APIE.

It’s the theoretical foundation for Therapeutic Recreation. It is the process that programs of therapeutic benefit follow.  In order to be successful, a program must follow implement the APIE process.

A good program, a program that is individualized to a client’s strengths and weaknesses, begins with assessment.  Everyone ages differently and possesses different strengths and faces different limitations.

What causes one person to fall may not phase another.  According to Fall Prevention Center of Excellence co-director, Dr. Debra Rose, “a successful fall prevention exercise program begins with a thorough fall risk assessment“.  She also explains that the assessment tool must match the population it is being used on.  The Fullerton Advanced Balance scale is a scientific-based assessment tool for higher functioning older adults.  This is one assessment tool used in Kelly Ward’s Sacramento-based fall prevention exercise research study.  Pre-study assessment testing dates and locations in Sacramento, CA:

Tues, July 6: 12:30-5.  Oak Park Community Center

Wed, July 21: 1-5.  Hart Senior Center

Sat, August 7: 10-2.  Cordova Senior Activities Center

Tues, August 10: 12:30-5.  South Natomas Community Center.

Afterall, “If you’re not assessing, you’re guessing”-Paul Chek.

After the initial assessment, a program is planned according to individual strengths and weaknesses.  The planning phase is critical to helping a person successfully meet goals and objectives.  Because we are unique beings, we all have different goals.  This is why a one-size fits all approach to fall prevention exercises and balance challenges does NOT work.  While the concepts may be similar, each person needs to be challenged differently.

After a qualified professional designs a program, it must be implemented.  Whether standing or seated, the key to successful fall risk reduction exercise programs is consistency. The program must be followed regularly and the difficulty of challenge must be progressive.  Fall prevention exercise training improves with practice.

And finally, in order to measure the success of the program, a professional must evaluate the impact of the program.  The evaluation done in Ms. Ward’s research study will done after the implementation of the 12-week FallProof at Home DVD program however a professional is constantly evaluating her program throughout the APIE process.

In order to succeed, you must have a starting point.  Get assessed for fall risk.  Take responsibility for your independence!   If you live in the communities of Sacramento, CA, are over the age of 65 and are concerned about falling, you may be eligible to participate in a free research study.

Copyright © 2010 Take 5 to Exercise. All Rights Reserved.

California State University at Sacramento’s Committee for the Protection of Human Subjects approved my “at risk” research proposal.  The California Parks and Recreation Society’s Therapeutic Recreation section awarded me a research grant scholarship to help fund my research study.  And a Kaiser grant funded the City of Sacramento’s 50+Wellness’ Stand Up to Falls program for the second year. As the Fall Prevention Lady, I will be conducting fall prevention exercise research this summer for my thesis!

The topic of my research is “Effectiveness of FallProof™ home-based DVD program in improving balance, select functional fitness parameters, and balance-related self-confidence among community dwelling older adults who have been identified as moderate to high risk of falls”.  This is a pilot study to gather data on Dr. Rose’s home-based FallProof™ balance and mobility program.  The purpose of the study is to investigate the relationship between participating in the FallProof™ at Home (FAH) program and fall risk.

As part of the City of Sacramento’s 50+ Wellness efforts to reduce falls among community-based older adults, I will be conducting Fullerton Advanced Balance (FAB); clinics to increase awareness fall risk through this insightful balance and mobility assessment.  During these Kaiser-funded clinics, I will describe my research study to participants and those who meet the strict eligibility requirements and want to be part of this study will be randomly assigned to two groups.

The intervention group will participate in the progressively challenging DVD program in their home and the control group agrees to not begin any new activity program.  After 12-weeks, both the control and intervention group return to the original site of testing for post-testing.  The control group is offered the 3-level DVD program at this time.

I will analyze and interpret the findings during the fall semester and finish my thesis for graduation in December, 2010.  As part of the scholarship requirements, I will submit a paper on my thesis research study.  I am so blessed to be able to help older adults who live in the communities of Sacramento reduce the risk of falls and provide Dr. Rose with data on her home-based program all while earning my Master of Science in Therapeutic Aging degree!

I present fall risk awareness workshops for the Kaiser funded program, Stand Up to Falls.  Working in partnership with the City of Sacramento’s 50+ Wellness program, I visit local community centers throughout the city in order to increase awareness of fall risks and teach fall prevention exercises.  This is the second year I have had the privilege to do what I love; empower older adults to take responsibility for their health in order to reduce the risk of an accidental fall.

Yesterday, I presented my 3-hour workshop at the Evelyn Moore community center in South Sacramento and the house was packed!  Thirty older adults, mostly of Asian descent, listened attentively as I explained the four components of a fall prevention exercise program.  When the interactive exercise segment started, I was surprised when everyone said yes when I asked if they wanted to do a second set of the clam!

As always, I enjoyed conversing with individual members during the break and answering fall-related questions and concerns.  What I found most interesting was the fact that there were (at least) four participants who were in their 90s.  Each one had experienced several falls at home and wanted to find out what they could do to reduce the risk of another fall!  Members of the old-old population are truly resilient; each one was proud of his/her age, aware of personal limitations and willing to take responsibility for their health.

The feedback was amazing.  Everyone loved the program and were so glad that they came. Several people indicated they were going to attend another one of my workshops at a later date because they enjoyed it so much.  As part of the grant-funded program, I want to teach 2 follow-up classes to help participants develop a fall prevention exercise program that works for them.  I cover a lot of information in three hours!  In an effort to help with a consistent program, participants are given one Take 5 to Exercise DVD and a pamphlet  of hand-outs that include exercise pictorial cards.

All I can say is Praise the Lord!  This is good.

Reducing the risk of an accidental fall is a result of one’s daily choices. Fall prevention is more than picking up throw rugs, it’s more than nightlights in the hallway, it’s more than being aware of the medications you take, it’s more than following a regular exercise routine. It’s all of those things together and then some!!!!

Research supports a multi-factorial approach to fall prevention. Everyone ages differently and therefore, everyone faces different limitations and possesses different strengths. The key to reducing the risk of a fall is being aware of what increases the risk of a fall and using your strengths to keep you safe.

Increased fall risk factors include:
1. Lower body weakness
2. Multiple sensory impairment (vision, vestibular, somatosensory)
3. Decreased flexibility
4. Poor posture
5. Fear of falling
6. Medication mismanagement
7. Environmental hazards
8. Poor diet
9. Lack of sleep
10. Lack of awareness of above risks

There are some risk factors you can control; exercise, posture, exercise, fears, exercise, awareness of risk factors, exercise, diet, exercise, rest, exercise, knowledge of medications, and exercise.

Do a home safety checklist with a loved one or trusted neighbor and make the recommended modifications. Eat a well balanced diet; fresh fruits and vegetables, lean proteins, calcium-fortified foods. Be aware of the side effects of all medications. Get plenty of rest and follow a regular exercise program!

Make sure you Take 5 to Exercise each day; stretch, strength, practice good posture, and safely challenge your balance.
Be consistent, make good choices and you will reduce the risk of an accidental fall.

The Fall Prevention Lady

All Content Copyright © 2007-2010, Take 5 to Exercise.

Studying diseases associated with aging, I have discovered several conditions that greatly increase the risk of falling.  The first that I would like to mention is diabetes.  Diabetes is uncontrolled blood sugar and over time, takes a drastic toll on the body. Diabetic neuropathy is nerve damage that results from elevated blood sugar. High levels of sugar in the blood interfere with the interaction between nerves and blood vessels, affecting the ability of nerves to transmit signals (Mayo clinic, 2010). Prolonged exposure to these high levels of blood glucose results in nerve damage throughout the body, most commonly in the legs and feet.

Nerve damage in the feet and lower legs is especially dangerous because the loss of sensation in the feet can result in unnoticed foot injuries that can progress to lesions, ulcers and amputation if left untreated (NINDS, 2008). Loss of sensation in the feet and lower legs can also affect muscle strength, balance and mobility and result in an increased risk of accidental falls.

If you or a loved one has diabetes, please take care of your feet!  I realize that managing your blood sugar may be difficult but even when you feel alright, damage is occurring if you do not manage your blood sugar. To manage your blood sugar, it is recommended that you eat frequent meals and try to keep your numbers from spiking; maintaining a steady blood glucose level is best.  I am not a nutritionist but fruits and vegetables and whole grains take a long time to digest, keep your blood sugar steady and keep you full for longer periods of time.

Regular exercise is recommended as is regular foot inspections.  Imagine how difficult it would be to react to life’s imbalances if you can’t feel the ground underneath your feet.  Balance and mobility are essential to independence so keep your tootsies moving and protected by managing your blood sugar levels.  It’s your life and the quality of it is up to you.

If you already have diabetic neuropathy, be aware of your limitations!  The somatosensory system is one component of your balance.  With proper instruction, you can learn to rely more on your vision, vestibular and musculoskeletal systems in order to remain safe.  The FallProof™ balance and mobility program teaches a multi-sensory approach to fall risk reduction and is helpful for older adults who are moderate to high risk of falling.

In addition to multi-sensory training, it is important that you consistently engage in some type of stretching or strengthening program to remain independent.  My Take 5 to Exercise DVD program provides 5 days of gentle seated routines that are designed to reduce the risk of an accidental fall.   Join me and the Take 5 to Exercise ladies as you learn how to move safely again.

The Fall Prevention Lady

All Content Copyright © 2007-2010, Take 5 to Exercise.

We’ve all heard of the circle of life.  We begin dependent on our parents, we have to master the skill of balance in order to walk, we learn to drive automobiles, we find a career we enjoy, we form our own families, become independent adults….or something like that! The irony of the circle of life is that, unfortunately some of us return to the dependent state we started this life;  wearing diapers and being dependent on others for our care.

That is not a pretty picture but unfortunately, chronic disease and premature disability challenge a person’s level of independence.  That is why I created the “3 Circles”.  As one of my Basic 5 exercises, I encourage older adults to do the 3 circles; wrist, arm and ankle circles.  Moving each joint of the body is important because if you don’t use it, you lose it!

Falls are accidents; no one plans on falling.  There are times when we have to react to life’s imbalances and sometimes, we have to catch ourselves from falling.  Your first instinct may be to stick your arm out.  In that instance, wouldn’t it be better if you wrist was flexible and strong?  That is why it is important to do wrist circles, in both directions.  Simply draw circles with your hand as you keep your arm still.

Then extend your arms out to the side, thumbs up, and begin making small circles with both arms.  Sit tall as you slowly start making bigger circles with your arms.  Pause then reverse the direction.  Start with small circles then slowly make bigger circles as you feel the muscles in your chest and back start to warm up.

Lastly but perhaps most importantly, ankle circles!  We have to react to life’s imbalances from the ground up so the ankle joint must be flexible or you will lose your balance.  After doing Basic 5 exercise #4, the leg extension, keep your leg extended and still as you start to draw circles with your toes.  Start small circles in clockwise direction.  Slowly make bigger circles as you keep your leg still.

My Basic 5 exercise, the 3 Circles, will help increase your circulation and improve your flexibility while reducing the risk of an accidental fall.  Remember to Take 5 to Exercise each day to remain independent.  These movements aren’t strenuous, they should not cause any pain.  Simple movements like wrist, arm and ankle circles will keep the muscles that surround and support your joints able to react to life.

Try these Basic 5 exercises each day to reduce your risk of a fall:

The Take 5 Hand Squeeze, The 3 Circles, Hamstring stretch, Leg Extenstion, and Kegal Squeeze.

The Fall Prevention Lady

All Content Copyright © 2007-2010, Take 5 to Exercise.

Sunday afternoon, I had coffee and conversation with a workshop participant of mine.  This 72 year old woman lives in her home, is extremely active and loves my Take 5 to Exercise DVD series!  She follows along with the exercises 5 days a week and is feeling stronger and more flexible as a direct result of her consistent efforts.  In addition to my Take 5 to Exercise DVDs, she has started the FallProof™ at Home balance and mobility DVD series. We met on Sunday to exchange level 2 for level 3 and to chat for a bit…..

During our conversation, my friend talked about a 47-year friendship she had with a woman who recently passed due to complications from diabetes.  47 years of laughing, crying and everything in between!!!  My friend’s eyes sparkled as she relived some of the fun times they had and how wonderful it was to have a friend who knew her through and through despite their personal differences and tastes.  Each year, they would meet somewhere and explore the area just like they did when they were younger.  Age didn’t bother them, they did what they wanted and had fun doing it!

My friend takes responsibility for her health.  She firmly believes in prevention and following a healthy life now so she can do what she wants when she gets older.  Although she is 72 years old, she does not consider herself old and refuses to bow down without a fight!  Even though she lost her closest friend, she has a strong support network and is social being; she remains active in her leisure time and loves it.

When reflecting on the loss of her friend, Pat got upset because her friend did not manage her diabetes…”it was the diabetes that killed her” and would not listen to her closest friend’s advice; get active, eat right and control your blood sugar.  Unfortunately, even the best of friends can’t make a person do something she doesn’t want to do.  Getting active and taking responsibility for your health and well being is a personal choice.

My suggestion? Get your loved ones the Take 5 to Exercise 5-day DVD set so they can remain independent as long as possible.  The quality of life is almost more important the quantity of years…live to your full potential by doing something beneficial to your body on a daily basis.  Let me guide you through seated exercises designed to keep you strong and flexible, improve your posture and maintain your shoulders and hips!  Not extremely long and not strenuous, my DVDs are educational and entertaining….give them a try, you’ll be glad you did.  If not for you, for a dear friend or loved one!

The Fall Prevention Lady
All Content Copyright © 2007-2010, Take 5 to Exercise.

As part of their spring activity guide, the Cordova Senior Activity Center (CSAC) in Rancho Cordova, CA is offering my multi-factorial fall prevention exercise class to anyone who is interested in learning how to reduce the risk of an accidental fall.  Each class is scheduled to meet once a week for 4 weeks and the cost $25.

Similar to my Stand Up to Falls 3-hour workshop, I educate about the four components of a fall prevention exercise routine and demonstrate specific movements from each component.  Since my Take 5 to Exercise class is in fact, an exercise class, I spend more time moving than talking!!!  I incorporate balance activities  that challenge each of the body systems responsible for both static and dynamic balance ability into each class and build on the skills from the previous week.

Aging is a unique and different process to everyone as indicated by the variety of physical challenges presented in class by my first group.  As a result, a “one size fits all” approach WILL NOT WORK when challenging balance not to mention one’s flexibility and strength.  Thus, I introduce the balance aspects in a progressive (semi)-individualized manner, so that each person understands the body systems involved and how he or she can safely challenge themselves at home.

Unfortunately, meeting once a week for 4 weeks is just long enough to cover the basics!  My first group of 7 older adults has been an absolute joy to work with and after 4 weeks, they are just getting started!  The good news is that everyone intends to continue into the next session of classes.  Research studies demonstrate that older adults benefit from consistent balance, resistance, and flexibility exercise designed to reduce the risk of a fall. The question of how long one needs to participate in a program until the benefits are evident remains unclear. The good news is that the body adapts to increased physical demands and neural pathways improve as you practice your balance skills; IT’S NEVER TOO LATE TO IMPROVE YOUR BALANCE, STRENGTH, FLEXIBILITY AND ENDURANCE.

Today, I provided the exercise pamphlets from the Fall Prevention Center of Excellence; “Balance Basics”, “Stretch and Flex”, and “Strong and Stable”.  For $20, you get professionally designed pictures and easy-to-understand exercise descriptions in LARGE FONT.  These are a great supplement to my Take 5 to Exercise fall prevention exercise class so everyone can practice these independence-building skills at home.
Next week:  if anyone is interested, my Take 5 to Exercise DVDs!

Sacramento….Take 5 to Exercise and reduce the risk of a fall!  Call the Cordova Senior Activities Center today and enroll in the next session;  916-366-3133.
All Content Copyright © 2007-2010, Take 5 to Exercise.

An effective fall prevention exercise routine includes exercises that challenge your flexibility, strength, balance and endurance.   It’s easy to remember; a well-balanced exercise program will help keep you balanced!  I am reading stacks and stacks of research studies and the consensus is in; exercise is the best way to reduce your risk of an accidental fall.  The “best” exercise is consistency.  And perseverance.

Today I met with an enthusiastic lady who attended my Stand Up to Falls workshop in January.  This 73 year old lady remains active and outgoing since retiring but she feels her body starting to slow down.  Despite the arthritis in her knee and the scoliosis in her back, she wants to maintain her active lifestyle.  She has bought my 5-day DVD series and her favorite is Take 5 for Flexibility.  She has set a routine for herself and everyday, she follows along with the Flexibility DVD to “get her body loosened up” before doing the second DVD.  The DVDs are not too long so REALISTICALLY, she has time to Follow two fall risk reduction exercise routines in the morning before getting her day started.  She is thriving as her body is adapting to the challenges and getting stronger.  Twice a week she follows my strength training DVDs and the other days, she works on her posture and maintenance movements.

Her name is Pat and she loves my DVDs because “although each DVD has the Basic 5 stretches, each DVD is different because there are different exercises on each one”.  For Pat, her health and independence are high priority in her life.  Although she has not fallen, she is concerned about falling so she is taking responsibility for her well-being by getting active today.  She makes the time to Take 5 to Exercise each day.

It doesn’t have to be strenuous, it doesn’t have to be an hour of grueling movement, and it should not hurt but it must be consistent!  “IT” is active movement.  Voluntarily engaging in movement that raises your heartbeat and makes your body warm.  Start with simple seated stretching to increase your blood’s circulation and progress to seated resistance movements.

My DVD series is easy to follow and as a certified personal fitness trainer, I verbally cue the viewer through each movement.  For example, I remind you to move slow and controlled, I remind you to breathe deeply, and I remind you what body part is supposed to be working!  I am a your own personal trainer….on a DVD!  Give it a try.  You will increase your awareness of fall risk behaviors and how to reduce that risk through exercise.   Pat gets it!  She has decided to make the time to Take 5 to Exercise each day and her body is reacting wonderfully.  Give it a try!

The Fall Prevention Lady
All Content Copyright © 2007-2010, Take 5 to Exercise.

Baby boomers are getting older.  Social marketing research is dedicated specifically to studying their needs and how to appeal to this group because of the sheer numbers and the fact that boomers are more educated and have more money than earlier generations.  As a result, businesses are popping up all over the place that “cater” to the needs of this aging group.  Unfortunately, some of these business owners don’t know a thing about the aging process; they are capitalists who are simply selling a product.

As a graduate student who is pursuing a masters of science in Therapeutic Aging, I am also studying to become a Certified Therapeutic Recreation Specialist (CTRS) who specializes in the older adult population, specifically how to reduce the risk of falls.  Recreation therapy is a growing field that follows strict standards in order to ensure consumer protection.  In order to become certified, a person must meet educational requirements, display work competence during a supervised internship and pass a national certification exam.  Once certified, CTRS must demonstrate continued learning each year.  The best thing about this?  The accrediting bodies of recreation therapy enact disciplinary consequences to those who violate the standard of care.

As a Certified Personal Fitness trainer, I get frustrated when I see trainers overstepping professional boundaries and implementing unsafe methods because there is no regulating body to impose disciplinary recourse.  Once certified, there is no accreditation in personal fitness training; anyone can take the exam and begin training others. The best, most credible agencies of certification are ACSM, NASM, and AFAA.  Look for these credentials, PLUS A COLLEGE EDUCATION AND WORKING EXPERIENCE when you pick a trainer.  Friend referrals are golden, too.

It scares me when I consider home health care agencies….Who regulates the safety and competency of the people you allow into your home?  The Joint Commission is a regulating body that determines the standards of care in healthcare facilities.  The good news is that home health care agencies can also be accredited through the Joint Commission.  Agencies that strive for accreditation are dedicated to providing the best care possible to consumers.  Look for the seal, check for accreditation through the Joint Commission and always be wise when choosing a healthcare professional.
All Content Copyright © 2007-2010, Take 5 to Exercise.