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The Functional Fitness MOT, Prof Dawn Skelton and Bob Laventure
1. The Functional Fitness MOT
Prof Dawn Skelton and Bob Laventure
Generations Working Together 1
2. Summary of workshop
• What is functional fitness
and why is it important?
• The Functional Fitness MOT
• A taste of MOT activities
• Examples and ideas
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3. What is functional fitness?
“Functional Fitness performance is having
the physiological capacity to perform
normal everyday activities safely and
independently without undue fatigue”.
(Rikli @ Jones 1999)
Greater priority in later life?
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6. Kneeextensionstrength(N/kg)
12
10
8
6
4
2
0
Strength to be confident of rising
from low chair without using arms
50-54
55-59
60-64
65-69
70-74
50-54
55-59
60-64
65-69
70-74
Age (years)
Quadriceps (thigh) Strength
Men
Women
Skelton et al.
ADNFS
(1999)
N=1318
Nationally
representative
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8. Sarcopenia
• “Flesh poverty”
• Decrease in lean body muscle
mass with age
• At same time as increase in fat
mass
• Total body weight and shape may
not change
• (Food plays a part)
Is not inevitable and is reversable!
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9. Implementation across the UK
UK CMO Physical
Activity Guidelines for
Older Adults (2011)
What are the key
messages of the
Physical Activity
Guidelines for Older
Adults?
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10. 10
Older adults – Moderate intensity –
accumulating 150 minutes per week
OLDER ADULTS (65 + )
• Older adults should aim to be active
daily, any activity will make a difference
• Over a week, activity should add up to
at least 150 minutes (2 ½ hrs) of
moderate intensity activity in bouts of
10 minutes or more.
• For those who are already active………
75 mins vigorous physical activity
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11. Older Adults – Sedentary,
Strength and Balance
• All Older adults should minimise the
amount of time spent being sedentary
(sitting) for extended periods.
• Older adults should also undertake
physical activity to improve muscle
strength on at least two days a week.
• Older adults at risk of falls should
incorporate physical activity to improve
balance and co-ordination on at least two
days a week.
CMO, Start Active Stay
Active, 2011Generations Working Together 11
12. Strength & Balance
• Necessary for
• independent living, use of public transport
and getting to places to be active!
• Strength (& size of muscles) to fight
infections, use the bath and stairs, play on
the floor with grandchildren and get up off
the floor!
• Preventing a trip, or fall
• Mobilize on uneven ground, get dressed and
use public transport
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13. Education about strength activities
• All major muscle groups (including the
shoulder girdle, arms, trunk, legs and
ankles) will provide substantial
benefits for older people.
• Muscle strength activities will make
the muscles feel more tension than
normal, perhaps “shake” and be
warmer.
• Normal and anticipated that the day
after strengthening activities, there
will be mild muscle stiffness, indicating
that the activity has had a training
effect.
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14. Sedentary behaviour in older adults
Older adults spend 80% of their waking day in
sedentary activities
This represents 8-12 hours/day
Matthews et al (2008) Am J Epidemiol. 167: 875-81
Davis et al (2001) Med Sci Sports Exerc. 43: 647-54
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15. Sedentary behaviour health risks
In older adults (>60 years old), sedentary behaviour has
been found to be significantly associated with:
Sedentary behaviour is also linked to musculoskeletal pain
and can affect quality of life, social inclusion and
engagement
• Higher plasma glucose
• Higher BMI and waist:hip ratio
• Higher cholesterol
• Reduced muscle strength
• Reduced bone density
Gennuso et al (2013) Med Sci Sports Exerc.; Skelton (2001) Age Ageing; Chastin et al
(2014) Bone.; WHO (2010) Global Recommendations on Physical Activity for HealthGenerations Working Together 15
17. History of the MOTs
• Developed in 2011 for the Glasgow Science
Festival and Active Ageing Week Glasgow
• Pilots at
• Govan Shopping Centre, the Arc Leisure
Facility
• 8th World Congress on Active Ageing
(Glasgow) 2012.
• Paisley with ROAR (Reaching Older Adults in
Renfrew) sheltered housing
• Broader programme June 2013 onwards, have
trained 1000 + professionals across UK
• Research – Musculoskeletal Physiotherapy
outpatient clinics (ongoing)
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18. • Highlight the 2011 UK CMO
Physical Activity Guidelines with
older people for professionals
• Highlight the importance of the
components of fitness, particularly
strength and balance
• Use as a motivational tool to
engage older people in
programmes and activities
Background to the Functional
Fitness MOT (FF MOT)
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19. What is an MOT?
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20. Utilising what works
• Fun or intriguing activity....what is an MOT for
people?
• Normal data sets from large studies (Rikkli and Jones
2005 and others)
• Evidence base (Behaviour change theories)
– One to one, tailored, advice and action planning
– Time to understand different components of
fitness, motivators & solutions
– Signposting information (local) on how they can
take action
– Personalised information to take away and digest
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23. Data compared to “peers”
• Each test explains reason
• Gender specific
• Actual data marked on graph and discussed
• Will do well on some things and not others
12 __
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26. Sit to Stands – a marker of frailty
Use of hands to rise from a chair is strongly related to
all cause mortality (taking into account age, body mass index and
gender)
Reduction in risk:
Unable to rise
Use of two hands to rise
Use of one hand to rise
No hands to rise
de Brito et al (2012) Eur J Prev Cardiol. 21(7):892-898Generations Working Together 26
27. Grip strength
• How important?
• Everyday activities, shopping,
cooking and moving
• Opening jars, bottles, doors
• Risk factor for falls
• Indicator of overall body
strength
• Indicator of mortality
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28. Balance – static and dynamic
• Standing or moving about
whilst standing
• Reduced base of support
• Movement of centre of mass
• Reduced holding
The Wobble?
Messages between
proprioceptors and the brain
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29. Toenails - Life Curve ™ Newcastle
Research and practice into Functional activities, decline in ADLs
and a sequence from independence to dependence
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30. Functional Fitness MOT in Practice
One day educational programme
1. Highlighting the importance of
functional fitness
2. Undertaking a Functional Fitness
MOT with each other
3. Assessing and interpreting the
results
4. Having a conversation about
taking action
5. Support to plan MOT events and
activities
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31. Having a conversation
• How much time can you build
in?
1. Some information, signposting and
direction about what to do
2. Using a brief intervention eg.
discussion about likes, dislikes, local
opportunities and preferences
3. Entering into a behavioural change
process eg, lifestyle, health
coaching, peer mentors, Solution
Focussed Approaches, motivational
interviewing
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32. Personal reminders
• You scored well on the grip strength, why do you
think that is?
• Do you remember when you were doing the Chair
Rises? The feeling in your thighs?
• The sit and reach showed that perhaps more
flexibility would assist your walking because….
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33. What needs some work and why?
• Lower limb strength and stamina not too bad
• Balance work needed to reduce risk of falls
• Flexibility needs improving for better walking
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34. Using the physical activity profile
What did it tell you about their….
• Lifestyle and physical activity/sedentary
patterns?
• Attitudes - what emerged as opportunities
and what emerged as barriers?
• Choices that they might make?
• Commitment to taking action?
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35. Simple listening strategies
Ask – open ended questions (about you)
Don’t tell? – what’s on, what would count?
Discuss - who could help, what is realistic, what
would you like to happen?
We provide some questions you can use
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36. 5 steps to Action planning
Step 1. Why - Reasons to be active
Step 2. Goals
What do you want to achieve?
Detailed planning, what, where, when
Step 3 Support – who can help you?
Step 4 Coping strategies – What might get in the
way?
Step 5. What else do you need to do
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37. Key learning 1 - motivation
• Beliefs and attitudes
• Has been previously active (has been
part of their life)
• a positive attitude towards physical
activity and a belief in the benefits of
physical activity
• Tangible rewards (it will make a
difference)
(BHF NC 2012)
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38. Key learning 2 – Strength and balance
• Need to believe – I can do this!!!!!
– they are the kind of person who should do
these activities (self-efficacy)
– other people think you should do these
exercises (social approval)
– they will be successful and that these activities
would be enjoyable (mastery)
(Yardley L., Donovan-Hall, Francis, K. and Todd C. (2005)
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39. Case study – Aberdeen City Council
• Two x one day events – 1st 40, 2nd 60 participants
• Focus on
– Keeping eyes, feet and mind healthy
– Preventing falls
– Technology and independence
– Suitable exercise classes, social activities and events
• Include health checks
• “Meet the provider” exhibition
• Now held every 6 months and additional training
across the community to sustain
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40. Case study - Local libraries
• Cumbria Partnership NHS
Foundation Trust - Physiotherapy
Services (Whitehaven Library)
• Health and Wellbeing MOT half-day
• Included Functional Fitness MOTs,
BMI and blood pressure checks, and
information tables and stands
• 273 people attended (49 to 92)
• 15 local organisations attended and
supported
• Events for family care givers
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41. Case study – supported living
Reaching Older Adults in
Renfrewshire (Roar) Scotland
• 27 older volunteers underwent a
Functional Fitness MOT facilitated by
physiotherapy students from GCU
• In conjunction with a motivational
interview.
• 3 month follow up reported individual
improvements
• Increase in attending ROAR social
activity events
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42. Case study – Higher Education
• Sheffield Hallam University
Sport and Exercise Science
Department
• Included in staff professional
learning “development away
day”
• Build into 1st degree exercise
science course module
• Using with Ageing Well
Community Groups
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43. Case study – University and age related NGO
• Aberystwyth University,
Wales and Age Cymru
Ceredigion
• 80 participants (aged 60 to 95)
• Planning included:
– 18 students trained to
undertake the FF assessments
– Local volunteer support
• intergenerational opportunity for
students working with older
people. Generations Working Together 43
44. Case study – Further Education
• Perth College UHI
• Included within HND in Fitness,
Health and Exercise course
• Using with 5 Residential Care
Homes in Perth and Kinross
• FF MOT alongside other training,
eg Boccia, Curling and adapted
Golf
• Annual Go for Gold Challenge
event (Perth)
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45. Strength activities – the same is going on
From? – ??!Generations Working Together 45
47. Reported advantages/applications
• Flexible use
– Professional
– Setting
– Scale
• Potential to initiate a variety
of interventions
• Target and reach both
professionals and public
• Low cost
• Tailored and person centred
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49. Resources available to support the FFMOT
• Available as downloads
• FF MOT forms
• Cards and protocols
• Posters
• Free use - please acknowledge
GCU, LLT and please email us to
let us know if you are using the
resources
http://www.laterlifetraining.co.uk/functional-
fitness-mots-for-awareness-raising/Generations Working Together 49