Fit for Life: Promoting Physical Fitness for Older Adults

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Fit for Life: Promoting Physical Fitness for Older

AdultsDavid M. Morris, PT, PhD

Professor and Vice ChairDepartment of Physical Therapy

University of Alabama at Birmingham

Session Objectives

Describe the health benefits that have been shown to be associated with exercise.

Discuss established exercise guidelines for exercise for older adults.

Describe evidenced based programs that promote physical fitness for older adults.

Locate and utilize resources that assist health care professionals to promote physical fitness with their older adult consumers.

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Plan for today

The language of physical fitness Why physical fitness is important Physical activity guidelines Are Americans meeting these guidelines? Knowing if an older adult is ready to

initiate a physical fitness program Behavior change issues Evidenced based programs Resources

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Health and Human Services: Physical Activity

Guidelines

Physical fitness includes a number of components consisting of cardiorespiratory endurance (aerobic power), skeletal muscle endurance, skeletal muscle strength, skeletal muscle power, flexibility, balance, speed of movement, reaction time, and body composition.

Physical Activity

Any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal level.

Occupational Leisure Transportation

Physical Activity Guidelines Advisory Committee Report. Washington, DC: US Department of Health and Human Services, 2008

Exercise

A subcategory of physical activity that is “planned, structured, and repetitive and purposive in the sense that the improvement or maintenance of one of more components of physical fitness is the objective.”

Benefits: Moderate Evidence

A lower risk of hip fracture Lung cancer Endometrial cancer Weight maintenance after weight loss Increased bone density Improved sleep quality

Benefits: Moderate to Strong Evidence

Better functional health (for older adults)

Reduced abdominal obesity

Benefits: Strong Evidence

A lower risk of: Early death Coronary heart disease Stroke High blood pressure Adverse blood lipid profile Type II Diabetes Metabolic syndrome

Benefits: Strong Evidence

A lower risk of: Colon Cancer Breast Cancer

In addition to: Weight loss, particularly when combined with

reduced caloric intake Improved cardiorespiratory fitness & muscular

fitness Prevention of falls Reduced depression Better cognitive function in older adults

Physical Activity Guidelines

HHS Physical Activity Guidelines

American College of Sports Medicine (ACSM)/ American Heart Association (AHA)

Australian Guidelines

World Confederation for Physical Therapy (WCPT)

World Health Organization (WHO)

APTA Physical Fitness for Special Populations (PFSP) Pocket Guides

Physical Activity Guidelines for Americans

(HHS) Methodology established first All research rated based on pre-

established methodology All recommendations rated based on

pre-established methodology


(HHS) Older adults need at least:

Aerobic exercise: 2 hrs 30 min at moderate intensity OR 1 hr 15 minutes or vigorous intensity OR An equivalent mix of moderate and

vigorous intensity AND Muscle strengthening on 2 or more

days/week that work all major muscle groups


(HHS) Older adults get even greater benefits

from: Aerobic exercise:

5 hrs at moderate intensity OR 2 hrs 30 minutes or vigorous intensity

OR An equivalent mix of moderate and

vigorous intensity AND Muscle strengthening on 2 or more

days/week that work all major muscle groups


(HHS) Intensity - How hard* is your body

working? Moderate activity = 5 or 6 Vigorous activity = 7 or 8

* On a 10-point scale – “0” is sitting AND “10” is working as hard as you can.

WHO

WHO and WCPT

Adults (18-65 years old) 30 minutes of moderate-intensity

physical activity 5 days per week; OR 20 minutes of vigorous-intensity physical

activity 3 days per week; OR An equivalent combination of moderate-

vigorous intensity physical activity; AND 8-10 muscular strengthening exercises

(8-12 repetitions) at least 2 days per week.

WHO and WCPT

Adults (65 years and older) same recommendations as described for

adults (outlined previously) with due consideration for the intensity and type of physical activity appropriate for older people; AND

exercises to maintain flexibility; AND balance exercises

How are we Doing?

Less than half (48%) of US adults meet the PA guidelines

Racial disparities Non-Hispanic white adults (22.8%) Non-Hispanic black adults (17.3%) Hispanic adults (14.4%)

Men (52.1%) more likely than women (42.6%) to meet the 2008 PAG for aerobic activity

Younger adults are more likely than older adults

Income level above poverty level more likely than below

How are we doing?: 2008 Age-Adjusted Estimates of the Percentage of Adults Who Are

Physically Inactive

Are You Ready for Exercise?

Physical Activity Readiness Questionnaire (PARQ)

• Has your doctor ever said that you have a heart condition and that you should only do PA recommended by your doctor?

• Do you feel pain in your chest when you do PA?

• In the past month, have you had chest pain when you were not doing PA?

• Do you lose your balance because of dizziness or do you ever lose consciousness

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Are You Ready for Exercise? Cont…

• Do you have a bone or joint problem that could be made worse by a change in your PA?

• Is your doctor currently prescribing drugs for your blood pressure or heart condition?

• Do you know of any other reason why you should not do PA?

If you answered yes to one or more questions, see your doctor before you start becoming more PA.

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Why do people change their behavior?

What we know and think influences our behavior.

ButKnowledge is not sufficient to produce

behavior change. People change when:

THEY have a perceived need to change. THEY are ready to change. THEY have the necessary knowledge,

skill and tools. THEY have a supportive environment.

Particularly Important for PA and Older Adults

Increasing Self-efficacy

Readiness to change

Overcoming barriers

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Self Efficacy

The level of confidence individuals have in their ability to perform a certain behavior (Bandura, 1997)

Influences: Choice of behaviors How much effort a person will expend How long they will persevere How resilient in the face of setbacks How much stress and anxiety they will

experience Motivation

Measuring Self Efficacy

Physical activity or exercise includes activities such as walking briskly, jogging, bicycling, swimming, or any other activity in which the exertion is at least as intense as these activities.

Scale1 = not at all confident, 2 = slightly confident, 3 = moderately confident, 4 = very confident

5 - extremely confident

How confident are you that you could be physically active in each of the following situations?

1. When I am tired 1 2 3 4 5

2. When I am in a bad mood 1 2 3 4 5

3. When I feel I don’t have time 1 2 3 4 5

4. When I am on vacation 1 2 3 4 5

5. When it is raining or snowing 1 2 3 4 5

Improving Self Efficacy

Strategy Example

Mastery experiences/performance accomplishments

Incremental mastery – start with low level difficulty activities and increase gradually

Modeling/vicarious experiences Watching others like you exercise

Social persuasion/credible source Enlisting a credible spokesperson; trusted health professional influencing decision

Internal feedback (psychological and physiological)

Facing barriers head on and learning that they can be managed

Stages of Change

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Physical Activity Stages of Change

B. Marcus and L. Forsyth, 2009, Motivating people to be physically active, 2nd ed. (Champaign, IL: Human Kinetics)

Instructions:a) For each of the following questions, please

circle Yes or No. Please be sure to read the questions carefully

b) Physical activity or exercise includes activities such as walking briskly, jogging, bicycling, swimming, or any other activity in which the exertion is at least as intense as these activities.

Physical Activity Stages of ChangeQuestions

No Yes

1. I am currently physically active. 0 1

2. I intend to become more physically active in the next 6 months.

0 1

For activity to be regular, it must add up to a total of 30 minutes or more per day and be done at least 5 days per week. For example, you could take one 30-minute walk or take three 10-minute walks for a daily total of 30 minutes.

No Yes

3. I currently engage in regular physical activity. 0 1

4. I have been regularly physically active for the past 6 months.

0 1From B. Marcus and L Forsyth, 2009, Motivating people to be physically active, 2nd ed. (Champaign, IL: Human Kinetics).

Physical Activity Stages of Change

Scoring Algorithm

If (question 1 = 0 and question 2 = 0) stage 1



If (quest. 1 = 1, quest. 3 = 1 & quest. 4 = 0 ) stage 4

If (quest. 1 = 1, quest. 3 = 1 & quest. 4 = 1 ) stage 5

Stages of Change

Stage of Change Patient Cognition and Behavior

Stage 1: Precontemplation • Does not think about change• Resigned or fatalistic• Does not believe in or

downplays personal susceptibility

Stage 2: Contemplation Weighs benefits vs. costs of proposed behavior change

Stage 3: Preparation Experiments with small changes

Stage 4: Action Takes definitive action to change

Stage 5: Maintenance Maintains new behavior over time

Process of Change

Cognitive strategies Examples

Increasing knowledge Encourage your client to read and think about physical activity

Being aware of risks Provide your client with the message that being inactive is very unhealthy

Caring about consequences to others

Encourage your client to recognize how his inactivity affects his family, friends, and co-workers

Comprehending benefits Help your client to understand the personal benefits of being physically active

Increasing healthy opportunities Help your client to increase her awareness of opportunities to be physically active

Process of Change

Behavioral strategies Encourage your client to…

Substituting alternatives exercise when she is tired, stressed, or unlikely to want to exercise

Enlisting social support find a family member, friend, or co-worker who is willing and able to provide support for being active

Rewarding yourself praise himself and reward himself for exercising

Committing yourself make promises, plans and commitments to exercise

Reminding yourself set up reminders to exercise such as keeping comfortable shoes in the care and at the office, ready to be used at any time.

Barriers to Exercise (Sallis and Hovell, 1990; Sallis et al., 1992; McCormack et al., 2003)

Do not have time Find it inconvenient Lack self-motivation Find exercise boring Lack confidence

(low self-efficacy) Instructors don’t

understand needs Stereotypical

images of aging Poor health

Fear of injury Lack of self-

management skills Lack of

encouragement, support, companionship

Transportation and access issues

Cost

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Selected Evidence Based Physical

Activity Programs for Older Adults

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Active Living Every Day (ALED)

Contact www.ActiveLiving.info or 800-747-4457

Program goals Behavior change program to promote physical activity (also have a Healthy Eating Every Day Program)

Participants learn to set goals, overcome barriers and find activities they enjoy

Target Audience Any adult interested in integrating physical activity into their daily lives

Program description 12-weekly class sessions (short lecture, group discussion)

Training requirements • Trained facilitators• At least 1 trained facilitator needed per

class

Program costs • Licensing costs: none• Training cost: $373 per facilitator• Participant material cost:

$37.95/participant

Programs in Alabama? None37

EnhanceFitnessContact www.projectenhance.org/

EnhanceFitness.aspx.

Program goals Improve overall functional fitness and well-being of older adults

Target Audience Sedentary older adults

Program description Ongoing 1 hour, 3 times/week; focus – stretching, low impact aerobics, strength training, balance

Training requirements • Certified fitness instructor

Program costs • Licensing costs:$6,000/site ($1,000/additional site)

• Basic Package cost: $5,000/site ($50/additional site); $200 Annual renewal fee

Programs in Alabama?

None

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Fit and Strong!

Contact www.fitandstrong.org.

Program goals Engagement in safe, balanced program to build lower extremity strength

Target Audience • Sedentary older adults with lower extremity joint pain and stiffness

• Physician clearance to participate

Program description • 90 minute sessions

Training requirements

• Certified instructor• licensed PT, PTA , COTA or student

Program costs • Licensing costs: $1,000/site in year one• Certified instructor training: $30/hr for 8

hours• Equipment costs: varied items • Instructor liability policies available


• None39

Geri-Fit Strength Training Workout

Contact www.gerifit.com

Program goals Increase strength, flexibility, mobility, and balance

Target Audience • Older adults age 65 and older• Medicare Advantage approved program

Program description • 45 minutes, twice weekly• Most exercises done seated with 2lb

dumbbell• Typically done in groups, can be done in

person’s home on individual basis


• Certified personal fitness trainer• Degrees in exer phys, kinesiology, PT, OT,

ATC, or Nursing • CPR certified

Program costs • Training costs - $2,000 plus travel


• None 40

Healthy Moves for Aging Well

Contact www.picf.org/landing/22,3.html

Program goals In-home PA intervention focused on maintaining health status and QOL of frail elders

Target Audience Adults 65 and older who are currently enrolled in a care management program

Program description • Movement repetitions 3-5 days per week; multiple times per day

• One 15-minute session between participant nd care manager

• 3 month follow-up period with weekly or biweekly phone calls

• Delivered by care managers and motivational volunteers


Varies depending on expertise

Program costs Licensing: $5,000 year 1; $2,000 renewal


None???41

Walk with EaseContact http://www.arthritis.org/wwe

Program goals • Reduce pain and discomfort of arthritis• Increase balance and strength• Build PA self-efficacy

Target Audience Community dwelling older adults with arthritis and other chronic conditions

Program description • Community-based group program 6 weeks, 1 hr, 3x/week• Self-directed program 30 min., 3x/week


• Arthritis foundation course• CPR certified (required)• First aid certification (recommended)

Program costs • Licensing cost: none• Training cost: $50-75• Participant cost: $11.95


Contact local Arthritis Foundation42

Helpful Resources

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Centers for Disease Control and Prevention

here Consumer information• Varied formats including videos• Selecting PA• Measuring PA

Success stories Resources for health professionals• Facts• Handouts• Social media tools

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Go4Life here

National Institute on Aging Consumer information:

Getting started Staying active Resources

Information for: Consumers Family and friends Organizations Health professionals

Success stories E-news and Twitter feed

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Exercise is Medicine here

Coordinated by the American College of Sports Medicine

Vision:• “Make physical activity and exercise a

standard part of global disease prevention and treatment medical paradigm.”

• “All health care providers consider physical activity as a vital sign in every patient”

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Lakeshore Foundation here

Available to people with physical disabilities and chronic health conditions AND

Anyone age 60 and older!

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Human Kinetics PA Intervention Series

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Your Professional Organization

American Physical Therapy Association here

Positions and Policies Podcasts and continuing educaio Physical Fitness for Special Populations Examination Strategies

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Summary

Our physical activity should not decrease as we age…we should actually do more!

Promoting physical activity is the responsibility of the entire health care team

Merely knowing that one should be physically active is not enough…they must be ready, motivated, and confident

Many great resources exist for health professionals to integrate physical fitness promotion into their clinical practice.

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Fit for Life: Promoting Physical Fitness for Older Adults

Thank [email protected]

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Fit for Life: Promoting Physical Fitness for Older Adults