1. Resistance bands/tubing, weights UE: Shoulders and elbows LE: hips and knees Strengthening 5-10 min. AFEP Manual, 2009

2. Variety of movements such as: Walking in place Dance type steps, sports themes Cardiovascular 1-20 min. AFEP Manual, 2009

3. Interspersed throughout Use of chair as support if needed Examples: heel raises, toe raises, tandem standing, weight shifts, single leg stand, leg swings, side steps, tandem walking Balance/Coordination AFEP Manual, 2009

4. Reduce soreness Transition to next segment Lower injury risk Jt. Check/Cool down 5-10 min. AFEP Manual, 2009

5. Progressive relaxation Guided imagery Slow, deep breathing Relaxation/Breathing 1-5 min. AFEP Manual, 2009

6. AFEP Forms Participant release form Ongoing assessment of participant reach NCOA, 2012

7. AFEP Leader Training Required instructor certification 8 hour training Typically leaders are health care professionals or fitness professionals CPR required; first aide recommended One instructor per class NCOA, 2012

8. AFEP Other Costs & Equipment Weights (optional) Guidebooks Other materials No licensing fee NCOA, 2012

9. Examples of an AFEP Class http://www.arthritistoday.org/what-you-can- do/staying-active/exercise-videos/two-minute- exercises/head-neck-stretch.php http://www.arthritistoday.org/what-you-can- do/staying-active/exercise-videos/two-minute- exercises/head-neck-stretch.php http://www.arthritistoday.org/what-you-can- do/staying-active/exercise-videos/two-minute- exercises/arms-and-elbows.php http://www.arthritistoday.org/what-you-can- do/staying-active/exercise-videos/two-minute- exercises/arms-and-elbows.php http://www.arthritistoday.org/what-you-can- do/staying-active/exercise-videos/two-minute- exercises/hips-knees-and-legs.php http://www.arthritistoday.org/what-you-can- do/staying-active/exercise-videos/two-minute- exercises/hips-knees-and-legs.php Arthritis Foundation, 2006a; 2006b, 2006c

10. AFEP Evidence Example Hinchman, 2001 178 Participants Less health care utilization (ER visits), Improved overall health

11. AFEP Evidence Example Arthritis Foundation, NY Chapter, 2001 551 Participants; pre-post testing, control group Results indicted: Reduced depression, pain, stiffness Improved self-efficacy and functioning Improved education on self-mgt

12. AFEP Evidence Example 347 participants (Schoster, Callahan, Meier, Mielenz, & DiMartino. (2005). Results indicated AFEP program provided social support for participants and increased self-efficacy

13. Improved arthritis self management AFEP Evidence Example 174 participants; RCT, pre-post test design study; 8 week, 16 week, & 6 month follow up (Minor, 2007) Reduced pain; improved endurance Improved self care behavior

14. AFEP Evidence Example 346 participants with arthritis, RCT, 8 week follow up and six month follow up (Callahan, et al., 2008) Less pain Improved self- mgt, arthritis Less stiffness Better endurance Improved strength

15. AFEP CMS Review Participants in this program had estimated total healthcare savings of over $750. Savings in inpatient unplanned stays ~$670 Savings in SNF stay ~$200 Less unplanned hospitalizations; more MD visits CMS, 2013

16. Group Activity Talk with one or two people near you and answer the following question. Please be ready to share your answers afterwards. Group Activity: What are some strategies to make it feasible to offer evidence-based health promotion classes in your community? What role(s), if any would you like to take in this process?

17. Tai Chi for Arthritis Tai Chi for Health Institute was founded by Dr. Paul Lam in 2009 Empower people to improve their health and wellness Recommended by CDC for fall prevention

18. Principles of Tai Chi Arthritis Improved flexibility Improved muscular strength Improved fitness Decrease pain and falls

19. Program 6-8 weeks 45-60 min 2x per week Led by certified instructor

20. Session Includes Warm-up 6 basic core movements 6 advance movements Breathing techniques Cool-down

21. Tai Chi Arthritis Example http://www.arthritistoday.org/what-you-can- do/staying-active/exercise-videos/tai-chi- exercises/tai-chi-video-spine-stretches.php http://www.arthritistoday.org/what-you-can- do/staying-active/exercise-videos/tai-chi- exercises/tai-chi-video-spine-stretches.php

22. Chronic Disease Self-Management Program (CDSMP) Enable to build self-confidence to take part in maintaining their health and managing chronic conditions Hypertension Arthritis Heart disease Stroke Lung disease Diabetes

23. Program 6 weeks 2.5 hours per week Program provides information and teaches practical skills on managing chronic health problems 2 trained leaders

24. Assessments STEADI – Stop Elderly Accidents, Death & Injury Timed Up and Go 30 Second Chair Rise 4 – Stage Balance Test

25. STEADI 12 item self assessment Printed by CDC Environmental checklist Safety tips

26. Timed Up And Go (TUG) Easy, reliable, and valid indicator of functional mobility and falls risk Predictive or morbidity, mortality, functional status (Studenski, 2011)

27. Timed Up And Go Rise from a standard height chair – May use arms – May use assistive device Walk 3 meters (@10’) Cross a visible line or around a visible pylon Turn 180  Walk to chair Turn & sit down

28. What it Tells Us Does the person have difficulty performing the task? Is the person slow? – 7-9 sec: low risk, typically a fit & active older adult – 10-12 sec: moderate risk, an ‘average’ older adult – ≥ 13.5 sec: high risk for future falls – (Bohannon, 2005)

29. What it Tells Us Best reliability and validity with independently mobile, healthy older adults Poor reliability in hospital settings Timing task can provide baseline measure of performance KEY – Does the person have difficulty performing????

30. 30 Second Chair Rise Indicator of strength and endurance Poor performance associated with increased falls risk

31. 30 Second Chair Rise Sit in middle of chair Cross arms, hands on shoulders Feet flat on floor On go, rise to full standing and sit Repeat for 30 seconds

32. 30 Second Chair Rise Begin timing on go Count number of times the patient comes to full standing in 30 seconds Record number of repetitions

36. http://www.cdc.gov/homeandrecreationalsaf ety/Falls/steadi/videos.html http://www.cdc.gov/homeandrecreationalsaf ety/Falls/steadi/videos.html

37. Resources National Council on Aging, Center for Healthy Aging

38.  www.ncoa.org/improve-health/center-for-healthy-aging/online-training- modules/series-1-intro-to-health.html www.ncoa.org/improve-health/center-for-healthy-aging/online-training- modules/series-1-intro-to-health.html

39. http://www.ncoa.org/improve-health/center-for-healthy-aging/about-evidence-based- programs.html

40. http://www.ncoa.org/improve-health/center-for-healthy-aging/where-to-find- evidence-based.html

41. http://www.ncoa.org/improve-health/center-for-healthy-aging/content- library/Title-IIID-Highest-Tier-Evidence-FINAL.pdf