Treatments and Interventions for Aging Adults

Question 1

An 84-year-old patient was seen in a skilled nursing facility. During the examination on the first day in clinic the therapist performed three outcome measures based on their observation of the patient and found the following: Occiput to wall distance: 8cm, the heel rise test: unable to complete full heel rise even with bilateral upper extremity support for balance, and the four square step test: 45 seconds with two attempts. From these results the therapist decides to work on breathing exercises and utilization of the extensor muscles for improved alignment. Which impairment and specific outcome measures can correctly align with this intervention choice?

Answer 1

Posture and Occiput to wall distance. Working on breathing exercises and extensor muscles to improve alignment correlates to the posture category and the occiput to wall distance outcome measure.

Question 2

After work on breathing exercises and utilization of the extensor muscles for improved alignment, a therapist decides to continue her plan of care by adding interventions focused on power training of the plantarflexors. Which impairment and specific outcome measures can correctly align with this intervention choice?

Answer 2

Strength and heel rise test. Working on power training of the plantarflexors correlates to the strength category and the heel rise outcome measure.

Question 3

A therapist focuses on functional activities that include dual tasking and changes in speed with adjustments in the base of support. Which impairment and specific outcome measures can correctly align with this intervention choice?

Answer 3

Balance and four square step test. Working on dual tasks, speed, and changes in base of support correlates to the balance category and the four square step test outcome measure.

Question 4

Refere algumas considerações acerca da fraca postura habitualmente observada.

Answer 4

Posture that can be considered poor is habitual positioning that causes unnecessary strain on the body (“awkward” posture).

Poor posture - secondary impairments are concerns:
• Try to maintain their baseline alignment;
• Forward flexed head and trunk (decreased ability for protective extension);
• Limited hip extension passive range of motion;
• Center of mass forward of base of support.

Question 5

Quais podem ser as relações entre a postura e a função?

Answer 5

• An increased Thoracic Kyphosis may bring the body’s centre of mass forward, requiring correcting responses
• Flexed Posture (FP)-patients had reduced ability to respond to perturbation, reflected by higher variation in gait patterns
• Impairments in postural control during walking are a major risk factor for falling: the results indicate that patients with FP have impaired postural control during walking and might therefore be at increased risk of falling.
• Older persons with hyperkyphotic posture are more likely to have physical functional difficulties;
• Evidence for an impaired postural control in all patient groups included. Impaired postural control is an important risk factor for falls.

Question 6

Que intervenções podem ser realizadas para melhorar a postura?

Answer 6

• Stretching in supine: take pillows out from under head in hospital room
• Active extensors in supine: cue to push heels down into bed and actively contract extensors
• Thomas Test: stretch hip flexor and strengthen extensors
• Perform squats against wall
• Foam half wedge against wall or in chair when performing functional activities
• Breathing exercises supine or against wall (inspirometer).

Question 7

Que tipo de alongamentos parece ajudar?

Answer 7

• Prolonged stretches if performing static stretching is optimal – Work toward sixty second holds for priority stretches
• Contract relax should be used when possible: six second hold
• Look for functional positions for stretches – Anterior pelvic tilt (backward chair); Hamstring stretch.

Question 8

What some of the literature has noted regarding the impact of posture on functional limitations?

Answer 8

• Patients with flexed posture have impaired postural control during walking and might therefore be at increased risk for falling.
• Older persons with hyperkyphotic posture are more likely to have physical functional difficulties.
• Impaired postural control is an important risk factor for falls.

Question 9

Since the previous research indicates that posture should be incorporated into the plan of care, the therapist decides to try and identify an activity the patient could perform repeatedly at home to work on improving the occiput to wall distance (OWD) measure. Which activities could MOST directly improve the occiput to wall distance (or decrease the 8cm)?

Answer 9

Perform activation of extensors in supine (push heels and hands down into bed) with head flat. This activity would directly facilitate improvement in the extensor range of the cervical spine and improved alignment, which could improve the occiput to wall distance score.

Question 10

The therapist tells the patient they should perform the supine activity with their head as flat on the bed as possible. Before beginning the activation of the extensors and pushing the heels and hands down into the mat, the therapist wants them to just lay flat and stretch to start. What would be the optimal time to hold the stretch for the best outcomes?

Answer 10

Prolonged static stretches are optimal working toward 60 seconds.

Question 11

Quais são as etapas apara um bom plano de fortalecimanto?

Answer 11

• Assess tolerance to exercise and baseline fitness level
• Determine appropriate intensity – Underdosing is not providing appropriate challenge to make change
• Progressive overload is the goal – Want to provide a challenge to the physiological system through a certain level of intensity and regularity
• Designed for each individual – Need to be willing to push them outside of their comfort.
zone

Question 12

Qual a relação entre os exercícios específicos e a função?

Answer 12

• Open chain activities do not strengthen muscles needed for closed chain activities and vice versa – Be specific and train to the activity needed
• Functional tasks improve if the activity is related.

Question 13

Que diferenças se verificam ao nível do esforço de execução de atividades funcionais entre jovens e idosos?

Answer 13

• Relative effort required during activities for young (mean age 22) versus old adults (mean age 74)
– Ascend stairs was 54% versus 78%
– Descend stairs was 43% versus 88%
– Chair rise was 42% and 80%

Question 14

Qual a parametrização dos exercícios que pode ser utilizada para orientar idosos frágeis?

Answer 14

Um estudo de 1990 obteve uma população com a média de 90 anos de idade, à qual aplicou a seguinte intervenção:
• Three times per week utilizing strength building machines at 80% of 1RM
• Average strength gain is 174% increase in 1RM strength
• No injuries or events
• Functional improvements (gait speed).

• Don’t prescribe underdosed strength training programs for older adults
• Instead, match the frequency, intensity, and duration of exercise to the individual’s abilities and goals.

Question 15

Quais os conselhos que nos permitem alcançar bons resultados com os exercícios?

Answer 15

• Need to challenge the system
• Need to prevent people with arthritis from getting weaker
• Challenge patients until they reach their limits
• We must monitor to determine if they reached their limits.

Question 16

How intense to strenghten?

Answer 16

• Similar to the cardiovascular system, skeletal muscle requires a workload of about 60% of maximum available strength (1RM) to increase in strength
– 60% threshold = 15 reps at RPE 12 to 13
– 80% threshold = 10 reps at RPE 15 to 17 (There should be deterioration of form for last 2 reps);
• If more than twenty repetitions are completed with good form (no fatigue noted), resistance is below the 60% threshold.

Question 17

Quais as considerações de garga em treino de resistência?

Answer 17

• Resistance to provide 15 to 20 repetitions, multiple sets, 12 to 14 RPE
• Proximal strengthening can benefit from muscular endurance
• Weighted vest.

Question 18

O que implica o treino de força?

Answer 18

• Power = force x velocity
• Power training is directly related to diminished ability to perform ADLs, increased risk for falling and functional dependency: so more relevant than strengthening – But you need to strengthen first.
• Perform functional movements as fast as possible while maintaining quality – Sit to stand as fast as possible and stand to sit slowly for eccentric control.
• Low strength and power are particularly powerful risk
factors to indicate declined mobility in men.

Question 19

Qual a estrutura musculo-tendinosa que desempenha um papel fundamental no balanço?

Answer 19

• Hip abductor muscles play an important role in mediolateral balance control
• Accurate balance performance appears limited by lower hip abductor strength when explicit visual information on balance reduces the need for hip abductor proprioception.

Question 20

O que devemos ensinar sobre a dor muscular tardia?

Answer 20

• Delayed soreness typically begins to develop 12 to 24 hours after the exercise has been performed and may produce the greatest pain between 24 to 72 hours after the exercise has been performed
• Educate patient on DOMS – Why it happens, how long, how often to train.

Question 21

A 77-year-old patient was admitted to a skilled nursing facility after being diagnosed with deconditioning one week earlier. He is able to ambulate in the gym with a large base quad cane 150 feet on the tile surface with contact guard assist. The therapist wants to make sure to stay focused on the patient learning the skill of ambulation and not just being able to perform it. The therapist wants to progress the above patient from a quad cane to a straight cane, but after performing the 30 second sit to stand, finds the patient is only able to perform three sit to stands with upper extremity support. For her age she should be able to perform 14 sit to stands in 30 seconds. Therefore, activities for lower extremity strengthening are a priority. Which intervention could be an option?

Answer 21

Resisted sit to stand with assist as needed to start. You want to use closed chain activities that mimic the priority functional activity as best as possible. You also want to push the patient outside of their comfort level. So although the patient may need assistance at first to get used to the resistance of the theraband, this will challenge the system to increase strength.

Question 22

The patient is able to perform the resisted sit to stands but feels like it isn’t necessary to work this hard. The patient states, “I am 77 years old - why do I need to work so hard.” Which could be a good response to this question?

Answer 22

“I want to help you be as independent as possible. You need to feel a challenge to reach the 80% relative effort you need to rise from a chair compared to 42% when you were 22 years old.”

Question 23

The therapist is now trying to determine how many repetitions would be needed to meet that 80% challenge. Which could be chosen to reach an 80% threshold for muscle strengthening?

Answer 23

10 repetitions at a rate of perceived exertion (RPE) of 15-17. If you want to reach an 80% threshold for muscle strengthening, then you need to have a high RPE of 15-17 at ~10 repetitions.

Question 24

Quais as intensidades de exercício aeróbico recomendadas depois de um AVC?

Answer 24

• Baixa intensidade - HRR (Heart Rate Reserve) abaixo de 45%; e RPE abaixo de 10.
• Intensidade moderada - HRR entre 45 e 60%; e RPE 11-13.
• Alta intensidade - HRR superior a 60; e RPE sup ou igual a 14.

• Exercise should be progressed as tolerated by the
participant. Make sure to monitor your patient’s heart rate even if the tasks are very easy to start with.
• Significantly greater improvements following high
versus low-intensity training
• Multiple ways to manipulate intensity: apply loads or
resistance to trunk and limbs (weighted vest, ankle
weights, theraband resistive forces to the trunk).

Question 25

Qual a resposta normal do nosso corpo ao exercício aeróbico?

Answer 25

• RPE=13/20
• Increase in SBP (sistolic blood pressure) of 20 to 30mmHg
• BP returns to normal within 10mmHg and HR within 10 bpm of preexercise value within five minutes of stopping exercise in sitting
• Decrease in diastolic BP and HRrest over time with high intensity exercise.

Question 26

Quais as principais respostas anormais ao exercício aeróbico?

Answer 26

• Failure to return to normal.
• DBP – Drops 10 to 20mmHg below baseline (could indicate heart failure); Over 110mmHg (Stroke risk); Over 10mmHg during or after exercise (potential CAD or labile HTN).
• SBP over 210 to 240mmHg (Stroke risk).
• HR decrease over 10bpm below baseline (cardiac decompensation).
• HR increase over 50 bpm with low level activity.
• If taking a beta blocker, their HR response to exercise is blunted. Use RPE and vitals.

Question 27

Quais as guidelines da american heart association (AHA) e da ACSM para o condicionamento aeróbio?

Answer 27

AHA - 20 to 60 minutes/session (10 minute bouts acceptable):
• 40 to 70% HR reserve
• 55 to 80% Hr max
• RPE 11 to 14.

ACSM - 20 to 60 minutes/session (10 minute bouts acceptable):
• Severely deconditioned: 30-40% HRR, 57-64 HRmax, RPE 9-11
• Deconditioned: 40-60% HRR, 64-76% HR max, RPE 12-13
• Sporadic physical activity: 60-90%HRR, 76-96% HRmax, RPE 14-17.

Question 28

Qual o benefício neuronal de começar o tratamento com uma atividade aeróbica moderada?

Answer 28

Moderate intensity aerobic exercise can prime the nervous system for improved performance, but not retention, of new motor skills but was dependent on motor training occurring immediately after exercise.

Question 29

Qual o benefício de exercícios por circuito?

Answer 29

• Evidence for the efficacy of a task-related circuit class at improving locomotor function in chronic stroke
• The use of task-oriented circuit class training to improve gait and gait related activities in patients with chronic stroke.

Question 30

Que tipo de ganhos se verificam com treinos de intervalos de alta intensidade (HIIT)?

Answer 30

• Repeated bouts of high intensity followed by recovery periods (no single formula)
• Allows greater stress to system
• Improved muscle metabolic function
• Trains aerobic and anaerobic system
• Build base first.

Question 31

Qual a orientação da ACSM relativamente à prática de exercício em geral?

Answer 31

• Exercise is safe for most people with great health benefits
• Cardiovascular risks associated with exercise lesson with increased physical activity
• Exercise-related cardiovascular events are rare and generally have warning signs and symptoms.

Question 32

O que deve ser vigiado paralelamente ao exercício em pessoas com neuropatia autonómica?

Answer 32

• Decreased cardiac response, postural hypotension, risk of dehydration
• Monitor BP, HR, BG, encourage fluid intake.

Question 33

Que tipo de exercício deve ser promovido em casos de osteoporose?

Answer 33

• Promote best posture

* Prescribe exercises to resistance training.

Question 34

A nível cardiovascular, o que podemos usar para adequar a nossa parametrização ao utente?

Answer 34

• Confirm use of betablockers and utilize RPE to maintain somewhat hard range
• Utilize the following formula: Hr max = 164 - .7 of age.

Question 35

Quais as recomendações a nível de exercício em diabéticos?

Answer 35

• Avoid vigorous exercise if ketosis is present. Work 50-70% HR max
• Maintain hydration.

Question 36

An active 76-year-old is being seen in outpatient therapy following a right total hip replacement two months prior. Currently the patient is weight bearing as tolerated and is ambulating with a straight cane with no precautions. The therapist performs a 2-minute walk test with the patient and finds they are only able to go 200 feet when a community ambulator should be able to go 493 feet. The therapist decides that aerobic conditioning should be a priority to get them back to being active. Which could be a good choice when designing an intervention with the above goal as a result?

Answer 36

Circuit training using functional activities. Designing a type of circuit training that could include functional activities like sit to stand, supine to sit, and resisted walking has been shown to be beneficial in the literature to improve aerobic challenge.
Include the patient in the decision making also is an activity that has been shown in the literature to improve outcomes. But it could be beneficial when integrated into any intervention plan.

Question 37

While the patient performs the circuit, the therapist is closely monitoring. The patient begins to breathe heavily and states their RPE is a 13/20. When you take their BP you find their systolic BP went up 20mmHg. What do those findings tell you regarding the parameters of the patient’s response and what you should do next?

Answer 37

These parameters are considered normal and you would continue with the circuit. An RPE of 13/20 and an increase in systolic BP of 20-30mmHg is considered normal.

Question 38

A therapist has decided to focus on aerobic conditioning with a new patient who is deconditioned. The therapist finds the patient’s resting heart rate and uses the formula to determine their heart rate reserve (HRR) and heart rate max (HRmax), referencing the American College of Sports Medicine (ACSM) Guidelines. Which guideline did the therapist use?

Answer 38

The ACSM guidelines for aerobic conditioning for a person who is deconditioned are 40-60% HRR, 64-76% HRmax, and RPE of 12-13.

Question 39

What is heart rate reserve (HRR)?

Answer 39

Heart rate reserve describes the difference between a measured heart rate or the predicted maximum heart rate and the resting heart rate in a person. It indicates the heart rate reserve cardiovascular fitness of a person.

Question 40

Quais os tipos de ambiente que devemos trabalhar para que a pessoa possa ser bem sucedida no seu dia-a-dia?

Answer 40

– Long distance walking over ten blocks
– Crossing busy streets
– Escalators
– Curbs (parapeitos e beiras)
– Carrying heavy loads
– Unfamiliar places
– One to two flight of stairs.

Question 41

Dá algumas ideias de estratégias para desafiar o balanço.

Answer 41

• Most balance/fall interventions emphasize voluntary, pre-planned movements
• Need to retrain unexpected balance challenges and increase the speed of reflexes
• Sudden release from forward lean
• Unexpected waist pulls
• Unexpected challenges.

Question 42

Quais as estruturas chave que permitem controlar o balanço reativo?

Answer 42

• One goal is to retrain stepping reactions
• Hip abductor-adductor control is the predominant neuromechanical contributor to lateral balance stability – Gluteal muscle composition discriminates between fallers versus nonfallers
• Improvements in stepping with practice – Two types: loaded step and crossover.

Question 43

Qual a importância de treinar o virar com os utentes?

Answer 43

• Critical to practice because it is dangerous and results in falls. Also functional and done throughout the day
– Falls during turning are eight times more likely to result in hip fractures compared with straight-line walking
• Turning more often than walking straight
– People turned 100 times an hour and up to a 1,000 times a day
– Almost every task requires some type of turning
– Two turns per ten steps.
• Eye movement is critical for the release of the steering synergy for turning control
– Start with eyes and head turning as well as when rolling in bed
• Future work should focus on improving saccade performance during functional tasks and testing the effects of therapeutic interventions on related outcomes
– Recommend training on saccades and practice turning eyes, then head, then trunk.

Question 44

An acute care therapist finishes evaluating a patient who is a 78-year-old woman with a diagnosis of osteoarthritis. She was admitted to the hospital for a total knee arthroplasty (TKA). She lived alone prior to the surgery and was very active, although she stated she had fallen a few times before her surgery and felt it could have been due to her knee pain, since it always seemed to happen when she was turning. Her weightbearing status is as tolerated and she had no problems getting up into the chair and taking a few steps. The therapist decides to take time to do some additional testing that may be related to her challenges with turning, which can be performed while she is sitting in the chair. Which test can the therapist perform and why?

Answer 44

Smooth pursuits to assess eye movements. They can be performed sitting in the chair, and they allow assessment of eye movements, which are critical for the release of the synergy for turning control.

Question 45

After two weeks in a subacute rehabilitation unit, the patient is at home and referred for home care physical therapy. The home care therapist finds the patient is doing very well and looks to be ready to progress to some reactive balance training. However, she decides she wants to do some further strength testing to confirm she is ready for this activity. Which muscles are predominant neuromechanical contributors to lateral balance stability that the therapist should, therefore, test?

Answer 45

Gluteus medius and maximus. The gluteal muscle composition discriminates between fallers and non-fallers since the hip abductor-adductor control is the predominant neuromechanical contributor to lateral balance stability.

Question 46

The patient has now progressed to outpatient therapy and is feeling like she is doing well and tells the therapist she may not need to continue with therapy since she is walking independently without the cane. The therapist performs the following outcome measures: a four square step test and a 2-minute walk test. The results of the four square step test are 35 seconds and the 2-minute walk test was 320 feet. The therapist explains that this indicates she is at risk for falls and is not in a normal range for community ambulation. The patient states she had no idea she could do better and asks what they will work on to improve her balance. Which can be a response given the concern with her previous falls?

Answer 46

Turning and reactive balance. People turn up to 100 times an hour and since this patient is walking independently without a cane, high level turning and reactive balance activities would be the best way to decrease her risk for falls.

Question 47

Quais os tipos de tratamento normalmente administrados para osteoporose?

Answer 47

• Exercício: carga, balanço, aeróbico e postura.
• Fortalecimento dos músculos antigravíticos.
• Prevenção de quedas.
• Exercícios de respiração.
• Ensinar a boa mecânica do corpo de modo a minimizar a flexão.
• Tratar a dor.
• Ortóteses - embora os coletes lombares não sejam aconselhados devido ao stress adicional que submetem à junção tóraco-lombar.

Question 48

O que a investigação nos diz acerca do tipo de exercícios mais eficazes para beneficiar a densidade óssea?

Answer 48

• Atividades aeróbicas como andar tem efeitos menos significativos do que treino de força e resistência ou atividades mais extenuantes.
• A bicicleta estática tem muitos benefícios para a saúde mas parece ter pouco benefício sobre a densidade óssea.

Question 49

Como se processa a reparação de fraturas em idosos?

Answer 49

• A reparação deve ser a mesma.
• Calo ósseo precoce em 2 a 4 semanas.
• Deve existir osso às 6 semanas.
• O osso osteoporótico pode não cicatrizar devidamente.
• As respostas inflamatória e circulatória podem não ser suficientes.
• Resposta morfogénica.

Question 50

Exemplifica fatores podem reduzir ou afetar a processo reparatório do osso?

Answer 50

• Nutrição.
• Diabetes.
• Hipovitaminose, especialmente C e D.
• Politrauma.
• Inflamação crónica.
• Fragilidade.
• Cognição.

Question 51

Qual o papel do exercício na prevenção e tratamento da osteoporose?

Answer 51

• Diminuição do risco de queda.
• Aumento de massa óssea e força.
• Melhorar a força muscular.
• Balanço melhorado, melhor postura.
• Aumento da flexibilidade dos tecidos moles.
• Aumento do fitness cardiovascular.
• Depressão reduzida.

Question 52

Que tipo de tratamentos são geralmente efetuados em fraturas?

Answer 52

• Controlo da dor.
• Ganho de mobilidade e função no devido tempo.
• Modalidades.
• Exercício apropriado.
• Treino de marcha com progressão, se possível.

Question 53

How can we verify if there is a kyphosis in the spine?

Answer 53

Palpamos o espaço entre a última costela e a crista ilíaca. Se entre as duas estruturas couberem 3 dedos é normal. Se couberem menos do que dois dedos, é indicação de cifose da coluna.

Question 54

A patient asked you to explain what her T-scores mean in a bone density result. What you respond?

Answer 54

Normal bone is determined by the density of young healthy adults. Osteopenia is defined as loss of bone amounting to at least 1 and up to 2.5 standard deviations from young healthy adults. Osteoporosis is 2.5 standard deviations or more from young healthy adults.

Question 55

You explain a patient that based on her T-scores she has osteopenia not osteoporosis. Which are physical findings that indicate that she is at risk?

Answer 55

Thin stature, the extreme closeness of the ribs to the pelvis, forward bent posture and high distances from the wall to the occiput are physical findings that are common in persons with low bone density.

Question 56

A patient with osteopenia wants to start exercising for her health including her bones; she wants to bike not lift weights. What you may tell her?

Answer 56

Biking has many benefits but does not enhance bone density in the hips or spine; weight bearing and resistive exercises enhance bone health.

Question 57

Persons have been successfully treated with medications for osteoporosis but there are some concerns. Exemplify three valid concerns.

Answer 57

There is some concern that persons with prolonged use of bisphosphonates may increase the risk for osteonecrosis of the jaw and possibly a very rare risk of subtrochanteric fracture. Calcium deficiency has been recognized as a risk in osteoporosis and there is debate whether or not calcium supplementation may have some potential effects on myocardial infarction.

Question 58

Além da função contráctil do músculo, quais as outras funções?

Answer 58

• Força
• Forma ao corpo
• Termoregulação
• Suporte aos outros tecidos, visceras e vasos sanguíneos
• Estabilidade articular
• Manter postura estática e dinâmica
• Promover a função cardiopulmonar e saúde
• Densidade óssea
• Nutrição articular
• Input neural, spindle.

Question 59

Quais as principais alterações musculares com o avanço da idade?

Answer 59

• Fraqueza - começando na terceira década da vida, a força muscular declina 8 a 12% por década.
• Diminuída velocidade de contração e relaxamento.
• Perda de potência.
• Fadiga mais rápida.

Question 60

O que é a sarcopenia? E quais os fatores que contribuem?

Answer 60

Sarcopenia é perda de massa e função muscular esquelética associada ao avanço da idade. Eis alguns fatores:
• Inflamação (interleucina-6)
• Deficiência em vitamina D
• Resistência à insulina
• Fome: malabsorção, perda de amino-ácidos
• Endócrino: défices na hormona do crescimento, e fator de crescimento 1 tipo insulina
• Desuso: inatividade física
• Senescência: diminuição das hormonas sexuais, disrupção das células satélite, perda de neuróneos motores alfa, abnormalidades mitocondriais.

Question 61

O que acontece com a unidade motora (UM) no avanço da idade?

Answer 61

• Diminuição do número de unidades motoras (UM) acompanhado com o aumento da secção transversal das unidades restantes.
• Desnervação das fibras musculares, especialmente no tipo II b e a reinervação resulta das unidades motoras adjacentes.
• Perda de fibras e UMs funcionais e um aumento do tamanho das UMs bem como a sua amplitude e duração do potêncial de ação.

Question 62

Quais as alterações fisiológicas que contribuem para a fraqueza?

Answer 62

• Diminuição da habilidade para ativar as fibras musculares.
• Reduzida qualidade do tecido muscular.
• Diminuição da velocidade de condução nervosa das fibras nervosas motoras.
• Alterações na junção neuromuscular.
• Diminuição da habilidade do retículo sarcoplasmático mover cálcio.
• Aumento da resistência passiva do tecido conectivo.

Question 63

Qual a relação entre o aumento da idade e a inflamação?

Answer 63

• O envelhecimento está associado à inflamação crónica, especialmente a interleucina-6.
• Altos níveis séricos de Il-6 predizem incapacidade.
• Os exercícios de resistência reduzem a inflamação e aumentam a massa muscular e função.
• O baixo nível plasmático de insulin-like grouth factor 1 (IGF-1) é encontrado com a diminuição da força dos extensores do joelho.
• O imbalanço entre as citocinas e o IGF-1 pode ser um fator em sacopenia.

Question 64

Porque é importante trabalhar uma reserva funcional?

Answer 64

Porque devido à perda de geração tensão no músculo em envelhecimento, o utente pode estar a usar a a habilidade muscular próxima do máximo durante a atividade. Por exemplo, uma senhora num lar está pronta para ser liberada para casa. Pergunta-se quantas escadas tem em casa e ela refere que são 12. Construir uma reserva funcional implica treinar 24 escadas. Os objetivos para a reserva funcional devem ser baseados nas necessidades funcionais do utente.

Question 65

Exemplifica a dose de um programa de exercícios que pode induzir hipertrofia em mulheres idosas.

Answer 65

Dose:
• treino 3x por semana em 12 semanas
• 3 séries de 6 repetições

• 65%RM x 5 semanas
• 70%RM x 4 semanas
• 75%RM x 3 semanas
(reteste para RM após 2, 5, 7 e 9 semanas)

Question 66

Qual a relação entre a velocidade da marcha e a mortalidade?

Answer 66

Um estudo demonstrou que uma diminuição mais rápida da velocidade da marcha tende a estar associado a maior risco de morte. A rápida diminuição da velocidade parece estar mais associada ao género feminino, raça negra, obesidade, força limitada dos extensores do joelho, pessoas com baixa atividade. Atenção: estes últimos fatores podem ser intervencionados e melhorados!

Question 67

Quais são os pontos chave para o exercício terapêutico em idosos?

Answer 67

• Usa qualquer tipo de contração muscular
• Adiciona carga os grupos musculares
• Procura o fortalecimento funcional
• Há benefícios mesmo no após os 90 anos
• Incluem-se efeitos sistémicos
• Usa a fase de aquecimento e retorno à calma, melhor para 45 a 60 minutos
• Exercício 3 a 5 vezes por semana
• Descanso e recuperação é muito importante
• Podem ganhar força lentamente
• Podem ganhar menos força absoluta
• Podem ter menos capacidade de adaptação à carga (risco de lesão)
• Diminuição do consumo do oxigénio (podem ter fadiga mais rapidamente)
• Exercícios curtos e graduados
• O músculo é um fator de controlo motor pelo que é importante a aprendizagem, usa técnicas neurofisiológicas.

Question 68

Porque é que a postura é um sistema complexo?

Answer 68

• Implica grandes interações para controlar o esqueleto axial e apendicular em relação ao ambiente. A postura é estática e dinâmica.
• Alterações em qualquer sistema neurológico, muscular ou esquelético (e frequentemente envolve vários graus) podem criar fracas posturas que podem tornar o movimento mais difícil e possivelmente prejudicial.

Question 69

Qual a tendência postural com o avanço da idade?

Answer 69

• Alterações típicas no esqueleto axial como anteriorização da cabeça, cifose dorsal, achatamento da lordose lombar e possível escoliose.
• Alterações no esqueleto apendicular como protração escapular, contraturas no cotovelo e possíveis desvios artríticos nas mãos e punhos. As ancas e os joelhos também perdem a extensão completa e o tricípete sural pode ficar tenso.
• Fracas posturas estão associadas com perda de função no tempo do 6-meter walk time, sit to stand, functional reach and the timed up and go tests.
• A postura pode ser melhorada com o tipo apropriado de exercícios. Devem ser treinadas e avaliadas a postura estática e dinâmica.

Question 70

Quando testa a performance muscular, devemos estar atentos a um momento em que há alteração de desempenho. Como se chama esse momento?

Answer 70

Ponto de fadiga. Ocorre quando diminui a velocidade de desempenho ou quando começam a haver compensações. O objetivo do treino será elevar esse ponto.

Question 71

You know that your patient has 3 steps to get into her house and she performs this safely. In her home activity program you ask her to go up and down the 3 steps 3 times to build her functional reserve. What is functional reserve?

Answer 71

Functional reserve is built by exercising above the basic physiological function level so that when there is an illness or surgery, trauma or other stressors, the person is still able to maintain that function (in the present case, climbing 3 steps). If the function is working at capacity level, any stressor can reduce that functional capacity.

Question 72

With your physical examination, you document your patient’s weakness in her anti-gravity muscle especially her quadriceps, hip extensors and trunk extensors. You establish a therapeutic program to be done in your clinic under supervision. What can include:

Answer 72

Any type of muscle contraction is effective in increasing strength and should be progressive load applied to the muscle and it should be aimed toward functional strengthening. Exercise should be performed 3-5 times weekly. There should be some concern about aging muscles adaptability to load. For this reason, exercise bouts should be short and graded, and not include a high number of repetitions.

Question 73

Quais os três pré-requisitos para andar (marcha)?

Answer 73

• movement synergy for propulsion;
• equilibrium maintenance during the movement;
• the “adaptation of locomotor pattern to the behavioural goals of the person and the constraints of the environment”.