1. Stay On Your Feet! Prevent Falls With Exercise AAHPERD National Convention 2011 Christian Thompson, Ph.D. Department of Exercise & Sport Science University of San Francisco

2. Objectives n Describe the prevalence of falls and falls-related injuries and the costs associated with them n Identify intrinsic and extrinsic risk factors for falls n Explain the balance control mechanisms in the body and how they work together to reduce falls risk n Learn about 3 simple screening protocols to identify falls risk in older clients n Develop a comprehensive falls prevention exercise program consisting of exercises for mobility, strength, balance, and gait enhancement n Identify appropriate exercise progression and regression strategies to use with older clients to reduce falls risk

3. The Older Adult Continuum

4. This Can Happen to Both of Them!

5. Too Bad It’s Not Funny… n Over 1/3 of people aged of 65+ fall each year n In 2004, over 1.8 million seniors were treated for fall-related injuries at emergency rooms n Approx. 400,000 fractures per year due to falls n Over 20% of hip fractures result in death in 1 yr n Problem will only continue to increase with the “Graying of America” and its changing demographics Sources: CDC, 2007; Kannus et al., 2005; Ngyuen et al., 2007

6. Golden Years in the Golden State? Almost 12% of older Californians fell more than once & 34% fell at least once in 2007 Diagnosed diabetes increased from 15% in 2001 to 17.5% in 2008 Diagnosed hypertension increased from 53% in 2001 to 60% in 2008 A coincidence…PROBABLY NOT!!! Source: UCLA Center for Health Policy Research, 2008

7. Factors Affecting Falls n Extrinsic Factors n External Issues –Weather or outdoor conditions – House clutter and obstacles –Poor lighting –Lack of adaptive devices in the home –Inappropriate footwear/clothing Intrinsic Factors Internal Issues –History of Falling –Chronic Diseases & Medical Conditions –Sensory/Vestibular Impairments –Medication Effects –Functional Level (Strength, Posture, Gait) Sources: (Rose, 2003; Tinetti et al., 1988; Carter, 2001; Lehtola et al., 2006) Risk linearly with number of risk factors present

8. Our Falls Defense Mechanisms

9. What To Do About It?? IDENTIFY the Balance Control Deficit(s) CONSTRUCT Corrective Strategies MODIFY Based on Functional Capabilities

10. IDENTIFY Multifactorial Interventions – 6 Studies Three simple, validated assessments Functional Reach Test Timed Up and Go Test 30 Second Chair Stand Test

11. Functional Reach Test Duncan & Colleagues, 1990

12. Timed Up and Go Test Podsiadlo & Richardson, 1990

13. Chair Stand Test Rikli & Jones, 1999

14. CONSTRUCT & MODIFY Mobilizations The ANKLE & HIP are KEY!!! – Subconscious utilization of ankle “strategy” during quiet standing – Reactive utilization of hip “strategy” during movement Isolated non-loaded mobilizations – Ankle Circles – Hip Circles Loaded integrated mobilizations – TADAs

15. CONSTRUCT & MODIFY Muscle Strengthening More than just gaining strength… Enhance neural recruitment & increase lean tissue mass Challenge postural control and improve stabilization capacity Emphasize eccentric control during movement – deceleration of gravitational forces is essential for falls prevention Selected exercise Chair squats

16. CONSTRUCT & MODIFY Gait Enhancement WHY do older people walk the way they do??? Reduced mobility of ankle & hip joint (reduced sensory input) Gravity is winning the battle FEAR!!!! (contracts the sphere of function) Pathological conditions (only in a small % of OAs) Gait Enhancement Enhancing the proprioceptive input Increasing awareness at long distance Selected Exercise Side Stepping

17. Recommendations for the Fitness or Activity Professional n Understand your older clients n Recommend clients to undergo multifactorial risk assessment n Progress clients safely but steadily n Include multiple modes of exercise to address modifiable physical characteristics

18. n Dr. Christian Thompson n Department of Exercise & Sport Science n University of San Francisco n 2130 Fulton Street n San Francisco, CA 94117 n cjthompson@usfca.edu n (415) 422-5270