David Rigg - Ageing and Rehabilitation


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David Rigg - Ageing and Rehabilitation

  1. 1. Ageing & Rehabilitation David Rigg BSc (Hons) GSR, CSCS
  2. 2. TODAY'S PRESENTATION <ul><li>Putting aging in to context what is it </li></ul><ul><li>Review Rehabilitation Procedures </li></ul><ul><li>Physiological Exercise Prescription and the Biomedical Model </li></ul><ul><li>Medical Exercise Therapy and the Biopsychosocial Model </li></ul><ul><li>Case Study </li></ul><ul><li>Statistics </li></ul>
  3. 3. AGE AND TIME TO RETIRE <ul><li>Army – 40 years old </li></ul><ul><li>Fire and Police Service – 55 years old </li></ul><ul><li>National Retirement Age – 60 – 65 years old and increasing </li></ul><ul><li>Over 65 years </li></ul>
  5. 5. CATEGORIES OF AGING <ul><li>Chronological aging </li></ul><ul><li>Cosmetic aging </li></ul><ul><li>Social aging (changes in interactions with others) </li></ul><ul><li>Psychological aging (age-related changes in perception and behaviour) </li></ul><ul><li>Economic aging (changes in financial status with age) </li></ul><ul><li>Ref:1 </li></ul>
  6. 6. AGE AND FUNCTIONAL LOSS <ul><li>Functional losses fall into 4 categories </li></ul><ul><li>Functions that are totally lost </li></ul><ul><li>Structural changes </li></ul><ul><li>Reduced efficiency </li></ul><ul><li>Altered control systems or reduced reserve capacity to respond </li></ul><ul><li>Ref:2 </li></ul>
  7. 7. TWO TYPES OF AGING IDENTIFIED IN THE LITERATURE <ul><li>Normal Aging - changes that are not produced by disease. </li></ul><ul><li>Pathological Aging – changes that result form environmental changes, genetic mutations and accidents of nature. </li></ul><ul><li>Ref: 2 </li></ul>
  8. 8. OPTIMAL AGING <ul><li>The preservation function at the highest level and the quality of life is maintained. </li></ul><ul><li>The Absence of disease and disease related disability </li></ul><ul><li>High functional capacity </li></ul><ul><li>Active engagement with life </li></ul>Ref: 3
  9. 9. OPTIMAL AGING INCORPORATES <ul><li>Physical health </li></ul><ul><li>Psychological state </li></ul><ul><li>Level of independence </li></ul><ul><li>Social relationships </li></ul><ul><li>Personal beliefs </li></ul><ul><li>Relationship to the environment </li></ul><ul><li>Ref :4 </li></ul>
  10. 10. PHYSICAL ACTIVITY REDUCES THE RISK <ul><li>Coronary heart disease </li></ul><ul><li>Diabetes mellitus </li></ul><ul><li>Cancer – colon and breast </li></ul><ul><li>Obesity </li></ul><ul><li>Hypertension </li></ul><ul><li>Bone and joint diseases – osteoporosis and osteoarthritis </li></ul><ul><li>Depression </li></ul><ul><li>Ref: 5,6 </li></ul>
  11. 11. Comprehensive Exercise Programme <ul><li>Aerobic work </li></ul><ul><li>Resistance training </li></ul><ul><li>Power training </li></ul><ul><li>Flexibility exercises and balance training </li></ul>
  12. 12. BENEFITS OF RESISTANCE TRAINING <ul><li>Positive effects on Muscle Mass </li></ul><ul><li>Enhanced motor unit recruitment </li></ul><ul><li>Improved contraction coupling and calcium handling </li></ul><ul><li>Relief from arthritis pain </li></ul><ul><li>Improved balance and reduced risk of falls </li></ul><ul><li>Strengthen of bones </li></ul><ul><li>Ref:7,8,9 </li></ul>
  13. 13. REHABILITATION PROTOCOL <ul><li>Control pain </li></ul><ul><li>Restore Range of movement </li></ul><ul><li>Restore Muscular Strength, Endurance and Power </li></ul><ul><li>Re-establish Neuromuscular control </li></ul><ul><li>Maintain cardio respiratory Fitness </li></ul><ul><li>Restore Function </li></ul>
  14. 14. NATIONAL STRENGTH AND CONDITIONING ASSOCIATION NEEDS ANALYSIS <ul><li>Needs Analysis </li></ul><ul><li>Exercise Selection </li></ul><ul><li>Training Frequency </li></ul><ul><li>Exercise Order </li></ul><ul><li>Training Load and Repetitions </li></ul><ul><li>Volume </li></ul><ul><li>Rest Periods </li></ul>
  15. 15. NEEDS ANALYSIS <ul><li>Evaluation of the sport, movement, physiology, injury </li></ul><ul><li>Assessment of the individual - Age, training and chronological, training status, technique experience. </li></ul><ul><li>Testing and evaluation </li></ul><ul><li>Set primary training goal </li></ul>
  16. 16. BUT HOW MUCH <ul><li>Hunter et al – 2-4 sets of 8-15 reps at 60-80% of 1RM, on 2-3 days per week (Ref: 10) </li></ul><ul><li>ACSM – 1 set of 10 -15 reps of a moderate intensity of 8-10 exercises using all major muscle groups at least 2 days per week 48 hours apart (Ref:10,11) </li></ul>
  17. 17. PROBLEMS WITH EXERCISE PRESCRIPTION <ul><li>Causes pain </li></ul><ul><li>Person feels uncomfortable in the situation </li></ul><ul><li>Low confidence with exercise </li></ul><ul><li>Poor understanding of the condition </li></ul><ul><li>Believes it will cause more damage </li></ul><ul><li>Does not like exercise and never has </li></ul><ul><li>Wants a quick fix </li></ul>
  18. 18. <ul><li>As the prescription for exercises vary among studies and as older adults vary considerably in health, fitness and functional status do we need to prescribe for the individual. </li></ul><ul><li>Meet the person where the person is </li></ul>
  19. 19. ASSESSMENT <ul><li>Treat the patient not the x-ray, the CT or MRI scan results. </li></ul><ul><li>Advances in diagnostic imaging do not replace the need for clinical interpretation. </li></ul><ul><li>Khan KM, Tress BW, Hare WSC, Wark JD. Treat the patient not the x ray: Advances in Diagnostic Imaging Do not replace the Need for Clinical interpretation. Clinical Journal of Sports Medicine 1998;8:1-4. </li></ul>
  20. 20. CLASSIFICATION FOR TREATMENT CONTINUUM <ul><li>Type 1 Type 2 Type 3 </li></ul>Organic Tissue Based Identifiable Tissue at fault Normal pain behaviour Recognisable pain patterns Reproducible signs Chronic Pain Abnormal Pain Behaviour Major Psychosocial Stressors Non specific diffuse pain Non reproducible
  21. 21. BIOPSYCHOSOCIAL MODEL OF CHRONIC PAIN AND DISABILITY Social Environment Illness Behaviour Biology Sensory Condition Thoughts and Beliefs
  22. 22. A COLLABORATIVE APPROACH <ul><li>Is the person ready to start a programme </li></ul><ul><li>Is the person confident they can do the program </li></ul><ul><li>Is the program important to the person </li></ul><ul><li>What is their motivation </li></ul><ul><li>What do they want to achieve </li></ul><ul><li>What do they think they can do, start with </li></ul><ul><li>What are they willing to try </li></ul><ul><li>Ref:13 </li></ul>
  23. 23. <ul><li>Motivational Interviewing </li></ul><ul><li>Cognitive Behavioural Therapy (CBT) </li></ul><ul><li>Cognitive Behavioural Approach (CBA) </li></ul>
  24. 24. CBT LONGITUDINAL FORMULATION (Beck 1967) Early Life Experiences Formation of Schema Conditional Beliefs Critical Incident Symptoms Cognitions Emotions Physical Symptoms Behaviour
  25. 25. Situation Thoughts Behaviour Feelings Physical Symptoms 5 Areas Model The CBT 5 Areas Model Hot Cross Bun (Ref: 12)
  26. 26. Situation GOING TO THE GYM FOR AN EXERCISE REHABILITATION PROGRAMME Thoughts Why have I been sent to the gym I have been told not to do to much This is going to cause more pain Behaviour Does not do exercise Keeps themselves safe Physical Symptoms Increased HR Feels more Pain Feelings Scared Anxious Worried Protective
  27. 27. Situation GOING TO THE GYM FOR AN EXERCISE REHABILITATION PROGRAMME Thoughts I am looking forward to this This will help me I might make some new friends Behaviour Complete Exercises Attend Regularly Physical Symptoms Reduced Pain Reduced muscle tension Reduced blood pressure Feelings Confident Happy Relaxed
  28. 28. MEDICAL EXERCISE THERAPY <ul><li>Founded by Oddvar Holten </li></ul><ul><li>Published in The Norwegian Physiotherapy Journal;Fysioterapeuten1968;Holt O. Treningsterapi. Fysiterapeuten 35(8):236-240. </li></ul><ul><li>Therapy where the patients performs exercises with specially designed apparatus without manual assistance </li></ul><ul><li>Defined starting positions and graded loads </li></ul><ul><li>One hour of effective treatment </li></ul><ul><li>7-9 exercises 2-3 sets or 20 -30 reps aiming for close to 1000 reps. </li></ul><ul><li>Must start to sweat </li></ul>
  29. 29. ADVANTAGES OF THIS TYPE OF PROGRAMME <ul><li>Positive Cognitive Experience </li></ul><ul><li>Blood circulation </li></ul><ul><li>Endorphin release </li></ul><ul><li>Improved endurance and strength </li></ul><ul><li>Improved function </li></ul><ul><li>↓ Pain </li></ul><ul><li>↓ Anxiety </li></ul><ul><li>↓ Depression </li></ul>
  30. 30. Advantages of this type of programme <ul><li>Some evidence suggests that supervised programmes increase compliance. </li></ul><ul><li>Collaboratively set goals appear to lead to higher levels of treatment compliance than set goals </li></ul><ul><li>Combined exercise and motivational program can increase compliance and reduce disability </li></ul><ul><li>Compliance may be directly influenced by the out come </li></ul><ul><li>Ref 14,15,16,17, </li></ul>
  32. 32. Summary <ul><li>Physiological principles apply </li></ul><ul><li>No template for prescription for – Age or condition </li></ul><ul><li>Identify – Thoughts, Feelings, Beliefs and Motivation </li></ul><ul><li>Apply the right model to the right individual </li></ul><ul><li>Use a collaborative approach </li></ul>
  33. 33. <ul><li>A healthy mind in a healthy body </li></ul><ul><li>Mens sana in corpore sano </li></ul>
  34. 34. <ul><li>Thank You </li></ul><ul><li>Discussion </li></ul>
  35. 35. References : <ul><li>1.Dirks AJ and Leeuwenburgh C. The role of </li></ul><ul><li>apoptosis in age-related skeletal muscle </li></ul><ul><li>atrophy. Sports Med 35: 473–483, 2005. </li></ul><ul><li>2. Taylor A Wand Johnson MJ. Physiology of Exercise and Healthy Aging. Champaign, </li></ul><ul><li>IL: Human Kinetics, 2008. </li></ul><ul><li>3. Rikli RE and Jones CJ. Senior Fitness Test Manual. Champaign, IL: Human Kinetics,2001. </li></ul><ul><li>4. Wolf SL, Sattin RW, Kutner M, O’Grady M, Greenspan AI, and Gregor RJ. </li></ul><ul><li>Intense Tai Chi exercise training and fall occurrences in older, transitionally frail </li></ul><ul><li>adults: A randomized, controlled trial. </li></ul><ul><li>J Am Geriatr Soc 51: 1693–1701, 2003. </li></ul><ul><li>5. Federal Interagency Forum on Aging- Related Statistics. Older Americans </li></ul><ul><li>2008: Key Indicators of Well-Being. Federal Interagency Forum on Aging- </li></ul><ul><li>Related Statistics. Washington, DC: U.S. Government Printing Office, 2008. </li></ul><ul><li>Available at: http://www.agingstats.gov. </li></ul>
  36. 36. <ul><li>6. Warburton DER, Nicol CW, and Bredin SSD. Health benefits of physical activity: </li></ul><ul><li>The evidence. CMAJ 174: 801–809, 2006. </li></ul><ul><li>Available at http://www.cmaj.org/.doi:10.1503/cmaj.051351 . </li></ul><ul><li>7. Dirks AJ and Leeuwenburgh C. The role of </li></ul><ul><li>apoptosis in age-related skeletal muscle </li></ul><ul><li>atrophy. Sports Med 35: 473–483, 2005. </li></ul><ul><li>8. Centers for Disease Control and </li></ul><ul><li>Prevention and The Merck Company </li></ul><ul><li>Foundation. The State of Aging and </li></ul><ul><li>Health in America 2007. Whitehouse </li></ul><ul><li>Station, NJ: The Merck Company </li></ul><ul><li>Foundation, 2007. Available at: </li></ul><ul><li>www.cdc.gov/aging and </li></ul><ul><li>www.merck.com/cr. Accessed March 12 , 2009. </li></ul><ul><li>9. Federal Interagency Forum on Aging- Related Statistics. Older Americans </li></ul><ul><li>2008: Key Indicators of Well-Being. Federal Interagency Forum on Aging- </li></ul><ul><li>Related Statistics. Washington, DC: U.S. Government Printing Office, 2008. </li></ul><ul><li>Available at: http://www.agingstats.gov . </li></ul>
  37. 37. <ul><li>10. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing </li></ul><ul><li>and Prescription (8th ed). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & </li></ul><ul><li>Wilkins, 2010. pp. 153, 172–174, 192–194. </li></ul><ul><li>11. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, and </li></ul><ul><li>Castaneda-Sceppa C. Physical activity and public health in older adults: </li></ul><ul><li>Recommendations from the American College of Sports Medicine and the </li></ul><ul><li>American Heart Association. Med Sci Sports Exerc 39: 1435–1445, 2007. </li></ul><ul><li>12. Williams C, Garland A,. Advances in Psychiatric Treatment (2002).vol8pp.172-179. </li></ul><ul><li>13. Rollnick S, Mason P, Butler C. Health Behaviour Change, A Guide for Practitioners. Churchill Livingston, 1999. </li></ul><ul><li>14. Reilly K et al. Differences between a supervised and independent strength and conditioning program with Chronic Low Back Pain Syndromes. Journal of Occupational Medicine , June 1989, vol 31, no 6. p547-550. </li></ul>
  38. 38. <ul><li>15. Bassett S, Petrie K. The effect of treatment goals on patient compliance with physiotherapy exercise programmes. Physiotherapy 1999,853,p130-137. </li></ul><ul><li>16. Fredrich M. Compined Exercise and Motivation Program: Effect on the compliance and level of disability of patients with chronic Low Back Pain: A randomised Controlled Trial. Arch Phys. Rehabil ., May 1998, vol79,p 475-487. </li></ul>