A toolkit for frontline caregivers to help maintain healthy

and active aging in seniors

With the goal of sustaining adequate IADLs to allow seniors

to remain as autonomous as possible for as long as possible

Relaxation exercises, physical exercises

and suggestions for cognitive activities for the home setting

1

Table of contents

Introduction

A healthy mind in a healthy body at any age! 2

Facts and Tips

Facts about frailty 3

Some false myths about exercising 3

Benefits of Exercising 4

Good Pain versus Bad Pain : How to Tell the Difference? 6

Appropriate Level of Effort 7

Functional Fitness Assessments 8

Physical Tests (TUG et STS) 9

Confidence Test 11

Functional Fitness Score 12

The Physical Exercise Program

Exercise Categories 13

Start with Relaxation (Listen to the audio monologue instructions!) 14

The Aerobic Exercises 15

The Muscle Strengthening Exercises 16

The Flexibility Exercises 17

The Balance-building Exercises 18

End with Relaxation (Listen to the audio monologue instructions!) 19

Client’s Exercise Calendar 20

Suggestions for Intellectual Activities 21

Client’s Functional Fitness Progress Report 22

And of course….EAT RIGHT! 23

2

Introduction

A healthy mind in a healthy body at any age!

Everyone wants to live independently with a good quality of life for the rest of their days. What

can help make this possible? The secret according to scientific research is maintaining an active

lifestyle. Contrary to popular belief, old age is definitely not the time to rest - if living

independently with good health and an alert mind is the goal.

With age, our physiological reserves and biological resilience declines. This can lead to frailty,

and it is easy to spot in some seniors. These seniors appear weak, look fragile, and move slowly

and without confidence. They often complain of low energy and have no interest in doing much.

But frailty is not the norm. Old age does not necessarily mean limited mobility, reduced zest for

life, and bad health. Nor does it always mean memory loss and cognitive decline. Frailty and

dementia need not always be a part of normal aging – at the very least their onset can be

postponed according to scientists. Indications are that all it takes is a commitment to moderate

daily physical and cognitive exercise, even from really senior seniors! The goal is long term

autonomy not long term care!

In the past, we would encourage our seniors to reduce their activities, get someone to do their

chores for them, and advise them to rest. Research has since shown that this approach to caring for

seniors has adverse effects – in fact is the opposite of what we should be doing for them. For this

reason, the Ontario government has implemented Ontario’s Action Plan for Seniors featuring the

theme "Independence, Activity and Good Health". It encourages seniors to stay active and

engaged in order to prolong a good quality of life with the goal of living at home independently

for as long as possible, which is the cherished wish of the overwhelming majority of seniors.

So let’s get started on the road towards maintaining independence and an active and healthy

lifestyle for our seniors! This manual contains everything you will need to help your clients

succeed in this new action plan. It contains facts about the benefits of an active lifestyle and

counterarguments to dispel harmful myths about seniors and exercise; it contains simple physical

and cognitive exercises, a progress report template, and tips on how to accompany them in their

new life routine.

The exercises proposed here meet the Canadian guidelines for physical activity for adults aged 65

and over and are supported by the Canadian Centre for Activity and Aging of Western University

and the Department of Physical Therapy of the University of Toronto. The cognitive activities are

endorsed by the Centre for Cognitive Health of York University.

3

Facts and Tips

Facts about frailty

What does it mean to be frail? It means that there is a decrease in functional mobility and overall

physical resiliency. Frailty is caused by a reduction in aerobic capacity, a loss of balance control

and a reduction in bone density. Physical frailty can also be associated with declining cognitive

functional capacity making seniors more vulnerable to stress, risk of falls, and depression.

Frailty is caused in part by the cumulative effects of a sedentary lifestyle and loss of physical

fitness and tone. Disuse and lack of physical conditioning reduces functional mobility which leads

to frailty and a loss of independence. But clients should not be discouraged because physical

activity can prevent frailty.

Some false myths about exercise

I am too old to do exercise.

No one is too old! And every little bit helps. http://www.csep.ca/en/guidelines/get-the-guidelines

Exercise is bad for people with varicose veins problems.

Actually exercise is good as gets blood moving! http://www.veinspecialists.com/blog/exercise-and-varicose-veins/

Exercise is bad for people with arthritis.

Actually exercise is good and will improve symptoms! http://www.health.harvard.edu/blog/exercise-is-good-not-bad-for-arthritis-201305086202

Exercise is bad for people with asthma.

Often, exercise can help control the frequency and severity of asthma

attacks. http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-and-chronic-

disease/art-20046049

Puttering around the house and walking to the store is enough.

This is not enough; the older we get the more we need to do a mix of

more formal functional exercises (aerobic, strength-building,

flexibility and balance). http://www.health.harvard.edu/newsletter_article/how-much-exercise-do-you-need

4

Benefits of Exercising : Let Your Clients Know That…

Exercise helps prevent falls

Did you know that 20-30% of people over 65 years of age will fall this year?

Did you know that 80% of these falls occur in the home?

Did you know that the main cause of hospitalization in people over 65 years of age is due to

falls (77% for men and 88% for women)?

Did you know that 95% of all hip fractures are due to a fall?

Did you know that 40% of all falls result in the person being hospitalized or sent to long-term

care?

Did you know that 39% of deaths in Canada are related to a fall?

Did you know that in 2004 the cost of falls to the health system in Ontario was $2 billion?

Don’t let your client be one of these statistics!!

All it takes is 10- 30 minutes of daily exercise.

https://www.stayonyourfeet.com.au/everyone/order-free-brochures-and-booklets/

While many falls do not result in

serious injuries, they cause discomfort

and often result in prolonged periods

of inactivity, which can have a

negative impact on the body.

But - for seniors who exercise and who

fall, they end up incurring fewer and

less serious injuries because their

bodies are a more resilient and they are

more relaxed..

5

Exercise helps us

digest better

sleep better

control their weight better

improve their mood

reduce the risk of memory problems

boost the immune system

increase their bone density

feel less anxious and less stressed

reduce the risk of cardiovascular problems

feel more confidence in themselves

DON’T FORGET TO CHECK OUT YOUR CLIENTS’ PROGRESS

by using the “Function Fitness Progress Report”.

There is nothing more motivating for you and for your client

than proof of progress! It makes it all worth it!

6

Good Pain versus Bad Pain : How to Tell the Difference?

Good Pain gets the thumbs up!

Good normal pain feels like stiffness or burning and can cause some discomfort, but it doesn’t

hurt when the person is at rest. Good pain is a good thing as it a sign that means that the muscles

are becoming stronger.

It normally occurs within 24-72 hours after the exercise session, and then it begins to disappear. http://www.hopkinsmedicine.org/orthopaedic-surgery/about-us/ask-the-experts/pain.htmlx

Bad Pain gets the thumbs down!

Bad pain is not normal. It is often a sharp pain, usually not located in a part of the body that you

were actually deliberately exercising. Often the pain is present even while the person is at rest.

This kind of pain persists after 72 hours. http://www.hopkinsmedicine.org/orthopaedic-surgery/about-us/ask-the-experts/pain.html

If your clients are reticent about exercising because they already have some pain, try to get them

do some a couple of repetitions of an exercise anyway. After a couple of repetitions, ask them if

the pain is worse. If the pain isn’t worse, then it means that the exercise is not aggravating the

situation. They should feel free to exercise. Simply continue to ask them if the pain is worsening

as they continue to exercise. If the pain level does not increase, then the client can proceed with

their exercise program. If the pain is increased by the exercise, they should stop.

Quand ne pas continuer avec les exercices!

• If the pain persists longer than72 hours.

• If the person has an injury.

• If the client has a severe medical condition such as a heart condition.

• If the client is at risk of falling.

• If the environment is not safe for exercising.

Wait until a doctor says

it is fine to start to

exercise again!

7

Appropriate Level of Effort The client should always be able to talk without being too out of breath during exercise. Engage

the client in a bit of a conversation from time to time throughout the exercise session. If the client

cannot talk without significant breathlessness, stop and rest for a while before proceeding and

select a less strenuous regime of exercise.

https://www.google.ca/search?q=modified+borg+scale+of+perceived+exertion&rlz=1T4MXGB_enCA584CA585&

biw=1536&bih=762&tbm=isch&imgil=rWnLw5tfKmLWlM%253A

Ideal level of exertion for your clients.

8

Functional Fitness Assessments

Tiered Exercise Program Participant Guide, Canadian Centre for Activity and Aging, Western University, 2016

The purpose of assessments:

To provide a baseline measurement so can compare future performance so as to be able to

measure changes;

To provide information as to the physical fitness of the client in order to design an

appropriate individualized exercise program for the client;

To help motivate clients through a record of their performance;

To help identify a risk of frailty and falls due to inactivity.

When To Assess:

An initial assessment should be done before the client begins the Dr Actif program.

Reassessments can be done every 3 to 6 months.

Take your time with the assessments so that the client does not feel stressed by them.

The Three Assessments:

1. TUG Test (Timed Up-and-Go) measures general mobility by assessing ability to rise

from a chair and to walk with good speed.

2. 5 Rep Sit to Stand (STS) measures lower body muscular strength and balance by

assessing stamina in raising and lowering into a chair.

Together these two assessments are good predictors of risk of falls and of frailty. http://www.medscape.com/viewarticle/578505_4; Podsiadlo D, Richardson S. The Time “Up & Go”: A Test of Basic

Functional Mobility for Frail Elderly Persons. Journal of the American Geriatrics Society 1991; 39(2):142148

3. The Functional Fitness Confidence Scale (FFC) assesses the client’s confidence level in

performing the activities of daily living, reflecting the client’s perceived judgment as to

their physical stamina, muscular strength and flexibility.

Confidence tests are important to administer because clients who are worried about falling

tend to be less active, which in turn feeds the cycle of inactivity and disuse leading to

higher risks of frailty and falls. A.M. Myers. Department of Health Studies and Gerontology, University of

Waterloo, Ontario, Canada, N2L 3G1. Funded by Searle Canada Inc. and Health Canada.

9

1. TUG (Timed Up-and-Go) Test

Instructions

Have client sit in a standard chair, like a dining room chair, that has a back and arm rests (about

46 cm or 16” high). Ask them to sit back in the chair with their back against the back of the

chair and arms resting on the chair’s arms.

On the word “go”, the client is to get up and walk at a comfortable and safe pace in a straight

line for 3 meters (10 feet), turn and return and sit down again in the chair. The client can use a

walking aid if the individual normally uses one.

Time the number of seconds it takes for the client to complete the task.

Allow the client can take a practice walk before being timed.

TUG Scoring Scale

# Seconds to Complete Task Level

Less than 7 1

7.1 - 8 2

8.1 - 9 3

9.1 - 10 4

10.1 - 11 5

11.1 - 12 6

12.1 - 13 7

13.1 - 14 8

14.1 - 15 9

More than 15 10

Client’s Score (Test 1): ____

10

2. STS (Sit-to-Stand) Test

Instructions

Have the client sit a standard chair, like a dining room chair, that has a back and arm rests

(about 46 cm or 16” high). The chair should be placed against a wall to prevent slipping.

On the word “go”, the client is to get up as quickly as possible to a fully erect position and sit

back down in the chair 5 times without stopping without using the arm rests if possible.

Allow the client to practice one sit-stand cycle before being timed.

Time the number of seconds it takes for the client to complete the task. Counting aloud can

keep the client oriented. Stop the watch when the standing position is achieved on the 5th

repetition. Do not mention it if they use their hands. Record the time in seconds that it takes for

the client to complete the task.

STS Scoring Scale

# Seconds to Complete Task Score

Less than 9 1

9.1 – 10.0 2

10.1 – 11.0 3

11.1 – 12.0 4

12.1 – 13.0 5

13.1 – 14.0 6

14.1 – 15.0 7

15.1 – 16.0 8

16.1 – 17.0 9

More than 17 10

Client’s Score (Test 2): ____

11

3. FFC (Functional Fitness Confidence) Test

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Not at all confident Moderately confident Completely confident

(1) Get up from a low chair without using the chair arms? ______%

(2) Cut and file your toenails? ______%

(3) Hold your arms above your head (for instance when doing your hair)? ______%

(4) Bend down to tie up your shoes without having to sit down? ______%

(5) Reach your arm back over your shoulder to touch the middle of your back (for instance, to pull up a zipper)? ______%

(6) Do 15 minutes of light house work? (such as cleaning bathrooms, washing or vacuuming floors) ______%

(7) Climb up one flight of stairs ______%

(8) Climb up three flights of stairs ______%

(9) Lift a bag of sugar (1 kg) from the counter to an overhead cupboard ______%

(10) Lift a bag of potatoes (5 kg) from the floor to the counter ______%

(11) Walk an hour around a shopping mall ______%

(12) Run quickly (about 50 feet) to catch a bus or cross a busy street when the light is changing ______%

Functional Fitness Confidence (FFC) Scoring Scale

Overall confidence

Add all scores and divide by 12 then code

the score

Score

91-100% 1

81-90% 2

71-80% 3

61-70% 4

51-60% 5

41-50% 6

31-40% 7

21-30% 8

11-20% 9

Less than 20% 10

Client’s Score (3): ____

12

Overall Functional Fitness Level

Score 1 (TUG) + Score 2 (STS) + Score 3 (FFC) = TOTAL = Overall FFL Score

_____ out of 30 (__/30)

Client’s score record and calculation of FFL Score:

Name of client:

Start Date:

Follow-up

Dates

TUG in

seconds

TUG

Score

STS in

seconds

STS

Score Total

FFL

Score Comments

Legend pour FFL:

Score Description of Functional Fitness Level

0 – 9 Good physical condition

10 – 18 Weakened physical condition

19 – 30 Compromised physical condition

13

The Exercice Program

Exercise Categories

To promote health and improve functional capacity, your client should do at least 150

minutes or 2 1/2 hours of physical activity per week. Start your client off with 10-minute

sessions 5 times a week. Gradually increase the duration of their exercise sessions to 30

minutes 5 times a week.

All seniors, including those with reduced mobility, should do physical exercises

belonging to the 4 following categories of exercise:

Exercise categories Reasons for doing them

Aerobic

To improve heart function, breathing,

digestion and sleep.

Muscles Strengthening

To increase mobility and strengthen bones,

and reduce joint pain

Flexibility

To improve mobility et achieve a larger range

of movement

Balance-building

To prevent falls and encourage mobility

Cognitive To maintain intellectual performance –

requiring the learning of something new every

day

Memory To maintain this crucial aspect of intellectual

capacity

“Every man desires to live long, but no man would be old”

Jonathan Swift

14

ALWAYS begin with la

relaxation

Put on some comfortable clothing.

Spend the next 30 minutes giving yourself

permission to take time for yourself, for your

body and your well-being.

Make yourself as comfortable as possible, whether you are sitting or lying down.

Uncross your legs and arms.

Do not think about your worries – convince yourself that you do not need to do anything right

now.

If you wish, close your eyes for less distraction thus promoting an atmosphere of relaxation.

Breathe deeply through your nose allowing the abdomen to expand so the lungs can fill

completely, then slowly and fully exhale to release tension. Think only of your breathing.

Give yourself time to calm your body and mind.

Identify an intention for your exercise program and remember this intention throughout your

exercise session. Take for example the commitment to have a positive attitude today or to make a

special effort to do the exercises so you can get out for more walks this summer.

Whenever you start thinking of other things, bring your awareness gently to the present moment

and your breathing.

15

Aerobic Exercises

Some examples…

Check the “Objectives Column” with your Case Manager.

Exercises Instructions

Images Objectives

(# of repetitions or

# of minutes)

Walking

Walk from room to room taking rest

periods when needed.

Chair Walking

In a seated position, go through the

motions of walking.

Chair Squats

Bend your knees and squat down as

far as you can as before sitting in the

chair with or without using the arms

of the chair for support; then stand up

again.

Leg Lifts From a standing position and with

hands resting on the back of a chair,

raise your left leg backwards,

forwards and sideways and then

replace it. Repeat with the right leg.

Toe Taps

From a seated or standing position,

tap the toes of one foot and then the

other.

Heel Raises From a standing or seated position,

raise yourself up on your toes.

The Fitness Plan

16

Muscle-Strengthening Exercises

Exercises Instructions Images Objectives

(# of

repetitions or

# of minutes)

Arm Circles In a standing or seated position, with arms

extended straight out from the side body, make

circles with arms clockwise and then counter-

clockwise.

Lunges Stand with feet apart about the width of the

pelvis, back straight, step forward with left foot,

bending both legs until your right knee almost

touches the ground. Straighten up. Repeat with

the other leg.

Strengthening

the Glutes

While sitting, place a ball under the arch of your

foot, then and push down with your foot while

flexing or working the buttocks muscles. Repeat

with the opposite foot.

Strengthening

the Deltoids and

Pectorals

From a standing or sitting position, place a ball

under your arm. Lower your arm towards your

body while squeezing the ball against you, then

release. Repeat with the other arm.

Wall Push-ups Standing or sitting upright in front of a wall,

push against the wall with your arms.

Some examples…

Check the “Objectives Column” with your Case Manager.

17

Flexibility Training Exercises

Some examples…

Check the “Objectives Column” with your Case Manager.

Exercises Instructions Images Objectives

(# of

repetitions or

# of minutes)

Runners’

Stretch

Stand facing a wall with your arms straight in front

of you and your hands flat against the wall. Extend

your left leg straight back, with your heel flat on

the floor. Lean into the wall without bending your

back knee until you feel the stretch in the back leg.

Hold for 15 seconds.

Back of Leg

Stretch

In a seated position, stretch one leg straight in front

and rest it on the floor, then hinging at the hips, not

the waist. Stop when you feel a stretch at the back

of your thigh. Hold for 20 seconds. Repeat with

other leg.

Arm Stretches Reach your arms above your head, out to the side

and then in front of you.

Back Stretch From a seated position, curve your back and point

your head towards your chest, then sit back up

straight.

Shrugs In a seated position, shrug your shoulders, holding

for 15 seconds before releasing.

18

Balance-building Exercises

Some examples…

Check the “Objectives Column” with your Case Manager.

Exercises Instructions Images Objectives

(# of

repetitions or

# of minutes)

Marching Band

Walk

With arms outstretched on either side, walk forward

while looking ahead and lifting one leg and keeping

it raised for 1 second each time before advancing.

Head Dance

Walking

Walk slowly across the room while slowing turning

your head as far to the right as you can. Walk back

to your starting point while slowly turning your

head as far to the left as you can.

Rock Around the

Clock Circles

Stand straight with your feet together and make

your body rigid as a board. Begin to sway in a circle

with your body. Sway for one minute in each

direction.

Heel to Toe

Walking

Place the heel of one foot just in front of the toes of

the other foot. Your heel and toes should touch or

almost. Look ahead. Walk forward.

Weight Transfer With one hand on the back of a chair, shift your

weight from one foot to the other.

19

End with Relaxation

At the end of your exercise session, give yourself time to enjoy the feeling of the benefits of your

practice and dedication to your health.

Make yourself as comfortable as possible, whether you are sitting or lying down.

Make sure that your body is perfectly supported by the surface upon which you are sitting or lying

so that your muscles can fully enjoy the feeling of rest and relaxation they deserve.

Become aware of the new sensations in your body stimulated by the healthy activity you have just

undertaken. Remember this pleasant sensation of revitalisation.

If you wish, close your eyes for a fuller relaxation and to avoid distraction and breathe slowly and

easily.

Take this time to celebrate that you have done something positive for your body.

Your body will thank you for permitting it to benefit from this time.

You can now continue your daily activities with the renewed sense of energy you feel in your

body.

20

Client’s Exercise Calendar

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Walking

Chair Walking

Chair Squats

Leg Lifts

Toe Taps

Heel Raises

Arm Circles

Lunges

Strengthening the glutes

Strengthening the

deltoids and pectorals

Wall Push-ups

Runners’ Stretch

Back of Leg Stretch

Arm Stretches

Back Stretches

Shrugs

Marching Band Walk

Head Dance Walking

Rock Around the Clock

Circles

Heel to Toe Walking

Weight Transfer

Create an exercise schedule for clients who want to continue the exercise program in-between PSWs visits by using the exercise calendar provided.

21

Suggestions for Intellectual Activities

A good memory and good overall brain function is the result of strong connections between brain

cells. What is the best way to strengthen these links? In other words, what is the best way to “exercise”

your brain? The answer is to perform one challenging intellectual activity per day.

Whether you prefer to read a book, do crossword puzzles, play a good game of chess or cards, attend

workshops, take part in social gatherings, attend a good show, play a musical instrument or sing in a

choir, it is important to focus on at least one intellectual activity every day.

Below are some cognitive activities to help you “exercise” your brain and keep it in shape!

I like this one!

Some Ideas

Doing some simple math problems / Undertake a numbers game like a Sudoku / Count

up from 0 by twos, by threes...

Make a list of items or words and then try to remember at least 12 of them.

Play a game of strategy such as Bridge or Chess.

Play a word game or complete a crossword puzzle.

Start and complete a difficult jigsaw puzzle.

Read a book, newspaper or magazine and then try to remember as many details as

possible.

Write a paragraph a keep or keep a daily diary or write a poem a day.

Name the streets to the east, west, north and south of your own address; expand your

geography as you learn the names.

Travel to a new place.

Further suggestions:

22

Functional Fitness

Progress Report

0

10

20

30

BASELINE A FTER 3 MONTHS A FTER 6 MONTHS A FTER 12 MONTHS

FU

NC

TIO

NA

LF

ITN

ES

SS

CO

RE

MONTHS

NAME OF CLIENT:

23

And of And of course …… EAT RIGHT !!!

Canadian Food Guide