Which strength and balance activities are safe and efficacious for individuals with specific challenges (osteoporosis, vertebral fractures, frailty, dementia)?: A Narrative review

Physical activity guidelines advocate the inclusion of strength and balance activities, twice a week, for adults and older adults, but with caveat that in some individuals there will be certain movements and activities that could lead to adverse events. This scoping review summarizes the evidence about how safe and efficacious these activities are in older adults with specific challenges that might make them more prone to injury (e.g. having recently fractured or at risk of fracture (osteoporosis) or those who are frail or who have cognitive impairment). The review identified that for prevention of falls in people with a falls history and/or frailer older adults, structured exercise programmes that incorporate progressive resistance training (PRT) with increasing balance challenges over time are safe and effective if performed regularly, with supervision and support, over at least 6 months. Some minor adverse effects mainly transient musculoskeletal pain) have been reported. For those with a higher risk of falls and fractures (very poor balance, vertebral fractures), supervised structured exercise programmes are most appropriate. People with diagnosed osteoporosis should be as active as possible and only avoid activities with a high risk of falls if they are naive to those activities. For those in transition to frailty who have poor strength and balance, exercises that are known to help maintain strength and balance (such as Tai Chi) are effective in preventing a decline in falls risk. For the very frail older adult, supervised structured exercise that has PRT, balance training and some endurance work, supervised and progressed by a trained person are advocated

Our Grandparents, Our Parents, Our Future Selves: Optimizing Function in Old Age. Syracuse Seminar Series on Aging.

Most of my research at Yale University School of Medicine over the past several years has focused on identifying older adults at risk of functional decline and disability, identifying events that may precipitate the transition from functional independence to disability, and developing strategies to postpone or reduce frailty and disability. As a result of the Precipitating Events Project (PEP) and other research conducted by the Yale Center on Aging/Pepper Center, we now realize that age is only a proxy for other factors that lead to disability, and that some of these factors can be modified to reduce the risk of disability. In fact, disability rates have been steadily declining among older adults for decades.geriatrics, aging, gerontology, disability, precipitating event, functional decline, vulnerability, compression of morbidity, reserve organ capacity, exercise, physical activity, falls, Yale PREHAB study, lifestyle interventions, independence, elders, FICSIT trial, frailty

A 3 Week Geriatric Education Program for 4th Year Medical Students at Dalhousie University

Purpose -Population demographics are shifting towards an increased average age. Yet, many medical schools still do not have mandatory comprehensive education in Geriatric Medicine. In 2001, the Division of Geriatric Medicine at Dalhousie University developed a required three-week geriatric course for fourth year medical students. This paper describes the details of the curriculum so that it can be reproduced in other settings. Results - The curriculum was successfully implemented. An examination, held at the end of each 3-week rotation, documented extensive learning of important concepts in Geriatric Medicine. The students gave positive feedback about the benefits of this training program. Conclusion -A well developed formal education program teaches students specific skills in Geriatric Medicine, which may improve the care of the growing elderly populatio

Effect of Different Types of Physical Activity on Activities of Daily Living in Older Adults : Systematic Review and Meta-Analysis

Peer reviewedPostprin

Gait, mobility, and falls in older people

My doctoral thesis contributes to the understanding of gait, mobility, and falls in older people. All presented projects investigated the most prominent and sensitive markers for fall-related gait changes, that is gait velocity and gait variability. Based on the measurement of these spatio-temporal gait parameters, particularly when using a change-sensitive dual task paradigm, it is possible to make conclusions regarding walking, balance, activities of daily living, and falls in older people. The research summarized in my doctoral thesis will help in the detection of early fall risk and modulation of therapeutic interventions to improve gait and consequently reduce fall risk in older people. To identify modifiable fall risk factors, such as gait disorders, the GAITRite electronic walkway system was used for objective spatio-temporal gait analysis. The simplicity and feasibility of the administration of single and dual task gait analysis make it a desirable clinical and research measurement tool. Gait analysis with walking as a single task condition alone is often insufficient to reveal underlying gait disorders present during everyday activities. However, measuring gait with a dual task paradigm can detect subtle gait deficits. Dual-tasking, walking while simultaneously performing an additional task, was used to assess the effects of divided attention on motor performance and gait control. The presented publications in this doctoral thesis investigated the association between gait parameters and several hypothesized fall-related modalities: (a) Our first review article highlighted the association between gait disorders and falls, and how related motor and cognitive impairments can be detected by measuring gait while dual-tasking. (b) A second review looked at how the dual task paradigm can be used for gait assessment in older people and how spatio-temporal gait parameters are associated with increased fall risk. (c) Our systematic literature review provided evidence about effective fall prevention interventions (exercise, home modifications, footwear, and walking aids) to reduce the risk of falls in vulnerable older people. (d) To evaluate which exercise modalities are effective in modifying risk factors for falls, we conducted an eight-week salsa intervention trial and measured the effect of dancing on static and dynamic balance, and leg muscle power in older people. (e) Besides exercise, inadequate nutritional intake is another modifiable risk factor for falls in older people, and therefore our most recent cross-sectional study examined how serum 25-hydroxvitamin D levels are associated with functional mobility in older people assessed in a memory clinic. (c) Walking aids are commonly prescribed for older people with a high risk of falls which is why we examined the influence of walking aids on spatio-temporal gait parameters in older people who used a cane, a crutch or a walker. (g) Finally, besides predominantly investigating fall risk factors for motor abilities, our prolonged and ongoing randomized, double-blind, and placebo-controlled intervention trial explores the potential influence of ginkgo biloba on the cognitive domain relevant for dual-tasking in older people with mild cognitive impairment

Interventions for Fall Prevention: An Evidence-Based Practice Project

This project considered the following Evidence-Based Practice (EBP) question: What occupational therapy and multidisciplinary/interprofessional interventions are most effective for preventing falls, decreasing fear of falling, improving safety in performing ADLs, and increasing quality of life in community-dwelling older adults

Our Grandparents, Our Parents, Our Future Selves: Optimizing Function in Old Age.

Most of my research at Yale University School of Medicine over the past several years has focused on identifying older adults at risk of functional decline and disability, identifying events that may precipitate the transition from functional independence to disability, and developing strategies to postpone or reduce frailty and disability. As a result of the Precipitating Events Project (PEP) and other research conducted by the Yale Center on Aging/Pepper Center, we now realize that age is only a proxy for other factors that lead to disability, and that some of these factors can be modified to reduce the risk of disability. In fact, disability rates have been steadily declining among older adults for decades

International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines

The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent