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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