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![Page 1: Resistance bands/tubing, weights UE: Shoulders and elbows LE: hips and knees Strengthening 5-10 min. AFEP Manual, 2009.](https://reader030.fdocuments.us/reader030/viewer/2022033107/56649d125503460f949e613e/html5/thumbnails/1.jpg)
Resistance bands/tubing, weights
UE: Shoulders and elbows
LE: hips and knees
Strengthening5-10 min.
AFEP Manual, 2009
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Variety of movements such as:• Walking in place• Dance type steps, sports themes
Cardiovascular1-20 min.
AFEP Manual, 2009
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• 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
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• Reduce soreness
• Transition to next segment
• Lower injury risk
Jt. Check/Cool down5-10 min.
AFEP Manual, 2009
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• Progressive relaxation
• Guided imagery
• Slow, deep breathing
Relaxation/Breathing1-5 min.
AFEP Manual, 2009
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AFEP Forms
• Participant release form
• Ongoing assessment of participant reach
NCOA, 2012
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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 classNCOA, 2012
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AFEP Other Costs & Equipment
• Weights (optional)
• Guidebooks
• Other materials
• No licensing fee
NCOA, 2012
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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/arms-and-elbows.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
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AFEP Evidence Example
Hinchman, 2001
178 Participants
Less health care utilization (ER visits), Improved overall health
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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
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AFEP Evidence Example
• 347 participants (Schoster, Callahan, Meier, Mielenz, & DiMartino. (2005). Results indicated
AFEP program provided social support for participants and increased self-efficacy
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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
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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 stiffnessBetter endurance
Improved strength
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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
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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?
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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
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Principles of Tai Chi Arthritis
• Improved flexibility• Improved muscular strength• Improved fitness• Decrease pain and falls
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Program
• 6-8 weeks• 45-60 min 2x per week• Led by certified instructor
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Session Includes
• Warm-up• 6 basic core movements• 6 advance movements• Breathing techniques• Cool-down
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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
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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
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Program
• 6 weeks• 2.5 hours per week• Program provides information and teaches practical
skills on managing chronic health problems• 2 trained leaders
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Assessments
• STEADI – Stop Elderly Accidents, Death & Injury• Timed Up and Go• 30 Second Chair Rise• 4 – Stage Balance Test
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STEADI
• 12 item self assessment• Printed by CDC• Environmental checklist• Safety tips
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Timed Up And Go (TUG)
• Easy, reliable, and valid indicator of functional mobility and falls risk
• Predictive or morbidity, mortality, functional status (Studenski, 2011)
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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
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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)
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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????
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30 Second Chair Rise
• Indicator of strength and endurance• Poor performance associated with increased falls risk
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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
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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
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• http://www.cdc.gov/homeandrecreationalsafety/Falls/steadi/videos.html
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Resources
National Council on Aging, Center for Healthy Aging
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www.ncoa.org/improve-health/center-for-healthy-aging/online-training-modules/series-1-intro-to-health.html
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http://www.ncoa.org/improve-health/center-for-healthy-aging/about-evidence-based-programs.html
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http://www.ncoa.org/improve-health/center-for-healthy-aging/where-to-find-evidence-based.html
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• http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-Evidence-FINAL.pdf
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http://www.ncoa.org/improve-health/center-for-healthy-aging/content-library/Title-IIID-Highest-Tier-Evidence-FINAL.pdf