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Welcome to Day 2 “Sit Tall, Stand Strong” Chair-Based Exercise Course for Frailer, Older Adults & Disabled Adults Any Questions? Recap of class structure: Warm-up Circulation Boosting 1 Mobility Circulation Boosting 2 Stretches Circulation Boosting 3 Endurance Strength Cool down How ageing, inactivity, disease, functional impairment and disability affect bones, joints, muscles, nerves, heart and lungs…. Bones Functions of the Skeleton Shape Protection Storage of minerals Production of blood cells Movement through joints Knowledge Base Page 43 Possible changes to Bone associated with ageing, disability and inactivity: Reduced bone mineral density Increased risk of osteoporosis Loss in height Postural problems What is Osteoporosis? Skeletal disorder characterised by low bone mass and deterioration of bone with increase in bone fragility and susceptibility to fracture (Consensus Department Conference 1993) Bone becomes thinner and more fragile Osteoporosis Osteoporosis 40 years 60 years 70 years JOINTS Structure of a synovial joint Knowledge Base Page 48 Possible changes to joints associated with ageing, disability and inactivity: • • • • • • • Less synovial fluid Synovial fluid more viscous Cartilage wear and tear Reduced joint stability Reduced range of movement Ligament less flexible Joints more stiff MUSCLES Structure of Skeletal Muscle Possible changes to Muscles associated with ageing, disability and inactivity: Reduction in muscle mass Reduction in number of muscle fibres Increased connective tissue Increased size of motor units Reduced elasticity of tendons 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) Potential consequences • Reduced: – Power – Strength – Endurance – Fine control – Heat production – Immune function Nervous System Knowledge Base Page 59 Nervous System Possible changes to Nerves associated with ageing, disability and inactivity: • Reduces number of nerves • Reduced speed of transmission • Slower information processing Potential consequences: Slower movement speed Impaired short term memory Reduced reaction time Slower pace of learning Reduced balance Increased falls Slower response to instructions Poorer coordination Reduced sight and hearing HEART AND LUNGS AND BLOOD VESSELS The Lungs Knowledge Base Page 56 Gaseous Exchange in the Alveoli Diaphragm and Intercostals Muscles Possible changes to the lungs associated with ageing, disability and inactivity: Decreased elasticity of the lungs Weaker breathing muscles Less flexible rib cage Reduced gaseous exchange Increased breathlessness Reduced maximal inspiration and reduced expiration Blood Vessels…. Arteries Veins Capillaries Possible changes to the blood vessels associated with ageing, disability and inactivity: • Increased furring and hardening of the arteries • Increased blood pressure and risk of hypertension • Reduced number of capillaries in muscles • Reduced oxygen delivery to muscles, reduced ability to sustain activity ATHEROMA The heart …. Possible changes to the heart associated with ageing, disability and inactivity: • Decreased cardiac muscle • Decreased blood pumped out • Decreased maximal heart rate Consequences… • Reduced ability to work at high intensity •Tasks require greater percentage of max heart rate • Reduced ability to sustain activity 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 Stretch 7. Chest Stretch 8. Calf Stretch 9. Upward Side Stretch The Functional Model Practice Workshop……. Safety First… • This session will cover: – – – – PARQ screening Contraindications to exercise Exercise cautions Medication effects on safe exercise participation PARQ… See pages 5 & 6 of your learner file Absolute contraindications • Unstable and uncontrolled health conditions as follows: – – – – – – – – – Uncontrolled pain or feeling unwell on arrival Lasting, increased pain following previous session Suspected acute injury Recent injurious fall without medical assessment Severe breathlessness or dizziness Recently diagnosed cardiovascular events Recent medication changes Uncontrolled pulmonary problems Inability to follow simple instructions placing themselves or others at risk of injury – RA flare up or acute systemic illness/infection – Unexplained lethargy Cautions • Known current injury/wound that is identified and/or protected • Observable pain of known origin • Problems understanding instructions • Unable to safely maintain balance while seated • Infection control • Latex allergy Common effects of medication • • • • • • • • Reduced alertness Postural hypotension Reduced balance Reduced proprioception Difficulties with exercise intensity monitoring Urinary urgency/frequency Slowed reaction time Poor coordination Session Plans Why? They will assist you in your exercise session What should it contain? Include relevant information to deliver a safe and effective exercise session! Session Plans Name of exercise and planned rests Repetitions and/or Time How to perform the exercise safely and effectively (teaching points/key safety considerations) Purpose of the exercise Alternatives and adaptations See page 23 of your learner file SAMPLE SESSION PLAN Posture/Teaching Points/or Instructions? Exercise Name & Planned Rest Shoulder Lifts Shoulder Rolls Exercise purpose & ADL’s Reps and/or Time Teaching Points (Key safety considerations) • Sit tall, feet flat on floor • Knees hip width apart • Knees above ankles • Smooth continuous movements • Lower with control • Lift shoulders up • Avoid poking chin • Roll shoulders back • Avoid arching the back • Breathe normally • Keep tummy in Adaptations and/or Alternatives What makes a COMPETENT and SUCCESSFUL Chair-Based Exercise Leader? Prepare to lead a small group on day 3 Use the “how to be even better” info sheet to help with the leading sequence Complete all 3 worksheets ready to hand in on day 3 for marking