Week 5 Lectures Flashcards
Bring multiple considerations to learning situation:
A need to know (how? why? who?) Independent self-concept Life experience Readiness to learn that is life centered Motivation that is primarily internal (how will learning help them?)
Adult learners require
Choice
Voice
Relevance
Ownership
Choice
provide options
Voice
listen to their needs
Relevance
connect learning to valued interests
Ownership
work collaboratively on goal setting
What does readiness to learn depend on?
previous learning
Intrinsic motivation
more pervasive/permanent learning
What is learning enhanced by?
repetition
meaningful tasks/materials
How to facilitate learning/motivation to learn?
A person learns what he/she wants to learn
Only patient can make decision that goal is worth striving for
Place responsibility for learning on patient, not on you
Age Changes in Motivation
self regulation
positive emphasis
stronger adherence to behavior
positive self-concept
Self-regulation
greater ability to control thoughts, emotions, behaviors with age
Positive emphasis
elderly respond better to emphasizing positive and short-term outcomes
Stronger adherence to behavior change
elderly slower to initiate change but more likely to adhere to changes
Positive self-concept
elderly less likely to conceptualize selves as personally deficient
How to address fear (motivational challenge)?
graded activity
graded exposure
cognitive behavioral therapy
Graded activity
start activity lower than painful level, slowly increase while providing positive reinforcement
Graded exposure
increased exposure to fear-causing events, can be real exposure or imagined
Cognitive behavioral therapy
address maladaptive thoughts to treat behaviors and feelings
Apathy:
lack of interest/concern, is opposite of motivation
Who is apathy noted in?
dementia/depression but can occur independently of these
Interventions for apathy:
Pharmacologic interventions may be recommended
Behavioral interventions – activities which stimulate and individual can complete
Transtheoretical Model of Change
Precontemplation Contemplation Preparation Action Maintenance Termination
Precontemplation
The individual has no intention to take action within the next 6 months and is generally unaware or under-aware of the problem
Contemplation
The individual intends to take action within the next 6 months. He or she is aware that a problem exists but has not yet made a commitment to take action
Preparation
The individual intends to take action within the next 30 days and has take behavioral steps in this direction
Action
The individual changes his or her overt behavior for less than 6 months
Maintenance
The individual changes his or her overt behavior for more than 6 months and works to prevent relapse and consolidate the gains attained
Termination
The individual has no temptation to relapse ans has 100% confidence in maintaining the change
Aspects of Change
consciousness raising dramatic relief environmental reevaluation self-evaluation self-liberation counterconditioning helping relationships reinforcement management stimulus control
Motivational Interviewing
Identifies dissonance between behaviors and values
Clinician listens reflectively and empathetically
What is the hallmark of motivational interviewing?
exploring client’s values and having client note mismatch between behaviors and life goals
Key Principles of Motivational Interviewing
express empathy
develop discrepancy
roll with resistance
support self efficacy
CDC guidelines for older adults exercising:
2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week AND weight training: muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms)…
OR
1 hour and 15 minutes (75 minutes) of vigorous-intensity aerobic activity (i.e., jogging or running) every week AND weight training: muscle-strengthening activities on 2 or more days a week that work all major muscle groups …
OR
An equivalent mix of moderate- and vigorous-intensity aerobic activity AND weight training: muscle-strengthening activities on 2 or more days a week that work all major muscle groups
What percentage of adults meet activity guidelines?
20% of adults
50% meet aerobic guidelines
fail at strength training
What causes a loss of function?
Typically it is the loss of strength (impairing balance and mobility) rather than a medical condition
Mobility disability:
Defined as the inability to walk a ¼ mile or climb a flight of stairs.
What is the single most important predictor of subsequent institutionalization>
leg strength
muscular system is entryway to frality
Strength components
Neural adaptations
Muscle adaptions
Neural adaptations
strength gains less than 6 weeks
intramuscular
intermuscular
Intramuscular:
improvements in ability to recruit and fire motor units in synchrony, improved rate of motor unit firing
Intermuscular
coordinating components of kinetic chain
Muscle adaptations:
6 weeks or more
Sarcoplasmic hypertrophy
Myofibrillar hypertrophy
Fraility:
Weight loss: 10 pounds or more over year (unintentional)
Self-reported exhaustion 3 or more days/week
Grip strength lowest 20% (<23 pounds women, <32 pounds men)
Walking speed lowest 20% (<0.8 m/s)
Activity lowest 20% (<270 kcal/wk women, <383 kcal/wk men); sitting/lying most of day
Meets 3/5 criteria
What is a decrease in grip strength associated with?
Every 5 kg (11 pound) decrease in grip strength associated with 17% increase in all cause mortality
Strength
ability to generate force
Power:
time rate of force development
Overload:
If too much stress is placed on a tissue, then it is susceptible to injury or even death
Underload:
If too little stress is placed on a tissue, then the tissue loses its ability to adapt to stresses; it atrophies.
ACSM Strength Guidelines
60-70% of 1 RM for novice
80-100% of 1RM for advanced
1-3 sets 8-12 reps for novice
2-6 sets 1-8 reps for advanced
ACSM Power Guidelines
Light load preferred, 0-60% of 1RM
1-3 sets of 3-6 reps
ACSM Frequency Guidelines:
Novice: 2-3 days/week
Advanced: 4-6 days/week
Overtraining:
Avoid substantial jumps in workload
Progress 2-10% of weight when can exceed by 1-2 reps current workload
TUG cutoff for fall risk
13.5 seconds
10 meter walk test cut off
0.8 m/s
5 time sit to stand cutoff
15 seconds or greater
Activities Balance Confidence Scale cutoff for fall risk
less than 80%
6 min walk test 60-69 YOM
572 meters
6 min walk test 60-69 YOF
538 meters
6 min walk test 70-79 YOM
527 meters
6 min walk test 70-79 YOF
471 meters
6 min walk test 80-89 YOM
417 meters
6 min walk test 80-89 YOF
392 meters
