Exercise Prescription For Older Adults

Question 1

What is the purpose of uni-factorial interventions?

Answer 1

Combine with physical exercises (balance and muscle strengthening). Together they will reduce the number of falls in people living at home. It is appropriate for frail subjects and/or those at high risk of falling.

Question 2

What are the key muscles to be strengthened in frail patient ?

Answer 2

Dorsal flexors of foot, triceps surae, quads, hamstrings

Question 3

Which type of exercising is the key to fall prevention?

Answer 3

Balance training

Question 4

What are the three types of interventions that helps maintaining autonomy of the elderly person ?

Answer 4

• balance rehabilitation
• muscular reinforcement
• improvement of endurance

Question 5

What is the characteristic of the rehab plan ?

Answer 5

It is tailored, targeted, adapted to each person

Question 6

What are the sensory inputs of balance ?

Answer 6

Vestibular
- equilibrium
- spatial awareness
- rotation
- linear movement

Visual
- sight

Proprioceptive
-touch

Question 7

What are the three brain structures involved in the integration of input (balance)

Answer 7

The cerebellum : coordinates and regulates posture, movement and balance.
The cerebral cortex: contributes to higher level of thinking and memory.
The brainstem : integrates and sorts sensory information

Question 8

What composes the motor output ?

Answer 8

• vestibulo ocular reflex
• motor impulses : to control eye movements
• motor impulses : to make postural adjustments

Question 9

What are the recommandations for strengthening to prevent falls?

Answer 9

• take into consideration fatigue
• strengthen up key muscles: ankle dorsiflexors, triceps, quadriceps and hamstrings :
  60-80% RM
  Closed chain
  Eccentric with lower energy cost
  Functional gestures

Question 10

How to approach foot in fall management ?

Answer 10

• important sensory input
• gait

ROM: ankle and foot
Muscle length: triceps surae
External sensory stimulation
Weight bearing proprioceptive exercises

Question 11

How to optimize sensory afferents ?

Answer 11

• exercise on foam cushions or mats
• do seated exercises on ball, chair + cushion
• exercise on unstable trays

Question 12

How to progress in optimizing sensory afferents ?

Answer 12

• reduce polygon sustentation
• add head oscillations
• close the eyes
• exercise with balls
• optokinetic rehab

Question 13

Give examples of optokinetic exercises ?

Answer 13

• Cx spine ROM
• Eye-head exercises
• egocentric and egocentric targets
• walking + eye-head dissociation

Question 14

What is an exocentric exercise, give 3 examples.

Answer 14

It involves motor tasks that require focus on external objects or targets in the environment. It requires the integration of visual and spatial information to interact with external works accurately and efficiently combined with motor planning and execution.

Examples:
- ball sports
- target based activities (darts)
- interactive activities (dance, martial arts)

Question 15

What is an egocentric exercise, give examples.

Answer 15

It is a motor task that require to focus on individual’s own body movements, positioning and spatial orientation. Implies body perception, proprioception and kinesthetic information to maintain balance, control movement and coordinate body segments.

Examples:
- balance exercises
- flexibility exercises
- body awareness exercises (yoga)

Question 16

Describe the walking rehab program guidelines

Answer 16

• footwear and adapted technical aids
• gait symmetry (height and length of step)
  Speed changes
  Phages of walking
• higher activities of walking
• walking on unstable surfaces
• catching up on balance in standing position
  Passing obstacles
• sit to stand and transfers
• walking with variations (speed, direction, changes in position)
• double tasking
• walking outdoor

Question 17

What are the roles of the physio in fall management ?

Answer 17

To work within an interdisciplinary team and investigate possible causes of falls through a detailed subjective history and:

• prevent future falls by ensuring the living environment is safe
• prevent future falls by working on mobility , balance and strength
• restoring confidence to improve quality of life and reduce fear of falling
• training patient to cope with future falls and minimise complications

Question 18

What are the steps of the desensitization process ?

Answer 18

1) think about doing the exercise
2) try to do the exercise
3) do it
4) repeat
5) reinforce automation

Question 19

What is the Ortago Home Exercise Program ?

Answer 19

Program specifically designed for falls prevention:
- strengthening of moderate intensity
- balance exercises
- walking

Question 20

What are the types of exercises to be prescribed in case of osteoporosis ?

Answer 20

• weight bearing exercises: brisk walking, dancing, stairs climbing, hiking, everything with a high impact to stimulate bone formation. At least 30 mn of moderate intensity at least 3 to 5 times a week.
• resistance training: target major muscle groups with a focus on spine and hips: squats, lunges, seated rows, 60%-80% RM 8-12 reps 2 to 3 sets, 2 to 3 times a week.
• balance and flexibility: single leg stance, tandem walking, heel to heel walking
• stretching
• postural exercises: address kyphosis (to reduce the risk of vertebral fractures), back extensors (thoracic extension)

Question 21

What are the precautions when prescribing exercises for osteoporosis ?

Answer 21

Avoid high-impact exercises, spinal flexion, twisting movements in individuals with severe osteoporosis or a history of vertebral fractures.

Question 22

What are the recommandations for exercise prescription in sarcopenia ?

Answer 22

• resistance training: progressive resistance training that target major muscle groups = seated rows, leg presses, biceps curls, 60-80% RM for 8-12 repetitions and 2 to 3 times per week
• aerobic exercises: moderate intensity= brisk walking, cycling, or swimming at least 150 mn per week or 75 mn of vigorous intensity per week
• balance and functional exercises: single leg stands, tandem walking (to reduce the risk of falls), chair stands and step-ups.
• flexibility: all major muscle groups 2 to 3 cessions per week, holding each stretch for 15-60s

Question 23

What are the precautions when prescribing exercise for sarcopenia ?

Answer 23

Obtain medical clearance before initiating an exercise program for individuals with significant functional limitations or comorbidities. Tailor the exercise prescription to capabilities, needs and preferences.