Download CBE-DAY-2-March-2010

Chair Based Exercise
Leadership Course
To Day 2
Any Questions?
Recap of class components and structure
Warm-up
Circulation Boosting 1
Mobility
Circulation Boosting 2
Stretches
Circulation Boosting 3
Strength
Warm-down
Effects of Ageing
on Bones
Functions of the
Skeleton
Functions of the
Skeleton
Shape
Protection
Storage of minerals
Production of blood cells
Movement through joints
Knowledge
Base
Page 24
Types of Bone
Bone Cells
• Osteoblasts
Bone Building Cells
• Osteoclasts
Bone Re-absorption
• During growth
• During adulthood
• Ageing process
-
Osteoblasts
Equal balance
Osteoclasts
Bone Density Changes with
Age in Women
B
Peak Bone Mass
O
N
Menopause
E
D
E
N
1
Fracture Threshold
S
2
I
T
3
y
20
1 = very active
2 = active
3 = inactive
30
40
50
AGE (YEARS)
60
70
80
90
Factors that influence
Peak Bone Mass
 Diet
 Alcohol
 Smoking
 Inactivity
 Low body weight








Age
Genetics
Gender
Hormones
Early menopause/hysterectomy
Long term use of steroids (< 3m)
Medication
Eating/digestive disorders
(Modifiable and non-modifiable factors)
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
Osteoporosis
Statistics
Approximately 30% of women
over the age of 65 are
Osteoporotic
70% of women over the age of
75 will have osteoporosis
(National Society for Osteoporosis)
Bone Fracture
Sites
Spine 1yr – 10 yrs after menopause
Wrist
5yrs – 10 yrs after menopause
Hip
75+ yrs
Osteoporosis
40 years
60 years
70 years
Functional
Consequences
 Fracture risk
 Pain
 Disability and Discomfort
 Exercise Cost
 Postural Instability
 Fear, anxiety,
loneliness

 Physical Activity
 Field of Vision
 Integrity of the Spine
 Digestion & Breathing
Confidence
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
Chair-Based Exercise
Increase muscle strength and power
Increase bone density
Improve everyday function
Reduce fatigue and risk of falling
Solutions
 Weight bearing, weight resisted exercises
 Target vulnerable fracture sites
 Safer exercise selection to reduce risk of injury
 More care with transitions
Summary of Ageing
and 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
Base
Page 31
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 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
Arthritis
Rheumathoid Arthritis (RA)
An inflammatory multi-joint disease where the
synovial membrane is inflamed
The wrist, hands, feet and cervical spine are the
most 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 Exercise
Rest or Exercise?
BOTH
Arthritis and ChairBased 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 exercise
Include mobility & flexibility training
Avoid exercise if increase in pain
Include strength training
Avoid exercising for too long, too soon
Reduce the number of repetitions/time
Hydration
Joint Replacement
(hip)
Contraindications (things to avoid)
Hip Replacement
Flexion beyond 90 degrees at the hip (deep
knee bends)
Rotation (pivoting/twisting)
Adduction (crossing legs)
Joint Replacement (Knee)
Contraindications
Knee Replacement
Avoid forced or weighted flexion
(Sitting back on heels)
Weighted rotation (Twisting)
Age Related Changes to Joints
Dehydration of cartilage
Dehydration of synovial fluid
Thickening of connective tissue
Less pliable connective tissue
Thinning of cartilage
Loss of muscular and tendon strength =
joint becomes less stable
Mobility
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 Workshop
Warm-up
CB1
Mobility
CB2
Stretches
Warm-Up Component
CB1
1. Alternate heel raises, Arm Swings, Leg Marches,
Tap & Clap
Mobility
2. Shoulder Lifts and Circles
3. Side Bends
4. Ankle Activators
5. Trunk Twists
CB2
Stretches
6. Back of Thigh
7. Chest
8. Calf
9. Upward Side Stretch
THE EFFECTS OF
AGEING ON MUSCLES
Function of Muscle
Tissue
Function of Muscle
Tissue
Knowledge
Base
Page 39
Movement
Strength of skeleton through the:
Pull of muscle
 Posture
 Alignment
 Protection
Produces heat
Stores nutrients to fight illness
Structure of Skeletal
Muscle
Types of Muscle Fibres
SLOW TWITCH FIBRES
Red fibres (highly oxygenated)
Slow to contract, slow to fatigue
Weaker force
Aerobic type activities
FAST TWITCH FIBRES
White fibres (little oxygen)
Fast to contract, fast to fatigue
Stronger force
Strength type activities
Strength - Endurance
Continuum
Fast Twitch
STRENGTH
Fibres
Age related loss
Slow Twitch
ENDURANE
Fibres
Ageing 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 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 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
Active, strength-trained
70 yr old
female
Sedentary
The same size difference is seen between 30 yr old and 80 yr old
(Adapted from Sipilä & Suominen
Muscle Nerve 1993;16:294)
Definition of a
Frozen 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 ChairBased Exercise
•
•
•
•
Controlled pain free ROM
Supported moves
Mobility and Flexibility
Postural training
Strength
 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
Flexibility Stretches
 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
Effects of Ageing on the
Nervous System
Knowledge
Base
Page 55
Nervous System
Functions of the Nervous
System
The body’s computer – it sends and receives all
messages processed around the body
It has 3 main functions:
1. Sensory input
2. Interpretation
3. Motor output
Changes 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
Nervous 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
Nervous System
Hearing:
The inner ear
thickens with age
and therefore affects
transmission.
Deafening occurs
and balance is
affected.
Changes in the
Nervous 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
System
Sight – 40+ years
Hearing – 60+ years
Taste and smell – 80+ years
Changes in the
Nervous System
The Solutions:
Modify speed
Slower transitions
Session to include exercise to improve balance
More rehearsal
Fewer, simpler moves
Ensure participants can see and hear clearly
Give slower, clear instructions and be visible
Stroke / Cerebrovascular
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 Survivors
NOT victims
Muscle 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
Exercise
Movement Control
Control of movement may be poor
Slow uncontrolled movement
Incorrect movement patterns may
need to be broken
Balance
Slow 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 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 /
Parkinsonism
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 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 Practice
Demonstration
Key Leading points
Posture
Observation
Correction
Strength Component
Rests?
Reps?
Speed?
THE EFFECTS OF
AGEING ON THE
HEART AND
LUNGS
The Lungs
Knowledge
Base
Page 47
Gaseous Exchange in the
Alveoli
Diaphragm and
Intercostals Muscles
Circulation of Blood
Arteries
Veins
Capillaries
Functions of
Blood
Functions of Blood
Blood is a fluid and the main transport system of the body.
It transports:
Nutrients (food)
Oxygen to the tissues
Waste to the tissues
Hormones
White blood cells to fight infection
Heat
Minerals (salts)
Clotting agents
Ageing and the Cardiorespiratory
System
Heart
Lungs
Blood Vessels
Reduced heart mass
Decreased nervous
stimulation to the
heart & pacemaker
cells
Decreased
maximum heart rate
Reduced CO and
SV
Decreased efficiency
of the circulatory
system
Dehydration
Decreased elasticity
of the lungs
Decreased efficacy
of the breathing
muscles
Less flexible rib
cage
Reduces oxygen
exchange
Increased breathing
rate
Reduced lung
capacity due to
postural changes
Dehydration
Increased furring
and hardening of the
arteries
Increased blood
pressure and risk of
postural hypotension
Reduced number of
capillaries
Reduces oxygen
exchange
Reduced
temperature control
Dehydration
Ageing and the
Cardiovascular 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
Cardiovascular System
Solutions
Longer, progressive circulation booster
Vary the pace
Incorporate recovery times/rest
Strength training
Reassurance
Hydration!
CHD
Major RISK FACTORS
Smoking
High cholesterol
High levels of LDL
Alcohol
Obesity
Physical Inactivity
Family History
Diet
Hypertension
Diabetes
Stress
Age
Gender
ATHEROMA
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 stress
the level at which an attack is brought on
will be lower if the environment is
particularly cold
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 Arrest
Is when the heart stops beating because a
large area of the cardiac muscle is deprived
of oxygen
A Myocardial Infarction
Hypertension
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) recommendations
Desirable
= 120/70
Normal
= 140/85
Borderline = 140-159/90-95
High risk
= 160/95
Measured in millimetres of mercury (mmHg)
POSTURAL 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 changes
Impaired baroreceptor function
What make a COMPETENT and
SUCCESSFUL Chair-Based
Exercise Leader?
Practical
Handbook
Page 85
Medical Conditions
Medical 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 sequence
Complete all 4 worksheets for day 3 for
marking