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Presented for the International Council for Active Aging,December 2010: It will give you many ways to add balance to everyday fitness programming for older adults
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BALANCING YOUR FITNESS PROGRAMAdding Balance to Everyday Fitness for Older Adults
I Blame ABLE
Bodies for this
Achieve Better Living with Exercise
With permission: ABLE Bodies Balance Training, 2008; Human Kinetics
Renewable Fitness, LLC
ABLE CAPABLEBALANCED
Randomized Control Trial
Robert Wood Johnson Foundation
84 Adults70+ yrs oldMean age = 83.5 yrs
CCRCsContinuing Care
Retirement facilities, Independent - Assisted Living
Study Sites & Participants
GenderFemale 69Male 15
Study Demographics
Medical Conditions Diabetes 12 Heart Disease 19 High BP 46 Stroke 13 Arthritis 40 Osteoporosis 13 Joint Pain 27 Hip Surgery 8
Prescribed Meds None 3 1 to 3 29 4 to 9 32 > 9 8
38% used Walkers
Results
Significantly Improved Balance & Mobility Physical Activity Levels Strength Flexibility Published
Medicine and Science in Sports & Exercise, 2005
Presented ACSM, ICAA, APHA, IAHSA,
IDEA World
Add Balance to Your Programs
Exercise Science Protocols
Peer reviewed, published Mode, Intensity, Frequency,
DurationSpecific to GoalsSpecific to Systems
Exercise Prescription
Mode –activity choices (active ingredient)
Intensity – challenge (dose)
Frequency – how often Duration – how long
Recipe . . . written to address certaingoals, systems
Get out of chairs Upright posture
Reach & Turn Gait & Mobility
Climb stairs Get up from floor
Confidence
Address Specific Goals
ACSM Protocols for Balance in Elderly
Conform to accepted theories for balance control
Multi Modal Address all systems & components of balance Engaging, challenging, complex, layered, functional
Progressively difficult postures, gradually reduce Sensory input Base of support
Dynamic movements disturb Center of Gravity
Strengthen leg and postural muscles
Build strength before endurance
A Walk in the Park
Multi-modal: Address allSystems & Components for Balance
Posture Flexibility
Strength Endurance
Sensory Systems Vision Vestibular Somatosensory
Automatic, Central, NM & Integrative
Cognition Experiences Skills & Learning
Sensory Systems
Incoming information about our
environment
Sensory Systems for Balance
VisionSomatosensory (touch, proprioception)
Vestibular
Source: Fay Horak, PhD; NSI Balance Disorder Laboratory, Hillsboro Oregon; used with permission
How Sensory Systems Function for Balance
Firm Surface 70% Somatosensory 20% Vestibular 10% Vision
Unstable, Compliant Surface 10% Somatosensory 60% Vestibular 30% Vision
Sensory Weighting
Balance Mat w/head turns
Horak, Fay B; OHSU, NSI Balance Disorders Lab; Hillsboro, OR; used w/permission
Tall Stand
Manipulate Vision Enhance vision
Optimal lighting External Cues
Visual Targets Eyes on the Prize Vertical lines
Mirrors Modeling
Reduce vision Less optimal lighting
Dim the lights Sun glasses No-body glasses
Fewer external cues
Eyes on the Prize
MirrorsKayaking thru poles w/ no-body glasses
H-Lines
Visual Tool: Follow the Light
Flashlight in reduced light
Laser Lightin well-lit room
Visual Targets
Visualization
Enhance Vision w/Mind’s Eye Visualize event
Make a plan “See” themselves doing it Look ahead (next turn or goal)
Look Ahead, next turn
Somatic Awareness
“Inside-Out” LearningListen to their BodiesIncrease Self Awareness
Cue/Focus on proprioceptive sensations
Sensational Somatic cues Feel, notice, lift, push
Tie Breath to movementReduce vision
Somatic Learning Tool
Coming to Our Senses
Somatic Learning Tool
The Ball Game
The Ball Game
Somatic Learning Tool Supple Spine
Supple Spine(Based on Feldenkrais)
Take Home MessageEven gentle
stretching improves function
Somatic Learning Tool
Belly Button Training Sways, circles, rocking One foot standing Steps
Belly Button Training
Somatic Learning Tools
Tai Chi Self Awareness Tie Breath to Movement Weight Shifts Upright posture
Yoga Pilates
Somatic Summary
Enhance SomaticInside-out Learning
Supple Spine
Belly Button Training
Tai Chi
Reduce visual input
Reduce SomaticCompliant surfaces
Dyna discs Stability balls Balance pads/mats
Belly Button Training
Supple SpineThe Ball Game
Balance Mat- Walking
Seated on compliant surface
Over the Moon Ball Stretch
Vestibular Function
Enhance/engage Vestibular Require Head Turns In multiple directions Slowly, carefully, to adapt
ProgressivelySeated Standing Walking
Words on the Wall in the
Hall
Making WavesHead Turns
More Tools to Enhance/Engage Vestibular System
Reduce Vision (engage other sensory input) Dim room Sun or no-body glasses Distracting busy patterns
Reduce Somatic Input (w/compliant surfaces) Mats, Dyna-Discs, Stability balls Outside: Grass, sand, gravelUse Caution
Fitness can’t fix, just help adapt Do activities seated, first Dizziness, peripheral neuropathy Stand/Walk on Foam
Follow the Light
Sensory Training Summary
Sensory Systems One part of Multi-modal program Their Job: Incoming info about environment How to Use Sensory input for balance:
Manipulate or vary environment Engage the system Enhance input Reduce input
ASCM protocol: gradually reduce Sensory input Base of Support
<Base Of Support (BOS)
Examples of <BOS for Tall Sit Sit back in chair, use arm rest Edge of chair Edge, arms lifted Heels up Feet tandem Knee lifted On dyna-disc On Ball w/holder On Ball
BOS Standing / MovingStanding Wide stance Narrow stance Off-set Tandem One foot Balance beam
Dynamic Normal steps Long steps
(lunges) Skipping? On Lines On Beams
H-Lines Ladder for Stride Length
<BOS: Walk the Line
Walk and Waddle
The Straight & Narrow
H-Lines
Ladder for Stride Length
Squiggly LinesBalance Beam or Narrow Path
Review ACSM Protocol
Multi-modal All systems, components of balance
Sensory systemsIntegrative/Automatic components
Gradually reduce: Sensory input BOSDynamic motions that challenge CoG
Multiple systems used simultaneouslyAutomatically & continually integrate
results w/feedback and goals
Movement goal-directed, centrally driven Sensori-motor feedback loops Neuromuscular
Integrative Aspects of Balance in Real Life
Whole skills Complex motor patterns Automaticity of balance
Aerobic (Treadmill) vs: Medication (Dopamine) More neural transmitter Better motor function
Renewable Fitness & ABLE Bodies
Exercise provides Neuroprotection in Parkinsonian Rats
Aerobic or Strength vs: Balance & Agility training Larger improvements in
motor function More new synapses
Renewable Fitness & ABLE Bodies
SM Agility Training for Rats
Sensori-motor tasks are largely controlled by
basal ganglia, master coordinator of
goal-directed movement
Sensori-Motor agility courses drive neuro-plasticity and >improvements in motor skills
Variety of Tasks ADLs, Functional Engaging, fun, novel
Vary the Task Multiple directions BOS Adapt for obstacles Add resistance Increase time
Vary Environment Surface Vision Location
Sensori-Motor & Agility
Balance Mats: Arm SwingsFigure 8 Walking
thru doors & chairs
Sensori-Motor SkillsVary Tasks & Environment
Traffic School Opposing Circles High Fives A Walk in the Park Games
Activities
Opposing Circles & High Fives
Momentum ControlPuddle Jumping
Puddle Jumping
Obstacle Courses for Agility
Music &Transitions Training Improves anticipatory skills
Helps initiate movement
Improves quality of movement Symmetry, size, cadence,
coordination Whole body response
Keeps movement flowing w/ rhythm & momentum
Waltzing Matilda
Music can enhance mind-body connections & SM skills
Agility & Music
Dual Tasks for Auto-Balance
Dual Tasks enhance automatic balance
Multi-tasking - no such thing! We switch. Former task left on auto-pilot Distraction from established motor task
with a secondary task . . . Requires automaticity of balance Training improves automatic balance!
Using Dual Tasking
Master base skill first Functional, ADLs
Add complexity in layers
>resistance, repsVary task Vary environmentAdd dual task
Progressing Dual Tasks
To established motor skill, add: Simple recitation
Counting, ABC’s, nursery rhymes, sing Motor task
Arm swings, kayaking, Snap claps, carry, toss or catch a ball
Cognitive task Count backwards, tongue twisters, word
winks, re-arrange numbers or words Functional: Cell phones, keep track of time
My pizza is cold 4 31 19 7 T__ L__ S__ B__ __ F__V __G __R
Attention Training
Renewable Fitness . . . imagine the possibilities
TTTT
Word Winks for Mental Agility
Think
Renewable Fitness . . .imagine the possibilities
fry fryRenewable Fitness . . .imagine
the possibilities
Distractions
What noise annoys an oyster most? Noisy noise annoys an oyster most
(Google – has gazillions)
Renewable Fitness . . .imagine the possibilities
Tongue Twisters
Require concentration and improves verbal skills (PD patients )
Review
Posture Flexibility
Strength Endurance
Sensory Systems Automatic, central, NM &
Integrative
Cognition Experiences Skills & Learning
Flexibility
Reduce BOS Seated positions Standing positions
Manipulate Sensory Input Reduce Vision by dimming lights Enhance Vision by using mirrors, modeling Enhance somatic awareness Facilitate Vestibular
Flexibility
Carry the Baby
Use Dynamic movements that disturb cog Lean and reach Dynamic Stretches Whole Body Stretches
Mind and Body / Engaging / Fun / Layers /Complexity Use Rhythm/Music Think BIG, stretch BIG Educate – It’s the ultimate mind body tool
Use Conceptual physical activities as learning tools Supple Spine – Even gentle stretching improves function Venus Di Milo Arms – Explores ROM in arms and trunk
Measure, re-test periodically
Posture & Core StabilityManipulate Sensory Input
Increase somatic awareness Upright, centered over base of support Cue with proprioceptive cues – feel, lift, notice
Enhance Vision Mirrors, Model
Reduce Somatic Input & Facilitate Vestibular
Balance mat with good posture and core stability Head turns, tilts while maintaining good posture
Posture & Core StabilityReduce BOS
Seated positions Standing positions
Challenge w/Dynamic Movements Add Arm Swings to upright postures Add Reaches, perturbations, turns Practice Transitions with trunk stability
Tall Sit to Tall Stand Rise to toes w/upright posture
Tai Chi, Yoga, Pilates
Posture & Core StabilityMind & Body/Engaging/Fun/Layer
Educate: Discuss value Use “hands-on” Conceptual learning
Torso as a Cylinder - Trunk Stability
When Push comes to Shove –Trunk stability
Parts of the Whole – Segmental alignment
Breathe Easy – Posture affects function
When Push Comes to Shove
Strength Targets ADLs
Anti-gravity muscles Getting out of Chairs Stairs Turn Reach Up from floor
Teeter Totter Chair Stands
Strength Targets for Balance
Upright posture Back & Hip extensors Core muscles Scapular retractors
Legs Lower legs Transitions Anti-gravity
Dynamic movements that disturb cog Dynamic Activities Progress from w/In-place w/Movement Whole Body Exercises
Vary environment
Vary task, BOS
Mind and Body / Engaging / Fun / Layers /Complex Use Music, rhythm Think BIG Visualize Dual Tasks Educate, show value Measure & re-test
Strength
Dynamic movements that disturb cog Require balance
Elliptical vs recumbent bike > movement size whole body work
Upper/lower body ie: add Arm Swings
Mind and Body / Engaging / Fun /Complexity Use Rhythm/Music Dual Tasks Think BIG Educate: Talk about its value Measure results, re-test over time
Endurance
Exercise Science Protocols
Evidence-based Peer-reviewed Published
Exercise Specificity Systems Tasks
Overload Challenge Engage Change Task/Environment
What’s in your tool box?
Did you find a few new tools here?
The Tools You’ll Use
You can’t possibly do it all. Your talents & choices that will
make a difference
Pick your favoritesVisualize
Make a planObserve
Keep learning
Philosophy
If it’s physical,it’s therapy
Physical Activity . . .The Tools of our Trade
Thank you for coming!
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