of falls.
Injury from a fall puts a person more at risk - particularly fractures.
25% of those who fracture a hip will die within six months of the injury.Falls can lead to loss of confidence and reduction in activity which can lead to more falls
The joints in the feet may have changed shape, have some arthritic changes and are not quite so mobile and stable. The muscles and ligaments may not be as strong as they used to be and so the shape of the foot may change becoming broader with arches flattening out. With these changes the whole foot can no longer provide as much support and the projectory powers it was designed to do so effectively and efficiently therefore compromising the gait pattern and body balance control.
The foot also serves as a sensory device (the sole of the foot and ankle area especially) relaying messages to the brain to assist with the fine tuning mechanism of the body. The foot and ankle area provides sensory input to the brain relating to where the body is positioned in space which enables the body to respond effectively and stay upright enabling everyday activities be carried out easily. This sense of the body position is necessary to maintain good balance and body control. The sensation in the foot can diminish for various reasons hence problems can start compromising movements especially those which involve travelling from place to place and in controlling any activity incorporating balance as an integral part of it.
Foot problems may change walking patterns mainly due to the pain and stiffness associated with the conditions. Generally with ageing there is increased stiffness in the joints of the feet especially in the metatarsal heads, smaller ranges of plantar flexion, inversion and eversion along with reduced flexibility and Range of Movement in the ankle. If there is also a reduction in strength in the muscles of the feet and toes, there will be functional ability issues affecting gait and balance (controlling sway). This will be affected especially when walking on uneven surfaces. With the above combined it results in a reduced response to different impact velocity and the ability to attenuate shock.
Obviously if you have problems with the foot it is advisable that it is addressed through the appropriate channels (health professionals) and well fitting comfortable shoes need to be acquired. This should the first step to assist people in their endeavors to walk easily and efficiently, be well balanced and remain in control. There are many exercises and activities which can, and need to, be undertaken to assist the foot remain as mobile and strong as possible allowing the body to function easily and maintain good body control.
Make the most of and enjoy the challenge of remaining as fit and healthy for as long as possible all the effort is worth it!
Like many things you have to work at it to get results!!
Movement is important and is necessary for everyone no matter their age or ability. It will be a continual learning, ongoing and evolving process for all concerned. There are multiple ways to encourage and support people to remain active.
Age is no different...if you want to get fit and stay as healthy as possible you have to invest your time and energy to achieve any reasonable results.p; There is no one way..one program cannot, will not suit and should not accommodate all. There are too many variables to consider and adaptations need to be made to ensure that exercises are appropriate, realistic and safe.
The following is the 1998 ACSM Position stand on exercise and physical Activity for Older Adults. Although it was produced some time ago the basic elements that need consideration and are to be applied remain the same.
5 Exercise / Physical Activity areas of Importance for the Older Adult
Cardiovascular response to both acute and chronic exercise (e.g. Cardiovascular, metabolic implications – Diabetes etc.)
Strength training, muscle mass and bone density implicationsPostural stability, flexibility and preventing falls
The role of exercise on psychological function
Exercise for the very old and frail
Medicine, Science and Sports Exercise vol. 30 No. 6 992 1008 98.
An exercise program primarily contains 3 major elements
a) Strength power and endurance
b) Suppleness muscle flexibility and length
c) Stamina energy to be active for long periods of time.
Safety issues are paramount and accommodation for individual abilities should be taken into account.
Exercise can be and should also be prescribed to suit conditions.
Aerobic type of exercises are prescribed for cardio vascular health conditions and fitness ;
Strength training are prescribed for muscle and bone heath;
Non weight bearing exercise need to be prescribed for severe arthritic conditions;
Specific back exercises need to be prescribed for back problems and specific exercises to improve balance and co-ordination etc. etc.
All factors will need to be taken into consideration and adaptations made when developing and undertaking any exercise program. It is important to seek advice and find the right health / fitness professional who can look after and provide a program to suit your individual needs.Emphasis should be placed on factors that result in permanent lifestyle change to encourage a lifetime of physical activity.Pollock M., Gaesser
Exercise routines may need to change throughout the life cycle when things change physically for some reason or other. The body adapts very quickly to changes made with exercise and if there is no ongoing challenge things will not continue to improve and so remain the same. There should be a gradual evolving process of improvement as far as is reasonably possible. We can get locked in the same old routines, thinking that that is sufficient to stay active and healthy, but another problem or issue can present itself and so changes need to be made.
Good health and fitness program outcomes that are successful depend very much on persistence. There is no quick fix, once is not enough! The applications for reasons of ability, safety and progression will require a degree of knowledge, flexibility and grading where and when necessary.
Please note the following which are the recommended ACSM multi-factorial physical activity for adults age; 65 (50 - 64 but with functional limitations) exercise guidelines and consider whether you are applying your exercise habits / routines within the frame work
1. Aerobic: 5 days/week moderate to Iight (30 minutes or accumulative in 10 min bouts) or 3 days/week for high (continuous 20 minutes)2. Strength: at least 2 days/ week, 8-10 exercises with major muscle groups, at least 1 set, 10-15 reps
3. Flexibility: 2 days/ week for 10 minutes
4. Balance training, if at risk of falls
Manini and Pahor (2008)
Because of their low functional status and high incidence of chronic disease, there is no segment of the population that can benefit more from exercise than the elderly.
American College of Sports Medicine Exercise training for the Elderly
Make the most of and enjoy the challenge of remaining as fit and healthy for as long as possible. All the effort is worth it!
This article provides you with some basic background on the issue of pain. There will be further and more specific articles on conditions and body parts to assist you with pain. Movement Matters in future newsletters. Sally Castell
There are many physical chronic conditions such as arthritis and osteoporosis of which pain is a contributing factor that can reduce lifestyle options. These conditions especially can limit movement if there is persistent pain present.
Here are some basic, simple self - help ideas that you could do and might find useful to help you cope. They do involve some thought and effort on your part, but if it’s going to make your life easier and more manageable in the long run, it’s worth giving it a go!
• Rest - sometimes the body needs to be supported and remain immobile for a certain period of time to allow that part of the body relief from all the stresses put on it which could be increasing the amount of pain present. It may be advisable to take several short breaks during the day. Having sufficient and correct support to the parts affected may be needed with use of resting splints.
• Using your body in the most efficient way eliminating any unnecessary movement and conserving your energy may reduce the amount of pain you have overall.
• Gentle movements to keep the muscles lengthened out prevents any tightness and tension in and around the joint which can make things more uncomfortable. The joints also need to be kept lubricated by gentle activity to keep them working as effectively as possible.
• Keeping the part of the body sufficiently warm can also help tremendously in your campaign to relieve your pain.
• Distraction. - By focusing on something good and positive other than the pain can result in reducing the amount of pain experienced, it can provide temporary relief but will not make the pain go away permanently. It is a strategy certainly worth practicing as it can help you get through a normally painful activity period.
It is important respect pain as it is the body’s warning sign of things not working quite correctly.
Many people with chronic pain develop some degree of depression which is another factor to cope with and seek help for.
There can be days when we can “fire on all cylinders” and then there are other days when it is very hard to get any spark at all going --- do you have those days? Things just don’t go right. There are possibly many reasons, and causes, for this happening to us. Sometimes there are things that have happened in the past, or currently, that acts as a trigger which can make us feel very sad, inadequate, lonely and anxious. The many changes and losses which need to be managed can bring on a deep emotional pain/ache making things very hard to cope with at any level. As you know, this can limit your options as well as quality of life.
• Memories are made of this: Remember and recall happier times.
• Music: sometimes favourite pieces can lift your mood, albeit temporarily.
• Talking to someone: A problem shared can be a problem halved.
• Writing it out: Writing is knows to assist with grief and other emotions.
• Relaxation / meditation. Well known to ease stress and exhaustion.
• Time out: Giving yourself permission to stop working or worrying.
• Positive thinking: A positive attitude helps the mind and body feel better.
Sally Castell - Movement Matters
Stay Alert and Active in Your Environment
Everyone wants to live an active and independent life - no matter how old! However, there are many hazards and situations which can become a challenge and so require a bit more effort (physically and mentally) especially where there is reduced activity or ability.
We all need to be able to manage the environment we live in. But as we age, it can become more difficult and thus our safety can be challenged on some occasions. Age diminishes our ability to move as efficiently and effectively as we used to. We can become more vulnerable and “at risk” in certain situations. In the increasingly ageing population, there is a trend towards maintaining the ability to live independently in the community as long as possible. Consequently more people are likely to be travelling as pedestrians. This means an increase in exposure and potential for greater risk of accidents.
It has been estimated that just under 50% falls occur in or around the home. Factors that may contribute to a fall include:
• poor lighting – (areas that are not easily visible or have excessive glare),
• different surfaces e.g. slippery and wet floors due to liquid, powder and food spills,
• uneven ground, or even obstacles in the way e.g. clutter, furniture etc.
Even so, most falls occur on level surfaces within commonly used rooms such as the bedroom, living room or kitchen.
Falls also occur in the bathroom, stairs or from ladders and stools (but not so frequently).
The location of falls is related to age, sex and frailty.
Understandably, with increased age the number of falls at home increases correspondingly.
The frailer group with limited mobility suffer most falls in their own home - these occur during periods of maximum activity in the morning and afternoon.
Trip -40%; Poor balance- 21%; Unsure -14%; Slip-13%; Weak legs -6%; Dizzy - 5%; Faint- 1%
Age 85+ 75- 84 65- 74
Chair / Ladder - 5% 4%
On stairs 13% 7% 5 %
Getting out of bed 3% 5% 2%
Shower /bath 4% 5% 6%
Level surface 35% 25% 24%
Adapted from: Lord SR., Ward J., Williams P., Anstey KJ An epidemiological study of falls in older community dwelling women: The Randwick Falls and Fracture study Australian Journal of Public health 1993; 17 (3): 240 –5
Walking is one of the least strenuous, safest types of activity even though we can still be vulnerable in some circumstances. It is particularly risky when we are not fully in control of our movements and also not fully aware of what’s happening around us. There are lots of environmental hazards which can cause one to slip, trip or fall. So we need careful planning when moving around open spaces. Consideration is needed of problems in the terrain which can include uneven footpaths, steps, stairs and ramps as well as surfaces that may be wet and/or slippery. Shopping centres and malls can present unexpected hazards including entrance-way steps, stairs, ramps, lighting, uneven or slippery surfaces, furniture and fittings, lifts etc.
Activities can be more challenging, such as crossing the road or using public transport where many elements of balance, speed and co-ordination are required. To manage activities safely, good vision and mental processing skills are all needed at the same time. Bearing this in mind, it is very important to be aware and to be as prepared as possible to manage these situations.
In NSW between 2006 and 2010 people 60 years and over accounted for only 19% of the population, yet 39% of the fatalities and 18% of the injuries were aged 60 years and over. (NSW centre for road safety 2010 crash stat data). People 70 years and over age group accounted for only 10% of the population, yet 29% of pedestrian fatalities and 11% of the injuries were in this age group. (NSW centre for road safety 2010 crash stat data). One of the reasons older pedestrians are over represented in fatalities is frailty, meaning that any crash could have a serious outcome.
• Walking more slowly across the road
• Taking longer to leave the kerb
• Having difficulty determining a ‘safe gap’ distance
• Failing to make eye contact with the nearside driver to make sure the car will stop
• Failing to look at vehicles travelling towards them on the far side of the road
• Failing to check and re-check for traffic prior to and while crossing the road
• Becoming confused in a complicated road environment –e.g. at an intersection
• Being slower to react to approaching traffic
• Losing confidence of their ability to cross the road safely
For your safety, when undertaking any activity, think through the many factors that will allow you to make appropriate adaptations and application. When crossing the road, getting on and off a bus, getting in and out of cars, moving around shopping areas consider the following points:
• What is needed to do the activity
• The environment inside and out (e.g. surfaces and wet conditions)
• Your equipment (e.g. clothing and walking aids)
In order to help minimise the risks as a pedestrian, please consider the following points;
• Try to always plan your trip – create either a mental map of your route or write it down
• Where possible cross at crossings with a signal
• Where possible cross on a pedestrian crossing
• Wait for vehicles to stop – some drivers will not stop for pedestrians, so wait until all vehicles have stopped before you start to cross
• Look both ways before you cross and while you are crossing. You should be sure that the driver, rider or cyclist has seen you and is going to stop
• Wear bright or light coloured clothes. This helps make you visible to drivers, rider or cyclist
• Utilise ‘traffic facilities’ that have been installed to assist pedestrians cross the road safely.
Shared paths across NSW can be used by both pedestrians and bicycle riders, as a pedestrian on a shared path, make sure you, keep to the left, move off the path to the left if you want to stop, keep any animals on short leads and under control
Acknowledgement RMS Walking Safely –Presenters guide
Plan, Be Prepared and Take Your Time to Ensure You Make Safe and Sensible Moves - Watch Your Step and Pick Up Your Feet!
Sally Castell - Movement Matters
People arrive at their later years with a variety of backgrounds, experiences and circumstances. We all have different needs, wants, expectations, aspirations and different prospects of what we want and can achieve. We still are individuals with many variables in ages having differences in health conditions and abilities yet the older adult is often “lumped into one category” with exercise programs often planned and delivered accordingly
Many of the effects of ageing are exaggerated and modified by an individuals personal habits, exercise levels, diet and psychological characteristics. A sedentary life can lead to functional capacity loss and ultimately diminished health (osteoarthritis, sarcopenia, diabetes, heart disease etc.) and declining independence. Pollock, 1998, Feigenbaum and Pollock,1997 Age Related Changes General mobility for free and easy movement
Physical activity levels play an important role in maintaining flexibility. Not all older adults lose flexibility at the same rate. Muscle strength and elasticity diminish gradually, by 7% from 30 onwards into middle age but becomes more noticeable after 60, especially in women (15% decrease). Joint ranges of movement and flexibility declines gradually from approximately the same age onwards, with greater decline after age 40 and more frequently used joints exhibit less decline. Joint stiffness is a result of;
a) Increased viscosity (thickening) of the joint synovium.
b) Calcification of articular cartilage
c) Stiffening of soft tissue (capsule & ligaments).General strength for free and easy movement - Muscle Power and Potential A reduction in muscle strength is part of normal ageing and inactivity. The collective result of changes in the muscle is reduced muscle strength, power, endurance and flexibility. This may eventually fall below the level required for everyday activities. There is also an increase in fat and connective tissue within older muscle. Between ages of 50 -70 muscle strength declines 30%. The most dramatic loss occurs after 70. Even more after 80 and is more pronounced in women. The changes in muscle mass (decrease in size and numbers) is a result of
a) A gradual reduction and selective loss of muscle fibers.
b) A reduction in the number of functioning motor units…..the greatest reduction is in fast twitch fibers used for faster movements and activityPhysiological and conditions changes
There are many conditions and associated linkages that present problems with being able to undertake free and easy movement. The following are some examples why movement can become harder. Conditions and issues such ………….
a) Musculoskeletal changes in joint and bone structure as in arthritis (reduced range of movement, increased pain and stiffness) and osteoporosis – (bone fragility, changes in posture).
b) Neurological changes involving hearing and vision e.g. glaucoma, cataracts, deafness and sensory system changes such as vestibular and kinesthetic issues that monitor changes of body sensation associated with balance and body control. Conditions such as Stroke, Parkinson's disease
c )Metabolic changes involving poor or malabsorption –resulting in mal-nutrition / dehydration, conditions such as Diabetes/osteoporosis (calcium and Vitamin D issues)
d) Cardiovascular changes that involve the overall functioning of the heart and circulation including: cardiac output, arrhythmia, syncope, alterations in blood pressure changes etc.
e) Respiratory volume changes and conditions such as Asthma, COAD
f) Mental health changes and cognitive processing resulting in issues relating to anxiety, mental alertness often associated with conditions such as Depression, Dementia
g) Other changes and issues such as sleeping problems, incontinence etc.With all the above examples and reasons it important to recognize there is a need for different exercises, grades and modalities to accommodate all these variables in age changes and conditions. There are multiple exercise recommendations to select from but one program does not and should not suit all. Key issues to consider are that programs are accessible, relevant and realistic with the end result being an ongoing life-long involvement in appropriate physical activity. We need to know and apply what exercise is suitable for us. Deciding on what program is right can depend on recommendation, referral and personal preference. There are many modalities available most of which can assist with maintaining movement. Over to you.....
Adopt an Active Lifestyle to Sustain Your Quality Life Sally Castell 2016 Through effective, comprehensive functional fitness programs, older adults may be able to avoid, postpone, reduce or even reverse declines in physical performance”
Patricia Brill - Functional Fitness for Older Adults
Your Muscles Matter
Keeping good muscle strength and length to maintain movement is important component of an exercise program
Muscle changes with age, inactivity, injury or a chronic condition which results in weak muscles, reduced mass, decreased quality and flexibility. Some muscles tighten whilst others lengthen which can change overall body alignment. Muscle can be improved with exercise. For best results and for safety reasons, maintaining correct alignment, form and technique are important elements to apply in any exercise regime. Muscle weakness can be overcome and improved by strength training. It is important therefore to include a strengthening component within any exercise program. Apart from improving muscle strength it also improves functional capacity and mobility. Muscle does not alter the ability to adapt to task requirements. It is possible for anyone at any age to undertake a strength training program provided basic safety considerations and exercise principles are adhered to.
For optimal lifelong functional capacity a certain amount of muscle mass is necessary otherwise activities become harder or impossible to do and diminish due to the effects of inactivity. Muscles have different properties which provide the variety of necessary daily movements undertaken by everyone. These range from free, easy functional movements to power and strength activities as well as flexibility; endurance; speed and fine motor skills.
Consequences of Weak Muscles (Sarcopenia)
Overall muscle strength changes that occur result in a) Reduction in muscle function relating to general movement involving activities of daily living capacity b) Reduced strength; mobility ; joint pain c) Reduced body control and Increased risk of falls and injuries (with bone fracture association) d) Loss of function, independence and reduced quality of life
Research is recognising the importance of maintaining muscle mass and strength to increase functional independence and decrease the prevalence of many age-associated chronic diseases.”
(Extracts obtained from ACSM position stand. Exercise and physical activity for older adults 1998
Strength and Stretching Exercises Benefits
Muscles essentially create and control movement therefore a good level of muscular strength and capacity is important. Muscles have many roles and functions linked to various activity needs as shown below
1. Progressive strength training can reduce preserve, protect and / or prevent some of the decline associated with ageing and inactivity. Good muscular control increases and maintains muscle mass, power, strength and endurance
2. Maintains a good circulatory system by working to pump blood through the body
3. Assists manage specific conditions by stabilising specific joints to retain good overall body alignment (decreasing joint swelling and pain related issues etc.)
4. Increases joint stability to prevent poor alignment/ postural problems and reduces pain associated factors.
5. Assists maintain bone strength to prevent / reduce the problems associated with osteoporosis
6. Maintains efficient and effective body systems.
7. Maintains free and easy movements for good functional activities necessary for daily living and protects against unsafe movement .e.g. lifting and carrying ; pushing and pulling
8. Helps in the management of diabetes (improved glucose uptake).
9. Increases vitality and energy levels which in turn improves stamina and general fitness
10. Lifts mood thereby reduces depression and improves mental capacity.
Strong Muscles …..Exercise Potential
Strength – Basics exercise guidelines
· Always include warm up and cool down before undertaking strength training
· Stretch at the end of the exercise- each muscle group or at end of session
· When starting - One set of 8- 12 repetitions is sufficient
· Consider and apply correct starting lifting techniques ….
· Lifting speed = 3 up 3 down - hold position for 2-3 seconds
· Don’t speed up as the weights increase
· Work on perceived rate of intensity (it shouldn’t be too easy)
· If there is a sub maximal effort increase the number of repetitions before increasing the resistance or weights
· Gradually progress the amount of weight being lifted to challenge the muscles
“In relation to daily functioning, a decline in strength may be more detrimental for the elderly than a decline in cardiovascular fitness”
Keeping flexible is an important component of an exercise program
Muscle elasticity diminishes with age with increased muscle stiffness resulting in joint stiffness and the body becoming tighter. Increased stiffness occurs in all joints of the body and surrounding soft tissue e.g. tendons, ligaments, joint capsule, fascia. Restricted movement is directly linked to reduction in functional abilities and there is a marked increased susceptibility to falls and associated injuries.
The overall body can become resistant to stretching. Stretching exercises are therefore an important component of an exercise program as well as strengthening exercises
Stretching - Basics exercise guidelines
· Always consider and apply correct starting position and body alignment
· Avoid bouncing or jerky movements (especially with arthritic joints changes)
· Only stretch as far as is comfortable (there is no such thing as no pain no gain)
· Try to hold the stretch for at least between 15- 20 seconds at a time
· Breathe normally and stay relaxed
Falls and their related injuries are a major concern for people who become less able and so less active, the consequences of which can be quite profound. Personal independence and quality of life can become compromised. Commonly associated with reduced activity, falls may result from a specific health condition and/ or ageing itself. Falls and their related injuries create major health and functional fitness problems. Increased falls risks and injuries tend to occur later in life (reduced physical activity and chronic condition association) as the body and mind reduces in ability and capacity.If an older person has had a fall, there is an increased risk of falling again and with a history of falls 66% of people who fall will experience another fall within six months (Recurrent falls of 1 - 4 this increases risk by 10 - 69%). Falls can often lead to loss of confidence and reduction in activity which can have the spiraling effect of reduced activity and weakness leading to more falls. Injury from a fall puts an older person more at risk - particularly of fractures.Falls risk factors are associated with intrinsic or internal issues that are particular to the person such as poor balance, a chronic condition, poor vision etc. and the issues that relate to the environment (hazards both in and outside) known as extrinsic or external factors.Functioning Well - Mobility and the Link to Fall Related Injuries Fitness and health declines with age and may eventually fall below the level required to undertake everyday activities easily and safely. The level of body control and the ability to move efficiently and effectively diminishes with age whether a person is stationary or when moving. The physical factors include lack of fitness, strength and suppleness. Strength and balance in fact decline gradually from 30 onwards with greater increases becoming more noticeable later in life. These subtle changes in movement and balance increase the risk of falls and can affect functional abilities. Physiological changes, along with many health conditions, can also affect balance and body control. Good mental processing is necessary for a person to respond and react quickly to any disturbances in movement. It is therefore important for people to stay alert and always be aware of their environment to avoid or manage the different hazards which can occur throughout the day. Optimal capacity is required to perform many daily tasks to achieve purposeful, good and safe results. Functionality can involve many tasks done together; these activities involve a combination of muscular strength (power), endurance, flexibility, balance, co-ordination and cognition. Physical and cognitive dysfunction are the major factors contributing to reduced function.
Why do people fall? - Major Fall Risk Factors • Underlying medical / chronic conditions and muscle weakness with associated factors e.g. pain resulting in joint stiffness, reduced activity, balance problems, dizziness and associated fear of falling
• Reduced physical activity and disturbances in gait patterns can cause unsafe mobility problems and transfers. Walking becomes slower and more cautious
• Reduced mental abilities can result in a reduction in alertness which reduces the ability to react quickly to unexpected situations
• Foot problems and inappropriate/ inadequate shoe wear.
• Eyesight changes and visibility involving issues such as changes in depth perception, acuity and adaptations to changes in lighting
• Poor or inadequate medication management and use as well as their side effects e.g. use of psycho-active medications which may cause light headedness and dizziness
• Environmental hazards inside the home and outside
* Plus many more related issues such as a previous fall, increasing age and frailty, use of a walking aid etc.Chronic condition examples that can increase the risk
• Musculo-skeletal conditions such as arthritis, osteoporosis and medical conditions such diabetes can reduce the ability to be active and strong.
Neurological conditions such as stroke and Parkinson’s disease in particular increase risk
• Cardiovascular conditions such as uncontrolled blood pressure and arrhythmias may cause light headedness and dizziness NB. The risk of a fracture following a fall greatly increases with people diagnosed with osteoporosis but osteoporosis itself is not a risk factor. Exercise has an important role to play in the “big picture” in relation to reducing falls risks and injuries as a result from a fall……
“The public health importance of physical activity may relate not just to its role in preventing decline, but also to its role in enhancing physical function” Cress, Buchner
“Emphasis should be placed on factors that result in permanent lifestyle change to encourage a lifetime of physical activity.” Pollock M., Gaesser G.,
There will be further and more specific articles on conditions and body parts to assist you with your health and fitness activities in future newsletters including specific exercise to improve strength and balance to reduce the risk of falls and related injuries.
Making Progress and Keeping Active
It is hard to keep on track and motivated to do things for long periods of time.....whether this is on a weekly basis or for longer periods of time.
Taking a little more time and effort to exercise beyond the normal daily activities undertaken is one thing that is often very low on peoples' agendas or not considered of any importance. The body is a machine and needs to be well maintained to function well and efficiently. Unfortunately, mostly over time and with age, structures can change and alter shape, so logically it would seem important to attempt to get things back and keep things in the best working order as possible. But does this happen?
Old habits, old ways; are they serving you well or do you need to rethink what you are doing? Changing ways and habits can be hard frustrating and threatening but exercising in the old way may not be serving you well anymore.
Changing some habits may need to get done for the results your body requires.
Say for instance you have a problem with your back or balance- are you undertaking the most effective ones to keep you upright and safe? You may have been doing a lot of aerobic exercise for many years and this has served you well from a cardio vascular perspective but if you have problems with balance then you will need to work on things that will improve the situation such as undertaking more strength training work especially for the muscles of the lower limbs or more specific exercises for a back problem.
If you have arthritis / joint problems then you might need to alter your exercises to protect you and prevent further problems with the joint damage. Non weight bearing exercises might be more suitable to reduce the load on the joints which might be causing pain and restricted movement as a result of doing too much.
It is possible to improve your lot but you may need find and work on the right format (be shown a new way of doing things), time to practise, persistence to keep on track to get the results.
"Embracing change is not always easy, but it is often and may be necessary." Quote based from article by Jim Bright, Sydney Morning Herald
Keeping Count and Making Progress
Sometimes it is important to stop and consider the way things are being done to enable new ideas / habits fit in with the old ones if they are and will more be beneficial to your lifestyle.
Tips to keep you on track
- Anticipate challenges, plan and find ways to overcome them
- Make a commitment to exercise regularly; consider it as a long term investment
- When encountering challenges - be prepared to deal with issues using active problem solving, understand, predict and control critically important aspects
- Recognise risky situations and avoid them whenever possible, develop coping / alternative strategies
No miracle cures and quick fixes a long term commitment
Consider how long term habits have taken to form it, no wonder everyday behaviours are difficult to change
Old habits are hard to unlearn. Habit change isn't a sprint, its a marathon
Good habits can save lives
Quotes from book "Making Habits Breaking Habits" by Jeremy Dean