To your “Sit Tall, Stand Strong”Chair-Based Exercise Course

forFrailer, Older Adults & Disabled Adults

Welcome

INTRODUCTIONINTRODUCTIONan opportunity to get to know each

other

The Course ManualsThe Course Manuals

1 The Knowledge Base Manual

2 The Practical Manual

3 Open Book Worksheets

4 Learner File

Aims of the Chair-Based Aims of the Chair-Based Exercise CourseExercise Course

• To provide underpinning knowledge about the ageing process, disability and functional impairment and about adapted exercise programming related to leading ‘Sit Tall, Stand Strong’, the Later Life Training (LLT) chair-based exercise programme.

• To provide opportunities to apply this knowledge in the safe and effective practice of leading the 22 ‘Sit Tall, Stand Strong’ chair-based exercises.

• To develop competence in leading the specific ‘Sit Tall, Stand Strong’ chair exercises for frailer, older adults or disabled adults.

• To provide information on how to access appropriate local resources to help set up ‘Sit Tall, Stand Strong’ chair-based exercise sessions in a range of community settings.

By the end of the course the By the end of the course the Learner should be able to:Learner should be able to:

• Identify the main functional impairments affecting frailer, older adults and/or disabled adults

• Describe the key approaches to adapting the 22 ‘Sit Tall, Stand Strong’ exercises accordingly

• Describe and demonstrate how to communicate with older or disabled individuals to encourage, motivate and give feedback to improve performance.

Links with NVQ’sLinks with NVQ’s

NVQ Level 2 Instructing Exercise and Fitness (Gym-Based Exercise) D417 Support Participants in Developing and Maintaining Fitness (D417.1, D417.2, D417.3) D410 Plan and Prepare a Gym Based Exercise Session D411 Instruct a gym based session Level 2 & 3 NVQ in Promoting Independence (within the Care Sector) Level 2 NVQ in Sport Recreation & Allied Occupations: Activity

Leadership Level 2 Care Level 3 Promoting Independence Z6 Links with Key Skills Communication: Levels 1, 2 & 3 Improving Own Learning & Performance: Levels 1, 2 & 3 Working with Others: Levels 1, 2 & 3 Problem Solving: Levels 1, 2 & 3

AssessmentAssessment

You will be expected to: Provide a written Health & Safety Plan Provide a full written plan of the Exercise

Session, covering all 22 exercises Lead 5 of the 22 chair-based exercises Provide a written self evaluation of the

session you lead

Page 12

Learner File

During the course you will complete 3 worksheetsrelating to the ageing process and exercise

OK – so here we goOK – so here we go

Physical Activity, Ageing & Disability

Page 31

Knowledge Base

Components of Total Fitness

• Physical

• Mental

• Social

• Emotional

• Medical

What is Physical Fitness?

“Physical fitness is the ability to meet the

demands of everyday life with vigour and alertness – without undue fatigue and

with enough energy in reserve to enjoy

leisure time pursuits”(The Presidents Council on Physical Fitness and Sport)

Page 36

Knowledge

Base

Components of Physical Components of Physical FitnessFitness

Muscular Strength and Power

Cardiorespiratory (aerobic fitness)

Flexibility (Suppleness)

Motor Skills

Muscular Endurance

Physical Fitness

Body Composition

What’s the difference?

• Physical Activity– Any muscular movement occurring above

resting levels

• Exercise– Planned/structured physical activity which has

an aim (Buckley, 2008)

• Examples….

Exercise for Older/Disabled Exercise for Older/Disabled PeoplePeople

General health & fitnessFunctional fitnessADLsStrength & PowerJoint range of

movementManagement of medical

conditions

Exercise helps to:

Feeling of well-being

Independence

Socialisation

Body image

Enjoyment

Mood

AActivitiesctivities ofof DDailyaily LLivingiving

BADL’s

BasicBasic activities of daily living such as eating,

bathing and dressing

IADL’s

InstrumentalInstrumental activities of daily living that are

required for independent living such as

housework, shopping and stair climbing

Exercise for Older/Disabled Exercise for Older/Disabled PeoplePeople

General health & fitness

Physical Activity helps to:

Feeling of well-being

Independence

Socialisation

Body image

Enjoyment

Absence of DiseaseAbsence of Disease

Physical activity helps to prevent:

OsteoporosisNon-insulin dependant diabetesHypertensionHeart diseaseStrokeColon cancerHigh cholesterol

Sedentary vs. Sedentary vs. active lifestylesactive lifestyles

>3 hrs per week targeted exercise♥ Myocardial infarct

- 3 x less likely

Osteoporosis

- 2 x less likely

Fall-related injuries

- 2 x less likely

Hip fracture

- 2 x less likely

Psychological Function

Physical activity improves:

DepressionAnxietyAlertnessSleep

YOUNG AND DINAN (2000)

Benefits to individuals

Frailer older adults Disabled adults

•Maintain function•Maintain independence•Manage medical condition(s)•Psychological benefits

•Maintain function•Maintain independence•Manage disability•Psychological benefits

AgeingAgeing

AgeingAgeingEverybody does it

Everybody does it differently

Ageing population

• 10 million people in the UK are over 65 years old • 5½ million more older people in 20 years’ time • 19 million by 2050• 3 million people aged more than 80 years • 6 million by 2030 and 8 million by 2050.  • 1 in 6 of the UK population is currently aged 65

and over• by 2050 this will be 1 in 4

Disability

Disability includes…

• Neurological • Arthritic• Cardiac • Metabolic (obesity, diabetes) • Anxiety and depression • Hearing and vision impaired• Learning disabilities • Spinal injuries

Disabled UK population

• Wheelchair users make up only 8% of the disabled population

• Obesity accounts for 40%• Only 17% of disabled people born with impairments • 1 million people in England have a learning disability • 9 million in UK - deaf/hard of hearing• 2 million in UK - sight problems• 78% of over 85s are disabled • 7% of disabled people (compared to 31% of non-

disabled) do enough physical activity to improve health and prevent disease

A different “spin” on A different “spin” on fitness?fitness?

Strength to lift household objects

or to get up from the floor

Flexibility to wash hair, tie shoes

Balance and agility to climb

stairs

Co-ordination and dexterity to

open a door with a key or get

dressed

Stamina to walk to the shops

Keeping up with the Keeping up with the grandchildrengrandchildren

Meeting FriendsMeeting Friends

Mental StimulationMental Stimulation

Exercise for Exercise for Older/Disabled PeopleOlder/Disabled People

Target functional muscles Practice functional movements Target postural muscles Provide opportunities for socialisation Improve body composition Bone loading activity

Physical Activity Over Physical Activity Over HealthHealth

Disease

Prevention

Age

Maintenance of Independence

How much is enough?How much is enough?

Page 40

Knowledge

Base

How much is enough?How much is enough?

Dept Health, 2011 :

Guidelines for older adults

• 150 minutes a week, moderate intensity, bouts of 10 minutes or more

• Muscle strength exercise - 2 days a week

• Older adults at risk of falls – balance exercise - 2 days a week

• Minimise sitting for extended periods

How much is enough?How much is enough?

Dept Health, 2011 :

Guidelines for disabled adults • “Most disabled people would benefit from

physical activity according to their capacity”• “The general guidelines are applicable to

disabled people (so long as safety is addressed/ activities may need to be adapted)”

• “The guidelines for older adults can be applied to older adults with disabilities”

So what's stopping youSo what's stopping you??

Not at my age Not with my

disability Not fit enough It’s not for me It’s a fad I might fall It’s too painful Can’t get there Too busy

I do enoughCan’t afford itNot the sporty typeIt’s too late for meYou can get

obsessedI’ve been told not to??

If I’d known I was going to live this long, I’d have taken better care of myself

Dubey Blake

“Man does not cease to play because he grows old. Man grows old because he ceases to play”

George Bernard Shaw

Introduction to The Functional Model

The LLT 4 Step Guide to Normal Function and Functional Impairment

Page 65KnowledgeBase

• A ‘model’ is a template, a way to approach something, a model to follow

• This is beneficial in the context of exercise because with this model, all exercise leaders can apply the same thought process in order to come up with solutions, regardless of the problem

• A ‘model’ is a tool for thinking, and solution finding. It has a start point, and then follows a path towards decisions….so;

What is The Functional Model?

Several body systems work together to produce ‘normal’ functional movement needed for

everyday activities 

Several body systems work together to produce ‘normal’ functional movement needed for everyday activities

 

Normal function movement requires:

Healthy Bones & joints Healthy Muscular systemHealthy Heart and lungs Healthy Nervous system Healthy Endocrine system

 

Several body systems work together to produce ‘normal’ functional movement needed for everyday activities

 

Normal function movement requires:

Healthy Bones & joints Healthy Muscular systemHealthy Heart and lungs Healthy Nervous system Healthy Endocrine system

 

Functional movement is impaired when something goes wrong as a result of processes such as:

Ageing,DeconditioningDisease/clinical conditionsTrauma and injuryHereditary/congenital

Several body systems work together to produce ‘normal’ functional movement needed for everyday activities

 

Normal function movement requires:

Healthy Bones & joints Healthy Muscular systemHealthy Heart and lungs Healthy Nervous system Healthy Endocrine system

 

Functional movement is impaired when something goes wrong as a result of processes such as:

Ageing,DeconditioningDisease/clinical conditionsTrauma and injuryHereditary/congenital

Resulting in:

Discomfort, pain, poor posture, early fatigue, injury, demotivation, low mood/depression, isolation, reduced activity levels, further deconditioning & further impaired functional movement

Several body systems work together to produce ‘normal’ functional movement needed for everyday activities

  Normal function movement requires:

Healthy Bones & joints Healthy Muscular systemHealthy Heart and lungs Healthy Nervous system Healthy Endocrine system

 

Functional movement is impaired when something goes wrong as a result of processes such as:

Ageing,DeconditioningDisease/clinical conditionsTrauma and injuryHereditary/congenital

Resulting in:

Discomfort, pain, poor posture, early fatigue, injury, demotivation, low mood/depression, isolation, reduced activity levels, further deconditioning & further impaired functional movement

Commonly leading to: *Reduced range and control of movement*Asymmetry*Impaired base of support, *poor balance and co-ordination*Sensory impairment*Abnormal movement patterns (compensatory)*Painful movement *Impaired communication

Movements must be ADAPTED to suit the individual in order to achieve safe, effective, comfortable function, motivation and enjoyment for people with functional movement

impairment

The LLT ‘4 step guide’ to adapting exercise and maximising CBE delivery for people with functional impairments are;

Several body systems work together to produce ‘normal’ functional movement needed for everyday activities

  Normal function movement requires:

Healthy Bones & joints Healthy Muscular systemHealthy Heart and lungs Healthy Nervous system Healthy Endocrine system

 

Functional movement is impaired when something goes wrong as a result of processes such as:

Ageing,DeconditioningDisease/clinical conditionsTrauma and injuryHereditary/congenital

Resulting in:

Discomfort, pain, poor posture, early fatigue, injury, demotivation, low mood/depression, isolation, reduced activity levels, further deconditioning & further impaired functional movement

Commonly leading to: *Reduced range and control of movement*Asymmetry*Impaired base of support, *poor balance and co-

ordination*Sensory impairment*Abnormal movement patterns (compensatory)*Painful movement *Impaired communication

Movements must be ADAPTED to suit the individual in order to achieve safe, effective, comfortable function, motivation and enjoyment for people with functional movement impairment

The LLT ‘4 step guide’ to adapting exercise and maximising CBE delivery for people with functional impairments are;

Listen to your

participant; they are the experts on adapting to their disability 1

 

Observe the impairment/ how are range, control and comfort of movement affected? Then focus on a ‘Can Do’ approach 2

Understand the exercise, what range of movement and functional activity is it aiming to achieve?

3

‘Instruct, and communicate with the participant’ to keep joint (s) and other body systems safe and to train functional movement, prevent pain and strain, and maximise gain. 4

Class StructureClass Structure

Warm up Circulation Booster 1

Mobility

Circulation Booster 2

Stretches

Main Workout

CV Endurance Exercises

Strength Exercises

Cool down Circulation Lowering

Pelvic Floor (strengthening exercise)

Flexibility

Relaxation

Revitaliser Page 85

Practical

Handbook

MODEL PRACTICAL MODEL PRACTICAL CLASSCLASS

The Warm-UpThe Warm-UpAims: To prevent injury To promote circulation, generate heat and warm the

muscles To mobilise the joints in order to improve joint

function & ROM in the performance of everyday activities

To stretch the muscles To stimulate the nervous system to enable more skilful

performance To enhance enjoyment and motivation by providing a

relaxed, fun atmosphere at the beginning of the classPage 16

Practical Handbo

ok

Warm up structure

1. Circulation booster 1 (2-3 minutes)

2. Joint mobility exercises (4 reps each)

3. Circulation booster 2 (2-3 minutes)

4. Warm up stretches (perform once, hold 8-10 seconds)

Warm-Up Content Warm-Up Content CB11. Alternate heel raises, Arm Swings, Leg Marches, Tap & ClapMobility2. Shoulder Lifts and Circles3. Side Bends4. Ankle Activators5. Trunk TwistsCB2Stretches6. Back of Thigh7. Chest8. Calf9. Upward Side Stretch

Guidelines to Leading Guidelines to Leading Warm-UpWarm-Up

Correct posture

Starting position

Gradual build up

Keep it simple and achievable

Page 19

Practical

Handbook

Cool Down Component Cool Down Component

Page 68

Practical

Handbook

Cool Down ComponentCool Down ComponentAIMS

To allow the body’s systems to recover from the exercises gradually

Maintain and increase flexibility and posture Reduce the likelihood of post exercise

stiffness Strengthen pelvic floor muscles To promote relaxation To refresh and revitalise, following relaxation

Guidelines to Leading Guidelines to Leading The Cool DownThe Cool Down

CIRCULATION LOWERING

Progressively reduce the intensity of the

Circulation Boosting exercises

Guidelines to Leading Guidelines to Leading the Cool Downthe Cool Down

STRETCHES:

Repeat the warm up stretches,

holding for a little longer, to develop

flexibility and increase the range of

movement (up to 20 seconds, if possible)

Progression - repeat each stretch 2/3 times

Guidelines to Leading Cool DownGuidelines to Leading Cool Down

PELVIC FLOOR: Ensure in a relaxed,

supported position

RELAXATION

REVITALISER: Mild circulation exercises

Adult Social Care

• Values and principles:– Individuality– Choice– Rights– Dignity– Independence– Partnership– Confidentiality– Empowerment– Privacy– Respect for the individual

Reasons for upholding values & principles:

• Care needs met• Quality of experience• Appropriate service delivery• Consistent approach• Promotion of overall well-being• Value people as individuals• Meet legal requirements – human rights,

anti-discrimination

Possible areas of conflict between own values and adult social care values?

• Culture• Religion• Morals• Ethnicity• Politics• Confidentiality v ‘right to know’• Balancing needs of family/needs of individual• Organisational policy

Importance of supporting diversity

• Self-esteem of person

• Important to them

• Recognition of individual

• Supporting choice

• Quality of experience

• Promotion of overall well-being

• Legal/organisational requirements

Importance of gathering information

• What?– History – Needs – Wishes– Likes/dislikes

• Why?– Person feels valued– Tailored support– Person-centred approach– Avoid negative experience– Promotion of choice

Task

• What questions might you ask relating to exercise/physical activity?

– history

– needs

– wishes

– likes/dislikes

Endurance Theory

• What is endurance training?– uses the large muscle groups of the legs

and arms– can be continued for a prolonged period– is rhythmical– is aerobic (‘with oxygen’) – ‘huff and puff’– e.g. walking, running, swimming and

dancing

Endurance component structure

How much?

• 150 minutes a week • Can be in bouts of 10 minutes• Moderate intensity (breathing more heavily but can still

talk)

What exercises in CBE programme?• 10 minutes of:

– Marching– Arm swings– Pat and clap– Standing up and sitting down– Rowing

PRACTICAL CLASSPRACTICAL CLASSStrength Component

Page 47

Practical

Handbook

Muscular Strength - Muscular Strength - Endurance ContinuumEndurance ContinuumFast/Explosive

Powerful

Fast to Fatigue

High Resistance

Low Repetitions

Slow

Stamina

Slow to fatigue

Low Resistance

High Repetitions

Muscular Strength - Muscular Strength - Endurance ContinuumEndurance Continuum

Muscular Strength

Muscular Endurance

1 RM 15+ RM8-12 RM

Strength - Endurance Strength - Endurance ContinuumContinuum

Muscular Strength

Muscular Endurance

1 RM 15+ RM8-12 RM

Age related loss

Strength TrainingStrength Traininghow much is enough?how much is enough?

ACSM Guidelines for Health ACSM Guidelines for Health Related gains in Strength Related gains in Strength

2 x per week8 – 10 exercisesModerate Intensity (80% of 1RM) 10-15 reps1 set training initially

American College of Sports Medicine, 2007

Strength GuidelinesStrength Guidelines

Start between 5 - 8 reps Aiming to progress to 8 - 12 reps When easier, increase resistance Slow Controlled repetitions (6-9 seconds) Hold (up to 5 seconds) at peak contraction

Progress cautiously but ambitiously

Strength WorkoutStrength Workout

AIMS Improve and maintain muscular strength and

also improve posture and muscle mass To improve skill and control of movement To reduce the risk of injury, strain and

fatigue doing every day activities To improve bone density To improve self-esteem and confidence

Page 47

Practical

Handbook

Guidelines to Leading Chair Based Guidelines to Leading Chair Based ExerciseExercise

Tell them what they are going to do (name the exercise)

What it works (body system/part)

Why they are doing it (mobility, flexibility or strength & ADL’s)

Demonstrate (show

front view or side view)

Give key leading points Ask questions to check

understanding Group perform Observe (get up, walk

amongst the group)

Reinforce key leading points

Praise, correct and reassure

The Functional Model in Practice

Adapting the Sit Tall, Stand Strong Exercises

Bones, Joints & Muscles

 Adapting the Sit Tall, Stand Strong Exercises

Where do we start ?

Listen to your participant; they are the experts on adapting to their disability 1

 

Observe the impairment/ how are range, control and comfort of movement affected? Then focus on a ‘Can Do’ approach 2

The Functional Model in Practice - Steps 1&2

Understand the exercise, what range of movement and functional activity is it aiming to achieve? 3

‘Instruct, and communicate with the participant’ to keep joint (s) and other body systems safe and to train functional movement, prevent pain and strain, and maximise gain. 4

The Functional Model in Practice - Steps 3&4

The Functional Model in Practice : Example 1, Optimum Sitting Posture

Mrs P tells you that she has;- hip discomfort on walking and in sitting- some low back discomfort- able sit-to-stand but requires use of her arms

You observe; she sits in her chair always leaning to one side. The chair is such that her hips are set lower than her knees causing her spine to be permanently curved

How Can Mrs P’s sitting position be improved ?

1. Where do you want her joints to be/how do you want her sit/what could you do to make more comfortable ?

2. What joint actions/movements will you need to observe/look out for things going wrong?

3. What STST exercises would benefit from her better sitting posture position? And Why?

Optimum Seated Posture – Learner Led Practical

What exercises are most affected by poor posture, And why?

1. Show us your exercise/s with correct technique

2. Show us what would happen to the exercise if sitting posture was poor/alignment not correct

Refer to the Solutions chart on page 66 of knowledgeBase manual to help you with this task.

Summary - Optimum Seated Posture

• All seated exercises will be affected by a poor sitting

posture

• Alignment of ankles, knees, hips, shoulders and head

will support freer movement at the joints

• Poor alignment will lead to movement restriction

• This alignment may not be possible for all, so joints

may need to be supported with cushions etc.

One Day Instructor Course OnlyOne Day Instructor Course Only

PLANNING FOR YOUR PLANNING FOR YOUR ASSESSMENT DAYASSESSMENT DAY

Page 13

Student File

ASSESSMENT ASSESSMENT INSTRUCTIONSINSTRUCTIONS

AAHHH

Assessment Instructions – Assessment Instructions –

PlanningPlanningYou must produce a session plan, which youwill bring with you on the assessment date.

Your plan will include -

a) Health and Safety document (Page 14 in Student File)

b) All 22 exercises and full session structure

c) Give specific and relevant teaching and safety points for each exercise (not instructions)

d) Give appropriate adaptations and progressions

Session PlanSession Plan

Remember to bring the completed session plan to the assessment

Check that you have named, initialled, dated and numbered every page of your plan and that they are secured

(please DO NOT put each page in a separate plastic folder)

Assessment Instructions – Assessment Instructions –

PracticalPractical

You will be asked to lead FIVE exercises. These are from your planned and practiced session

plan and will include:

2 warm up exercises 1 endurance exercise 2 strength exercises

1 endurance exercise

Circulation Booster 1 PLUS

one mobility exercise

Circulation Booster 2 PLUS

one stretch exercise

OR

2 strength exercises

Assessment Instructions - Assessment Instructions -

Self EvaluationSelf EvaluationAfter you have taught each of your exercises

you will be encouraged to make notes on

your teaching skills based on:

Feedback gained from the groupHow you feel the group performed What you didHow you felt about itWhat will you do differently next time

Student File

Page 19

Assessment Instructions – Assessment Instructions –

PlanningPlanning

You MUST bring

All 3 completed worksheets (even if marked and passed already, you still need to submit)

Your session plan (including the Health

and Safety Planning Document)

Your exercise band

PracticePracticePlease don’t put everything away until the

day before the assessment! Practice on ‘anyone’ you can find!

LAST BIT!LAST BIT!

Course EvaluationsCourse Evaluations

Thank you Thank you for your timefor your time

Your comments do make a difference Your comments do make a difference