What is functional fitness and why is it important? The Functional Fitness MOT A taste of MOT activities Examples and ideas

1. The Functional Fitness MOT
Prof Dawn Skelton and Bob Laventure
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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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4. How important is it?
“…… it is logical and possibly
safer to suggest that older
adults whose mobility is
compromised start by
increasing their strength
and improving their balance
before embarking on
aerobic training”.
WHO World Report on Ageing
and Health (Oct 2015)
Overall (I-squared = 61.5%, p = 0.000)
Ebrahim, 1997
Barnett, 2003
Woo, Tai Chi, 2007
Luukinen, 2007
Campbell, 2005
Schoenfelder, 2000
Sihvonen, 2004
Lord, 2003
Buchner, 1997
Author,
Nowalk, Tai Chi, 2001
Mulrow, 1994
Day, 2002
Reinsch, 1992
Skelton, 2005
Wolf, Balance, 1996
Woo, Resistance, 2007
Wolf, Tai Chi, 1996
year
McMurdo, 1997
Korpelainen, 2006
Morgan, 2004
Campbell, 1999
Hauer, 2001
Voukelatos, 2007
Faber, Functional walking, 2006
Li, 2005
Lord, 1995
Schnelle, 2003
Steinberg, 2000
Faber, Tai Chi, 2006
Liu-Ambrose, Resistance, 2004
Lin, 2007
Bunout, 2005
Liu-Ambrose, Agility, 2004
Resnick, 2002
Latham, 2003
Madureira, 2007
Carter, 2002
Green, 2002
Toulotte, 2003
Wolf, 2003
Cerny, 1998
Sakamoto, 2006
Rubenstein, 2000
Means, 2005
Protas, 2006
Suzuki, 2004
Campbell, 1997
Nowalk, Resist./Endurance, 2001
Robertson, 2001
0.83 (0.75, 0.91)
1.29 (0.90, 1.83)
0.60 (0.36, 0.99)
0.49 (0.24, 0.99)
0.93 (0.80, 1.09)
1.15 (0.82, 1.61)
3.06 (1.61, 5.82)
0.38 (0.17, 0.87)
0.78 (0.62, 0.99)
0.61 (0.40, 0.94)
Effect
0.77 (0.46, 1.28)
1.26 (0.90, 1.76)
0.82 (0.70, 0.97)
1.24 (0.77, 1.98)
0.69 (0.50, 0.96)
0.98 (0.71, 1.34)
0.78 (0.41, 1.48)
0.51 (0.36, 0.72)
size (95% CI)
0.53 (0.28, 0.98)
0.79 (0.59, 1.05)
1.05 (0.66, 1.68)
0.87 (0.36, 2.10)
0.75 (0.46, 1.25)
0.67 (0.46, 0.97)
1.32 (1.03, 1.69)
0.45 (0.33, 0.62)
0.85 (0.57, 1.27)
0.62 (0.38, 1.00)
0.90 (0.79, 1.03)
0.96 (0.76, 1.22)
1.80 (0.67, 4.85)
0.67 (0.32, 1.41)
1.22 (0.70, 2.14)
1.03 (0.36, 2.98)
0.71 (0.04, 11.58)
1.08 (0.87, 1.35)
0.48 (0.25, 0.93)
0.88 (0.32, 2.41)
1.34 (0.87, 2.07)
0.08 (0.00, 1.37)
0.75 (0.52, 1.08)
0.87 (0.17, 4.29)
0.82 (0.64, 1.04)
0.90 (0.42, 1.91)
0.41 (0.21, 0.77)
0.62 (0.26, 1.48)
0.35 (0.14, 0.90)
0.68 (0.52, 0.89)
0.96 (0.63, 1.46)
0.54 (0.32, 0.91)
100.00
2.64
1.88
1.22
3.85
2.74
1.40
0.98
3.38
2.21
%
1.88
2.75
3.80
2.04
2.81
2.86
1.41
2.67
Weight
1.48
3.05
2.04
0.88
1.89
2.56
3.31
2.87
2.38
1.98
3.97
3.34
0.72
1.13
1.67
0.65
0.11
3.46
1.34
0.70
2.21
0.10
2.58
0.31
3.34
1.11
1.40
0.88
0.80
3.13
2.27
1.84
0.83 (0.75, 0.91)
1.29 (0.90, 1.83)
0.60 (0.36, 0.99)
0.49 (0.24, 0.99)
0.93 (0.80, 1.09)
1.15 (0.82, 1.61)
3.06 (1.61, 5.82)
0.38 (0.17, 0.87)
0.78 (0.62, 0.99)
0.61 (0.40, 0.94)
Effect
0.77 (0.46, 1.28)
1.26 (0.90, 1.76)
0.82 (0.70, 0.97)
1.24 (0.77, 1.98)
0.69 (0.50, 0.96)
0.98 (0.71, 1.34)
0.78 (0.41, 1.48)
0.51 (0.36, 0.72)
size (95% CI)
0.53 (0.28, 0.98)
0.79 (0.59, 1.05)
1.05 (0.66, 1.68)
0.87 (0.36, 2.10)
0.75 (0.46, 1.25)
0.67 (0.46, 0.97)
1.32 (1.03, 1.69)
0.45 (0.33, 0.62)
0.85 (0.57, 1.27)
0.62 (0.38, 1.00)
0.90 (0.79, 1.03)
0.96 (0.76, 1.22)
1.80 (0.67, 4.85)
0.67 (0.32, 1.41)
1.22 (0.70, 2.14)
1.03 (0.36, 2.98)
0.71 (0.04, 11.58)
1.08 (0.87, 1.35)
0.48 (0.25, 0.93)
0.88 (0.32, 2.41)
1.34 (0.87, 2.07)
0.08 (0.00, 1.37)
0.75 (0.52, 1.08)
0.87 (0.17, 4.29)
0.82 (0.64, 1.04)
0.90 (0.42, 1.91)
0.41 (0.21, 0.77)
0.62 (0.26, 1.48)
0.35 (0.14, 0.90)
0.68 (0.52, 0.89)
0.96 (0.63, 1.46)
0.54 (0.32, 0.91)
100.00
2.64
1.88
1.22
3.85
2.74
1.40
0.98
3.38
2.21
%
1.88
2.75
3.80
2.04
2.81
2.86
1.41
2.67
Weight
1.48
3.05
2.04
0.88
1.89
2.56
3.31
2.87
2.38
1.98
3.97
3.34
0.72
1.13
1.67
0.65
0.11
3.46
1.34
0.70
2.21
0.10
2.58
0.31
3.34
1.11
1.40
0.88
0.80
3.13
2.27
1.84
Favours exercise Favours control
1.25 .5 1 2 4
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5. How important? – the evidence
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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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7. 3 Dimensions of Human Frailty
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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

16. Working towards achieving the guidelines
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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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21. Circuit approach
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22. Circuit approach
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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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24. Personalised take home information
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25. Let’s try
some
Functional
Fitness
Activities?
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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

46. Balance training– the same is going on
From 8 – 88!
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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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48. Limited equipment required
• Weighing Scales
• Height Scale
• Handgrip Dynamometer
• Stop Watch
• Clicker/counter
• Tape measure (to measure distance )
• Ruler (to measure flexibiity/reach)
• Marker cones
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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

50. www.laterlifetraining.co.uk
www.gcu.ac.uk
Thank you for listening
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