April 10, 2023

P r e s e n t e d b y

Sue Scott, MS

Renewable Fitness & ABLE BODIES®

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Balance Training Tool Box

for Older Adults

A Squeaky Wheels Approach to Balance and Mobility

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Better Living through Exercise

ABLE CAPABLEBALANCED

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Squeaky Wheels Approach to Balance

• Exercise Science Perspective

• Critical Thinking

• People Skills

Able, Capable Living

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Perspective: Exercise As Medicine

Imagine the possibilities!

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Exercise as Medicine

Movement is a medicine

for creating change

in a person's

physical, emotional, and mental states. 

~Carol Welch

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Prescribing Exercise as Medicine

Specificity

Overload

Protocols Mode, IntensityFrequency, Duration

Outcomes

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Specificity

Finding the right targets

• Specific to tasks• Appropriate systems

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Overload

Stress that is more than normalIndividualSystem(s)Engaging, challenging, safe

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ACSM Position Statement on Balance Training

Use progressively more difficult postures . . .

that gradually reduce the base of support

require dynamic movements that disturb the center of gravity

stress posturally important muscle groups

reduce sensory input

conform best to the accepted theories of balance control and adaptation

~ASCM Position Statement, 1998

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Balance Protocols for Fragile Elderly

SpecificityOverload

ProtocolModes

•Specific to goals •Engage relevant systems•Multiple modes•Layering

Intensity•Challenge system •Engage the Individual

Frequency & Duration•Still researching

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Understand the Overall Picture . . . Specific components for balance in the

elderly

Strength

PostureFlexibility

VisionVestibularSomatosensoryReflexes

ExperiencesSkillsLearning

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What Tools Will You Need in Your Tool Box?

Posture & Flexibility

Strength & EndurancePurposeful strength

•Legs, core muscles and triceps

Balance and MobilityVisual, vestibular Somatosensory Automatic systemsGait training & ADL skills

Confidence & Trust Educate and engage their mind Good, clean fun

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Where to Start?

Tools Critical thinking skills

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Assessments

Identify & Explore ProblemsObserve

•Posture•Flexibility•Agility•Strength

Written evaluations•Existing•Balance Confidence

So Ma’am, What seems to be the

problem?

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Assessments

Flexibility & PostureModified Sit & Reach (Rikli, Jones) Back Scratch Test (Rikli, Jones) Grids

StrengthChair Stands

Endurance 2-minute Step Test (Rikli, Jones) 6-minute Walk (Rikli, Jones)

PowerMax Gait Speed (Rose)

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Balance Assessments

BALANCE Walkie Talkie (Rose) Walk with Head Turns (Horak)

Modified CTSIB (Horak, Rose)

Get up and Go (Rikli, Jones; Horak)

Rise to Toes (Horak)Toe Taps on Step (Horak) Functional Reaching (Rose)

Tandem Walk (Rose)Tandem Stand

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Balance Training Progressions and Layering . . .

Gradual increases in difficultyResistanceBalance requiredComplexity of the taskNumber of systems involved

Makes each exercise or activity more productive

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Flexibility

Improves range of motion in key joints

Better posture More efficient movement

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Flexibility

Ankles & Calves Hamstrings, Gluteals AB/ADDuctors

Chest & BackShoulder girdleTriceps

Axial skeletonHead turns, tilts, rolls, chin dips

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FLEXIBILITY Tools

Conceptual Activities Enhance cognitive learningLearn with their bodies and their minds •Inside out Learning

Build confidence & trust

Physical ActivitiesTarget key jointsProvide somatic cues & sensations

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Conceptual Flexibility

Venus Di Milo Arms

Inside-Out Learning

A sense that their arms can reach much

further

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Flexibility Activity

Supple Spine

Relaxercise - Zemach-Bersin and Reese, 1990

Even gentle flexibility can improve function

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Whole Body Flexibility

Farmer’s StretchCarry the

Baby

Gentlemen’s Bow

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Posture & Core Stability

Inter-related, ComplimentaryProper alignmentBraces posture

Steadies against balance disturbancesJostling crowds, perturbationsHead turns, arm swings

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Conceptual Posture Tools

Parts of the Whole

Breathe Easy

Posture Affects Function

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Conceptual Core Strength Tool

Torso as a Cylinder

Take Home MessagePosture affects balanceRenewable

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Conceptual Tool for Core Stability

Mohammed & the Mountain

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Training Core Strength

Target MusclesScapula & Head RetractorsAbdominals & Obliques Back Extensor

Simple to ComplexParts to WholeResistanceTask ComplexityElements of Balance

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Sample Strength Progressions

Tall SitsAdd overload

•Reps, time•Resistance

Add motion •Buddha’s Prayer•Curl up & sit tall•Indian Chiefs, Chiefs w/a twist, w/ knee lift

Add elements of Balance •Narrowed base•Dyna Disc

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Posture & Core Strength Training

Rows Seated w/ a tall a sit Alternating arms or obliquely Seated on a Balance discCombined with small squats

Knee Lift, Abs inSeatedCurl up and sit tallStandingDyna disc or ball w/ holder

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Core Stability – Back Extensors

Up & UpsStretchingReaching w/one armAdd Venus Di Milo ArmsW/ balloon W/resistance YMCAsStanding

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Strength with a Purpose

Target MusclesPosture and Back ExtensorsWhole legTriceps

Movement patterns mimic ADLsFlag SalutesTeeter Totter Chair Stands

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Progressions & Layering for Strength Training

As tolerated To fatigue (within 6-15 reps)Parts of motion before whole motionSingle muscles groups to multiple muscle groupsSeated, Standing, MovingMusicSecondary tasks

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More Examples: Heel & Raises

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Balance Training

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Balance Safety & ConfidenceTAKE TURNS!

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Systems of Balance

Visual Somatosensory Vestibular

Automatic

Integrated Many systems are used simultaneouslyLayers of systems, skills, experiences

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Vision - Visual Targets

Look ahead HorizonNext turnLook awayFlash Lights

Layer Posture & Core StabilityBalance Challenge

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Kinesthetic – Somatosensory

The Ball GameComing to our Senses

Belly Button Training

Sways and CirclesTai Chi

Reduced vision

Inside Out Learning

Cue for sensations

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Vestibular

Head & or Eye MotionSeatedDiscs, BallsStandingWalking

ExamplesSeated

•Head moves•Eyes move

Walking•Words on the Wall in the Hall

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Transitions – Control CoM

Already covered Sit to Stand Belly Button Training Sways Heel Toe Rocking

Traffic SchoolChange of PaceChange Directions Red light, Green LightObstacle Course

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Transitions – Controlling C of M

Walk the Line

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Transitions with Music

Side SteppingHeel ToeHeel touchesBack touchesBoth

MarchingToe TapsOn the groundTo a lineOn a stepOn a higher step Mind -

Body Connection

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Gait

Rock n WalkStride LengthObstacle Course

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Automatic

Dual TasksVerbalMotorCognitive

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The Need for Better Balance Programming

In 2004

Best Practices StatementBest Practices Statement

Physical Activity Programs and Physical Activity Programs and Behavior Counseling in Behavior Counseling in Older Adult PopulationsOlder Adult Populations

MSSE 36:11; 2004MSSE 36:11; 2004

Found just 6 exercises to improve balance in frail

elderly

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Background: How Did I Get Here?

Sue Scott, MSMasters & Bachelors in Exercise Science

ASCM certified

Exercise Prescription, Kinesiology at PSU

Specialize in balance & mobility for older adults•Frail Elderly •Parkinson's Disease

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Develop appropriate physical activities to improve balance and balance confidence in frail populations Encourage the elderly to live active, capable, involved lives Make these ideas available to others

Mission

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Exercise Enables

Capable, Able, ActiveTo do whatever we enjoyMore self-reliant, independentConnected to families, communities & values

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Achievements

Achievements2000 Developed a balance training program•Designed for Frail Elderly

PostureFlexibilityStrength with a purposeBalance Challenges

2003 Grant from National Blueprint Active Aging Partnership •Tested ABLE BODIES® techniques•Significant improvements Balance, strength, flexibilty and daily activity

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Blueprint Momentum

IAHSA Trondheim, Norway

ACSMAnnual Meeting, Nashville

APHAPhiladelphia

OHCAPortland, Oregon

Human KineticsDue out next year