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Stay On Your Feet! Prevent Falls With Exercise. AAHPERD National Convention 2011 Christian Thompson, Ph.D. Department of Exercise & Sport Science University of San Francisco. Objectives. Describe the prevalence of falls and falls-related injuries and the costs associated with them
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Stay On Your Feet!Prevent Falls With Exercise • AAHPERD National Convention 2011 • Christian Thompson, Ph.D. • Department of Exercise & Sport Science • University of San Francisco
Objectives • Describe the prevalence of falls and falls-related injuries and the costs associated with them • Identify intrinsic and extrinsic risk factors for falls • Explain the balance control mechanisms in the body and how they work together to reduce falls risk • Learn about 3 simple screening protocols to identify falls risk in older clients • Develop a comprehensive falls prevention exercise program consisting of exercises for mobility, strength, balance, and gait enhancement • Identify appropriate exercise progression and regression strategies to use with older clients to reduce falls risk
Too Bad It’s Not Funny… • Over 1/3 of people aged of 65+ fall each year • In 2004, over 1.8 million seniors were treated for fall-related injuries at emergency rooms • Approx. 400,000 fractures per year due to falls • Over 20% of hip fractures result in death in 1 yr • Problem will only continue to increase with the “Graying of America” and its changing demographics Sources: CDC, 2007; Kannus et al., 2005; Ngyuen et al., 2007
Golden Years in the Golden State? • Almost 12% of older Californians fell more than once & 34% fell at least once in 2007 • Diagnosed diabetes increased from 15% in 2001 to 17.5% in 2008 • Diagnosed hypertension increased from 53% in 2001 to 60% in 2008 • A coincidence…PROBABLY NOT!!! • Source: UCLA Center for Health Policy Research, 2008
Factors Affecting Falls • Intrinsic Factors • Internal Issues • History of Falling • Chronic Diseases & Medical Conditions • Sensory/Vestibular Impairments • Medication Effects • Functional Level (Strength, Posture, Gait) • Extrinsic Factors • External Issues • Weather or outdoor conditions • House clutter and obstacles • Poor lighting • Lack of adaptive devices in the home • Inappropriate footwear/clothing Risk linearly with number of risk factors present Sources: (Rose, 2003; Tinetti et al., 1988; Carter, 2001; Lehtola et al., 2006)
What To Do About It?? • IDENTIFY the Balance Control Deficit(s) • CONSTRUCT Corrective Strategies • MODIFY Based on Functional Capabilities
IDENTIFYMultifactorial Interventions – 6 Studies • Three simple, validated assessments • Functional Reach Test • Timed Up and Go Test • 30 Second Chair Stand Test
CONSTRUCT & MODIFYMobilizations • The ANKLE & HIP are KEY!!! • Subconscious utilization of ankle “strategy” during quiet standing • Reactive utilization of hip “strategy” during movement • Isolated non-loaded mobilizations • Ankle Circles • Hip Circles • Loaded integrated mobilizations • TADAs
CONSTRUCT & MODIFYMuscle Strengthening • More than just gaining strength… • Enhance neural recruitment & increase lean tissue mass • Challenge postural control and improve stabilization capacity • Emphasize eccentric control during movement – deceleration of gravitational forces is essential for falls prevention • Selected exercise • Chair squats
CONSTRUCT & MODIFYGait Enhancement • WHY do older people walk the way they do??? • Reduced mobility of ankle & hip joint (reduced sensory input) • Gravity is winning the battle • FEAR!!!! (contracts the sphere of function) • Pathological conditions (only in a small % of OAs) • Gait Enhancement • Enhancing the proprioceptive input • Increasing awareness at long distance • Selected Exercise • Side Stepping
Recommendations for the Fitness or Activity Professional • Understand your older clients • Recommend clients to undergo multifactorial risk assessment • Progress clients safely but steadily • Include multiple modes of exercise to address modifiable physical characteristics
Dr. Christian Thompson • Department of Exercise & Sport Science • University of San Francisco • 2130 Fulton Street • San Francisco, CA 94117 • cjthompson@usfca.edu • (415) 422-5270