Ageing Ageing & Rehabilitation & Rehabilitation David Rigg BSc (Hons) GSR, CSCS David Rigg BSc (Hons) GSR, CSCS
Nov 01, 2014
AgeingAgeing & Rehabilitation& Rehabilitation
David Rigg BSc (Hons) GSR, CSCSDavid Rigg BSc (Hons) GSR, CSCS
TODAY'S PRESENTATION
• Putting aging in to context what is it Putting aging in to context what is it • Review Rehabilitation Procedures Review Rehabilitation Procedures • Physiological Exercise Prescription and the Physiological Exercise Prescription and the
Biomedical ModelBiomedical Model• Medical Exercise Therapy and the Medical Exercise Therapy and the
Biopsychosocial Model Biopsychosocial Model • Case Study Case Study • Statistics Statistics
AGE AND TIME TO RETIRE
• Army – 40 years old • Fire and Police Service – 55 years old• National Retirement Age – 60 – 65
years old and increasing• Over 65 years
CATEGORIES OF AGING
• Chronological aging • Cosmetic aging • Social aging (changes in interactions with others)
• Psychological aging (age-related changes in perception and behaviour)
• Economic aging (changes in financial status with age)
Ref:1
AGE AND FUNCTIONAL LOSS
Functional losses fall into 4 categories1. Functions that are totally lost 2. Structural changes 3. Reduced efficiency4. Altered control systems or reduced
reserve capacity to respond
Ref:2
TWO TYPES OF AGING IDENTIFIED IN THE LITERATURE
1. Normal Aging - changes that are not produced by
disease. 2. Pathological Aging – changes that result form
environmental changes, genetic mutations and accidents of nature.
Ref: 2
OPTIMAL AGING
The preservation function at the highest level and the quality of life
is maintained.
• The Absence of disease and disease related disability
• High functional capacity• Active engagement with life
Ref: 3
OPTIMAL AGING INCORPORATES
• Physical health • Psychological state • Level of independence • Social relationships• Personal beliefs • Relationship to the environment
Ref :4
PHYSICAL ACTIVITY REDUCES THE RISK
• Coronary heart disease
• Diabetes mellitus• Cancer – colon and breast • Obesity• Hypertension • Bone and joint
diseases – osteoporosis and osteoarthritis
• Depression Ref: 5,6
Comprehensive Exercise Programme
• Aerobic work • Resistance training • Power training • Flexibility exercises and balance
training
BENEFITS OF RESISTANCE TRAINING
• Positive effects on Muscle Mass • Enhanced motor unit recruitment • Improved contraction coupling and
calcium handling • Relief from arthritis pain • Improved balance and reduced risk
of falls • Strengthen of bones Ref:7,8,9
REHABILITATION PROTOCOL
• Control pain • Restore Range of movement • Restore Muscular Strength,
Endurance and Power• Re-establish Neuromuscular control• Maintain cardio respiratory Fitness • Restore Function
NATIONAL STRENGTH AND CONDITIONING ASSOCIATION NEEDS ANALYSIS
1. Needs Analysis
2. Exercise Selection
3. Training Frequency
4. Exercise Order
5. Training Load and Repetitions
6. Volume
7. Rest Periods
NEEDS ANALYSIS
• Evaluation of the sport, movement, physiology, injury
• Assessment of the individual - Age, training and chronological, training status, technique experience.
• Testing and evaluation
• Set primary training goal
BUT HOW MUCH
• Hunter et al – 2-4 sets of 8-15 reps at 60-80% of 1RM, on 2-3 days per week (Ref: 10)
• ACSM – 1 set of 10 -15 reps of a moderate intensity of 8-10 exercises using all major muscle groups at least 2 days per week 48 hours apart (Ref:10,11)
PROBLEMS WITH EXERCISE PRESCRIPTION
• Causes pain • Person feels uncomfortable in the situation
• Low confidence with exercise • Poor understanding of the condition
• Believes it will cause more damage • Does not like exercise and never has • Wants a quick fix
• As the prescription for exercises vary among studies and as older adults vary considerably in health, fitness and functional status do we need to prescribe for the individual.
• Meet the person where the person is
ASSESSMENT
Treat the patient not the x-ray, the CT or MRI scan results.
Advances in diagnostic imaging do not replace the need for clinical interpretation.
• Khan KM, Tress BW, Hare WSC, Wark JD. Treat the patient not the x ray: Advances in Diagnostic Imaging Do not replace the Need for Clinical interpretation. Clinical Journal of Sports Medicine 1998;8:1-
4.
CLASSIFICATION FOR TREATMENT CONTINUUM
Type 1 Type 2 Type 3
Organic Tissue Based
Identifiable Tissue
at fault
Normal pain behaviour
Recognisable pain patterns
Reproducible signs
Chronic Pain
Abnormal Pain Behaviour
Major Psychosocial
Stressors
Non specific diffuse pain
Non reproducible
BIOPSYCHOSOCIAL MODEL OF CHRONIC PAIN AND DISABILITY
Social Environment
Illness Behaviour
Biology Sensory Condition
Thoughts and Beliefs
A COLLABORATIVE APPROACH
• Is the person ready to start a programme • Is the person confident they can do the program • Is the program important to the person
• What is their motivation
• What do they want to achieve • What do they think they can do, start with• What are they willing to try
Ref:13
• Motivational Interviewing • Cognitive Behavioural Therapy (CBT) • Cognitive Behavioural Approach
(CBA)
CBT LONGITUDINAL FORMULATION (Beck 1967)
Early Life Experiences
Formation of Schema
Conditional Beliefs
Critical Incident
Symptoms
Cognitions
Emotions Physical Symptoms
Behaviour
Situation
Thoughts
Behaviour
Feelings Physical Symptoms
5 Areas Model
The CBT 5 Areas Model
Hot Cross Bun (Ref: 12)
Situation
GOING TO THE GYM FOR AN EXERCISE REHABILITATION PROGRAMME
Thoughts
Why have I been sent to the gym
I have been told not to do to much
This is going to cause more pain
Behaviour
Does not do exercise
Keeps themselves safe
Physical Symptoms
Increased HR
Feels more Pain
Feelings
Scared
Anxious
Worried
Protective
Situation
GOING TO THE GYM FOR AN EXERCISE REHABILITATION PROGRAMME
Thoughts
I am looking forward to this
This will help me
I might make some new friends
Behaviour
Complete Exercises
Attend Regularly
Physical Symptoms
Reduced Pain
Reduced muscle tension
Reduced blood pressure
Feelings
Confident
Happy
Relaxed
MEDICAL EXERCISE THERAPY
• Founded by Oddvar Holten • Published in The Norwegian Physiotherapy Journal;Fysioterapeuten1968;Holt O.
Treningsterapi. Fysiterapeuten 35(8):236-240.
• Therapy where the patients performs exercises with specially designed apparatus without manual assistance
• Defined starting positions and graded loads • One hour of effective treatment • 7-9 exercises 2-3 sets or 20 -30 reps aiming for
close to 1000 reps.
• Must start to sweat
ADVANTAGES OF THIS TYPE OF PROGRAMME
• Positive Cognitive Experience • Blood circulation • Endorphin release • Improved endurance and strength • Improved function
↓↓Pain Pain
↓↓Anxiety Anxiety
↓↓DepressionDepression
Advantages of this type of programme
• Some evidence suggests that supervised programmes increase compliance.
• Collaboratively set goals appear to lead to higher
levels of treatment compliance than set goals • Combined exercise and motivational program can
increase compliance and reduce disability • Compliance may be directly influenced by the out
come
Ref 14,15,16,17,
CASE STUDY PRESENTATION AND DISCUSSION
Summary
• Physiological principles apply • No template for prescription for – Age or
condition
• Identify – Thoughts, Feelings, Beliefs and Motivation
• Apply the right model to the right individual
• Use a collaborative approach
A healthy mind in a healthy body
Mens sana in corpore sano
Thank You
Discussion
References :
1.Dirks AJ and Leeuwenburgh C. The role ofapoptosis in age-related skeletal muscleatrophy. Sports Med 35: 473–483, 2005.
2. Taylor A Wand Johnson MJ. Physiology of Exercise and Healthy Aging. Champaign,IL: Human Kinetics, 2008.
3. Rikli RE and Jones CJ. Senior Fitness Test Manual. Champaign, IL: Human Kinetics,2001.
4. Wolf SL, Sattin RW, Kutner M, O’Grady M, Greenspan AI, and Gregor RJ.Intense Tai Chi exercise training and fall occurrences in older, transitionally frailadults: A randomized, controlled trial.J Am Geriatr Soc 51: 1693–1701, 2003.
5. Federal Interagency Forum on Aging- Related Statistics. Older Americans2008: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office, 2008.Available at: http://www.agingstats.gov.
6. Warburton DER, Nicol CW, and Bredin SSD. Health benefits of physical activity: The evidence. CMAJ 174: 801–809, 2006.Available at http://www.cmaj.org/.doi:10.1503/cmaj.051351.
7. Dirks AJ and Leeuwenburgh C. The role ofapoptosis in age-related skeletal muscleatrophy. Sports Med 35: 473–483, 2005.
8. Centers for Disease Control andPrevention and The Merck CompanyFoundation. The State of Aging andHealth in America 2007. WhitehouseStation, NJ: The Merck CompanyFoundation, 2007. Available at:www.cdc.gov/aging andwww.merck.com/cr. Accessed March 12, 2009.
9. Federal Interagency Forum on Aging- Related Statistics. Older Americans2008: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. Washington, DC: U.S. Government Printing Office, 2008.Available at: http://www.agingstats.gov.
10. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testingand Prescription (8th ed). Philadelphia, PA: Wolters Kluwer/Lippincott Williams &Wilkins, 2010. pp. 153, 172–174, 192–194.
11. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, andCastaneda-Sceppa C. Physical activity and public health in older adults:Recommendations from the American College of Sports Medicine and theAmerican Heart Association. Med Sci Sports Exerc 39: 1435–1445, 2007.
12. Williams C, Garland A,. Advances in Psychiatric Treatment (2002).vol8pp.172-179.
13. Rollnick S, Mason P, Butler C. Health Behaviour Change, A Guide for Practitioners. Churchill Livingston, 1999.
14. Reilly K et al. Differences between a supervised and independent strength and conditioning program with Chronic Low Back Pain Syndromes. Journal of Occupational Medicine, June 1989, vol 31, no 6. p547-550.
15. Bassett S, Petrie K. The effect of treatment goals on patient compliance with physiotherapy exercise programmes. Physiotherapy 1999,853,p130-137.
16. Fredrich M. Compined Exercise and Motivation Program: Effect on the compliance and level of disability of patients with chronic Low Back Pain: A randomised Controlled Trial. Arch Phys. Rehabil., May 1998, vol79,p 475-487.