Function and Exercise

Question 1

Lancet Commission 2020 - Physical activity and exercise effect on normal adults, MCI

Answer 1

1. SR - cognitively normal adults, global cognitive improvement for mod-vigorous resistance or aerobic exercise, no effect from yoga
2. MA - MCI global cognition in intervention group with aerobic exercise improved more

Question 2

Evidence regarding group and home based exercise programs

Answer 2

Community dwellers
Falls reduced in those who undergo program
Usually in multiple exercise categories (balance and function plus resistance) and Tai Chi alone

Question 3

12 benefits of physical activity aside from those related to DM, HTN, obesity, TIA

Answer 3

1. Increase bone density
2. Decreased risk of hip fracture
3. Decreased risk of falls/improved balance
4. Decreased risk of frailty
5. Increase muscle mass (tx/px sarcopenia)
6. Improved appetite
7. Decreased rates of depression
8. Improved sleep
9. Preservation of cognitive function
10. Decreased CV mortality
11. Decreased risk of cancer
12. Decreased all cause mortality

Question 4

6 components of an exercise program for falls prevention

Answer 4

1. Balance challenging and functional exercises
2. Sufficient intensity and duration, delivered in safe way that considers functional abilities
3. Sessions 3x/wk or more
4. Program should be individualized (trained professionals)
5. Progress in intensity for at least 12 weeks
6. Include Tai Chi +/- additional progressive resistance strength training

Question 5

Canadian physical activity guidelines for >65 yo

Answer 5

1. Mod-vigorous aerobic activities, min 150 mins/wk
2. Muscle strength 2x/wk
3. Activities that challenge balance
4. Several hrs of light physical activity, including standing

Question 6

What are the components of an exercise prescription?

Answer 6

1. Frequency - work up to daily
2. Duration - 150 mins /wk
3. Intensity - mod to vigorous
4. Type - aerobic

Question 7

What are two physiologic causes for change in balance?

Answer 7

1. Decreased joint proprioception
2. Decreased vestibular hair cells = decreased proprioception

Question 8

Four tools to assess balance

Answer 8

1. Berg balance scale
2. SPPB
3. Tinetti - POMA
4. TUG
5. Functional reach test

Question 9

8 aspects of home exercise program that increase adherence in older patients

Answer 9

1. Educate patients pain vs. harm
2. Reinforce messages to reduce fear/anxiety about pain
3. Emphasize that exercise will lead to less pain, anxiety, depression
4. Countering maladaptive coping strategies
5. Motivational techniques to set personal goals
6. Manage expectations
7. Minimize pain
8. Graduate program
9. Provide clear instructions, printed and verbal
10. Encourage to keep logs, diaries etc.
11. Review at every treatment
12. Tailor to the patient
13. Telerehab/apps
14. Pictures and videos
15. Include social network

Question 10

How to help discharge planning in patient post stroke, functional dependence, cognitive impairment

Answer 10

1. Family meeting with allied health, use of interpreter
2. Home OT safety assessment for modifications
3. OT assessment for functional abilities/tools
4. Indigenous health navigator
5. Determine capacity/POA
6. Close follow up on discharge/?home visit

Question 11

5 components of the Functional Independence Measure (FIM)

Answer 11

1. Self care - eating, grooming, bathing, dressing (upper and lower), toileting
2. Sphincter control - bladder and bowel
3. Transfers - bed, chair, wheelchair, toilet, tub, shower
4. Locomotion - walk, wheelchair, stairs
5. Communication - comprehension and expression
6. Social cognition - interaction, problem solving, memory