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All Bodies Like Exercise! By Priscilla Laula, M. Ed.
In 1996, 1999 and 2000, Priscilla’s ABLE! Program won the NC Governor’s Council on Health and Fitness Award for Mature Adult Programming.
The goal of a program of physical activity program for impaired adults is to promote optimal function. It is never too late to get moving and receive physical, psychological, emotional and social benefits. By learning about set-up and safety, motivational techniques, involving participants with interesting programs, leadership and evaluation, you will be able to design and implement safe and effective exercise programs for impaired frail older adults. These programs will improve health (physical and emotional), enhance quality of life, and put SMILES on the faces of your participants, their families and your staff!
S Set-up and Safety: Things to Consider
Facility safety † Room temperature and adequate ventilation † Passageways wide enough to accommodate all participants † Lighting—avoid glare and shadows † Floor surface—not slippery or shiny † Avoiding drafts, direct sun or air conditioning/ heating † Carpeting—can be dangerous if participant is unsteady † Having drinking water or juice nearby † Wheelchairs—Lock in place, remove footrests if participant can maintain good posture † Uncluttered space with few interruptions or distractions † Chairs—sturdy, preferably without arms (Get participants out of recliners!) † Room set-up—Put chairs in a circle with room for all the stretch out arms and so everyone can see and hear. † Insurance policy—Make sure all are covered and that every precaution is made to minimize risk. † Hiring a qualified/trained leader † Training all personnel in CPR and First Aid † Having an emergency plan
PARTICIPANT SAFETY † Suggesting loose, comfortable, non-restrictive clothing † Lap blanket for those in skirts or dresses † Proper, supportive footwear † Making sure restraints are properly used † Having the medical release with information about participant abilities and limitations. Allow instructor to review. † Not exercising if participant has cold or flu, acute pain, inflamed joint, fever or infection, recent surgery or hospitalization or recent fall.
EQUIPMENT/PROPS † Should be in good repair † Light-weight and easy to grasp for arthritic hands
SCHEDULING † Time of day—when participants are most alert and medicine is working † Morning—People have the most energy † Afternoon or early evening may help stimulate or relax † Offering exercises when folks are already gathered before or after another activity or before meals † Length of class depends on participants’ abilities † Offering exercises every day, minimum twice per week
FORMAT/CLASS DESIGN Warm-up: 10 minutes Activity: 5-15 minutes Cool Down: 10 minutes Relaxation: 5 minutes † Coaching breathing and posture all the time † Keeping exercises simple and use one body part at a time † Exercising all muscle groups † Using 3-5 repetitions in warm-up, with beginners or those which chronic disease and 8-12 repetitions during activity † Varying the routines—Repetition and routine are fine, too, but variety keeps participants interested. † Alzheimer’s: Keep directions simple, one command at a time. † Stretching tight muscles—like chest, calves, hips, hamstrings
M Motivation: Things to Consider J Dispelling myths of aging and impairments—change beliefs to change behavior J Letting participants name the class. They will choose words they like and will invest more in the program. Avoid using words like aerobics or exercise (some have bad associations with “exercise”). Encourage the words “movement” or “activity”. J It is motivating when they perceive there is personal benefit. J There is value in feeling part of a meaningful and ongoing group. J Designing a program that participants experience as stimulating and enjoyable J Engaging a well-liked staff person to invite a reluctant person and/or to accompany him/her to class J Inviting staff to participate, offering a family fitness class, sending a written, personal invitation or developing a team of participants who encourage each other by extending invitations J Setting up a buddy system J Providing rewards—extrinsic: t-shirts, certificates, recognition, door decorations; intrinsic: well-being, enjoyment, etc. J Setting the standard that each goes at own pace so all can be successful J Offering activities that allow for individual differences J Offering a variety of programming yet with some routine J Giving positive feedback J Greeting individuals by name J Using ice breakers and welcoming activities J Using themes—seasonal, health promotion, etc. J Holding class outside periodically J Music stimulates interest and responsiveness, sets mood, provides rhythmic patterns, helps release stress, promotes relaxation, sets pace, brings back memories. Consider tempo and volume (volume should not interfere with verbal instructions). J Using music without words.
I Interesting & Involving: Things to Consider Programming should be interesting and provide opportunities for interaction and socialization. Take time to socialize, laugh, think, talk, interact, as well as engage in physical activities. ” Encouraging participation—active, passive anything is okay ” Adding movement to other existing programs or activities such as musical events, games, sports, picnics ” Increasing activity in daily routines—while waiting for meals, during personal care or chores ” Making announcements frequently to remind participants and staff to stretch, breathe, walk and drink water ” Using words that appeal to men, also ” Using humor ” Inner-focused movement forms—yoga, tai chi ” Networking with other providers and sharing ideas ” Intra-agency interactions like intramural sports ” Linking up with people from other generations ” Using props. They are colorful, enticing and fun! L Leadership: Things to Consider « Building trust « Setting clear goals « Validating, encouraging and reinforcing « Being patient « Showing respect and appreciation for each member of the group—treating them as adults, not children « Starting on time « Removing distractions « Assuring safety « Empowering the participants « Being warm, friendly, animated and enthusiastic—having fun « Developing your own personal style. Be who you are—understand and accept your strengths and weaknesses. « Building relationships « Communicating clearly « Including personal information and events—using names, birthdays, anniversaries, honoring special memories « Allowing participants to contribute—soliciting and working in their concerns, interests, talents and ideas « Using personality, choreography, humor and props « Sharing knowledge about how each movement helps in activities of daily living and showing exercise modifications « Expressing sincerity « Showing sensitivity to participants’ needs « Wearing appropriate clothing.
E Evaluation: Things to Consider We need to know how/or if our programs are impacting participants—what we are doing well, what can be improved. In this day and age, we are increasingly being asked to measure our results. You must set clear and realistic goals, both short- and long-term. Goals can be for individuals, the overall needs of participants, the fitness program or the benefits for your center.
Once you’ve identified goals, evaluation is a process of determining whether (or to what extent) your goals have been accomplished. Sources for measurement can be participants, staff and activity program standards.
METHODS OF MEASUREMENT Subjective is easiest. It uses observation and feedback. ¥ Effects of socialization ¥ Degree of participation (number of smiles, ability to follow along, level of activity) ¥ Observation and comments from participants, staff and families ¥ Participant self-assessment or complaints
Quantitative has to do with numbers. ¥ Attendance (who attends, doesn’t attend) ¥ Number of falls/injuries/length of hospital stay for participants vs. non-participants) ¥ Number of activities in which movement has become a part ¥ Number of care plans that include movement as an intervention
Qualitative—need staff to help. Staff can do written assessment which rate participant abilities at the beginning of an exercise program and after a designated period of time. Assessments can measure the · Degree of self-care or functional status (mobility, eating, dressing) · Flexibility, strength, posture, coordination, ease of breathing, etc. Don’t forget to assess your exercise leadership! How is the leader doing in these areas: logistics, motivation and leadership skills. Priscilla is the Health Educator at Mecklenburg County Health Department in Charlotte, North Carolina.
Reprinted from The Information Source for Adult Day Centers®, April 2002 |