Transcript promoting activity in persons with low vision and diabetes

PROMOTING ACTIVITY IN
PERSONS WITH LOW VISION
AND DIABETES
Stephen C. Rankin, OTD, MOT, MS
• Visual impairment is one of the leading causes of disability
and it often leads to a less active lifestyle. Diabetes
incidence has increased in the US population and is a
major contributing factor to disability and increased
mortality. The inactivity associated with perceptual
impairment can contribute more to a decline in health status in
diabetics than those with normal blood glucose levels.
Lifestyle modifications are difficult due to both the limits of
perception and the disease state. Diabetics with low vision
represent a sub-group of low vision patients with special needs
and conditions based on their metabolic pathology. The goal
of the described program is to promote the ability of low
vision to engage in activities and to meet those needs by
overcoming barriers related to common perceptual-visual
limits that accompany their pathology.
Visual Impairment and DM
• Address barriers, Attempt to remedy the disconnect that
exists between services and needy people and will create
a participant guided approach in a primarily auditory
based format to address those who are unable to leave
their home with ease.
Initial Challenge
• Persons who have low vision (some were legally blind)
• Persons who (primarily) have Type 2 DM
• Persons who have lost, are losing or are in fear of losing their active
lifestyles, their friends, their abilities to read, drive and with a new
eye-dentity crisis
• Persons who are often depressed and have lost sight of their own
sense of personal wellness
• Persons who may not only have lost sight but may become
INVISIBLE or unseen within their own social arenas
• Persons who need to realize again their own worth, their own
potential for self-actualization and their value to others
Who?
• United States, approximately 3 million people have low vision,
about a million are legally blind, and 200,000 are severely
visually impaired (retrieved from:
www.ahrq.gov/clinic/vision). Visual impairment is a
considerable issue at local and national levels. Diabetics
comprise one of the largest groups of low vision patients. The
American Diabetes Association reports 8.3% of the population
of the United States is diabetic (attained
fromhttp://professional.diabetes.org/admin/UserFiles/0%20%20Sean/FastFacts%20March%202013.pdf). Diabetes is also
the leading cause of blindness in those 20 to 74 years of age.
Some degree of retinopathy and related vision loss is present in
28.5% of diabetics. The annual healthcare related costs of the
disease are estimated by the American Diabetic Association as
$245 billion
DM compounding the problems
• Not just diabetic retinopathy most are cataracts and AMD
• Neuropathy (coupled with perceptual impairment increases
falls far greater than just visual impairment)
• Weakness
• Deconditioned
• Fearful, depressed and poorly motivated
• UNSAFE (Falls and genuine concern are real)
Person Factors
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Low vision adaptive devices
large-print reading material
large-button telephones
enlarged checks
felt-tip pens for writing
large-print playing cards
needle readers
talking watches
bump dots for dials
tactile devices for glucose monitoring
Self-Care: Become Aware of Low
Vision AE and visual or optical aids
They are worth it
“Self-care is never a selfish act - it is simply good
stewardship of the only gift I have, the gift I was put on
earth to offer others. Anytime we can listen to true self and
give the care it requires, we do it not only for ourselves, but
for the many others whose lives we touch.”
Parker Palmer
More Wisdom of the
Greats…
• They have given up hope
• Different stages of grieving functional loss
• “If you wish to find yourself, you must first admit you are
lost.”
Brian Rathbone
Must be at a point they are
ready to move forward –
Motivation Needed
• They may feel isolated, hopeless and unable to move
forward
• “No matter who you are, no matter what you did, no
matter where you've come from, you can always change,
become a better version of yourself.”
Madonna
• Address visual deficit and immediate safety first
Perception was usually
the primary barrier
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Graded home activity program
Diabetes, low vision and compounded problems
The program, the delivery and what worked
The unfriendly community
The idea, the program and what didn't’t work
Why increased activity is necessary
Activity with the goal of formal exercise/Reverse Task Analysis
Formal exercise with the goal of improved activity
Barriers and addressing them
Falls, fear and the idea of base fitness
Compound and functional
Training systems applications and integration
Things we will talk about
Rationale:
Visual impairment is a leading cause of
disability and often results in people with the
condition engaging in less activity.
BACKGROUND
There is an inverse relationship between activity participation and low
vision; however, little has been written on interventional strategies
(Berger, McAteer, Schreier, & Kaldenberg, 2013)
People with low vision often have lower levels of general fitness than
the general population (The American College of Sports Medicine
[ACSM], 2010, Crews & Campbell 2004)
VISION FIRST THEN INCREASE
NEEDED ACTIVITY FOR DM
The inclusion of an exercise program or other means of
increasing overall PA (physical activity) is critical for optimal
health in individuals with type 2 diabetes” (Colberg, 2010 )
Research … Even simply standing is useful..
Rationale:
Supporting Literature
Setting the Context
Well-Elderly Study by Jackson, Carlson, Mandel , Zemke and Clark (1998)
Compared active adults 60 or older, with no OT lifestyle intervention to a group
with OT intervention.
Demonstrated effectiveness of a structured, occupation-focused, individualized
therapy treatment on health promotion. The authors concluded OT was beneficial
in enhancing physical, mental and occupational measures of functioning
• Jackson J, Carlson M, Mandel D, Zemke R, Clark F
(1998). Occupation in Lifestyle Redesign: The Well
Elderly Study Occupational Therapy Program
American Journal of Occupational Therapy, 52 (5):
326-36
• This and the subsequent study are large and as far as OT
evidence based are REQUIRED READING for all Ots
• Look them up, Read them if you have not
Well Elderly Studies
• Those with lower vision were 1.8 times more likely to
fall in the past year (26.0%) and 1.7 times more likely to
have broken a hip (6.3% vs 3.8%). They had higher
risk of other health consequence. They were 2.6 times as
likely to suffer a stroke and more likely to have heart
attack. Hypertension was also higher in those with
vision problems
DM with low vision is very risky
• Those with low vision are also two times more likely to report
being frequently depressed or anxious than those without
sensory problems. The visually impaired group is 3 times
more likely to report trouble walking and 3.3 times more likely
to report difficulty getting outside than others of the same
age. They are 2.8 times more likely to report difficulty getting
in or out of bed or a chair. The visually and hearing impaired
were between 4 and 7 times more likely to report difficulty
getting meals and about 4 times more likely to have
difficulty managing medications. While 74% of those
without perceptual impairment reported visiting friends only
66.8% of those with vision impairment reported doing so …
• Crews, J. E., & Campbell, V. A. (2004). Vision
Impairment and Hearing Loss Among CommunityDwelling Older Americans: Implications for Health
and Functioning. American Journal of Public
Health, 94(5), 823–829. doi:10.2105/AJPH.94.5.823
• Blood sugar control (Colberg, et al, 2010)
• Increased function; socialization; prevention of cardiac
disease (Chau, et al, 2012) and decreased risk of falls are
just a few.
Primary 2 Reasons Exercise
Needed in the Target Group
• Resistance training exercise may be of greater value to
diabetics than aerobic activity according to some studies
(Castaneda, 2011 and Diabetes Health Center, 2010).
Other research indicates sustained activity of sufficient
intensity is just as good. Some persons cannot engage in
sufficient resistance activity.
• The goal of the program must center around the goal of
the patient. The best therapies eliminate the barriers to
occupational role fulfillment and that requires a highly
tailored approach and is customizable by the participant
Types
Rationale:
•Background/Context
AGAIN:
Sundsli, Söderhamn, Espnes, and Soderhamn (2014)
Examined the effects of a telephone-based self-care intervention on persons
over 75.
Group-based chat sessions were primary source of information
Improved mental health was the indicated effect of the self-care telephone
talks, attributed improved mental health as important for establishing selfcare proficiency in older home-dwelling persons.
Will repeat this again (very significant in formulation or this program)
• Regular exercise is anti-inflammatory and has many
benefits but initial conditioning must be attained and
requires a guided and graded approach (De Lemos, et al,
2012)
• Household level activity to prepare for more intensive
activity or exercise
Pre-Exercise Conditioning
• Group based activities do tend to be more easily adopted
than those simply provided via education (Broxterman,
2012).
• Access
• Walks (group, treadmill, perimeter walking, dog, white
cane)
• Activity inventory, their goals, again customized
If it is necessary medicine then
it becomes an act of self-care
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Glucose control – receptor sensitivity/decrease resistance DM2
Trained liver (type II), Increased glycogen mgt
Contraction glucose mgt. Indep of insulin (especially Type 2
Morning exercise risk DM I (hypoglycemia and increased breakdown = elev.
glucose)
Decreased falls increased strength
Improved renal, kidney, heart and eye health
Decreased PN
Improved mobility and decreased
Increased socialization, decreased depression
Decreased atrophy and age related sarcopenia
Post exercise glycogen synthetase activity
Epigenetic – mRNA and methylation level
Improved Well being
Improved lipid profile including HDL:LDL
Exercise & Activity are Medicine
Context and Setting
Interview Questions and Suggested Interventions.
Needs Assessment
Study Question
Do these patients have barriers to
Response
100% Yes
exercise?
Do these patients have barriers to
100% Yes
Possible Intervention
Outcome
Assessment
Home Exercise
Increase
Increased HEP related
Program
Activity
mobility and
Readiness
Fitness
Increase
Increased social/
Public Access
Recreational
Address public transport/access
social/recreational activities?
activity
Do these patients have problems with
self-care /safety?
100% Yes
Intro to related aids?
Improve Safe Self-Care
Decreased home based
Intro to Low Vision
Proficiency
barriers to home and
Providers?
Provide Safety awareness checklist
BACKGROUND AND NEED
community activities
• “Plans are only good intentions unless they immediately
degenerate into hard work”
Peter Drucker
• Assessment to Determine Needs
• Observation and interview of clinical staff were obtained in
a manner which provided qualitative assessment based on
professional experience. Time constraints, to ensure patient
confidentiality, study control and the significant expertise and
experience of those interviewed were all a part of the reasons
the type of data and methodology was employed. Observation
done was of one of the largest eye clinics in Nevada and
included several specialists unique to the state including the
state’s only neuro-ophthamologist. Physicians and patient care
associates were interviewed as they were the ones with direct
clinical patient care responsibilities and contact.
Needs Assessment Interview
Program Description
Findings: Respondents indicated:
• Barriers (to exercise, safety, self-care, social and community activities)
Evident in most of the patients.
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Program should address those barriers as well as low vision and visual aid
training, transportation; and both community and home based mobility.
• They indicated the community lacked services for persons with low vision
with poor coordination.
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Low vision therapy, transportation services, services to address self-care and
independence, should be priorities.
• OT low vision services would likely be beneficial.
THE PROGRAM
Setting and Population:: Vision Center Patients in Las Vegas NV
Gap Analysis
Current State
Goal State
Unsafe: Falls Risk
Safe
Factors
Barriers
Environment
Impaired roles
Poor control
Action
Safety Ed.
Home Training
Environmental Mod
Activity
Self-Management
MD Visit
Possibly Depressed
Engaged
Social Isolation
Social Activity
Impaired Transport
Apprehension
Impaired Self Care
Proficient
Perceptual Limits
Promote Low Vision
Simulate ADL Activity
Poor Access
to Services
Access to Low Vision
Community Services
Transportation
Safety
Mobility
Education for Transit and Safety
Transit Use Ed
Why Telephone based
• Effective at treating mental health and improving SelfCare performance,\
• Sundsli, K., Söderhamn, U., Espnes, G. A., &
Söderhamn, O. (2014).
• Not invasive, confidentiality with the opthomology
patients
• They simply could not make it to an in person meet up
Telephone approach necessity
• The intervention group reported improvement of
symptom severity and quality of life, with better scores
on all of the tests. Improved patient and physician
communication
Telephone intervention
both effective and feasible
• Balato, N., Megna, M., Di Costanzo, L., Balato, A., &
Ayala, F. (2013). Educational and motivational
support service: a pilot study for mobile-phonebased interventions in patients with psoriasis. The
British Journal of Dermatology, 168(1), 201-205.
http://dx.doi.org/10.1111/j.1365-2133.2012.11205.x
More
A Number of other studies
support telephone
intervention
• Blickem, C., Kennedy, A., Jariwala, P., Morris, R., Bowen, R.,
Vassilev, I., Rogers, A. (2014). Aligning everyday life
priorities with people's self-management support
networks: an exploration of the work and implementation
of a needs-led telephone support system. BMC Health
Services Research, 14, 262. doi:10.1186/1472-6963-14262
• Brown, R., Pain, K., Berwald, C., Hirschi, P., Delehanty, R., &
Miller, H. (1999). Distance education and caregiver
support groups: comparison of traditional and telephone
groups. Journal Of Head Trauma Rehabilitation, 14(3),
257-268.
For teaching and intervention
• Patnaik, L., Joshi, A., & Sahu, T. (2015). Mobile PhoneBased Education and Counseling to Reduce Stress
Among Patients with Diabetes Mellitus Attending a
Tertiary Care Hospital of India. International
Journal Of Preventive Medicine, 61-4 .
doi:10.4103/2008-7802.156267
NOT Less Stress for the OT
Theoretical Framework
• Designed around the Ecology of Human Performance, a
conceptual framework created by occupational therapists
(Scaffa, Reitz, & Pizzi, 2010). Occupational performance
is best considered in context and realized as both unique
and dynamic (Scaffa et al., 2010,). Effective promotion
of activity in persons with visual impairment warrants a
role-based focus, with repaired roles restoring the ability
to engage in activity (Scaffa et al., 2010).
• The Ecology of Human Performance is a good fit as
involves creating, preventing, establishing, alter,
modifying factors as intervention (Scaffa, 2010)
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Medical Readiness
Safety
Self-care
Activity Promotion
Exercise Adoption or high level activity (Greatest
medical benefit and integration of this as a lifestyle
change)
Logical Process (base on pt.
goals)
Theoretical Framework
Establish and Restore for the person
Develop and improve skills and abilities to increase occupation specific task
performance.
Connect to restorative services.
Adapt and Modify the target task
Important to consider social and cultural environment as well. Employ
social constructs and services.
Prevent possible negative outcomes
Attempt to avoid it using any of the other intervention strategies before problem
develops. Inform regarding safety and prevention.
Create opportunities to support occupational performance in personal context
Alter Improve fit
Do not change person, task, or context use existing person, task and context
factors.
Facilitate customization of services to desired activities and roles.
Gathered from: https://prezi.com/qf3cfedv1m36/ecology-of-human-performance/
Theory, Framework and Implication: Considerations of NPS
The National Prevention Strategy (NPC) (National Prevention Council,
2011)
Outlines a plan to employ preventive measures to improve the health
and wellness of the nation. The plan identifies needs and related
strategies established to implement the formulated plan.
http://www.surgeongeneral.gov/priorities/prevention/strategy/
Four strategic directions of the National Prevention Strategy are to promote healthy
and safe community environments, clinical and community preventive services,
empowered people, and to eliminate health disparities.
The low vision program was in part, inspired by the NPC. The primary focus of
the program was to empower persons of Las Vegas with low vision to engage
in active living and to eliminate health disparities.
The use of coordinated clinical and community services were advocated. The
desired influence was to empower the participants in the program through
information and instigated interaction so that they could choose a path of their
choice and establish activity promoting roles.
Become familiar with the NPS
• Purpose Statement:
The goal of the low vision program was to
address areas of concern for the identified population
of low vision persons in Las Vegas. This included:
supporting the integration of health care services, use
of alternative transportation services, improving
healthy and safe home environments, and convening
diverse partners in promoting community health
efforts directed at enabling safe home and
community interaction (National Prevention Council,
2011).
PROGRAM OVERVIEW AND DESCRIPTION
Vision Focused First
Program Description
• Method
• The program was designed based on successful
similar programming for other populations and
modified in method of delivery. Telephone meetups for compliance at the home level for persons
with visual impairment unable to leave home
without difficulty.
PROGRAM OVERVIEW AND
DESCRIPTION
Module 1: Self-Care Activities- self-care, safety and proficiency direct to services
Module 2: Safety and Community Access- awareness of safety
community level, transportation recommend training.
Module 3: Low Vision Introduction and Community services
low vision aids and equipment related community services
Module 4: Low vision doctors and professional services and transportation
Module 5: Social Activities and Contacts - community center, accommodating gyms,
mall walking and activity promotion.
Fitness, recreational and social activities and events.
Planned final meet-up for both summary and networking with available services
PROGRAM OVERVIEW AND DESCRIPTION
Survey and Assessment
Not Effective
Somewhat
Very
Not Rated
Score
Physical Activity
0
1
9.0(90%)
.0
19/20
Social Activity
0
0
10(100%)
0
20/20
Home Exercise
0
1
9(90%)
0
19/20
*HEP Memory
1
4
5(50%)
0
14/20
Self-Care
0
1
9(90%)
.0
19/20
Safe Home Leisure
0
3
7(70%)
.0
17/20
Improve Home
0
2
8(80%)
.0
18/20
Service Awareness
0
1
9(90%)
0
19/20
Service Use
1
2
7(70%)
.0
16/20
*DM
0
2
8(80%)
.0
18/20
Transportation Use
2
1
7(70%)
.0
15/20
Program Effective
0
2
8(80%)
.0
18/20
Addressed Needs
0
1
9(90%)
0
19/20
Continuous
0
1
9(90%)
.0
19/20
Effectiveness topic
Safety
Understanding
Program
PROGRAM EVALUATION
Survey and Assessment
Survey Outcomes and Participant Open Ended Questions of the Activity Promotion Program
Trend/Response
Suggested Solution/
Response
Indicated Problem
Comments
Service and Resource Info
Raise Awareness
Program Purpose
More Resources
Increase resource
Poor
Awareness
Inadequate resources
Youtube Video
5 would access
5 do not use computers
Interest in exercise video
10 Yes
100% stated yes
Would use texted info
8 No 2 Yes
80% unable
Would use emailed info wav
8 No 2 Yes
80% would not
Would use web info
6 No 4 Yes
60% would not
Would attend meet-ups
3 Yes 2 Maybe 5 No
Phone format useful
10 Yes
100% stated yes
Was Program Useful
10 Yes
100% stated yes
PROGRAM/ PROGRAM EVALUATION
Influenced
program
50% computer
access
Perceived as effective and with a general improved perceived ability
to engage in activity. Most were scored very effective at 70% or higher.
Only memorability of the home exercise program (HEP) had a score of 50%,.
An individualized intervention was indicated as desirable. The persistence
of barriers to engaging effectively particularly due to transportation difficulties,
is evident.
IN GENERAL POSITIVE
REVIEWS
Program did allow for in home connection without transportation
to a group. Modifications included : rescheduling of programs
around the holiday, the modification of survey administration and
the lack of participation in the final session, were the most
significant amendments to the program. Changes in survey
administration continued after modifications were made to allow
for in person survey administration. Survey completion required
many repeat calls to the participants.
FEASIBLE ALLOWING FOR
PARTICIPATION
1.
2.
3.
4.
5.
Integrates well with other programs that are designed to meet client
needs and will assist with leading participant in logical sequence so
that needs are met across services
Is low cost
Aligned with National Prevention Strategies
Is adaptable to a variety community environment
High degree of customization by the participant
DISCUSSION/IMPLICATIONS
MORE IMPLICATIONS
Physicians, family members and participants
want EXERCISE enabled by activity
• https://www.youtube.com/watch?v=lHPcvU6Ytyk&featu
re=youtu.be
Exercise as the goal of
activity (Reversing
Paradigm)
1. By increasing the logical connectivity and sequence of
services in any community for persons with low vision this
may be applied by numerous service providers to serve the
broader needs of the persons they serve.
2 .The need for this integrated approach appears to exist on a
national if not global scale and could be adapted far beyond
the bounds of Las Vegas.
3. Participants all indicated they wanted program continuation
PROGRAM CONTINUATION
The persistence and sustainability of the
program is dependent on continued finding a
willing and able, interested stakeholder.
“BLIND CONNECT” IMPORTANT
PARTNER
Teaching, Education and The Gap:
New tools should be explored.
Community services may limit.
Modification may be required.
Low technology may be more acceptable by some.
Environment and service may limit even motivated.
TECH AND SERVICE ISSUES
Environment must be considered.
Directed specific programs are desired.
Research implications include:
Public Services (Advocacy).
Low tech phone for learning.
Facility and services are lacking.
OT Practice and Research
Need to further address
• Due to many perceptual barriers the use of low tech,
operator assisted, rather than automation was highly
desired by almost all the participants
PERSON OVER AUTOMATION
• The service of Blind Connect, made this program much
more feasible
• http://blindconnect.org/programs.html
• 90 HOURS of in home training for legally blind
• O and M, OT etc. Self-Care Focus
THEIR MODEL WAS CRITICAL
QUESTIONS ABOUT THE
PROGRAM?
The Biggest Barriers:
Falls and Fear
• Balance
• Depth perception
• Avoiding obstacles
• Mobility
Falls increased by
perceptual impairment?
• Balance (vestibulation)
• Cognition/State
• Pain/Neuropathy
• Mobility/Kinesthesia
• Proprioception
• Weakness
Falls increased by DM
• Balance - Environment, PT, Tai Chi and
other activities
• Cognition/State – varied and barrier to
participation
• Pain/Neuropathy – medical tx, glucose
control
• Mobility/Kinesthesia – Activity/Exercise
• Proprioception – As above, long term
• Weakness – PT, conditioning (where?)
DM factors more long
term intervention
These longer term
strategies merit a
conditioning focus and
a lifestyle change
• Impaired contrast sensitivity
• Ability to see edges of borders and objects
• Contrast between light and dark
• Fields of vision changes
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Cataracts – blurry images; double images
Macular degeneration – loss of central vision
Glaucoma – tunnel vision
Diabetic retinopathy – random blind spots
Common visual
difficulties – Not just DMR
• Reduced depth perception (stairs, use contrast)
• Impaired dark adaptation (lighting)
• Affects spatial orientation at night
• Moving between light and dark places
• Reduced color perception (blues, greens, purples)
Common visual
difficulties
Eye Conditions in many parts of the eye can affect vision
and falls
Optic nerve
Cataracts
•
http://www.eyectexas.com/cataracts/
View with clear vision.
Cataracts
View with cataracts.
Normal macula
Wet macular degeneration
Macular Degeneration
Blood in the macula
View with clear vision
View with macular degeneration
Macular Degeneration
View with clear vision
Glaucoma
View with glaucoma
Diabetic Retinopathy
Retinopathy was NOT
the primary visual
impairment seen in
this group – It did
vary
Lighting
• Try different types of lighting as well as different wattages
to see what works best
• Broad spectrum fluorescent lighting works best for large
areas
• Use natural light by opening blinds and curtains
• Halogen lighting works best to enhance contrast between
print and background
• Pay special attention to early sunsets
**Improved illumination at home can
improve visual ability**
• Your environment should provide maximum visibility and minimal hazard.
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Clear up clutter, i.e. tripping hazards, throw rugs
Rugs should have flat edges, secure to the ground
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Be aware of small furniture, such as table legs and mobile furniture with casters
that can intrude on pathways.
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Move slowly: your eyes need time to adapt to sudden changes in lighting or
environment.
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Scan
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Use absorbent robe (avoid standing on 1 foot on slippery surface)
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Not skid in and out of shower/non-skid wax (Falls)
Environment & Behavior
• Your environment should provide maximum visibility.
• Use color contrast or safety strips to highlight step edges
and changes in level, making them safer.
• Scan ahead for hazards when outdoors.
• Be careful of pets. Feed them away from doorways and
pathways.
• Wipe up spills right away.
Environment & Behavior
• Bifocals, multifocals, and progressive lenses have been
implicated in falls.
• They can distort depth perception and diminish the ability to
see obstacles and tripping hazards, gutters, curbs, and step
edges.
• Take the time to adjust to them by learning to move your head
when negotiating changes of level and scanning ahead.
• Do they steam up
• DISCUSS YOUR NEEDS WITH YOUR EYE DOCTOR
Multifocal Glasses
• Wear sunglasses or colored lenses
• Routine eye exams (once yearly if no known
underlying conditions)
• Clean glasses on a regular basis
Falls and Related Fear are
HUGE
• https://www.youtube.com/watch?v=kw9F0Ix_vA&feature=youtu.be
• HIT protocol
• A good gym based goal but doesn’t translate well to home
activity
5 Minutes of Exercise
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We push
We pull up or lift or row
We Squat
We Stand
We Get up
We walk
Classifying Movement
What should activity focus
on?
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Falls
Hypertension (especially isometric and head low)
Eye integrity
Orthopedic injury
Injury related to vascular impairment
Glycolysis or Hypoglycemia
DOMS and other muscle pain limiting activity
• Lower and not to failure reps less likely to lead to pain
Dangers of Exercise
(Acute) When Px apply
• Exercise is a specific form of physical activity —
planned, purposeful physical activity performed with the
intention of acquiring fitness or other health benefits,
When it is not possible to access facility or situations
allowing for medically prescribed activity gradation of
activity may promote the ability to later exercise, The
two become less unique and more complementary.
Exercise Vs Activity
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Improves or involves
Standing
Sitting
Kneeling
Jumping
Fall resistance (greater strength = lower risk)
Squatting
Squat and Combined push
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Walker
Pushing up from chair or bed
Washing a surface (stand of 4 point)
Chest Press/Dips
Reduces falls risk in those eccentric control to sit or
FWW
Pushing
Squat and pushing
Overhead (low load)
PULL: LIFT CURL ROW
• GENERAL COMPOUND and FUNCTIONAL
APPROACH
• Pushing
• Overhead
• Pulling
• Squatting
• UP From Bed or floor
• Most are not going to use written program
POPS Walks (functional
and memorable program)
• Conditioning for most daily activities can be derived from
or classified within these categories
• Most gym or home based exercises can also be classified
in this way
• Function focused, exercise for activity and when no gym
or formal options are available activity as training for
future exercise (or as exercise itself)
General patterns – Easier to
Describe over phone
• Principles to blur the scope of exercise and activity
Activity to promote
Exercise? Really?
Discussion
• The gym, the track, the mall may never become
assessable
• Consider making the challenges of home safer but
perhaps no less challenging (perhaps progressively more
challenging)
• If Activity promotes exercise and exercise is medicine
Increasing safe activity makes it a more useful modality
The HOUSEHOLD ATHLETE
• Activity: Gym based conditioning techniques and how
conditioning for them could be completed in home.
Training Systems
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HIT (Great research, not very feasible)
3x10
Circuit (feasible in gym methods)
EDT (Feasible)
Old soviet concepts (daily cumulative frequency works well) 5
reps tops, never to failure, (lower falls)
The all day workout (cumulative – may track)
Stationary Aerobic or intervals (feasible when available)
HITT 4 min on a bike
Need baseline fitness and ability to navigate
Again initially chair level fitness
Training Systems Applied
to Daily Activity
• EDT Circuit
• 3-5 reps x 5 or 10 minutes track the reps x wt x sets
Volume
• Squat-Row-Push up
• CAN be applied to activity
EDT and Circuit Training
EDT, Pavels outlined Soviet Techniques, Circuit all share
common concepts
Avoid failure
Avoid Fatigue
Tolerate more volume and or frequency
Stability and control are necessary
Chair level or controlled space may be needed initially
May need to establish base fitness sitting in a chair at home
(None of the gyms were modified and trainers unaffordable)
Fatigue Management
• Tai Chi, Chi Gong (enhance other senses and decrease
falls)
• https://www.youtube.com/watch?v=RNy353C_ivM
• Yoga modified mat and cd for blindness and visual
impairment
• https://www.youtube.com/watch?v=G0wUo-c-AGg
Other Activities
• Establish Safety at home and Find Community Resource
• Environment
• Address Vision and Perceptual Limits
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General Mobility for Self-Care
Chair level Fitness (Stable and POPS)
Topographic (Introduce after safety)
Falls and fall recovery
Increase in a graded manner especially frequency
Mimic Fatigue management training
Assess Home for both safety and useful training challenges
(the bottom step or 2)
Recommendations/Summary:
How to Approach This
• All Project References Available in doc form upon
request
• [email protected] (contact me with any questions or
concerns)
Questions?