A toolkit for frontline caregivers to help maintain healthy and active aging in seniors With the goal of sustaining adequate IADLs to allow seniors to remain as autonomous as possible for as long as possible Relaxation exercises, physical exercises and suggestions for cognitive activities for the home setting
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A toolkit for frontline caregivers to help maintain healthy
and active aging in seniors
With the goal of sustaining adequate IADLs to allow seniors
to remain as autonomous as possible for as long as possible
Relaxation exercises, physical exercises
and suggestions for cognitive activities for the home setting
1
Table of contents
Introduction
A healthy mind in a healthy body at any age! 2
Facts and Tips
Facts about frailty 3
Some false myths about exercising 3
Benefits of Exercising 4
Good Pain versus Bad Pain : How to Tell the Difference? 6
Appropriate Level of Effort 7
Functional Fitness Assessments 8
Physical Tests (TUG et STS) 9
Confidence Test 11
Functional Fitness Score 12
The Physical Exercise Program
Exercise Categories 13
Start with Relaxation (Listen to the audio monologue instructions!) 14
The Aerobic Exercises 15
The Muscle Strengthening Exercises 16
The Flexibility Exercises 17
The Balance-building Exercises 18
End with Relaxation (Listen to the audio monologue instructions!) 19
Client’s Exercise Calendar 20
Suggestions for Intellectual Activities 21
Client’s Functional Fitness Progress Report 22
And of course….EAT RIGHT! 23
2
Introduction
A healthy mind in a healthy body at any age!
Everyone wants to live independently with a good quality of life for the rest of their days. What
can help make this possible? The secret according to scientific research is maintaining an active
lifestyle. Contrary to popular belief, old age is definitely not the time to rest - if living
independently with good health and an alert mind is the goal.
With age, our physiological reserves and biological resilience declines. This can lead to frailty,
and it is easy to spot in some seniors. These seniors appear weak, look fragile, and move slowly
and without confidence. They often complain of low energy and have no interest in doing much.
But frailty is not the norm. Old age does not necessarily mean limited mobility, reduced zest for
life, and bad health. Nor does it always mean memory loss and cognitive decline. Frailty and
dementia need not always be a part of normal aging – at the very least their onset can be
postponed according to scientists. Indications are that all it takes is a commitment to moderate
daily physical and cognitive exercise, even from really senior seniors! The goal is long term
autonomy not long term care!
In the past, we would encourage our seniors to reduce their activities, get someone to do their
chores for them, and advise them to rest. Research has since shown that this approach to caring for
seniors has adverse effects – in fact is the opposite of what we should be doing for them. For this
reason, the Ontario government has implemented Ontario’s Action Plan for Seniors featuring the
theme "Independence, Activity and Good Health". It encourages seniors to stay active and
engaged in order to prolong a good quality of life with the goal of living at home independently
for as long as possible, which is the cherished wish of the overwhelming majority of seniors.
So let’s get started on the road towards maintaining independence and an active and healthy
lifestyle for our seniors! This manual contains everything you will need to help your clients
succeed in this new action plan. It contains facts about the benefits of an active lifestyle and
counterarguments to dispel harmful myths about seniors and exercise; it contains simple physical
and cognitive exercises, a progress report template, and tips on how to accompany them in their
new life routine.
The exercises proposed here meet the Canadian guidelines for physical activity for adults aged 65
and over and are supported by the Canadian Centre for Activity and Aging of Western University
and the Department of Physical Therapy of the University of Toronto. The cognitive activities are
endorsed by the Centre for Cognitive Health of York University.
3
Facts and Tips
Facts about frailty
What does it mean to be frail? It means that there is a decrease in functional mobility and overall
physical resiliency. Frailty is caused by a reduction in aerobic capacity, a loss of balance control
and a reduction in bone density. Physical frailty can also be associated with declining cognitive
functional capacity making seniors more vulnerable to stress, risk of falls, and depression.
Frailty is caused in part by the cumulative effects of a sedentary lifestyle and loss of physical
fitness and tone. Disuse and lack of physical conditioning reduces functional mobility which leads
to frailty and a loss of independence. But clients should not be discouraged because physical
activity can prevent frailty.
Some false myths about exercise
I am too old to do exercise.
No one is too old! And every little bit helps. http://www.csep.ca/en/guidelines/get-the-guidelines
Exercise is bad for people with varicose veins problems.
Actually exercise is good as gets blood moving! http://www.veinspecialists.com/blog/exercise-and-varicose-veins/
Exercise is bad for people with arthritis.
Actually exercise is good and will improve symptoms! http://www.health.harvard.edu/blog/exercise-is-good-not-bad-for-arthritis-201305086202
Exercise is bad for people with asthma.
Often, exercise can help control the frequency and severity of asthma
There is nothing more motivating for you and for your client
than proof of progress! It makes it all worth it!
6
Good Pain versus Bad Pain : How to Tell the Difference?
Good Pain gets the thumbs up!
Good normal pain feels like stiffness or burning and can cause some discomfort, but it doesn’t
hurt when the person is at rest. Good pain is a good thing as it a sign that means that the muscles
are becoming stronger.
It normally occurs within 24-72 hours after the exercise session, and then it begins to disappear. http://www.hopkinsmedicine.org/orthopaedic-surgery/about-us/ask-the-experts/pain.htmlx
Bad Pain gets the thumbs down!
Bad pain is not normal. It is often a sharp pain, usually not located in a part of the body that you
were actually deliberately exercising. Often the pain is present even while the person is at rest.
This kind of pain persists after 72 hours. http://www.hopkinsmedicine.org/orthopaedic-surgery/about-us/ask-the-experts/pain.html
If your clients are reticent about exercising because they already have some pain, try to get them
do some a couple of repetitions of an exercise anyway. After a couple of repetitions, ask them if
the pain is worse. If the pain isn’t worse, then it means that the exercise is not aggravating the
situation. They should feel free to exercise. Simply continue to ask them if the pain is worsening
as they continue to exercise. If the pain level does not increase, then the client can proceed with
their exercise program. If the pain is increased by the exercise, they should stop.
Quand ne pas continuer avec les exercices!
• If the pain persists longer than72 hours.
• If the person has an injury.
• If the client has a severe medical condition such as a heart condition.
Tiered Exercise Program Participant Guide, Canadian Centre for Activity and Aging, Western University, 2016
The purpose of assessments:
To provide a baseline measurement so can compare future performance so as to be able to
measure changes;
To provide information as to the physical fitness of the client in order to design an
appropriate individualized exercise program for the client;
To help motivate clients through a record of their performance;
To help identify a risk of frailty and falls due to inactivity.
When To Assess:
An initial assessment should be done before the client begins the Dr Actif program.
Reassessments can be done every 3 to 6 months.
Take your time with the assessments so that the client does not feel stressed by them.
The Three Assessments:
1. TUG Test (Timed Up-and-Go) measures general mobility by assessing ability to rise
from a chair and to walk with good speed.
2. 5 Rep Sit to Stand (STS) measures lower body muscular strength and balance by
assessing stamina in raising and lowering into a chair.
Together these two assessments are good predictors of risk of falls and of frailty. http://www.medscape.com/viewarticle/578505_4; Podsiadlo D, Richardson S. The Time “Up & Go”: A Test of Basic
Functional Mobility for Frail Elderly Persons. Journal of the American Geriatrics Society 1991; 39(2):142148
3. The Functional Fitness Confidence Scale (FFC) assesses the client’s confidence level in
performing the activities of daily living, reflecting the client’s perceived judgment as to
their physical stamina, muscular strength and flexibility.
Confidence tests are important to administer because clients who are worried about falling
tend to be less active, which in turn feeds the cycle of inactivity and disuse leading to
higher risks of frailty and falls. A.M. Myers. Department of Health Studies and Gerontology, University of
Waterloo, Ontario, Canada, N2L 3G1. Funded by Searle Canada Inc. and Health Canada.