Organised by: Co-Sponsored: Malaysian Healthy Ageing Society
Professo fessor r Keith Hill, School of Physiot other erapy py Keith.Hill Hill@C @Curti rtin.edu edu.a .au Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
Definitions of frailty What exercise do older people do? What types of exercise are there and what are their general benefits? Review evidence for exercise in reducing frailty in different samples Highlight issues in targeting exercise, with examples of research
Many definitions in the literature “Frailty, a primary pathway to disability, has been defined as a pathological condition that results in a constellation of signs and symptoms and is characterized by high susceptibility to adverse health outcomes, impending decline in physical function, and high risk of death ” Peterson et al, 2009 (Fried et al 2004; Ferrucci et al, 2004) Footer Text 5/27/2012
Frailty syndrome (Fried et al, 2001) (3 or more present) INDICATOR OR Weakness Slow walking speed Self reported exhaustion Low levels of physical activity Unintentional weight loss Rockwood et al, 2005 Footer text - slideshow title 30.07.2010
Range commonly seeking health professional assistance Ideal range for for early risk assessment Very frail/ Healthy older High falls risk people CONTINUUM OF FRAILTY Starting to feel a little unsteady, Residential care, or receiving curtailing activity, minor falls or near falls considerable home supports
Incidental physical activity is unstructured activity undertaken at times that suit the individual, that often meet a functional need, eg, walking to the shop, performance of ADLs, taking steps instead of elevator Organised physical activity is activity performed usually for the purpose of improving physical performance, eg gym, swimming, exercise classes. Both are beneficial, and count towards your daily physical activity
Discussion paper: Physical activity recommendations for older Australia http://www.health.gov.au/internet/main/publishing.nsf/content/phd-physical-rec-older
50 Older people participated in fewer types of activity (ave=1.6) 40 Participation in organised physical activity lowest in older 30 percentage people (30.7%; vs 66.1% for 15-24 yo) 20 10 0 W A G e o a r l l o k f b i n i g c / f i t n e s s Exercise, recreation and sport (ERASS) survey, conducted by the Australian Sports Commission, 2006
World Health Organisation Health-Fitness gradient Group II Physically fit, Physically unfit, Healthy Unhealthy independent Group III Physically unfit frail, Unhealthy dependent
Exercise various forms of exercise strong evidence ◦ balance ◦ strength of effectiveness ◦ cardiovascular fitness of training in ◦ flexibility older people to specificity of training improve specific risk factor other health benefits of exercise programs
SING NGLE LE FOR ORMS strengthening MULTI-FACETED EXERCISE flexibility PROGRAMS cardiovascular balance desensitising any combination of these (vestibular) weight-bearing hydrotherapy others...
Reduced mortality: ◦ All cause ◦ Cardiovascular ◦ Respiratory (Dutch) Australian recommendations for physical activity for older people: Discussion document http://www.health.gov.au/internet/main/publishing.nsf/content/phd-physical-rec-older
Reduced risk of: ◦ coronary and cardiovascular disease ◦ diabetes ◦ obesity ◦ cancer (especially colo-rectal cancer) ◦ falls / falls related injury http://www.medicinenet.com Improved physical performance / function / independence ◦ Including in chronic disease (eg OA) Improved mental health (eg reduced depression) Australian recommendations for physical activity for older people: Discussion document http://www.health.gov.au/internet/main/publishing.nsf/content/phd-physical-rec-older
Group exercise programs Home exercise programs (often prescribed by a physiotherapist Tai Chi- (note: different types of Tai Chi may have different effects) Key elements of successful Foot and ankle exercise exercise interventions: as part of podiatric multi- Moderate balance faceted program (Spink et component al, 2011) Moderate intensity (Sherrington et al, 2008) Cochrane review: Gillespie et al 2009
Positive outcomes when applied appropriately: Improved fitness, function, Eg Walking program reduced risk of cardiovascular disease.... Negative outcomes when applied inappropriately: Increased falls when at risk samples recommended to increase walking without individualisation … (Ebrahim S et al, 1997)
Tai chi for arthritis – Sun style 24 form Beijing style – Yang style Very frail/ Healthy older High falls risk people CONTINUUM OF FRAILTY “Otago Plus” – incl VHI kit Otago Exercise Program
World Health Organisation Health-Fitness gradient Group II Physically fit, Physically unfit, Healthy Unhealthy independent Group III Physically unfit frail, Unhealthy dependent
Health ABC study (USA) – healthy cohort followed longitudinally (5 years), n=2964, mean age 73.6 Initial sampling: no difficulty doing mobility- related tasks, such as walking quarter mile or climbing one flight of stairs or performing activities of daily living Identified those with incident frailty: ◦ Gait speed <0.6m/s and / or ◦ Inability to stand (arms across chest) from chair (one impairment= moderately frail, both = severely frail) Peterson et al, 2009 Footer Text 5/27/2012
Results: 37% performing >150 minutes physical activity / week (19% in regular vigorous physical activity) ◦ 40% walked regularly ◦ 5% regular strength training Sedentary group had significantly increased odds for developing frailty relative to those with regular exercise participation (OR=1.45; 1.04-2.01) Significant dose response association between activity types (sedentary, lifestyle active, and exercise active) and development of frailty Significant independent predictors of onset of frailty included number of co-morbidities, increased age, male gender, African American race, and lower educational level Peterson et al, 2009 Footer Text 5/27/2012
Ind ndepende pendent, nt, gene nera rally lly well ll Infor form m general eral practit ctition ioner er / other er • healt alth h profes ofessional sionals An Any form m of exercise rcise likely ely to be • benefici eficial al Aim Ai m for at least st mo moderate erate inte tens nsity ity and • >150 50 minutes utes / week http://www.medicinenet.com Opti timi mise se outcomes comes by including cluding va vari riety ety • of exercise rcise types s (resistanc istance, e, cardiov rdiovascu ascula lar, , balanc nce and flexi xibil bility ity) Interm ermittent ittent revie view w of key indi dicators cators for • feedback dback and to facil ilitate itate adhere erence nce (eg eg fitness tness test, , BP, balance, ance, etc)
World Health Organisation Health-Fitness gradient Group II Physically fit, Physically unfit, Healthy Unhealthy independent Group III Physically unfit frail, Unhealthy dependent
Keith Hill, Xiao Jing Yang, Kirsten Moore, Sue Williams, Karen Borschmann, Leslie Dowson, Shyamali Dharmage Project funded by the Australian Government Department of Veterans’ Affairs 23
Feeling of “balance not as good as it used to be” Effect of age, or PhD candidate: something Xiao Jing Yang else??? Balance screening process Loss of confidence Activity curtailment Increased falls risk 24 Yang et al, Physical Ther 2012 Yang et al, J Clin Geriatr & Gerontol 2012
To determine the proportion of older people expressing concerns about their balance who do have a measurable balance impairment For those with identified mild balance dysfunction, to determine the effectiveness of a home based exercise program in improving balance and related measures 25
Sample and recruitment Participants were recruited from Melbourne. Inclusion criteria were: • aged 65 years or older • living in the community • being community ambulant • used no walking aid or a single point stick; • had no more than one fall in the past 12 months; • reported concerns about balance, confidence or near falls . 26
Lower limb Static Dynamic balance Gait muscle balance Reaching Stepping Turning strength / leaning Clinical Hand-held six measures Functional Step Dynamometer metre Reach Test walk (FR) (ST) Sit-to-Stand STS (5 times) Modified Limits of Laboratory Measures Clinical Stability Step (NeuroCom Test of (LOS) Quick Sit-to-Stand Walk Balance Sensory Turn (STS) Across Interaction Rhythmic (SQT) (WA) Master) of Balance Weight (MCTSIB) Shift (RWS) 27
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