Transcript Jordan bicher - PA Behavioral Health and Aging Coalition

Functional Issues in Older
Adults
Jordan Bicher, D.P.T
Director of Rehabilitation; Physical
Therapist
What is Function?
• The kind of action or activity proper to a
person, thing, or institution; the purpose
for which something is designed or exists;
role
• Everyone’s Functionality is different;
dependent on environment and support.
• Ultimate goal for all people is to function at
a SAFE level.
• Safety is always the key.
Aging Process
• Aging is inevitable, however the pace at
which we age varies based on physiology
and environmental factors.
• Our Chronological Age is not the same as
our Physiological Age.
• You can be an “old” 55 or a “young” 80.
Current Aging Trends
• Life expectancy in the U.S. went from age
47 to 77 during the last century.
• The fastest-growing age group is age 85
and older.
• 35 million older Americans today will
increase to 70 million by 2030.
What Contributes to lack of
function?
**Immobility**
Immobility
• Aging of Muscles
– Decrease in Muscle function of 30-50% by
age 65.
– Muscle fibers become smaller; decreased
number of myofibrils.
• Reduction in size, strength, endurance.
• Tendency to fatigue more rapidly.
– Decreased cardiovascular function causes
less blood flow during activity compared to
younger person.
Immobility
• Aging of Muscles (cont.)
– Decreased muscle elasticity
• Fibrosis occurs causing increased collagen tissue formation
which restricts movement and circulation
• Decreased Cardiovascular function
– Decreased elasticity of arterial system
• Decreased Cardiac Output (stroke volume x heart rate)
• Decreased Ejection Fraction
• Aortic Stenosis
– Decrease in pacemaker cells
• Decrease in regulated heart rate
Immobility
• Decreased Cardiovascular function (cont.)
– Increased incident of disease, to all systems,
that stress the heart.
– Resting heart rate does not decrease, but
maximum heart rate does.
• Limits ability to exercise
– Hypertension
Immobility
• Pain (see pain scale on next slide)
– If it hurts, you don’t use it.
– Arthritis
– If Immobility occurs, recovery time in elderly is longer.
• Decline in Memory (will discuss in depth later)
– If you don’t remember what you need to do you are
less likely to move.
• Psychosocial
– Depression
– Isolation
• Loss of ability to drive (Will discuss later)
Pain Assessment Scale
A resident is asked to rate their pain on a numerical
scale from 0-10, with 10 representing the worst pain
experience.
Resident can be asked the following:
Is the pain constant?
Is the pain intermittent?
If pain is relieved what activities or interventions relieve
the pain?
How long is the pain relieved?
What time of day is the pain the greatest?
When pain affects sleep, how much sleep is obtained in
a given period of time?
Describe the medication schedule and the affect of
medication on the pain type and duration.
Rating Scale:
0 = No Pain
1 = Mild Pain
2 = Moderate Pain
3 = Quite A lot of Pain
4 = Very Bad Pain
5 = Worst Pain
Pain Scale
0
1
2
3
4
Resident is asked to describe the pain as:
Pain Descriptors
S = Sharp
A = Aching
D = Dull
B = Burning
C = Cramping
N = Numbness
TH = Throbbing
T = Tingling
5
Immobility
• Decline in Respiratory Function
– Not as prominent as cardiovascular function
in the non-smoker.
– Decline in oxygen exchange.
– Decline in motility of cilia.
– Decreased elasticity.
• Decreased inflation/deflation
– Lung tissue as well as decrease in rib cage movement.
– On average one foot of membrane is lost
every year after age of 30.
Immobility
• 5 Senses (Decline in all five as we age)
– Vision-3rd leading cause of disability in the
elderly.
• Poor vision can lead to a fear of moving.
• Less motivated to get up since we can’t see things.
• Can greatly contribute to decline in memory.
– Hearing-unaware of our surroundings.
– Touch-Sensation
• Peripheral neuropathy
• DM
Immobility
• 5 senses (cont.)
– Taste and Smell
• A decline in our taste and smell leads to a decrease in
appetite.
• Only 17% of adults over 60 have an appropriate diet.
• Decreased Caloric intake
– More processed food
– Less energy
– Less ability for our body to heal
• Decline in Fluid/Water intake.
– Decreases elasticity in tissue
A Decline in Mobility leads to a
decline in balance.
• Balance is controlled by 3 main factors
– Eyes/vision
– Vestibular System
– Contact with earth
• Muscles
• Sensation
How do we affect immobility?
How Do We Affect Immobility?
• As we age we slow down
– As caretakers, we don’t allow people enough
time to complete tasks.
• We’re in a hurry.
• We confuse slow movement with
“struggling” to complete a task.
• We feel bad.
– It’s easier for us to do the task for them.
– We don’t appropriately modify home to allow
for maximum function and safety.
Effects of Immobility
Cardiovascular
• 12 weeks of bedrest can cause a 15%
decline in cardiac muscle mass
– Orthostatic Hypotension
• Decreased pressure sensors
– Decreased Stroke Volume
– Blood Clots
Respiratory
• Decreased respirations cause decreased
use of pulmonary tissue
• Fluid build up
• Pooling of secretions
– Atelectasis
• Pressure on certain areas of lungs
Digestive
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Constipation
Anorexia
Pain
Diarrhea
Poor Gas/Nutrient
exchange
Genitourinary
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Decreased Mobility
Fluid retention
Kidney infection
Limited bladder
emptying
• Incontinence
Nervous
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Cognitive decline
Depression
Decreased Sensation
Decreased Pain Sensation
Decreased Coordination
Pressure Sores
Musculoskeletal
• 50% muscle mass loss in 3 weeks
• Osteoporosis
– Calcium imbalance can affect cardiac function
• Joint fusing
• Decreased joint mobility=decreased
balance
• Muscle wasting
Promoting Mobility…
…and Function
Mobility and Function
Mobility and Function
Mobility and Function
Mobility and Function
Dycem
Mobility and Function
Mobility and Function
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Wheelchairs
Powerchairs
Power scooters
Stair Climbs
Life Lines
Ramps
Public Transportation
Church Organizations
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Meals on Wheels
Adult Day Centers
Senior Centers
Area office of the
aging
• AARP
• Association of the
Deaf
• Association of the
Blind
Mobility and Function
• Ramps
– ADA says 1:12 Ratio; really
it needs to be at least 1:6.
– Maximum rise for any Run
should be 30 inches
– Needs to be 36 inches
wide.
– Have at least a 2 inch
railing.
– Should have at least a 60
inch platform prior to
entering structure
– Standard step is 6 inches.
1in.
12 in.
2 in.
<30 in.
> 60 in.
Driving
Question: When should someone talk to you about driving?
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Health Change –74%
General Safety Concerns –72%
Forgetful/Getting Lost –71%
Serious accident –50%
Near miss –29%
Minor accident –18%
Older drivers said they were more likely to listen if the
person talking to them had their best interests at heart –
focus on the older adult, his/her safety and mobility
needs
Driving
• Self-Regulation
• Most healthy drivers make their own decisions to cut
back on their driving to stay safe
• Older drivers avoid driving:
– At night, or at dusk or dawn
– In heavy traffic congestion
– On highways or freeways
– Long distances
– In unfamiliar areas
– In poor weather
– Making left hand turns
Driving
Who should talk? Who would you be most likely to listen
to?
• Married drivers prefer to hear from their spouse, doctor,
or adult child.
• Single drivers prefer to hear from their doctor or adult
child.
Who would you absolutely not want to hear from?
– Married drivers would not want to hear from the police
or DMV or, for some of them, a spouse.
– Single drivers would not want to hear from the police
or DMV.
Driving
• www.AARP.ORG
• www.thehartford.com/talkwitholderdrivers
Bladder Control
• Check out this link
– http://www.youtube.com/watch?v=bhehwx2u0oE
• Kegel Exercises
– Strengthen the Plevic Floor (pubococcygeus) Muscle
The Best way to identify
your Pelvic Floor Muscles,
is during urination. Once
your flow begins, try to stop
it completely. The muscle
that you feel tightening is
the pelvic floor muscle.
Cognition
Cognitive Decline
• Dependent on location of damage in brain
– Attention and Concentration
– Slowed Processing Speed
– Decreased ability to learn
– Word Finding/Naming difficulties
– Poor Decision-Making
– Difficulty Planning/Organizing
– Memory Loss
Cognitive Decline
• Irreversible Memory
Loss
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Alzheimer’s
Vascular Dementia
Lewey Body Dementia
Frontotemporal
Dementia (Social)
• Reversible Memory
Loss
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Meds/Drugs
Emotional/Depression
Metabloic (Deyhdration)
Sensory Loss
Tumor
Infection
Anemia/B12 Deficiency
NPH
Cognition Strategies
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**IF YOU DON’T USE IT, YOU LOSE IT**
Crosswords/Suduko/Word Finds
Puzzles
Reading (Adaptive equipment)
Appointment Calenders/Memo pads
Sticky Notes
Voice Recorders
Alarm Clocks/Timers
Pill Box/Automatic Pill Dispenser
Label Makers/Electronic Spellers
Cognitive Strategies
**IF YOU DON’T USE IT, YOU LOSE IT**
• Color Coding Files/Sorters
• Key Finders
• Written Instructions/Maps/Cue Cards
• Senior Center
• Church Groups
• Coglink.com (Email Address)
Swallowing and Dysphagia
Swallowing
• Normal swallowing involves a complex
sequence of movements which occur
rapidly and require precise muscle control.
• It takes food/liquids about 2-3 seconds to
pass from the back of the mouth to the
stomach.
• Difficulty with swallowing is known as
Dysphagia.
Dysphagia
• Neurological
– CVA
– Parkinson’s Disease
• Structural
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Stricture
CA
Muscular (age-related)
Diverticulum
• Psychological
– Dementia
– Fear
Dysphagia
• Leads to Aspiration
– Passage of foreign material into the lungs
rather than the stomach.
– Aspiration can lead to severe disease or
death.
– Approximately 60% of aspiration is silent
– Everyone aspirates, however most are
healthy enough to avoid illness.
– Approximately 40,000 people die annually
from Dysphagia complications.
Signs of Dysphagia
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Coughing
Choking
Watery eyes
Wet, gurgly voice
Excess chewing
Residual food in mouth
Pocketing
Change in respiration rate
Change in lung
sound/congestion
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Difficulty breathing
Gagging
Chest pain
Pain
Temperature after eating
Report of “something
stuck in throat”
• Multiple swallows
• Attempts to clear throat
• Pneumonia or chronic
URI
3 Ounce Water Test
• Quick and easy test to check for
dysphagia:
– Pour 3 ounces of water into a cup
– Have patient drink the water taking
normal sips, as many as needed, but
they must be continual.
– Look for any difficulty with swallowing or
inability to drink the full glass in one
attempt.
Diagnosing Dysphagia
• Refer to a Physician
• Refer to Speech and Language
Pathologist (SLP)/Speech Therapist
• Video Esophagram
• Modified Barium Swallow
• ENT to rule out Esophageal causes
Correct
Swallowing
“chin tuck”
Incorrect
Swallowing
Beyond head
neutral
Aspiration Prevention Tips
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Make sure patient is awake/alert.
Small Bites (1/2-1 Teaspoon).
Enourage coughing/clearing airways.
Allow time to swallow and re-swallow.
Relax!!!
Place Spoon on tongue, not in mouth
Watch for larynx to rise and fall
Ensure mouth is empty
Present liquids from midline or below…Not
above.
Aspiration Prevention Tips (cont.)
• Do not Dump liquids in mouth
• Alternate liquids and solids. Drink after every 2-3
bites.
• Alternate hot and cold items.
• END THE MEAL WITH A LIQUID.
• Make sure patient remains upright 30 minutes
after meal.
• Do not “drown” a cough.
• We should take each pill with 4 ozs. of water.
Feeding Posture
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DO’s
Sit upright with hips at 90
degrees of flexion
Head at 45 degrees of
natural flexion.
Head should not be
hyper-extended.
Make sure dentures are
in
And glasses are on, with
proper lighting.
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DON’Ts
Extend head and neck
forward
Sunken chest
Rounded shoulders
Leaning
Protruding abdomen
Slouching
Dysphonia
Dysphonia
• Disorder of the voice; inability to produce
voice using voice organs.
– A phonation problem
– Different from dysarthria, which is a condition
of the voice muscles.
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Weakness
Breathiness
Hoarseness
Strained/struggled
Dysphonia Causes
• Voice Misuse and Abuse
– Yelling
– Smoking
• Trauma
– Heat
– Blunt
• Nervous System
– ALS
– MS
– PD
– Huntington’s Chorea
• Organic Disease
– Granulomas
– Cancer
Dysphonia Signs
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Horseness
Breathiness
Tension
Tremor
Strained-Strangled
Pitch Breaks
Monopitch
Monoloudness
Glotial Fry
Dysphonia Treatments
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Always consult with ENT
Decrease amount of talking
Decrease loudness/Whisper
Limit Caffeine
Eliminate vocal abuse
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Smoking
Throat clearing
Alcohol
Environment
Extra hydration
Speech Therapy
Humidify air
GERD management
HOME SAFETY
Home Safety Tips:
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Good Lighting
Eliminate floor rugs
Eliminate clutter
Eliminate unneeded
furniture
• Elevate height of
chairs/bed
• Safety Rails/Grab bars
• Non-skid mats on all noncarpeted floors
• Non-skid shoes/socks
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Avoid high heels
Avoid slippers
Avoid hard soled shoes
Avoid shoes without backs
Tub bench
Dry Floors
Skids in Shower
Place frequently used
objects at most
accessible locations
Home Safety Tips (cont.)
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Don’t ever stand on a chair or stool
Keep phone within reach
Emergency numbers handy
Pets!!!!!!!
Remove doorway thresholds or have them
covered
• Keep Electrical Cords out of the way
Energy Conservation
• Remember we want to maximize function
• Prioritize tasks that need to get done
– Use planner to assist plan of day/week
• Sit instead of stand to do activities
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Dressing
Shower
Cooking
Folding laundry
Ironing
• Use a lightweight cart to move objects
Energy Conservation (cont.)
• Take breaks to preserve energy
• Minimize trips up and down stairs
• Use of energy saving tools
– Reachers
– Shower brushes
– Electric can opener
– Electric razor
– Dishwasher
Energy Conservation (cont.)
• USING PROPER BODY MECHANICS:
– Sit and stand with good posture
– Lift with your legs, keeping your back straight
– Keep your nose and toes pointed in the same
direction; do not twist your trunk
– Push . . . don’t pull
– Slide . . . don’t lift
– When need be, use both hands to carry items
and hold them close to your body
FALLS
• In the U.S. one of every three people older than age 65
fall each year.
• Falls are the most common cause of injuries and hospital
admissions for trauma among the elderly, and are
recognized as a leading cause of injury and death in the
aged.
• 50% of all fallers fall repeatedly.
• 9,500 elderly deaths each year are related to falls.
• Falls account for 87% of all fracture among people aged
65 or older and are the second leading cause of spinal
cord and brain injury.
• The economic cost of osteoporotic fracture will exceed
$45.2 billion annually.
FALLS (cont.)
• Half of all elderly adults hospitalized for hip fractures
cannot return home or live independently after the
facture.
• For people aged 65 or older, 60% of fatal falls occur in
the home, 30% occur in public places, and 10% occur in
healthcare institutions.
• Risks of falls increases proportionally with age.
• Half of those over age 75 who fracture a hip as a result
of a fall die within 1 year of the incident.
• Between 50% to 90% of elders who report a fall admit to
restricting their activities for fear of another fall.
Fall Risk Factors
Medications that Contribute to Falls
Balance Tests
• Center for Disease Control
– www.cdc.gov/
• Home Safety Council
– www.homesafetycouncil.org/
Rehabilitation Goals
1. Does your family member plan to return home? ____________________
If so, will they live alone? ______________________________________
2. Was your family member walking before this recent hospitalization? ____
Used a cane? _____ Used a walker? ____
Used a wheelchair? ____ Do they have their own wheelchair? _______
How long has it been since they last walked? ______________________
How far where they able to walk? _____________
3. Was your family member able to bath and dress independently? ________
How much help was needed? ___________________________________
4. Did your family member use the bathroom for toileting? ______________
Did they depend on undergarment pads or briefs? __________________
5. Does your family member have difficulty eating or swallowing? ________
___________________________________________________________
6. Have you noticed any increase in confusion or memory problems? ______
____________________________________________________________
7. What are your goals for your family member’s rehabilitation?
____________________________________________________________
Exercise Program
Adapted from “Exercise and Physical Activity, Your Everyday Guide from The
National Institute on Aging”
• Even very small changes in muscle strength can make a
real difference in function, especially in people who have
already lost a lot of muscle. An increase in muscle that
you can’t even see can make it easier to do everyday
things like get up from a chair, climb stairs, carry
groceries, open jars, and even play with your
grandchildren. Lower body strength exercises also will
improve your balance.
• Depending on your condition, you might need to start out
using 1-pound or 2-pound weights or no weight at all.
Your body needs to get accustomed to strength
exercises.
Exercise Program
Adapted from “Exercise and Physical Activity, Your Everyday Guide from
The National Institute on Aging”
• Use a light weight the first week; then gradually add more weight.
Starting out with weights that are too heavy can cause injuries.
• Gradually add more weight in order to benefit from strength
exercises. You need to challenge your muscles to get the most
benefit from strength exercises. (The Progressing section will tell
you how).
– It should feel somewhere between hard and very hard for you to
lift or push the weight. It shouldn’t feel very, very hard. If you
can’t lift or push a weight 8 times in a row, it’s too heavy for you.
Reduce the amount of weight.
– Take 3 seconds to lift or push a weight into place, hold the
position for 1 second, and take another 3 seconds to return to
your starting position. Don’t let the weight drop; returning it
slowly is very important.
– Try to do 10 to 15 repetitions for each exercise. Think of this as a
goal. If you can’t do that many at first, do as many as you can.
You may be able to build up to this goal over time.
Exercise Program
Adapted from “Exercise and Physical Activity, Your Everyday Guide from The
National Institute on Aging”
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Safety
– Talk with your doctor if you are unsure about doing a particular
exercise. For example, if you’ve had hip or back surgery, talk
about which exercises might be best for you.
– Don’t hold your breath during strength exercises. Holding your
breath while straining can cause changes in blood pressure. This
is especially true for people with heart disease.
– Breathe regularly. Breathe in slowly through your nose and
breathe out slowly through your mouth. If this is not comfortable or
possible, breathe in and out through either your nose or mouth.
– Breathe out as you lift or push, and breathe in as you relax. For
example, if you’re doing leg lifts, breathe out as you lift your leg,
and breathe in as you lower it. This may not feel natural at first
and you probably will have to think about it for a while as you do it.
Exercise Program
Adapted from “Exercise and Physical Activity, Your Everyday Guide from The
National Institute on Aging”
• Safety (cont.)
– Proper form and safety go hand in hand. For some exercises,
you may want to start alternating arms and work your way up to
using both arms at the same time. If it is difficult for you to hold
hand weights, try using wrist weights.
– To prevent injury, don’t jerk or thrust weights into position. Use
smooth, steady movements.
– Avoid “locking” your arm and leg joints in a tightly straightened
position. To straighten your knees, tighten your thigh muscles;
this will lift your kneecaps and protect them.
– Muscle soreness lasting a few days and slight fatigue are normal
after muscle-building exercises, at least at first. After doing these
exercises for a few weeks, you will probably not be sore after
your workout.
Exercise Program
Adapted from “Exercise and Physical Activity, Your Everyday Guide from The
National Institute on Aging”
• Progressing: Muscle strength is progressive over time.
– Gradually increase the amount of weight you use to build
strength. When you can do 2 sets of 10 to 15 repetitions easily,
increase the amount of weight at your next session.
– Here is an example of how to progress gradually: Start out with a
weight that you can lift only 8 times. Keep using that weight until
you become strong enough to lift it easily 10 to 15 times.
– When you do 2 sets of 10 to 15 repetitions easily, add more
weight so that, again, you can lift it only 8 times.
– Keep repeating until you reach your goal, and then maintain that
level as long as you can.
Exercise Program
Adapted from “Exercise and Physical Activity, Your Everyday Guide from The
National Institute on Aging”
• Working with a Resistance Band: Resistance bands are stretchy
elastic bands that come in several strengths, from light to heavy.
You can use them in some strength exercises instead of weights.
– 1. Lay the band flat in your hand with the end toward your pinky finger.
– 2. Wrap the long end of the band around the back of your hand.
– 3. Grasp firmly.
• If you are a beginner, try exercising without the band until you are
comfortable; then add the band.
– Choose a light band if you are just starting to exercise, and move on to
a stronger band when you can do 2 sets of 10 to 15 repetitions easily.
– Hold on to the band tightly (some bands have handles), or wrap it
around your hand or foot to keep it from slipping and causing possible
injury.
– Do the exercises in a slow, controlled manner, and don’t let the band
snap back.
Exercises
Hand Grip: This simple exercise should help if you have trouble
picking things up or holding on to them. It also will help you open
things like that pickle jar more easily. You can even do this exercise
while reading or watching TV.
1. Hold a tennis ball or other small rubber or foam ball in one hand.
2. Slowly squeeze the ball as hard as you can and hold it for 3-5 seconds.
3. Relax the squeeze slowly.
4. Repeat 10-15 times.
5. Repeat 10-15 times with other hand.
6. Repeat 10-15 times more with each hand.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Wrist Curl: This exercise will strengthen your wrists. It also will help
ensure good form and prevent injury when you do upper body
strength exercises.
1. Rest your forearm on the arm of a sturdy chair with your hand over the
edge.
2. Hold weight with palm facing upward.
3. Slowly bend your wrist up and down.
4. Repeat 10-15 times.
5. Repeat 10-15 times with other hand.
6. Repeat 10-15 more times with each hand.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Overhead Arm Raise: This exercise will strengthen your shoulders
and arms. It should make swimming and other activities such as
lifting and carrying grandchildren easier.
1. You can do this exercise while sitting in a sturdy, armless chair of
standing.
2. Keep your feet flat on the floor, shoulder width apart.
3. Hold weights at your sides at shoulder height with palms facing forward.
Breathe in slowly.
4. Slowly breathe out as you raise both arms up over your head keeping
your elbows slightly bent.
5. Hold the position for 1 second.
6. Breathe in as you slowly lower your arms.
7. Repeat 10-15 times.
8. Rest; then repeat 10-15 more times.
•
As you progress, use a heavier weight and alternate arms until you can lift the weight
comfortably with both arms.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Front Arm Raise: This exercise for your shoulders can help you put
things up on a shelf or take them down more easily.
1. Stand with your feet shoulder width apart.
2. Hold weights straight down at your sides with palms facing backward.
3. Keeping them straight, breathe out as you raise both arms in front of you
to shoulder height.
4. Hold the position for 1 second.
5. Breathe in as you slowly lower arms.
6. Repeat 10-15 times.
7. Rest; then repeat 10-15 more times.
•
As you progress, use a heavier weight and alternate arms until you can lift the weight
comfortably with both arms.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Side Arm Raise: This exercise will strengthen your shoulders and
make lifting groceries easier.
1. You can do this exercise while sitting in a sturdy, armless chair or
standing.
2. Keep your feet flat on the floor shoulder width apart.
3. Hold hand weights straight down at your sides with palms facing inward.
Breathe in slowly.
4. Slowly breathe out as you raise both arms to the side, shoulder height.
5. Hold the position for 1 second.
6. Breathe in as you slowly lower your arms.
7. Repeat 10-15 times.
8. Rest; then repeat 10-15 more times.
•
As you progress, use a heavier weight and alternate arms until you can lift the weight
comfortably with both arms.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Arm Curl: After a few weeks of doing this exercise for your upper
arm muscles, lifting that gallon of milk will be much easier.
1. Stand with your feet shoulder width apart.
2. Hold weights straight down at your sides with palms facing forward.
Breathe in slowly.
3. Breathe out as you slowly bend your elbows and lift weights toward
chest. Keep elbows at your sides.
4. Hold the position for 1 second.
5. Breathe in as you slowly lower your arms.
6. Repeat 10-15 times.
7. Rest; then repeat 10-15 more times.
•
As you progress, use a heavier weight and alternate arms until you can lift the weight
comfortably with both arms.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Arm Curl with Resistance Band: This variation of the Arm Curl
uses a resistance band instead of weights. (See Working with a
Resistance Band.)
1. Sit in a sturdy, armless chair with your feet flat on the floor shoulder width
apart.
2. Place the center of the resistance band under both feet. Hold each end of
the band with palms facing inward. Keep elbows at your sides. Breathe in
slowly.
3. Keep wrists straight and slowly breathe out as you bend your elbows and
bring your hands toward your shoulders.
4. Hold the position for 1 second.
5. Breathe in as you slowly lower your arms.
6. Repeat 10-15 times.
7. Rest; then repeat 10-15 more times.
•
As you progress, use a heavier strength band.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Seated Row with Resistance Band: This exercise to strengthen
upper back, shoulder and neck muscles should make everyday
activities such as raking and vacuuming easier. (See Working with
a Resistance Band.)
1. Sit in a sturdy, armless chair with your feet flat on the floor shoulder width
apart.
2. Place the center of the resistance band under both feet. Hold each end of
the band with palms facing inward.
3. Relax your shoulders and extend your arms beside your legs. Breathe in
slowly.
4. Breathe out slowly and pull both elbows back until your hands are at your
hips.
5. Hold the position for 1 second.
6. Breathe in as you slowly return your hands to the starting position.
7. Repeat 10-15 times.
8. Rest; then repeat 10-15 more times.
•
As you progress, use a heavier Strength band.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Wall Push-Up: These push-ups will strengthen your arms,
shoulders, and chest. Try this exercise during a TV commercial
break.
1. Face a wall, standing a little farther than arm’s length away, feet
shoulder-width apart.
2. Lean your body forward and put your palms flat against the wall at
shoulder height and shoulder width apart.
3. Slowly breathe in as you bend your elbows and lower your upper body
toward the wall in a slow, controlled motion. Keep your feet flat on the floor.
4. Hold the position for 1 second.
5. Breathe out and slowly push yourself back until your arms are straight.
6. Repeat 10-15 times.
7. Rest; then repeat 10-15 more times.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Elbow Extension: This exercise will strengthen your upper arms. If
your shoulders aren’t flexible enough to do this exercise, try the
Chair Dip.
1. You can do this exercise while sitting in a sturdy, armless chair or
standing.
2. Keep your feet flat on the floor shoulder width apart.
3. Hold weight in one hand with palm facing inward. Raise that arm toward
ceiling.
4. Support this arm below elbow with other hand. Breathe in slowly.
5. Slowly bend raised arm at elbow and bring weight toward shoulder.
6. Hold the position for 1 second.
7. Breathe out and slowly straighten your arm over your head. Be careful
not to lock your elbow.
8. Repeat 10-15 times.
9. Repeat 10-15 times with other arm.
10.Repeat 10-15 more times with each arm.
•
If it is difficult for you to hold hand weights, try using wrist weights.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Chair Dip: This pushing motion will strengthen your arm muscles
even if you are not able to lift yourself up off the chair.
1. Sit in a sturdy chair with armrests with your feet flat on the floor, shoulder
width apart.
2. Lean slightly forward; keep your back and shoulders straight.
3. Grasp arms of chair with your hands next to you. Breathe in slowly.
4. Breathe out and use your arms to push your body slowly off the chair.
5. Hold position of 1 second.
6. Breathe in as you slowly lower yourself back down.
7. Repeat 10-15 times.
8. Rest; then repeat 10-15 more times.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Back Leg Raise: This exercise strengthens your buttocks and lower
back. For an added challenge, you can modify the exercise to
improve your balance. (See Progressing to Improve Balance)
1. Stand behind a sturdy chair, holding on for balance. Breathe in slowly.
2. Breathe out and slowly lift one leg straight back without bending your
knee or pointing your toes. Try not to lean forward. The leg you are standing
on should be slightly bent.
3. Hold the position for 1 second.
4. Breathe in as you slowly lower your leg.
5. Repeat 10-15 times.
6. Repeat 10-15 times with other leg.
7. Repeat 10-15 more times with each leg.
•
As you progress, you may want to add ankle weights.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Side Leg Raise: This exercise strengthens your hips, thighs, and
buttocks. For an added challenge, you can modify the exercise to
improve your balance. (See Progressing to Improve Balance.)
1. Stand behind a sturdy chair with feet slightly apart, holding on for
balance. Breathe in slowly.
2. Breathe out and slowly lift one leg out to the side. Keep your back straight
and your toes facing forward. The leg you are standing on should be slightly
bent.
3. Hold the position for 1 second.
4. Breathe in as you slowly lower your leg.
5. Repeat 10-15 times.
6. Repeat 10-15 times with other leg.
7. Repeat 10-15 more times with each leg.
•
As you progress, you may want to add ankle weights.
Courtesy of Rehabcare's Smart
Moves Program.
Exercise
Knee Curl: Walking and climbing stairs are easier when you do
both the Knee Curl and Leg Straightening exercises. For an added
challenge, you can modify the exercise to improve your balance.
(See Progressing to Improve Balance.)
1. Stand behind a sturdy chair, holding on for balance. Lift one leg straight
back without bending your knee or pointing your toes. Breathe in slowly.
2. Breathe out and slowly bring your heel up toward your buttocks as far as
possible. Bend only from your knee, and keep your hips still. The leg you
are standing on should be slightly bent.
3. Hold the position for 1 second.
4. Breathe in as you slowly lower your foot to the floor.
5. Repeat 10-15 times.
6. Repeat 10-15 times with other leg.
7. Repeat 10-15 more times with each leg.
•
As you progress, you may want to add ankle weights.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Leg Straightening: This exercise strengthens your thighs and may
reduce symptoms of arthritis of the knee.
1. Sit in a sturdy chair with your back supported by the chair. Only the balls
of your feet and your toes should rest on the floor. Put a rolled bath towel at
the edge of the chair under thighs for support. Breathe in slowly.
2. Breathe out and slowly extend one leg in front of you as straight as
possible, but don’t lock your knee.
3. Flex foot to point toes toward the ceiling. Hold position for 1 second.
4. Breathe in as you slowly lower your leg back down.
5. Repeat 10-15 times.
6. Repeat 10-15 times with other leg.
7. Repeat 10-15 more times with each leg.
•
As you progress, you may want to add ankle weights.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Chair Stand: This exercise strengthens your abdomen and thighs,
will make it easier to get in and out of the car. If you have knee or
back problems, talk with your doctor before trying this
exercise.
1. Sit toward the front of a sturdy, armless chair with knees bent and feet flat
on the floor, shoulder width apart.
2. Lean back with your hands crossed over your chest. Keep your back and
shoulders straight throughout the exercise. Breathe in slowly.
3. Breathe out and bring your upper body forward until sitting upright.
4. Extend your arms so they are parallel to the floor and slowly stand up.
5. Hold the position for 1 second.
6. Breathe in as you slowly sit down.
7. Repeat 10-15 times.
8. Rest; then repeat 10-15 more times.
•
People with back problems should start the exercise from the sitting upright position.
Courtesy of Rehabcare's Smart
Moves Program.
Exercises
Toe Stand: This exercise will help make walking easier by
strengthening your calves and ankles. For an added challenge, you
can modify the exercise to improve your balance. (See Progressing
to Improve Balance.)
1. Stand behind a sturdy chair, feet shoulder width apart, holding on for
balance. Breathe in slowly.
2. Breathe out and slowly stand on tiptoes as high as possible.
3. Hold the position for 1 second.
4. Breathe in as you slowly lower your heels to the floor.
5. Repeat 10-15 times.
6. Rest; repeat 10-15 more times.
•
As you progress, try doing the exercise standing on one leg at a time for a total of 10-15
times on each leg.
Courtesy of Rehabcare's Smart
Moves Program.
Exercise Program
Adapted from “Exercise and Physical Activity, Your Everyday Guide from The
National Institute on Aging”
• How to Improve Your Flexibility
– Stretching or flexibility exercises are an important part of your
physical activity program.
– They give you more freedom of movement for your physical
activities and for everyday activities such as getting dressed and
reaching objects on a shelf.
– Stretching exercises can improve your flexibility, but will not
improve your endurance or strength.
• How Much, How Often
– Do each stretching exercise 3 to 5 times at each session.
– Slowly stretch into the desired position, as far as possible
without pain, and hold the stretch for 10 to 30 seconds. Relax,
breathe, then repeat, trying to stretch farther.
Exercise Program
Adapted from “Exercise and Physical Activity, Your Everyday Guide from The
National Institute on Aging”
•
Safety
– Talk with your doctor if you are unsure about a particular exercise. For example,
if you’ve had hip or back surgery, talk with your doctor before doing lower-body
exercises.
– Always warm-up before stretching exercises. Stretch after endurance or strength
exercises. If you are doing only stretching exercises, warm up with a few minutes
of easy walking first. Stretching your muscles before they are warmed up may
result in injury.
– Always remember to breathe normally while holding a stretch.
– Stretching may feel slightly uncomfortable; for example, a mild pulling feeling is
normal.
– You are stretching too far if you feel sharp or stabbing pain, or joint pain – while
doing the stretch or even the next day. Reduce the stretch so that it doesn’t hurt.
– Never “bounce” into a stretch. Make slow, steady movements instead. Jerking
into position can cause muscles to tighten, possibly causing injury.
– Avoid “locking” your joints. Straighten your arms and legs when you stretch them,
but don’t hold them tightly in a straight position. Your joints should always be
slightly bent while stretching.
•
Progressing
– You can progress in your stretching exercises. For example, as you become
more flexible, try reaching farther, but not so far that it hurts.
Flexibility Exercises
Courtesy of Rehabcare's Smart
Moves Program.
Flexibility Exercises
Courtesy of Rehabcare's Smart
Moves Program.
Flexibility Exercises
Courtesy of Rehabcare's Smart
Moves Program.
Flexibility Exercises
Courtesy of Rehabcare's Smart
Moves Program.
Flexibility Exercises
Courtesy of Rehabcare's Smart
Moves Program.
Flexibility Exercises
Courtesy of Rehabcare's Smart
Moves Program.
Flexibility Exercises
Courtesy of Rehabcare's Smart
Moves Program.
Flexibility Exercises
Courtesy of Rehabcare's Smart
Moves Program.
Flexibility Exercises
Courtesy of Rehabcare's Smart
Moves Program.
Special Thanks
• RehabCare: A Division of Kindred HealthCare
• Melanie Heck
• Susan Bolash