Chair Based Exercise Leadership Course

To Day 2

Any Questions?Any Questions?

Recap of class components and structureWarm-up Circulation Boosting 1MobilityCirculation Boosting 2StretchesCirculation Boosting 3StrengthWarm-down

Effects of Ageing Effects of Ageing on Boneson Bones

Functions of the Functions of the SkeletonSkeleton

Functions of the Functions of the SkeletonSkeleton

ShapeProtectionStorage of mineralsProduction of blood cellsMovement through joints

Knowledge

Base

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Types of BoneTypes of Bone

Bone Cells• Osteoblasts

Bone Building Cells

• OsteoclastsBone Re-absorption

• During growth - Osteoblasts• During adulthood - Equal balance• Ageing process - Osteoclasts

Bone Density Changes with Bone Density Changes with Age in WomenAge in Women

Peak Bone Mass

Menopause

Fracture Threshold 1

2

3

1 = very active 2 = active 3 = inactive

20 30 40 50 60 70 80 90

B

O

N

E

D

E

N

S

I

T

y

AGE (YEARS)

Factors that influence Factors that influence Peak Bone MassPeak Bone Mass

Age Genetics Gender Hormones Early menopause/hysterectomy Long term use of steroids (< 3m) Medication Eating/digestive disorders

(Modifiable and non-modifiable factors)

Diet Alcohol Smoking Inactivity Low body weight

What is Osteoporosis?What is Osteoporosis?

Systemic skeletal disorder characterised

by low bone mass and

micro architectural deterioration of bone

tissue with consequent increase in bone

fragility and susceptibility to fracture(Consensus Department Conference 1993)

Bone becomes thinner and more fragile

OsteoporosisOsteoporosis

StatisticsStatistics

Approximately 30% of womenover the age of 65 are

Osteoporotic

70% of women over the age of 75 will have osteoporosis

(National Society for Osteoporosis)

Bone Fracture Bone Fracture SitesSites

Spine 1yr – 10 yrs after menopause

Wrist 5yrs – 10 yrs after menopause

Hip 75+ yrs

OsteoporosisOsteoporosis

40 years 60 years 70 years

Functional Functional ConsequencesConsequences Fracture risk

Pain

Disability and Discomfort

Exercise Cost

Postural Instability

Physical Activity

Field of Vision

Integrity of the Spine

Digestion & Breathing

Fear, anxiety, loneliness

Confidence

The Good News!The Good News!

Physical activities can improve balance and

muscle strength, which reduce the risk of falling

Weight-bearing and Resistance activity

(strength training) can strengthen the bones and

reduce the risk of fractures

Osteoporosis and Osteoporosis and Chair-Based ExerciseChair-Based Exercise

Increase muscle strength and power

Increase bone density

Improve everyday function

Reduce fatigue and risk of falling

SolutionsSolutions

Weight bearing, weight resisted exercises

Target vulnerable fracture sites

Safer exercise selection to reduce risk of injury

More care with transitions

Summary of Ageing Summary of Ageing and Boneand Bone

Reduced bone mass

Reduced mineral content

Reduced bone density

Increased collagen density

THE EFFECTS OF AGEING ON

JOINTS

Structure of a synovial joint

Knowledge

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Definitions of Arthritis

Osteoarthritis (OA)A localised, progressive joint disease where there is degeneration of the cartilage that lines the joint. There may also be formation of bone spurs within the joint.

It is most common in the spine, knees and hips and is found predominantly in older people.

OA Knee

Risk Factors for OARisk Factors for OA

Age Lifestyle (inactive/over active) Family History & Gender Body Fat % Low Muscular Strength Ligament Strength Previous Injury Rheumatoid Arthritis Poor Joint alignment & Posture Medication Disease

Definitions of Definitions of ArthritisArthritis

Rheumathoid Arthritis (RA)

An inflammatory multi-joint disease where the synovial membrane is inflamed

The wrist, hands, feet and cervical spine are themost commonly affected joints and it predominates

in the 20-55 year old (women)

DO NOT

Exercise in acute flare up (RA)

Arthritis and Chair-Based ExerciseArthritis and Chair-Based Exercise

Rest or Exercise?

BOTH

Arthritis and Chair-Arthritis and Chair-Based ExerciseBased Exercise

Rest or Exercise? BOTH

Improve muscle strength to support joints and reduce body fat % (Strength training)

Improve everyday function Improve range and ease of movement (Mobility

and Flexibility training) Improve pain control Reduce fatigue

Solutions

Avoid early morning exerciseInclude mobility & flexibility training Avoid exercise if increase in painInclude strength trainingAvoid exercising for too long, too soonReduce the number of repetitions/timeHydration

Joint Replacement Joint Replacement (hip)(hip)

Contraindications (things to avoid)Contraindications (things to avoid)Hip ReplacementHip Replacement

Flexion beyond 90 degrees at the hip (deep knee bends)

Rotation (pivoting/twisting)

Adduction (crossing legs)

Joint Replacement (Knee)

ContraindicationsContraindicationsKnee ReplacementKnee Replacement

Avoid forced or weighted flexion

(Sitting back on heels)

Weighted rotation (Twisting)

Age Related Changes to JointsAge Related Changes to Joints

Dehydration of cartilageDehydration of synovial fluidThickening of connective tissueLess pliable connective tissueThinning of cartilageLoss of muscular and tendon strength =

joint becomes less stable

MobilityMobility

To mobilise (loosen) specific joints Fluid, controlled, full and natural, pain free

range of movement (not held)Four repetitions of each mobility exercise will

be sufficient without over working or under-working the joint

Mobility = Movement

Leading WorkshopLeading Workshop

Warm-up CB1MobilityCB2Stretches

Warm-Up Component Warm-Up Component CB11. Alternate heel raises, Arm Swings, Leg Marches, Tap & ClapMobility2. Shoulder Lifts and Circles3. Side Bends4. Ankle Activators5. Trunk TwistsCB2Stretches6. Back of Thigh7. Chest8. Calf9. Upward Side Stretch

THE EFFECTS OF THE EFFECTS OF AGEING ON MUSCLESAGEING ON MUSCLES

Function of Muscle Function of Muscle TissueTissue

Function of Muscle Function of Muscle TissueTissue

MovementStrength of skeleton through the: Pull of muscle Posture Alignment ProtectionProduces heatStores nutrients to fight illnessKnowledg

e

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Structure of Skeletal Structure of Skeletal MuscleMuscle

Types of Muscle Fibres

SLOW TWITCH FIBRESRed fibres (highly oxygenated)Slow to contract, slow to fatigueWeaker force

Aerobic type activities

FAST TWITCH FIBRESWhite fibres (little oxygen)Fast to contract, fast to fatigueStronger force

Strength type activities

Strength - Endurance Strength - Endurance ContinuumContinuum

Fast Twitch STRENGTH Fibres

Slow Twitch ENDURANE Fibres

Age related loss

Ageing and MusclesAgeing and Muscles

The changes

Reduction in muscle mass Reduction in number of muscle fibres Reduction in size of fast twitch fibres Reduction in number of motor nerves Reduction in number of motor units Reduced nerve response in muscles and tendons Increased stiffness and thickness of connective tissue

Ageing and MusclesAgeing and Muscles

Exercise considerations:

Smaller, weaker muscles Slower responding muscles More easily fatigued muscles Less elastic muscles Less able to generate heat Less able to assist immune function

Ageing and MusclesAgeing and Muscles

The solution

Target functional strength Target postural and pelvic floor muscles Each complete repetition should take 6 – 9

seconds (when performed without a hold) Allow 1-2 seconds between repetitions Allow 48-72 hours between sessions Progress slowly Use 1 set training initially

The same size difference is seen between 30 yr old and 80 yr old

Active, strength-trained 70 yr old female

Sedentary

(Adapted from Sipilä & SuominenMuscle Nerve 1993;16:294)

Definition of a Definition of a Frozen ShoulderFrozen Shoulder

The shoulder joint allows the hand to perform and hold many movements

The joint is surrounded by a loose fitting tough fibrous capsule

This fibrous capsule is covered by the rotator cuff muscles

Muscles and tendons merge with the capsule, these become inflamed and thickened

= FROZEN SHOULDER

Frozen Shoulder and Chair-Frozen Shoulder and Chair-Based ExerciseBased Exercise

• Controlled pain free ROM

• Supported moves

• Mobility and Flexibility

• Postural training

StrengthStrength

To challenge the muscles by providing a resistance which will encourage them to adapt (hypertrophy)

To improve and maintain muscular strength, posture and body shape

To improve skill and control of functional movement

To reduce the risk of injury, strain and fatigue To improve bone density To improve self-esteem and confidence

To lengthen (stretch) specific muscles and increase ROM at specific joints

To reduce risk of injury, improve posture and ease of every day tasks

Move slowly into position and hold still for 8 - 10 seconds The aim is mild discomfort not pain One repetition of each stretch will be sufficient for the

warm-up stretches Warm down stretches held for 10-20 seconds and can be

repeated 2-3 times to increase flexibility

Stretch = Static

Flexibility StretchesFlexibility Stretches

Effects of Ageing on the Effects of Ageing on the Nervous SystemNervous System

Knowledge

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Nervous System Nervous System

Functions of the Nervous Functions of the Nervous SystemSystem

The body’s computer – it sends and receives all messages processed around the body

It has 3 main functions:

1. Sensory input2. Interpretation3. Motor output

Changes in the Nervous SystemChanges in the Nervous System

• Nerve supply diminishes – reduces the number of fibres therefore transmission time is slower

Slower processing Slower reaction time Reduced balance and co-ordination Forgetfulness Dehydration

Changes in the Changes in the Nervous SystemNervous System

Slower circulatory responses – blood vessels less able to respond leading to dizziness and fatigue

Impaired short term memory – may not remember the exercise programme from last week

Movement slows, hands and feet swell, range of movement is reduced

= Increased Stress

Sensory changes in the Sensory changes in the Nervous SystemNervous System

Hearing:

The inner ear thickens with age

and therefore affects transmission.

Deafening occurs and balance is

affected.

Changes in the Changes in the Nervous SystemNervous System

Vision – what happens to our eyes

as we age?

The pupil slows and affects transmission,

the lenses affects focus therefore

affecting posture and balance.

Changes in the Nervous Changes in the Nervous SystemSystem

Taste and smell – 80+ years

Sight – 40+ years

Hearing – 60+ years

Changes in the Changes in the Nervous SystemNervous System

The Solutions:

Modify speedSlower transitionsSession to include exercise to improve balanceMore rehearsalFewer, simpler movesEnsure participants can see and hear clearlyGive slower, clear instructions and be visible

Stroke / Cerebrovascular Stroke / Cerebrovascular Accident (CVA)Accident (CVA)

A stroke is;

“the relatively sudden onset of neurological

disfunctioning resulting from interruption in

the blood supply to part of the brain”• as the result of a blockage (embolus or

thrombosis) • or a rupture (aneurysm) resulting in

INTER-CEREBRAL HAEMORRHAGE

80% of strokes are caused by a blockage

Stroke SurvivorsStroke Survivors

NOT victims

Muscle ToneMuscle Tone

Low muscle tone – resisted movements could help re-establish a

ROM and develop function in the limb

High muscle tone – mobility and flexibility will help to reduce

increased muscle tone

Any exercise that increases spasticity should be avoided

Considerations For Considerations For ExerciseExercise

Movement Control

Control of movement may be poorSlow uncontrolled movementIncorrect movement patterns may

need to be broken

BalanceBalanceSlow reactions and adapted poor posture

cause difficulties with balance, increasing the risk of a fall, therefore support should be available

Balance and quality of movement will deteriorate if hurried/stressed or tired

Benefits Of ExerciseBenefits Of Exercise

Reduced fatigue and increased endurance Improved posture Improved balance and co-ordination Increased confidence General fitness increased Increased functional ability and functional

strength Increased speed Lower blood pressure

Parkinson’s Disease / Parkinson’s Disease / ParkinsonismParkinsonism

A disfunction of the neuro-transmitter DOPAMINE causes a progressive neurological disorder

The dopamine reduction is a result of the death of dopaminergic cells within the basal ganglia

Benefits of ExerciseBenefits of Exercise

Increased movement control Improved range and ease of movement Improved posture and balance Quicker reaction time and improved co-ordination Increased ADLs and functional ability Reduced levels of fatigue Increased confidence and reduced depression Increased social contact and a more positive

attitude

Leading PracticeLeading Practice

Strength Component

Rests?

Reps?

Speed?

DemonstrationKey Leading pointsPostureObservationCorrection

THE EFFECTS OF THE EFFECTS OF AGEING ON THE AGEING ON THE

HEART AND HEART AND LUNGSLUNGS

The LungsThe Lungs

Knowledge

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Page 47

Gaseous Exchange in the Gaseous Exchange in the AlveoliAlveoli

Diaphragm and Diaphragm and Intercostals MusclesIntercostals Muscles

Circulation of BloodCirculation of Blood

ArteriesArteries

Veins Veins

CapillariesCapillaries

Functions of Functions of BloodBlood

Functions of BloodFunctions of Blood

Blood is a fluid and the main transport system of the body. It transports:

Nutrients (food)Oxygen to the tissuesWaste to the tissuesHormonesWhite blood cells to fight infectionHeat Minerals (salts)Clotting agents

Ageing and the Cardiorespiratory Ageing and the Cardiorespiratory SystemSystem

Heart Lungs Blood VesselsReduced heart massDecreased nervous stimulation to the heart & pacemaker cellsDecreased maximum heart rateReduced CO and SV Decreased efficiency of the circulatory systemDehydration

Decreased elasticity of the lungsDecreased efficacy of the breathing musclesLess flexible rib cageReduces oxygen exchangeIncreased breathing rateReduced lung capacity due to postural changes Dehydration

Increased furring and hardening of the arteriesIncreased blood pressure and risk of postural hypotension Reduced number of capillariesReduces oxygen exchangeReduced temperature controlDehydration

Ageing and the Ageing and the Cardiovascular SystemCardiovascular System

Exercise Considerations

Tire more quickly and recover less quickly Cannot maintain maximum pace More comfortable at moderate workloads Get over heated very rapidly

Ageing and the Ageing and the Cardiovascular SystemCardiovascular System

SolutionsLonger, progressive circulation booster Vary the paceIncorporate recovery times/restStrength trainingReassurance Hydration!

CHDCHD

Major RISK FACTORS

SmokingHigh cholesterolHigh levels of LDLAlcoholObesityPhysical Inactivity

Family HistoryDietHypertensionDiabetesStressAgeGender

ATHEROMA

ANGINA Pectoralis ANGINA Pectoralis Chest Pain: Owing to insufficient supply of blood

and therefore oxygen to the heart muscle that comes on with exertion (exercise induced

angina)after eating a heavy meal when under emotional stressthe level at which an attack is brought on will

be lower if the environment is particularly cold

Myocardial Infarction (M.I.)Myocardial Infarction (M.I.)

Heart Attack♥ Part of the heart muscle is deprived of oxygen

and as a result dies, consequently affecting the function of the heart

♥ A MI is caused by a blockage of the coronary arteries

♥ The severity of the heart attack depends on the amount of cardiac muscle affected and the health of the other coronary arteries

Cardiac ArrestCardiac Arrest

Is when the heart stops beating because a

large area of the cardiac muscle is deprived

of oxygen

A Myocardial Infarction

HypertensionHypertension

Blood pressure = pressure exerted by the flow of

blood through the arteries

SYSTOLIC pressure is created by the contraction of the heart and the elastic recoil of the aorta, as blood is forced through it

DIASTOLIC pressure is the pressure during the relaxation phase of the ventricles

The British Hypertension Society

recommends a blood pressure below

160/90 for exercise

British Association of Cardiac Rehabilitation

(BACR) recommendationsDesirable = 120/70Normal = 140/85Borderline = 140-159/90-95High risk = 160/95Measured in millimetres of mercury (mmHg)

POSTURAL HYPOTENSION POSTURAL HYPOTENSION (orthostatic hypotension)(orthostatic hypotension)

A fall in blood pressure that occurs on

standing up after sitting or lying down

Changes in the nervous system Increase in the time it takes to constrict

blood vessels Reduced response to postural changesImpaired baroreceptor function

What make a COMPETENT and What make a COMPETENT and SUCCESSFUL Chair-Based SUCCESSFUL Chair-Based

Exercise Leader?Exercise Leader?

Practical Handbo

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Medical ConditionsMedical Conditions

Medical ConditionsMedical Conditions

Osteoporosis (Page 28)Arthritis (Page 35)Frozen Shoulder (Page 43)Stroke (Page 52)Parkinson’s Disease (Page 59)Hypertension (Page 48)Coronary Heart Disease

Knowledge

Base

Name of Condition

Characteristics and risk factors

Types and benefits of exercise

Considerations for exercise

Prepare to lead a small group on day 3 Use the “how to be even better” info sheet

(pg 84 in Practical Handbook) to help with the leading sequenceComplete all 4 worksheets for day 3 for marking