Be Active Your Way Blog - LCulver

Physical Activity and the Prevention of Falls in Older Adults

LCulver — Wed, 13 Apr 2011 12:26:00 -0400

With the recent activities of the American Public Health Association's "Safety is No Accident: Live Injury-free" campaign during the week of April 4-10, we would like to continue to raise awareness about falls prevention. Falls are a major health concern among older adults. More than one-third of older adults fall each year, and fall rates increase with advancing age.¹ Falls are the leading cause of injury deaths, the most common cause of non-fatal injuries, and the most common reason for hospital admission due to trauma in older adults.² Every hour, there is one death and 183 emergency department visits for falls-related injuries among older adults and more than 95% of hip fractures are caused by falls.³

These facts are a scary reality; however, we know the most common risk factors⁴ of falling. They include the following:

Conditions associated with aging
Muscle weakness
Difficulty with balance or walking
Vision problems
Pre-existing medical conditions that limit mobility, such as Parkinson's disease, stroke or diabetes
Conditions that cause confusion
Being on more than four medications at the same time
Use of assistive walking device
Environmental hazards (e.g. throw rugs or pets)
Difficulty completing daily living activities
Low blood pressure
Fear of falling
History of fears

We also know that maintaining physical activity is critical in helping to prevent falls and can have a significant impact on many of the risk factors listed above. Performing physical activities of any fitness level - including programs, Tai Chi, aerobics and yoga - can help improve balance, strength and flexibility, and get patients moving again. In fact, effective interventions to prevent falls in community-dwelling older adults included exercise-based interventions provided in the home or group setting.⁵ Exercise interventions that appear to have the greatest impact are balance activities performed in standing (limit upper-extremity support), and exercise programs that are progressed based on the individual person. General exercise programs on the other hand, which do not focus specifically on balance and strength, are not as effective as individually tailored exercise.⁶ Finally, there has been strong evidence that supports a multifactorial approach to preventing falls with programs that include not just exercise but also appropriate screening, gait training and environmental assessments.⁷

According to the American Geriatrics Society's (AGS) Clinical Practice Guidelines, all should be screened for risk of falling. The AGS recommends a brief screening tool that includes three questions:

1) Have you ever fallen in the past year?

2) Has the patient had an acute fall?

3) Does the patient have difficulty with walking or balance?

If inviduals aged 65 years and older state that they have experienced two or more falls or has sustained an injury from a fall, they are considered to be at risk for falling. Likewise, if the person has difficulty with balance or walking, they may be at higher risk.

All professionals working with older adults should be aware of the risk for falls and the factors associated with a higher risk. With greater vigilance, we can prevent the injuries related to falls in older adults, as well as the related loss of function and participation in daily activities.

Are you screening older adults for falls? What community fall prevention programs are available for older adults in your community?

You can find more consumer resources about risk factors, testing balance, and where to find a physical therapist by visiting Move Forward.

Addressing a Communities Fitness Needs: One Person at a Time

LCulver — Fri, 04 Feb 2011 13:52:00 -0400

Physical inactivity is a leading cause of death in the U.S. due to heart disease, stroke, diabetes, and cancer. Physical activity is critical in the prevention of the detrimental effects of aging, obesity (33 to 35% of the US adult population), and chronic illnesses. The Finnish Medical Society Duodecim, has also documented the importance of physical activity in the prevention, treatment and rehabilitation of diseases . Despite well‐documented evidence of the benefits of physical activity, we still have not approached the recommendations of the HHS Physical Activity Guidelines .

What is the problem? Approximately 70% of US adults are underactive, 40% of American adults do nothing to exercise, and 50% of individuals who start an exercise program drop out after 6 months. (SportsEconomics: Battling Attrition – A Study in Improving Member Retention at Health Club Facilities. SportsEconomics Perspectives, Issue 3. 2001.)

Barriers to implementation by physicians include limited time, lack of tools and skills, and lack of reimbursement. Patient barriers to exercise include lack of time and confidence, presence of an injury, and incomplete/improper information regarding exercise relevance, content and dosing. Research shows that exercise advice given by a primary care physician may be effective in increasing physical activity in the short‐term [after two months], but not in the long‐term [after four and twelve months], due to insufficient support, accountability, and implementation strategies.

Who is currently in position? The health and fitness industry is uniquely positioned to meet the growing need for easily accessible, supportive, and guided fitness venues. They clearly have a role but health clubs average a loss of 1 to 6 of every 10 members, and experience a mean attrition rate of 40% annually., Furthermore, program planning at most health clubs is targeted towards individuals who have already committed to making physical activity a habit (which may explain why so many new members drop off).

Who else can help? Successful exercise among those individuals who see more barriers than benefits to exercise depends on four key provider-driven characteristics: clear, credible data; specific, attainable goals; directed programming; and appropriate reinforcement/support.

What’s Our Solution? Conduct Annual Physical Therapist‐based Fitness Physicals to establish objective, norm‐referenced baseline measures of strength, flexibility, postural habits, cardio respiratory fitness, risks for injury, and readiness for change. Develop individual fitness plans to specifically address findings; provide patient education, support, and ongoing feedback; establish multi‐modal fitness strategies including home exercise, private fitness training, and/or group fitness classes to best fit patient’s lifestyle, level of confidence and commitment, and experience; provide structured accountability and positive re‐enforcement systems.

What is your organization doing to engage communities to be more physically active?

Written by: Jennifer M. Gamboa, DPT, OCS, MTC

Dedicating Awareness Months to Helping Families Avoid Obesity by Physical Activity

LCulver — Wed, 15 Dec 2010 14:16:00 -0400

Montefiore Medical Center Physical Therapy Department promoted physical activity by sponsoring a two-mile run/walk to benefit B'N Fit, a Montefiore program that teaches teens how to adopt healthy, physically active lifestyles.

According to the Centers for Disease Control and Prevention (CDC), 68% of adults over the age of 20 are either overweight or obese.

With Americans' health challenges in mind, the American Physical Therapy Association (APTA) dedicated October’s annual National Physical Therapy Month (NPTM) to letting people know that children and adults ― both able-bodied and differently-abled ― can help prevent obesity and its consequences by following the HHS Physical Activity Guidelines for Americans. We chose to place our emphasis on obesity prevention

According to a 2009 PEW Research Center study, 61 percent of American adults look online for medical help. Knowing this we decided to engage our audience by hosting a Tweet Chat. We partnered with AOL’s “That’s Fit,” a popular, interactive, online fitness, health and wellness resource to host the chat and addressed issues related to the role of physical activity in staying fit, starting an exercise regimen, and exercise considerations for people who are obese and/or have type 2 diabetes. We found that this was a great addition to our PR efforts, as our post-chat report indicated that we reached an estimated audience of 81,000. We plan to incorporate social media into our NPTM efforts for the foreseeable future and we plan to encourage our members to make social media part of their own efforts.

We developed a variety of materials for members, the media, and the public. For APTA members, the NPTM Web page featured new additions to our “staple” resources such as sample Facebook and Twitter posts and a downloadable board game. For the public and the media, we included some of the above, with links to HHS physical activity guidelines, including guidelines for adults with disabilities and health conditions such as type 2 diabetes. We also posted a “physical activity” page on our consumer Web site that included information from our press release and links to our Find-a-PT database and a YouTube video about physical activities for kids of all abilities.

It was satisfying to see the creative ways in which members got the word out in their communities. These included free community lectures, booths at local health fairs, a run/walk to benefit a program that teaches teens how to adopt healthy, physically active lifestyles, and a professor and her students visiting all three national morning shows. We always ask for members to send us their photos and descriptions of their events so we can showcase them on our NPTM page. We also provide links to the previous years’ descriptions and photos so members can get ideas for the current year.

Building a Healthier Community: Helping Those Who Help Us

LCulver — Wed, 20 Oct 2010 11:33:00 -0400

A frequently forgotten segment of our community are the public servants who keep our cities running well and safely. If we don’t hear from them we assume everything is okay. But if they aren’t functioning well our cities and our safety may suffer. What better place to start building a healthier community than by helping those who help us, our public servants?

Being interested in the health and wellbeing of our communities, there are many levels at which we may begin to make a positive difference in the lives of our public servants. Here is an example of supporting physical activity efforts ― progressive guidelines used by physical therapists in Florida to incorporate physical activity into their community - Evaluation, Education, and Integration.

Evaluation – Look for occasions to assess and evaluate levels of physical fitness in the public servants in your city. This can open doors for exercise prescription according to the Physical Activity Guidelines. For instance, employment screenings and training assessments are a part of many public servants’ jobs. Research indicates that physical activity is beneficial to mental, emotional, and physical health and wellbeing. Physical activity also results in improved work-site morale, increased productivity, and decreased worker compensation claims. http://aspe.hhs.gov/health/reports/physicalactivity/
These are just a few benefits to both the employer and employee that make living an active, well lifestyle appealing.

St. Johns County Fire-Rescue Job Function Training assessment.

Education- Look for the opportunities to educate your “local leaders” on the value and importance of living an active, well lifestyle. Brown Bag lunch series are often conducted by various departments to provide instruction and incentive to the employees. Most public servants are required to attend mandatory in-service trainings, so consider becoming a part of the in-service curriculum by adding a wellness/physical activity component. As movement experts, physical therapists are uniquely qualified to serve as consultants on a variety of physical wellness issues, not only including rehabilitation, but also wellness and prevention.

Mandatory Wellness In-Service Block Training for county law enforcement.

Integration- Face-to-face group instruction is great, but not always possible. Think about alternate modes of delivering information on ways that public servants may integrate physical activity and wellness into their lifestyles. Develop a CD/DVD they can keep in their Human Resource department that they can access at any time. Better yet, make physical activity a part of the community and invite them to attend. Organize a community event, a 5 K run/walk, a family fun day, or the like....include everyone. You will be surprised at what this can do for the entire city.

Family Fun Day/5K hosted annually at the University of St. Augustine for Health Sciences, St. Augustine, FL.

As you begin to implement some of these ideas remember:

Public servants will need to know why they need physical activity in their lives. EVALUATE them to establish a need and give them a “why”. Then, EDUCATE them on how to be physically active and well. Finally, INTEGRATE physical activity into their lives and the community. As you prepare to help those who help us consider:

What can you do to Evaluate, Educate and/or Integrate physical activity for your public servants and community?
Do you have staff or employees within your organization qualified to begin these strategies? If not, can you hire a consultant? Physical therapists are uniquely qualified to integrate movement and physical activity for both rehabilitation and wellness.

Goofy for Exercise

LCulver — Wed, 07 Jul 2010 09:58:00 -0400

The home and community environment can set the tone for a healthy lifestyle for children and adolescents. This is particularly true in the area of physical activity. Parents and caregivers can be role models in their levels of activity and also support community activities that encourage regular physical activity and make it fun.

To foster that notion, the Section on Pediatrics (SOP) of the American Physical Therapy Association (APTA) recently hosted their first annual conference in Orlando, Florida. The conference provided 3 days of educational programming and networking focused on a lifespan approach from neonatal and infancy through the young adult, including fitness and sports participation within the community.

An exciting element of the conference was the coordinated participation in the Walk Disney World Marathon Weekend Events.

The SOP instituted a fitness challenge, “GOOFY FOR EXERCISE” which encouraged children and adults of all age groups and abilities to be “Goofy for Exercise!” The challenge went out to all SOP members and the community to train for a 5K, half marathon, or full marathon. Team Members (many who were first timers) met in Orlando the weekend of January 8 – 10, 2010 to participate in the event.

More than 50,000 runners (including their family and friends) passed through the SOP booth at the health fair to retrieve their race packets. As an exhibitor, the SOP provided fitness literature that included APTA’s Fit Teens and Fit Kids magazines and “Fit for Life” stuffed toy bears.

This event supported three key messages:

Being active can be a family affair and fun for adults and children alike,
Pediatric physical therapists can support children and their families by being good role models and ensuring opportunities for children and families to participate, and
Physical activity is important regardless of a persons’ abilities

Presently the SOP envisions “Goofy for Exercise” as an on-going campaign/training event, involving more families and coordinating with other small pediatric charity groups. We plan to identify several diverse fitness events and health fairs throughout the year to “encourage exercise for all.”

The SOP and the APTA also have a number of current and future resources for children and families that encompass all ability levels. These resources can be found at: http://www.pediatricapta.org/consumer-patient-information/index.cfm.

Potential Future “Goofy for Exercise Events” inlcude:

September 3-5, 2010 Disneyland –Family Fun Run & Half Marathon Team; SOP Booth at Health Fair
January 6-9, 2011 Walt Disney World - Family Fun Run & Events, Half & Full Marathon Team; SOP Booth at Health Fair
September 2-4, 2011 Disneyland - Family Fun Run & Half Marathon Team; SOP Booth at Health Fair
Web Link to training schedule
Simultaneous races/events throughout country

We are on the way to more fun stuff!

“It’s Kind of Fun to Do the Impossible” Walt Disney

Do you plan on joining the SOP “Goofy for Exercise” Challenge at one of our planed events?

What event will you plan in your community to be “Goofy for Exercise?”

Physical Activity - When Movement May Already be a Challenge

LCulver — Wed, 17 Feb 2010 10:13:00 -0400

The benefits of physical activity are well documented and participation in regular physical activity can prevent or reduce the risk of numerous diseases and health conditions. In addition, physical activity has been shown to improve a person’s function and allow him or her to better participate in their chosen life roles. These benefits extend to individuals with functional impairments and movement limitations. In 2008 there were more than 35 million persons in the United States living with a disability in the US. Individuals with mobility challenges often experience difficulties participating in their routine physical activities. They also may experience access problems to typical environments for exercise. Others may be fearful of further injury or have co-morbidities which they perceive as a barrier to activity. These individuals may often require additional education, counseling, and other assistance to overcome barriers and optimally participate in physical activity.

Connecting the Dots: Community Participation

All healthcare professionals need to actively engage patients in conversations about physical activity and its lifelong health benefits. In doing so we need to consider not only their individual needs and capabilities, but also the environment in which they live. But do we provide enough input and advice to our patients to support them in this endeavor? In order to be successful, physical activity needs to be integrated into their lives – where they live, work, learn and play. All healthcare providers should be knowledgeable about and collaborate with the available resources in the local community to meet patients’ needs as they move from rehabilitation to managing their own care.

How well do you know your community resources? Do you know...

Where your patients can go in the community to be physically active?
Where there is a gym that is accessible for individuals with mobility complications?
If there is a local shopping center that opens its doors to ‘mall walkers’ in the morning?
If there are municipal sites (parks, trails) that might encourage physical activity?
If your community supports programs such as bike to work, walking school bus, stroller moms group, etc?

Collaborative Leadership: Community Advocacy

As health care providers we can play an essential role in our local communities through leadership and advocacy for a well designed community plan that encourages activity and reduces barriers for people with disabilities. We are well aware that the external environment can significantly help or hinder an individual’s ability to participate in all of life’s roles, and this holds true for participation in physical activity.

How can organizations collaboratively address the crisis of inactivity for those with movement or other challenges?