balance training toolbox for older adults
DESCRIPTION
Designed for Personal Trainers, this workshop will help trainers asses the needs and design exercise programs for older adults to improve balance, stength, posture and flexiblity. The ideas are fun and fresh, specific to balance and mobiltiy skills and based on the book, ABLE Bodies Balance Training (Human Kinetics, 2008).TRANSCRIPT
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April 10, 2023
P r e s e n t e d b y
Sue Scott, MS
Renewable Fitness & ABLE BODIES®
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Balance Training Tool Box
for Older Adults
A Squeaky Wheels Approach to Balance and Mobility
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Better Living through Exercise
ABLE CAPABLEBALANCED
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Squeaky Wheels Approach to Balance
• Exercise Science Perspective
• Critical Thinking
• People Skills
Able, Capable Living
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Perspective: Exercise As Medicine
Imagine the possibilities!
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Exercise as Medicine
Movement is a medicine
for creating change
in a person's
physical, emotional, and mental states.
~Carol Welch
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Prescribing Exercise as Medicine
Specificity
Overload
Protocols Mode, IntensityFrequency, Duration
Outcomes
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Specificity
Finding the right targets
• Specific to tasks• Appropriate systems
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Overload
Stress that is more than normalIndividualSystem(s)Engaging, challenging, safe
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ACSM Position Statement on Balance Training
Use progressively more difficult postures . . .
that gradually reduce the base of support
require dynamic movements that disturb the center of gravity
stress posturally important muscle groups
reduce sensory input
conform best to the accepted theories of balance control and adaptation
~ASCM Position Statement, 1998
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Balance Protocols for Fragile Elderly
SpecificityOverload
ProtocolModes
•Specific to goals •Engage relevant systems•Multiple modes•Layering
Intensity•Challenge system •Engage the Individual
Frequency & Duration•Still researching
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Understand the Overall Picture . . . Specific components for balance in the
elderly
Strength
PostureFlexibility
VisionVestibularSomatosensoryReflexes
ExperiencesSkillsLearning
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What Tools Will You Need in Your Tool Box?
Posture & Flexibility
Strength & EndurancePurposeful strength
•Legs, core muscles and triceps
Balance and MobilityVisual, vestibular Somatosensory Automatic systemsGait training & ADL skills
Confidence & Trust Educate and engage their mind Good, clean fun
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Where to Start?
Tools Critical thinking skills
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Assessments
Identify & Explore ProblemsObserve
•Posture•Flexibility•Agility•Strength
Written evaluations•Existing•Balance Confidence
So Ma’am, What seems to be the
problem?
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Assessments
Flexibility & PostureModified Sit & Reach (Rikli, Jones) Back Scratch Test (Rikli, Jones) Grids
StrengthChair Stands
Endurance 2-minute Step Test (Rikli, Jones) 6-minute Walk (Rikli, Jones)
PowerMax Gait Speed (Rose)
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Balance Assessments
BALANCE Walkie Talkie (Rose) Walk with Head Turns (Horak)
Modified CTSIB (Horak, Rose)
Get up and Go (Rikli, Jones; Horak)
Rise to Toes (Horak)Toe Taps on Step (Horak) Functional Reaching (Rose)
Tandem Walk (Rose)Tandem Stand
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Balance Training Progressions and Layering . . .
Gradual increases in difficultyResistanceBalance requiredComplexity of the taskNumber of systems involved
Makes each exercise or activity more productive
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w w w . i d e a f i t . c o m I N S P I R E T H E W O R L D T O F I T N E S S®
Flexibility
Improves range of motion in key joints
Better posture More efficient movement
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Flexibility
Ankles & Calves Hamstrings, Gluteals AB/ADDuctors
Chest & BackShoulder girdleTriceps
Axial skeletonHead turns, tilts, rolls, chin dips
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FLEXIBILITY Tools
Conceptual Activities Enhance cognitive learningLearn with their bodies and their minds •Inside out Learning
Build confidence & trust
Physical ActivitiesTarget key jointsProvide somatic cues & sensations
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Conceptual Flexibility
Venus Di Milo Arms
Inside-Out Learning
A sense that their arms can reach much
further
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Flexibility Activity
Supple Spine
Relaxercise - Zemach-Bersin and Reese, 1990
Even gentle flexibility can improve function
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Whole Body Flexibility
Farmer’s StretchCarry the
Baby
Gentlemen’s Bow
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Posture & Core Stability
Inter-related, ComplimentaryProper alignmentBraces posture
Steadies against balance disturbancesJostling crowds, perturbationsHead turns, arm swings
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Conceptual Posture Tools
Parts of the Whole
Breathe Easy
Posture Affects Function
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Conceptual Core Strength Tool
Torso as a Cylinder
Take Home MessagePosture affects balanceRenewable
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Conceptual Tool for Core Stability
Mohammed & the Mountain
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Training Core Strength
Target MusclesScapula & Head RetractorsAbdominals & Obliques Back Extensor
Simple to ComplexParts to WholeResistanceTask ComplexityElements of Balance
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Sample Strength Progressions
Tall SitsAdd overload
•Reps, time•Resistance
Add motion •Buddha’s Prayer•Curl up & sit tall•Indian Chiefs, Chiefs w/a twist, w/ knee lift
Add elements of Balance •Narrowed base•Dyna Disc
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Posture & Core Strength Training
Rows Seated w/ a tall a sit Alternating arms or obliquely Seated on a Balance discCombined with small squats
Knee Lift, Abs inSeatedCurl up and sit tallStandingDyna disc or ball w/ holder
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Core Stability – Back Extensors
Up & UpsStretchingReaching w/one armAdd Venus Di Milo ArmsW/ balloon W/resistance YMCAsStanding
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Strength with a Purpose
Target MusclesPosture and Back ExtensorsWhole legTriceps
Movement patterns mimic ADLsFlag SalutesTeeter Totter Chair Stands
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Progressions & Layering for Strength Training
As tolerated To fatigue (within 6-15 reps)Parts of motion before whole motionSingle muscles groups to multiple muscle groupsSeated, Standing, MovingMusicSecondary tasks
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More Examples: Heel & Raises
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Balance Training
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Balance Safety & ConfidenceTAKE TURNS!
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Systems of Balance
Visual Somatosensory Vestibular
Automatic
Integrated Many systems are used simultaneouslyLayers of systems, skills, experiences
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Vision - Visual Targets
Look ahead HorizonNext turnLook awayFlash Lights
Layer Posture & Core StabilityBalance Challenge
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Kinesthetic – Somatosensory
The Ball GameComing to our Senses
Belly Button Training
Sways and CirclesTai Chi
Reduced vision
Inside Out Learning
Cue for sensations
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Vestibular
Head & or Eye MotionSeatedDiscs, BallsStandingWalking
ExamplesSeated
•Head moves•Eyes move
Walking•Words on the Wall in the Hall
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Transitions – Control CoM
Already covered Sit to Stand Belly Button Training Sways Heel Toe Rocking
Traffic SchoolChange of PaceChange Directions Red light, Green LightObstacle Course
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Transitions – Controlling C of M
Walk the Line
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Transitions with Music
Side SteppingHeel ToeHeel touchesBack touchesBoth
MarchingToe TapsOn the groundTo a lineOn a stepOn a higher step Mind -
Body Connection
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Gait
Rock n WalkStride LengthObstacle Course
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Automatic
Dual TasksVerbalMotorCognitive
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The Need for Better Balance Programming
In 2004
Best Practices StatementBest Practices Statement
Physical Activity Programs and Physical Activity Programs and Behavior Counseling in Behavior Counseling in Older Adult PopulationsOlder Adult Populations
MSSE 36:11; 2004MSSE 36:11; 2004
Found just 6 exercises to improve balance in frail
elderly
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Background: How Did I Get Here?
Sue Scott, MSMasters & Bachelors in Exercise Science
ASCM certified
Exercise Prescription, Kinesiology at PSU
Specialize in balance & mobility for older adults•Frail Elderly •Parkinson's Disease
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Develop appropriate physical activities to improve balance and balance confidence in frail populations Encourage the elderly to live active, capable, involved lives Make these ideas available to others
Mission
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Exercise Enables
Capable, Able, ActiveTo do whatever we enjoyMore self-reliant, independentConnected to families, communities & values
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Achievements
Achievements2000 Developed a balance training program•Designed for Frail Elderly
PostureFlexibilityStrength with a purposeBalance Challenges
2003 Grant from National Blueprint Active Aging Partnership •Tested ABLE BODIES® techniques•Significant improvements Balance, strength, flexibilty and daily activity
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Blueprint Momentum
IAHSA Trondheim, Norway
ACSMAnnual Meeting, Nashville
APHAPhiladelphia
OHCAPortland, Oregon
Human KineticsDue out next year