Presented for the International Council for Active Aging,December 2010: It will give you many ways to add balance to everyday fitness programming for older adults

1. Balancing Your Fitness Program Adding Balance to Everyday Fitness for Older Adults I Blame ABLE Bodies for this

2. Achieve Better Living with Exercise With permission: ABLE Bodies Balance Training, 2008; Human Kinetics Renewable Fitness, LLC

3. ABLE CAPABLE BALANCED

4. Randomized Control Trial Robert Wood Johnson Foundation

8. Physical Activity Levels

9. Strength

10. FlexibilityPublished Medicine and Science in Sports & Exercise, 2005 Presented ACSM, ICAA, APHA, IAHSA, IDEA World

11. Add Balance to Your Programs

12. Exercise Science Protocols Peer reviewed, published Mode, Intensity, Frequency, Duration Specific to Goals Specific to Systems

14. Intensity – challenge (dose)

15. Frequency – how often

17. ACSM Protocols for Balance in Elderly Conform to accepted theories for balance control Multi Modal Address all systems & components of balance Engaging, challenging, complex, layered, functional Progressively difficult postures, gradually reduce Sensory input Base of support Dynamic movements disturb Center of Gravity Strengthen leg and postural muscles Build strength before endurance A Walk in the Park

18. Multi-modal: Address allSystems & Components for Balance Posture Flexibility Strength Endurance Sensory Systems Vision Vestibular Somatosensory Automatic, Central, NM & Integrative Cognition Experiences Skills & Learning

19. Sensory Systems Incoming information about our environment

20. Sensory Systems for Balance Vision Somatosensory (touch, proprioception) Vestibular

21. How Sensory Systems Function for Balance Source: Fay Horak, PhD; NSI Balance Disorder Laboratory, Hillsboro Oregon; used with permission

22. Sensory Weighting Firm Surface 70% Somatosensory 20% Vestibular 10% Vision Unstable, Compliant Surface 10% Somatosensory 60% Vestibular 30% Vision Tall Stand Horak, Fay B; OHSU, NSI Balance Disorders Lab; Hillsboro, OR; used w/permission Balance Mat w/head turns

23. Manipulate Vision Enhance vision Optimal lighting External Cues Visual Targets Eyes on the Prize Vertical lines Mirrors Modeling Reduce vision Less optimal lighting Dim the lights Sun glasses No-body glasses Fewer external cues Eyes on the Prize Kayaking thru poles w/ no-body glasses Mirrors H-Lines

24. Visual Tool: Follow the Light Visual Targets Laser Light in well-lit room Flashlight in reduced light

25. Visualization Enhance Vision w/Mind’s Eye Visualize event Make a plan “See” themselves doing it Look ahead (next turn or goal) Look Ahead, next turn

26. Somatic Awareness “Inside-Out” Learning Listen to their Bodies Increase Self Awareness Cue/Focus on proprioceptive sensations Sensational Somatic cues Feel, notice, lift, push Tie Breath to movement Reduce vision

27. Somatic Learning Tool Coming to Our Senses

28. Somatic Learning Tool The Ball Game The Ball Game

29. Somatic Learning Tool Supple Spine Take Home Message Even gentle stretching improves function Supple Spine (Based on Feldenkrais)

30. Somatic Learning Tool Belly Button Training Sways, circles, rocking One foot standing Steps Belly Button Training

31. Somatic Learning Tools Tai Chi Self Awareness Tie Breath to Movement Weight Shifts Upright posture Yoga Pilates

32. Somatic Summary Enhance Somatic Inside-out Learning Supple Spine Belly Button Training Tai Chi Reduce visual input Reduce Somatic Compliant surfaces Dyna discs Stability balls Balance pads/mats Belly Button Training Seated on compliant surface Supple Spine Balance Mat- Walking Over the Moon Ball Stretch The Ball Game

34. Slowly, carefully, to adapt

35. Progressively

36. Seated

37. Standing

38. WalkingWords on the Wall in the Hall Making Waves Head Turns

40. Sun or no-body glasses

43. Do activities seated, first

44. Dizziness, peripheral neuropathyFollow the Light Stand/Walk on Foam

45. Sensory Training Summary Sensory Systems One part of Multi-modal program Their Job: Incoming info about environment How to Use Sensory input for balance: Manipulate or vary environment Engage the system Enhance input Reduce input ASCM protocol: gradually reduce Sensory input Base of Support

46. <Base Of Support (BOS) Examples of <BOS for Tall Sit Sit back in chair, use arm rest Edge of chair Edge, arms lifted Heels up Feet tandem Knee lifted On dyna-disc On Ball w/holder On Ball

47. BOS Standing / Moving Standing Wide stance Narrow stance Off-set Tandem One foot Balance beam Dynamic Normal steps Long steps (lunges) Skipping? On Lines On Beams H-Lines Ladder for Stride Length

48. <BOS: Walk the Line Walk and Waddle Ladder for Stride Length The Straight & Narrow H-Lines Squiggly Lines Balance Beam or Narrow Path

49. Review ACSM Protocol Multi-modal All systems, components of balance Sensory systems Integrative/Automatic components Gradually reduce: Sensory input BOS Dynamic motions that challenge CoG

51. NeuromuscularWhole skills Complex motor patterns Automaticity of balance

53. Better motor function

54. Aerobic or Strength vs: Balance & Agilitytraining

55. Larger improvements in motor function

56. Morenew synapses Renewable Fitness & ABLE Bodies

57. SM Agility Training for Rats Sensori-motor tasks are largely controlled by basal ganglia, master coordinator of goal-directed movement Sensori-Motoragility courses drive neuro-plasticity and >improvements in motor skills Renewable Fitness & ABLE Bodies

58. Sensori-Motor & Agility Variety of Tasks ADLs, Functional Engaging, fun, novel Vary the Task Multiple directions BOS Adapt for obstacles Add resistance Increase time Vary Environment Surface Vision Location Balance Mats: Arm Swings Figure 8 Walking thru doors & chairs

59. Sensori-Motor SkillsVary Tasks & Environment Activities Traffic School Opposing Circles High Fives A Walk in the Park Games Opposing Circles & High Fives

60. Momentum ControlPuddle Jumping Puddle Jumping

61. Obstacle Courses for Agility

62. Agility & Music Music &Transitions Training Improves anticipatory skills Helps initiate movement Improves quality of movement Symmetry, size, cadence, coordination Whole body response Keeps movement flowing w/ rhythm & momentum Waltzing Matilda Music can enhance mind-body connections & SM skills

63. Dual Tasks for Auto-Balance Dual Tasks enhance automatic balance Multi-tasking - no such thing! We switch. Former task left on auto-pilot Distraction from established motor task with a secondary task . . . Requires automaticity of balance Training improves automatic balance!

64. Using Dual Tasking Master base skill first Functional, ADLs Add complexity in layers >resistance, reps Vary task Vary environment Add dual task

65. Progressing Dual Tasks To established motor skill, add: Simple recitation Counting, ABC’s, nursery rhymes, sing Motor task Arm swings, kayaking, Snap claps, carry, toss or catch a ball Cognitive task Count backwards, tongue twisters, word winks, re-arrange numbers or words Functional: Cell phones, keep track of time

66. Attention Training My pizza is cold 4 31 19 7 T__ L__ S__ B__ __ F__V __G __R Renewable Fitness . . . imagine the possibilities

67. Word Winks for Mental Agility T T T T Think fry fry Renewable Fitness . . .imagine the possibilities Renewable Fitness . . .imagine the possibilities

68. Distractions

69. Tongue Twisters What noise annoys an oyster most? Noisy noise annoys an oyster most (Google – has gazillions) Require concentration and improves verbal skills (PD patients ) Renewable Fitness . . .imagine the possibilities

70. Review Posture Flexibility Strength Endurance Sensory Systems Automatic, central, NM & Integrative Cognition Experiences Skills & Learning

71. Flexibility Reduce BOS Seated positions Standing positions Manipulate Sensory Input Reduce Vision by dimming lights Enhance Vision by using mirrors, modeling Enhance somatic awareness Facilitate Vestibular

72. Flexibility Use Dynamic movements that disturb cog Lean and reach Dynamic Stretches Whole Body Stretches Mind and Body / Engaging / Fun / Layers /Complexity Use Rhythm/Music Think BIG, stretch BIG Educate – It’s the ultimate mind body tool Use Conceptual physical activities as learning tools Supple Spine – Even gentle stretching improves function Venus Di Milo Arms – Explores ROM in arms and trunk Measure, re-test periodically Carry the Baby

73. Posture & Core Stability Manipulate Sensory Input Increase somatic awareness Upright, centered over base of support Cue with proprioceptive cues – feel, lift, notice Enhance Vision Mirrors, Model Reduce Somatic Input & Facilitate Vestibular Balance mat with good posture and core stability Head turns, tilts while maintaining good posture

74. Posture & Core Stability Reduce BOS Seated positions Standing positions Challenge w/Dynamic Movements Add Arm Swings to upright postures Add Reaches, perturbations, turns Practice Transitions with trunk stability Tall Sit to Tall Stand Rise to toes w/upright posture Tai Chi, Yoga, Pilates

75. Posture & Core Stability Mind & Body/Engaging/Fun/Layer Educate: Discuss value Use “hands-on” Conceptual learning Torso as a Cylinder - Trunk Stability When Push comes to Shove –Trunk stability Parts of the Whole – Segmental alignment Breathe Easy – Posture affects function When Push Comes to Shove

76. Strength TargetsADLs Anti-gravity muscles Getting out of Chairs Stairs Turn Reach Up from floor Teeter Totter Chair Stands

77. Strength Targets for Balance Upright posture Back & Hip extensors Core muscles Scapular retractors Legs Lower legs Transitions Anti-gravity

78. Strength Dynamic movements that disturb cog Dynamic Activities Progress from w/In-place w/Movement Whole Body Exercises Vary environment Vary task, BOS Mind and Body / Engaging / Fun / Layers /Complex Use Music, rhythm Think BIG Visualize Dual Tasks Educate, show value Measure & re-test

79. Endurance Dynamic movements that disturb cog Require balance Elliptical vs recumbent bike > movement size whole body work Upper/lower body ie: add Arm Swings Mind and Body / Engaging / Fun /Complexity Use Rhythm/Music Dual Tasks Think BIG Educate: Talk about its value Measure results, re-test over time

80. Exercise Science Protocols Evidence-based Peer-reviewed Published Exercise Specificity Systems Tasks Overload Challenge Engage Change Task/Environment

81. What’s in your tool box? Did you find a few new tools here?

82. The Tools You’ll Use You can’t possibly do it all. Your talents & choices that will make a difference Pick your favorites Visualize Make a plan Observe Keep learning

83. Philosophy If it’s physical, it’s therapy Physical Activity . . . The Tools of our Trade

84. Thank you for coming! I THINK MY WORK HERE IS DONE Cartoonstock.com

85. Contact Information Sue Scott RenewableFitness@comcast.net 503-720-9161 .org www.