Staying Fit, Active and Functioning Well

Focus: “Don’t lose any more function than can be helped”

The Aged Population is on the Increase!

The fastest growing population is the older adult with the majority of them are living well and independently in their own homes. This population is getting increasingly “top heavy”. At the last Australian census 6 million people were aged between 50 and 89 years. Demographic trends over the next three decades project that the global numbers of adults aged 65 years and older will double to around two billion by 2050. These demographic trends will have an impact on the health care system.

Regular physical activity is a priority health issue for all Australians. “Whilst we are young we challenge our bodies, but over time the mind and body can start become more challenged”. A fulfilling quality life is important for everyone. Anybody, no matter their condition, culture, age or ability needs exercise to remain active throughout life. The benefits of exercise are universal and span across all decades.

Everyone wants to be as active, for as long as possible to remain independent and in control of their life. Age should not be a barrier to participation in an appropriate activity program. There is a good percentage of older people who are still very capable of participating in some form of exercise and remain active and able a s result. How this is carried out is dependent on health, ability and fitness status. For an active life everyone needs sufficient energy, adequate strength, balance and functional mobility to maintain good body control and prevent any unnecessary losses occurring. Physical activity programs combining aerobic, strength and flexibility components (including a balance element) have promising results and can protect against physical and cognitive decline associated with ageing.

Functionality involves many tasks done together to achieve purposeful results throughout the day. These activities involve a combination of muscular strength (power), endurance, flexibility, balance and co-ordination as well as good cognitive skills. Optimal capacity is required to perform daily tasks and achieve purposeful and effective results. With advancing age and low activity levels, muscle strength and elasticity diminish. There is also an associated loss of reserve capacity (reduced energy supply). Flexibility and strength declines gradually from 30 years onwards with greater declines after age 40 years and beyond. The long-term implication in reduction of strength is decreased functional ability and increased risk of falls (+ fractures). Joints stiffen and the body becomes tighter which can restrict daily activity, making movement more difficult. All these factors contribute to a reduction in physical abilities, fitness and health, loss of function and reduced activity levels.

Ask yourself these questions… How Well Are You Doing Now?

• Do you have enough energy for all activities throughout the day?
• Do you feel you are coping well?
• What are you not able to do as well as before?
• Do you have any chronic conditions that limit movement?
• What exercise are you currently doing?
• Do you have any mobility problems?
• Do you have any chronic conditions that limit movement?
• How strong do you feel you are?
• How flexible are you?
• Any changes with age or condition?
• Do you have good balance?
• Have you sustained a fall (s) over the past year
• Are you walking well or slower than before?

If any of your answers to the above questions are a problem, take action to improve your overall functional abilities by doing effective and safe exercises. Seek help from appropriate health/fitness professionals concerning the exercises you need to stay active

NB. If you would like some more practical ideas concerning fundamental movement to assist maintain your functional abilities you can purchase some resources from Movement Matters. Please see Movement Matters website for more information

Sources/References

1. World Health Organization. (2002). Active ageing: A policy framework (WHO/NMH/NPH/02.8), Geneva: WHO Noncommunicable Diseases and Mental Health Cluster. Retrieved May 2015, from http://whqlibdoc.who.int/hq/2002/
2. The Gerontologist, 2016, Vol. 56, No. S2 Updating the Evidence for Physical Activity: Summative Reviews of the Epidemiological Evidence, Prevalence, and Interventions to Promote “Active Aging”. This review highlights the importance, and complexity, of promoting PA among older adults. Adrian Bauman, MD, MPH, PhD,¹ Dafna Merom, PhD,² Fiona C. Bull, PhD,³
   David M. Buchner, MD, MPH,⁴ and Maria A. Fiatarone Singh, MD⁵

• ¹School of Public Health, Sydney University, New South Wales, Australia.
• ²School of Science and Health, Western Sydney University, New South Wales, Australia.
• ³Centre for Built Environment and Health, The University of Western Australia, Perth, Australia.
• ⁴Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
• ⁵Exercise, Health and Performance, Faculty of Health Sciences, Sydney University, New South Wales, Australia.

Keep Moving – Stay Mobile

Focus : Arthritis and Exercise

Fitness and health decline with age and may eventually fall below the level required to be able to undertake everyday activities easily and safely. One reason for this could be as a result of arthritis causing joints stiffening and muscles to weaken. The body becomes less easy to move and joints become stiffer restricting effective daily activity.

Inactivity is associated with:

• 400% increased risk of disability which restricts the ability to perform of daily activities
• 300% increase in risk of balance disorders and increased risk of fall related injuries;
• 200% increase in risk of gait abnormalities

There are many reasons why it becomes harder to move. Some of the following are the causes and limitations that may reduce and change activity:

• Ageing
• Injury
• Changes in fundamental function occur due to reduced little / limited activity (being sedentary)
• Changes in overall fitness and body control such as endurance, strength and flexibility.
• Changes in the physiology of the body occur in the musculo-skeletal, neuromuscular and neurological systems
• Multiple chronic conditions such as osteoarthritis, osteoporosis, sarcopenia (muscle weakening) diabetes, heart disease etc. can alter the bodies ability to move effectively and efficiently.
• Changes in mental states, for example depression and dementia, can reduce an individuals’ motivation and ability to stay active
• Changes in balance and walking patterns increases the fear of falling which in turn also reduces the motivation to move more than necessary

These factors all correlate and contribute to a reduction in physical abilities, fitness and health, loss of function and reduced activity levels.

It is vital that the body is kept as flexible as possible.

Ask yourself these questions:

• Are you flexible enough to carry out all activities throughout the day easily?
• Do you feel you are doing activities well as you always have?
• What are you not able to do as well?

If any of your answers to the above questions are a problem, take action to improve your overall mobility by undertaking appropriate exercises. Seek help from appropriate health/fitness professionals concerning the exercises you need do to stay mobile

Arthritis

Arthritis is one major condition that can restrict movement. It is important however to keep the joints moving and working as best as possible to keep them from stiffening up and limiting movement further. Some important facts and considerations need to be taken into account prior to participation in an exercise program.

Facts

There are over 120 conditions that fit under the umbrella of arthritis but the major ones being Osteoarthritis and Rheumatoid Arthritis. It is a condition which affects joints and the surrounding tissue and is often associated with joint pain, stiffness, swelling, fatigue, reduced mobility and reduced muscle strength. It is not wear and tear, degenerative changes occur within the structure and composition of the cartilage resulting in structural weakness and damage. This degeneration limits movement, causing pain and swelling within and around the joint structure. Cartilage is designed for load bearing; absorbing impact; sustaining shear forces. The major potential problems associated with arthritis are functional limitations and lifestyle restrictions. Exercise is one important way of keeping joints as healthy as possible and preventing the muscles surrounding the joints from weakening

Osteoarthritis – generally affecting a few joints.
Hallmark signs and symptoms: Joint pain; Stiffness; Muscle weakness; Instability; (inflammation).

Rheumatoid Arthritis – affects the entire body systems.
Hallmark signs and symptoms: More swelling although intermittent

Arthritis and Exercise

Exercise is an important part of the management of arthritis and its associated complications. It is not contraindicated for either condition and will assist maintain functional activities necessary for daily living.

Overall Aims with Exercise

• Mobilise joints – move the joints as far as possible
• Relieve pain (not exacerbate it)
• Stabilise joints by strengthening surrounding muscles.
• Work on improved functional activities.
• Protect joints to prevent deformity (good form and alignment needed).
• Work to improve posture and gait patterns. Improve general fitness.
• Maintain a healthy weight

NB. If you would like some more practical ideas concerning fundamental movement to assist maintain your functional abilities you can purchase some resources from Movement Matters. Please see www. movementmatters.info website for more information

Stretching – Not Straining… the basics

The body becomes resistant to stretching but it is an important component of an exercise program (as is strengthening).

Keeping flexible is an important component of an exercise program especially for people who are inactive and have arthritis. Muscle elasticity diminishes with age with increased muscle stiffness that results in joint restriction and the body becomes tighter. Increased stiffness can occur in all joints of the body and surrounding soft tissue e.g. tendons, ligaments, joint capsule, fascia. Restricted movement is directly linked to reduction in functional abilities and there is a marked increased susceptibility to falls and associated injuries.

• Always consider and apply correct starting position and body alignment for all movements
• Avoid bouncing or jerky movements (especially with arthritic joints changes)
• Only stretch as far as is comfortable (there is no such thing as no pain no gain)
• Try to hold the stretch for at least between 15- 20 seconds at a time to allow the tissues to stretch as far as they are able

Exercise Tips

• Be aware of any AGGRAVATING exercises or movements and change your exercise regime accordingly.
• Keep movements as smooth as possible.
• Avoid weight bearing exercises for long periods of time.
• Care needs to be taken to prevent getting overtired.
• Any inflammatory response may require rest and limited excess movements
• Little and often is often a good way to start exercising and then build up the level and degree of activity

When to be Cautious

• Consider that inflammatory responses may require APPROPRIATE rest. Be aware of possible AGGRAVATING exercises or movements
• After joint replacement surgery follow the guidelines and instructions carefully

When Not to exercise!

• If there is a flare up of the condition, (hot and swollen joints) with very limited movement and extreme pain is present.
• Remember the 2 hour pain rule… Reduce the program if the pain in the joints persists longer than two hours immediately following an exercise session and does not settle for a couple of days.

NB. Exercise in warm water as an alternate type of exercise (it can make movements easier to manage and provide some pain relief).