Functional Fitness Solutions for Older Adults: How to Assess and Interpret Postural Needs More Specifically
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Postural Assessment and Body Mechanics approach to selection of exercise makes movement more beneficial and less likely to cause injury. A step-by-step plan not entirely different from apparently healthy populations can be applied for individuals and with planning in groups where one-on-one is not feasible. Special conditions can be overcome with careful planning.
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Functional Fitness Solutions for Older Adults: How to Assess and Interpret Postural Needs More Specifically
- 1. Functional Fitness Solutions Assess, Interpret, Solve Presented by Debra Atkinson, MS, CSCS
- 2. Ability vs. Age • • • • • Athletic Already Active Getting Started Needs a Little Assistance Needs Ongoing Support
- 3. Modifying movement solutions MODIFYING ASSESSMENTS
- 4. Assessments • • • • • • • • • Lateral Anterior Posterior Articulation Squats Tandem Lunge Tandem Walk Step Over Clock • • • • • • • • • Support Support Support Possible Elimination Height Support and Depth Support Support Reach Height
- 5. Interpretation Static Posture • Ankle Mobility • Knee F – E – N • Adductors • Abductors • Pelvis A – P – N • Thoracic Spine • Shoulders • Cervical Spine • Head Movement Mechanics • Flexion – Extension, In-Ev • Strengthen – Stretch • Strengthen – Stretch • Strengthen - Stretch • Abs – Back • Retraction & Extension • Retraction • Retraction-Extension • Forward head -tilt
- 6. Progression Plan • • • • • • • • Mobility (before Strength) Clean Up Imbalances Strength (neural connection) Balance Multi-planar & Unilateral movement Physical Activity or Cardio Exercise Increased Intensity Power – Agility - Reaction
- 8. Sample Strength & Function Class • • • • • • Core Temp Elevation Functional Warm-up (unilateral) Strength Reaction – Agility – Coordination Balance – Dual Tasking Mobility
- 9. GROUP VS. PRIVATE • AVERAGE TARGET • Safety via Support • • • • • ATHLETE: A. ACTIVE: GETTING STARTED: Needs Assistance Ongoing Assistance • SPECIFIC GOALS • Ability focused • Spotting Available
- 10. Lower Back Indirect • Hip Flexibility – – – – #4 Hip Flexor Hamstring Legs Open • • • • Lying, Standing, Seated Kneeling, Half-stand, Standing Lying, Seated, Standing Lying
- 11. Lower Back • Spinal Mobility – Articulation – Rotation – Lateral flexion • • • • Seated Standing Seated on Floor Propping with ball
- 12. CORE Ex Rx Standing • Pulling, Pushing, Static • Rotation Seated • Pulling, Pushing, Static • Rotation MOVEMENTS of the CORE • STABILIZATION • LATERAL FLEXION • ROTATION • EXTENTION • (FORWARD FLEXION 0)
- 13. SOLUTIONS Wall Anchored Tubing Cable Machines Reinforced Walls (med ball toss) One sided carry Single Arm Pull -tubing Single Arm Press-tubing Alternate Elbow to Knee Band step Long Lever Weight Raise Flashlight Rotation Functional Limitations • Inability to floor • Limited by Back Pain • Compromised Balance
- 14. Center of Balance, Strength, Functional Stability and Movement CORE STRENGTH
- 15. Progression • Stabilization – Bilateral – Unilateral – Linear – Multiplanar – Standing – Seated
- 16. Progression • Dynamic Stabilization – Body weight – Resistance bands – Weighted Balls – Reaction
- 17. Progression • Rotation – BOS manipulation – Bilateral – Unilateral – Chest height – Superior to inferior – Inferior to Superior
- 18. Progression • Back Extension – Limb extension – Bridge (floor mobile) – Bridge Roll (floor mobile) – All Fours Mobility or Bent Over Chair – All Fours Mobility with band
- 19. Progression • Lateral Flexion – Side Bridge knees vary hand placement – Side Bridge Feet scissor – Side Bridge Feet stacked – Side Bridge with Flexion
- 20. Dealing with Vulnerability and Fear Caused by Conditions EXCUSES ARE REASONS
- 21. Knee and Other Joint Issues The lack of confidence and pain result in less activity…result in greater weakness….increasing risk
- 22. Obesity Additional weight adds stress to knees, joint pain often excuse for not moving won’t improve without weight control…
- 23. Vertigo Begin with static positions, move to dynamic without rotation or head movement, and pay attention to focus, and no rapid changes
- 24. Prioritize: Pain-Free Movement Enhanced Mobility Increased Stability Additional Strength
- 25. Include All Components Every Session Include “homework” for individuals by level for ex.
- 26. Thank You Presented By Debra Atkinson, MS, CSCS www.voiceforfitness.com debra@voiceforfitness.com To request a pdf of core progressions “Navigating” Udemy.com Prevent Back Pain with Five Steps
Editor's Notes
- 10:15Preview: Defining Functional. Looking at Assessments in new way. Knowing what you’re looking for compared to what you see, and identifying what can or should I do about it. Then overcoming some of the obstacles that you might have in getting people to do the things that will help- vertigo, obesity, joint issues, postural blood pressure challengesThe challenge we face first is defining FUNCTIONAL… because any exercise CAN be functional. And any exercise CAN be dysfunctional …it’s about the right exercise, at the right time, for the right personFOUNDATIONAL> FUNDAMENTAL>FUNCTIONAL but we often jump to describing a class or an exercise as more or less functional…when it truly depends on the individual we’re talking about. Marketing or advertising when we target an entire group we miss everybody. Cast the biggest net possible so we get the greatest group of people. Think about how YOU shop, buy, have a seed of desire planted…So the exercise we choose, instruct, cue, correct, has to be targeted toward an individual ….and if you are aging …ContinuumNever going to leave completely. Machine weights, focus on weak links, creating mobility, beginnings of neural components and recruitingMoving to more core focus and free weights, activation of kinetic chainAddition of power, combined movement of rotation, flexion, extensionTo a starting exerciser who has limited mobility and strength….exposure to functional activity could be detrimental at worst and fail to help optimally at the least. That’s not to say that eventually that same exercise couldn’t be just what they need…but it’s like taking a genius child and placing him or her in third grade immediately…without allowing him the opportunity to first learn the alphabet, writing reading…even if he’ll do that on an accelerated basis a step backward to go forward is necessary. If THIS, then that. And truthfully it is a fluid term quite often used to describe movements that enhance activities of daily living/ reduce risk of injury/ by in fact reducing effects of inactivity due to both choice and conditions and thought patters around those conditions.I do want to challenge your current definition or at the least enhance awareness that sometimes our definitions don’t get the whole picture. In personal training or physical therapy there are certain modalities and protocols indicated by a condition and a goal. But within that each client’s selection will be different based on his or her unique abilities. So with functional fitness being the goal….Functional fitness IS creating a program that moves one down the path toward more optimal mobility, stability, and strength endurance, less pain more, better reaction skills and agility, from where ever they are on the continuum now. That definition is not the same as movement that simply features balance and multidirectional exercise. Strength is functional and foundational for some – it should happen first in order to provide physical and mental improvements.May I see who is in the room today:How many are directors or managers? How many owners or executives?….. leading exercise in a retirement community? Applying the information to residents? And raise your hand if that is primarily in group…..one-on-one…..or bothRaise your hand if you are a fitness trainer or director applying this information to one-on-one or small group programs?
- 10:18Many of those with Athletic and Already Active Status don’t possess the foundational core strength they need or have balance issues they don’t realize (until it’s too late- unless you do some assessment and program development for them)Across all levels it is possible to have areas of strengths and weaknessesThat said according to ICAA’s continuum we have a readily available way to assess physical status by simple interviewing: not ability necessarily since where they are may be due to choice or circumstance. They may have not had access or the right environmental support- the right culture encouraging activity. You could find that an older adult moving into a retirement community who has not been very active is not more inclined because of the encouragement, the invitation to join. (physically Elite)- Three or more days a week fitness activity, strength training, may be competing against others or self(physically fit)- Two days a week getting physical exercise, and otherwise active in daily living for instance golf, gardening, walking the dog(Physically Independent) Frequency is perhaps not there but beginning- perhaps they’ve joined an exercise class that meets once a week…and otherwise is semi-active with independent living tasks Still able to perform most adls, may require assistance due to a physical or neural condition, cognitive ability, use of a walker, cane, unable to stand or sit or get to the floor, transfer alone(Physically dependent) Unable to completely perform adls without assistance. Has physical help for some meals, no longer shopping or bathing, dressing completely alone, but can perform exercises and improve function and decrease pain, enhance cognitive abilityDisabledCombining the cognitive function with the physical function can be a challenge
- 10:22Movement solutions that apply to general population can be applied to aging population. Movement solutions specifically designed to asses older adults by Rose, Rikli, Tinetti, Fullerton, Berg, Functional Movement Screens (Gray Cook) provide a basis and benchmark for documenting change.Sometimes we don’t however have from our assessments the means for determining the exercise that we should do. So my focus today is defining what is not only functional exercise but functional assessment. Close that GAP from ASSESSING What the needs are>Delivering Exercise the Focuses on Enhancing (or getting around limitations that can’t be changedIt has a purpose – related to providing information about where an individual is right now, so that we can decide what is possible and what is done easily and what is not possible and collects information or CLUES about why. It gives us then a spot to start…..that spot where in the big path a person is and toward categories of exercise.Haven’t been moving at all and are not limited really ……..are they pain-free….do they have optimal mobility? Then do they have optimal strength? How is their core stability? How is their balance? How are reaction skills and agility- ability to move quickly out of harms way/right themselves/respond to an obstacle?Mobility or core strength (indicated by low back pain) a problem….where on the continuum are they with that? Mobility- ankle joint, knee joint, hip joint, low back joints, upper back, shoulders, Take a combination of several pre-programmed assessment batteries and make them your own. Tinetti, Fullerton, Berg Scale, Rikli and Jones, and Functional Movement Screens that give you very specific feedback that you can use. Of these screens you are likely most familiar with Older Adult testing that include the Up and Go Test, the Sit to Stand assessments
- 10:26Modified…Both in WHAT you select and HOW you apply it.So rather than choosing a full battery of ONE single assessment tool. When it isn’t feasible to measure each individual how can you assess during a movement class?How can you assess their level entering the room? Transferring from their chair?We provide Active Aging presentations that feature a message about latest and greatest research and practical tips….as series of assessments and follow it with …. A movie – the Age of Champions. Within the stations we selected…our audience includes community members…not by ability level…but based on interest in starting or sticking with it. So we can create an environment where at each of 10-13 stations everyone can participate in at least half of them…we had to mix up for those athletes, for those using walkers, or with severe dowagers hump…So we selected up and go, standing balance, standing reach, Base of support balance, tandem walking as well as an assessment of flexibility, strength, aerobic exercise activity participation. Our “report card” allowed them to see if they had room for improvement or overall were controlling those things they could. Gave suggestions for improvement.And within that so that you get feedback and yet you keep them safeStatic assessments: through articulationIssues with postural hypotension? Movement assessments:
- 10:35Static posture LATERAL VIEW- ANTERIOR VIEWAudience VolunteerPlumlinePoint Out “Perfect” and comparing that to what you see. From static posture>assessing what you see and what is true>and what to doADD a Note: Cervical Spine- Extension or HyperextensionHead- forward head- retraction or tiltLATERAL VEIW Provides the most informationFront View next- and confirming BACK view much more a confirmation of what you’ve found
- 10:50Your MANTRA: mobility before strength So that we don’t contribute to more imbalance Might provide insight to how to offer and structure your classes. Include some mobility- only sessions with core stabilization and make these separate from your strength training sessions. May mean you have residents coming every day to exercise or that you suggest for them the mobility focus instead untilDays, weeks, months- focus on mobility and flexibility Consider those who have not exercised for quite some time may need a lot of focus, those regularly active may need lessThose with cognitive challenges Mobility is the new flexibility Working One-on-One if you have that ability- cleaning up imbalances. One leg falls in more than another. One leg is not used as much…pain? Habit?Ankle ROMHIP ROMHeavy on stretches, releases, rolling, movement coordination > neural component: core activation through stabilization***DemonstrateStrength FOUNDATION- the one thing to have if you can- a leg press machine Core activation through movementBegin to integrate more core seated or standing if have not beenIncrease multiplanar movements: cable use, tubing use (anchored) forcing leverageUnilateral Work“Power” – fast twitch muscle fibers are lost first. And bone density research showing more increase with power compared to slow
- 11::05Muscle Memory…the one time you wish they would lose memory- it staysRestoring length and or mobility to the bodyTypically we do or have done in segments- one muscle at a time and ideally we want to do so in unison or an integrated way …helping connect the dots. One exception to that being chronically tight areas that might be treated well with rolling using something like The Stick, a rolling pin, a small roller, foam rollerFormula for stretching based classes or cool downs1.) Chest muscles/ back muscles/chest muscles2.) Hip Flexors- Hamstrings and Glutes-Hip Flexors3.) Anterior shoulders-Rear Shoulders- Anterior Shoulders
- 11:10Core Temperature Elevation- in alignment with the function of individuals within Sagittal> Frontal>Transverse ( a reminder from Lawrence B)Two different occasions an instructor leading an exercise class using a grapevine to warm up- yes matched to core temperature elevation but balance static and balance dynamic and mobility not present in the individual … sets you up for potential risk.Knees up in a chair, standing, center of gravity movement changesThe outcome- hip replacement or partial in both casesAs LEVELS of FUNCTION decrease you might pre- and post MOBILITY Balance with reading a paragraph, balance reciting a line from Robert Frost, balance reciting multiplication tables or completing a math problem
- 11:15Level of participation is a challenge in a group setting.You have to choose. Focus has to be on the lowest level attending. Success determines return.Consistency above all else determines success. Social advantagesSet the Who should attend/Who Should Not Attend/Specific Goals or Outcomes for each group you do/stay consistent with those goals with your verbal cuesFrom Here- addressing specific challenges of older adults and solutions to progression that serves themAllowing success for all- choosing groups to be A and groups to be 1, so all are first and important
- 11:19Restoring MobilityIF they aren’t active why aren’t they?Relate to the research regarding Obese population – starting slow making it manageable – and pleasurable – sense of acheivementMental- never occurred to themPhysical- avoidance of pain, not accessible to options or instruction? Didn’t know what to do?Restoring FLEXIBILITY ALONE- through stretching WILL NOT ENHANCE GAIT- there has to be retraining that goes on helping them change the pattern of movement.Sprained Ankle- example of learning a pattern- this is not going to happen overnight. Reminders and frequent cues.Focus on some specific Challenges and modifications for varying levels of function
- 11:21From the videoCat Cow Back: Floor? Chair while standingThe Clock on the WallSeated Lateral Flexion – Standing toward a wall or using chair Spoon feeding every time you do it- step by step for All – not just newSeated on the floor- rolling back – rolling up from a bridge, pelvic tiltRolling up and down on a ball
- 11:22Lying on the floor : Pelvic tilting, bridge sequencesSeated in a chair leg lift, pushing, pulling rotatingAgainst a wall for a target (dependent on posture)On your sheet- order is different- but these are not presented in any order based on what to do first on right side- left side is.Udemy: Prevent Back Pain (Navigating) for extremely already active, athletes
- 11:25Core: Stabilization before movement:**TUBING“chest Press” 1.Ankle mobility2.Hip mobility3.Hip strength4. All together light weightBand Stepping Over KneeAround AnklesFeet
- 11:28SpecificsMo Hagen did a specific core session earlier in the conference if you had a chance to print the handouts out she included some great variations, easy to remember names
- 11:30Examples of eachChanging Upper body and center of gravity with base of supportPushing with both armsPushing with one armStraight forwardAdding rotationStanding vs Seated (increasing core call to action)Standing with feet parallel vs staggered, dominant and non-dominantWhich one is going to be more difficult?
- 11:32Stabilizing against movement where the arms and the legs go but the spinal stabilization remainsEven occurs when you are standing and they are doing tubing work- such as bicep curlsMoving the leg against resistance of limbs- seated knee lift, lying leg lift and lowerResistance bands bracing not hollowingWeighted balls catch and toss or change direction up and down, swing side to side,
- 11:35Mimics daily living or sport activity – be careful of mechanics FIRST
- Demonstrate it during
- For your clients/residents – none of this matters…unless you get them to the session
- Vicious circle Pain>avoid activity>further immobility>insecurity and instabilityBegin with decreasing pain, short but frequent exposure without painWater? Strength without resistance
- 10:35Pleasure Needs to be coupled with activity or they WILL NOT continueResearch on obesity and exercise
- Keep them from feeling that you’re having to eliminate exercises or work around them
- 11:40Mobility and “clean up” imbalances – find out first what is going onDon’t be afraid of machine weights to gain strength, a leg press can be a good place to start for some to boost confidence, gain strength and develop a foundation
- 11:40 Heavier emphasis on movements that allow you to “assess” without stressMobility with specific instruction about what to feel where to feel it and cues from front, back, imagery Strength at first will focus on core- stabilization and connective tissue, not about amount of resistanceGlobal stabilizers to local stabilizers> both are important- recruitment vs. stability
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