October 5th, 2010

Table of Contents:

Get Some Sleep (Medical research)

Get Your Voice On! (A worthwhile activity resource)

The Critically Ill Benefit from Mild Exercise (News from Johns Hopkins)

Many Chronically Ill Elderly Live Alone (Recent analysis)

Who’s Who in Senior Fitness: Featuring Jan Montague (Industry leader)

A-h-h-h-h (A word to the wise)

Get Some Sleep

by American Senior Fitness Association

Researchers have identified what they believe is the most healthful length for sleeping: between six and eight hours per day. More specifically, they concluded that short sleep increases the risk for death and that over long sleep may indicate serious illness. Following is a news release on the study from the University of Warwick in the United Kingdom:

Research carried out by the University of Warwick in collaboration with the Federico II University Medical School in Naples, Italy, has found that people who sleep for less than six hours each night were 12 percent more likely to die prematurely than those who get the recommended six to eight hours.

The study, published in the journal Sleep, provides unequivocal evidence of the direct link between short duration of sleep (less than six hours sleep a night) and an increased chance of dying prematurely.

The research also notes that consistent over long sleeping (over nine hours a night) can be a cause for concern. While, unlike short sleeping, over long sleeping does not in itself increase the risk of death, it can be a significant marker of an underlying serious and potentially fatal illness.

The study looked at the relationship between the level of habitual duration of sleep and mortality by reviewing 16 prospective studies from the UK, USA, European and East Asian countries. The study included more than 1.3 million participants, followed-up for up to 25 years, with more than 100,000 deaths recorded.

This study provides unequivocal evidence of the direct link between both short (less than six hours sleep a night) and long (nine hours or more) duration of sleep and an increased chance of dying prematurely, compared to those who sleep six to eight hours a night on average.

Professor Francesco Cappuccio, leader of the Sleep, Health and Society Programme at the University of Warwick and Consultant Physician at the University Hospitals Coventry and Warwickshire NHS Trust, said, "Whilst short sleep may represent a cause of ill-health, long sleep is believed to represent more an indicator of ill-health."

He said: "Modern society has seen a gradual reduction in the average amount of sleep people take, and this pattern is more common amongst full-time workers, suggesting that it may be due to societal pressures for longer working hours and more shift-work. On the other hand, the deterioration of our health status is often accompanied by an extension of our sleeping time."

"Consistently sleeping six to eight hours per night may be optimal for health," he continued. "The duration of sleep should be regarded as an additional behavioural risk factor, or risk marker, influenced by the environment and possibly amenable to change through both education and counseling as well as through measures of public health aimed at favourable modifications of the physical and working environments."

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Get Your Voice On!

by American Senior Fitness Association

American Senior Fitness Association (SFA) fitness professional Kim Vickers, MA, ACC, has developed a unique music and vocalization program for seniors called Voc-Aerobics (TM). Kim holds her master’s degree in gerontology and teaches fitness to older adults in Northern California.

This product, designed to increase communication abilities, provides a manual and an accompanying CD. The 71-page manual contains 10 lesson plans which include physical exercises, deep breathing exercises, vocal warm-ups, vocalization exercises, five sing-along songs with all the lyrics, as well as an enjoyable conclusion to each lesson. Each plan begins by establishing its goals, for example, to gain better control over vocal function, to improve enunciation, and/or to feel more confident while speaking. Notes are provided to help the "non-musical person" lead the program, and the CD demonstrates the 10 vocal warm-up exercises.

Voc-Aerobics (TM) will be especially appreciated by activity coordinators, music therapists and recreational therapists who work primarily with elderly and disabled persons. Ideal for small to medium groups of seniors living in long-term care communities, the program is also suitable for individuals living at home. In the manual’s introduction, Kim writes: "Specifically, in its design this program is intended to help seniors and disabled people who have difficulty with self-expression for any number of reasons, including dementia, heart and lung disease, Parkinson’s disease, stroke, and any of the myriad issues that can interfere with one’s ability to communicate with others."

Kim Vickers’ approach is likely to result in smiles and laughter among elderly Voc-Aerobics (TM) participants. SFA president Janie Clark describes the program as "both creative and practical, a winning combination." For price and ordering information, email Kimv442@gmail.com.

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The Critically Ill Benefit from Mild Exercise

by American Senior Fitness Association

Researchers have found that critically ill ICU patients recover more quickly and can decrease their use of sedatives by beginning an early program of mild exercise. Following is a report on the study from John Hopkins Medicine:

A report from critical care experts at Johns Hopkins shows that use of sedatives goes down by half so that mild exercise can be introduced to the care of critically ill patients in the intensive care unit (ICU). Curtailing use of the drowsiness-inducing medications not only allows patients to exercise, which is known to reduce muscle weakness linked to long periods of bed rest, but also reduces bouts of delirium and hallucinations and speeds up ICU recovery times by as much as two to three days, the paper concludes.

Mild exercise, the experts say, with sessions varying from 30 minutes to 45 minutes, should be performed by patients under the careful guidance of specially trained physical and occupational therapists and can include any combination of either leg or arm movements while lying flat in bed, sitting up or standing, or even walking slowly in the corridors of the ICU. Indeed, the Johns Hopkins team has since evaluated a number of additional physical rehabilitation therapies, such as cycling in bed using a specially designed peddling device, or stimulating contractions of the leg muscles with overlying electrical pads. Patients can often exercise while still attached to life support equipment, such as a mechanical ventilator that helps them breathe, the group shows.

In its exercise report, published in the journal Archives of Physical Medicine and Rehabilitation online, the Johns Hopkins team closely monitored the progress of 57 patients admitted to The Johns Hopkins Hospital’s medical intensive care unit (MICU) in 2007. Their treatment encompassed 794 days spent in the unit. Members of the MICU team checked the patients’ records daily for several months before and after the physical rehabilitation project began. Each patient was mechanically ventilated for at least four days, with half receiving no more than one exercising session before the enhanced exercise plan started, while half received at least seven physical therapy sessions after the plan’s implementation.

"Our work challenges physicians to rethink how they treat critically ill patients and shows the downstream benefits of early mobilization exercises," says critical care specialist Dale Needham, MD, PhD, who spearheaded the project.

"Our patients keep telling us that they do not want to be confined to their beds, they want to be awake, alert and moving, and engaged participants in their recovery," says Needham, an associate professor at the Johns Hopkins University School of Medicine. "Patients are not afraid of exercising while they are in the ICU, and they are embracing this new approach to their care in the ICU. It actually motivates them to get well and reminds them that they have a life outside the four walls surrounding their hospital beds."

Needham’s latest findings contribute to his team’s other research in the past three years, demonstrating in more than 500 patients how early physical rehabilitation and mild exercise helped ICU patients move about, sit and stand up. He says patients can lose as much as five percent per week of leg muscle mass when confined to bed rest.

In the report, Needham and colleagues found that the use of drowsiness-causing benzodiazepines declined to only 26 percent of patient days spent in the MICU in the four months following introduction of early mobilization practices, compared to 50 percent of patient days in the three months leading up to the project. Daily doses dropped even further. Half of the patients were given more than 47 milligrams of midazolam and 71 milligrams of morphine before early exercising was emphasized. After exercising became more widespread, half needed less than 15 milligrams of midazolam and 24 milligrams of morphine.

Daily episodes of delirium, when a patient may hallucinate, be unable to think straight, or simply be unaware of their surroundings, were sharply curtailed. Before exercising began, ICU patients were spending as little as 21 percent of all patient days without such disturbances, but this grew to 33 percent clear-thinking days afterward. Delirium is known to occur in ICU patients who have been heavily sedated, prolonging their ICU stay and recovery.

Overall time spent in intensive care and in the hospital also dropped after exercising was promoted, by 2.1 days and 3.1 days, respectively. And with patients recovering faster, the Johns Hopkins MICU was able to treat 20 percent more patients even though its capacity, at 16 beds, remained the same.

Critical care expert Eddy Fan, MD, a member of the project team and instructor at Hopkins, says physicians are changing their perspective on prolonged bed rest with heavy sedation, and its long-term consequences to patient health.

Fan says developing appropriate physical therapy regimens involves careful planning and coordination among all members of the critical care team, including physicians, nurses, and respiratory, physical and occupational therapists. He notes that it can take an hour to get a patient ready to perform and finish certain exercises, such as walking short distances, and that patient comfort and safety must be monitored throughout the activity.

Launching this kind of early physical medicine and rehabilitation program requires serious commitment. Fan says the Hopkins initiative involved nearly 150 hospital physicians and staff in meetings about early mobilization of their patients, including 16 educational seminars on sedation alone with MICU nurses, as well as staff presentations by former ICU patients about their problems with muscle weakness since their discharge.

"Things can change quickly in the ICU, but if the patient has the energy to exercise and their vital signs are okay, and the staff are trained and confident in the type of activity to be performed, then it is in the patient’s best interest to get them moving," says Fan.

Needham says long-term clinical studies of these treatment techniques are already under way, in which some critically ill patients are performing early-mobilization exercises and others less so or not at all. The goal of researchers, now that the immediate physical benefits have been shown, is to gauge if early rehabilitation therapy improves patients’ quality of life, such as their ability to stay active and mobile inside and out of the home, and to quantify any hospital cost savings accruing from the effort. Funding support for the report was provided by The Johns Hopkins University and The Johns Hopkins Hospital.

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Many Chronically Ill Elderly Live Alone

by American Senior Fitness Association

Family and friends outside of the household are an important resource for older adults with chronic health problems, according to University of Michigan (U-M) research. Below is a report on the subject from the University of Michigan Health System:

Almost 40 percent of chronically ill older adults in the U.S. live alone, and a majority of those who are married have spouses with at least one chronic illness than can affect their ability to provide support, according to a U-M study published in the journal Chronic Illness.

The results underscore the importance of health care professionals directly addressing the roles that family members play in the care of their aging parents or other relatives.

"Family members have the potential to significantly help many patients with chronic illness manage their health conditions," says co-author Ann-Marie Rosland, MD, clinical lecturer in the Department of Internal Medicine at the University of Michigan Medical School and research investigator for the Center for Clinical Management Research in the VA Ann Arbor Healthcare System.

"However those family members need more than just information to be successful. We need to teach family members communication skills and provide the tools that they can use to encourage patients to stick to their health regimen."

The study’s authors looked at U.S. residents who were age 51 or older with chronic health problems who participated in the 2006 Health and Retirement Study, a national longitudinal study conducted at the University of Michigan’s Institute for Social Research and funded by the National Institute on Aging.

Researchers found that 93 percent of the chronically ill older adults had adult children, but for half of them, the children lived more than 10 miles away. Roughly 19 million older chronically ill Americans have adult children living at a distance.

"Even when a spouse is available, the vast majority struggle with their own
chronic medical needs and functional limitations," says John D. Piette, PhD, professor of internal medicine and a senior career scientist with the VA Ann Arbor Healthcare System.

"Fortunately, most of these people had adult children who could be another source of support for their chronic illness care," he says. "But these
relationships are increasingly strained as adult children move farther away from their parents to seek employment or find a more affordable living situation. Distances pose a barrier to the monitoring and frequent support for behavior change that many chronically ill patients need."

Piette and his colleagues at U-M are working to develop telephone monitoring systems that involve family members in a relative’s care through email alerts or automated phone calls. The "CarePartners" program has been developed for
patients with heart failure, diabetes, depression, and cancer chemotherapy. The program is being studied as part of randomized trials and community demonstration programs.

"We know that people with family support follow their self-care regimen more regularly and this is vital to maintaining their health," says Maria Silveira, MD, MPH, physician scientist at the VA Ann Arbor Healthcare System and assistant professor of internal medicine at the U-M Medical School.

"The challenges facing chronically ill patients, their families and their clinical teams are enormous," Piette says. "We need a recognition that for many patients ‘self’ management is a misnomer, since their disease care is actually shared by their family and broader social network."

Informal caregivers play essential roles in filling the gaps in services found in most formal health care systems, such as providing assistance with transportation, medication refilling, emotional support, activities of daily living and a host of other vital tasks.

"Indeed, for many chronically ill patients, sharing their burden with intimate others makes living with their disease not only possible physically, but also worthwhile emotionally and spiritually," says Piette.

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Who’s Who in Senior Fitness: Featuring Jan Montague

by American Senior Fitness Association

SFA National Advisory Board member Jan Montague is a strong voice for wellness and quality of life among older adults. She is Vice President for Whole-person Wellness Solutions Inc., a for-profit division of Life Enriching Communities in Cincinnati, Ohio. Jan was recruited by Life Enriching Communities (LEC) to further its effort to create a learning, teaching, and consulting whole-person-wellness environment. This environment can impact not only LEC’s residents and staff, but also – through consultations, management, and research with various national wellness partners – throughout the nation.

Jan has devoted her entire professional life to wellness and health promotion. Early in her career, she owned and managed a chain of fitness centers. Continuing to expand the dimensions of wellness beyond the physical to the whole person, she implemented and directed a state-of-the-art wellness center at a senior living community, Maple Knoll Village, in Cincinnati, OH. Knowing that other communities had similar needs, she began a consulting company and worked with more than 100 such communities in their efforts toward wellness. In the process, she collaborated with fitness equipment companies, health clubs, hospitals, physical therapy companies, and large architectural firms, developing wellness centers and programs that truly serve the whole person.

Jan obtained a BS in Applied Sociology from Northern Kentucky University and was honored to be accepted by the Scripps Gerontology Center, Miami University, Oxford, Ohio, obtaining her Master’s of Gerontological Studies (MGS) degree in 1992. She has conducted collaborative research with gerontology professors at both of these universities, as well as with researchers at the University of Cincinnati, Ball State Fisher Institute on Aging, Manchester College, Cal State Fullerton, and the Mather Institute on Aging.

In 1997, Ms. Montague received the Professional Achievement Award from Northern Kentucky University. She received the Cottrell Distinguished Alumni Award from Scripps Gerontology Center in 2007. Jan serves on several national and international advisory boards and has authored numerous articles for professional journals focusing on whole-person wellness and optimal aging.

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A-h-h-h-h

by American Senior Fitness Association

 

The English Elizabethan poet and dramatist, Thomas Dekker, who lived from 1572 to 1632, knew that slumber plays an important role in life:

    "Sleep is the golden chain that ties health and our bodies together."

    – Thomas Dekker

 

 

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