Topic: Exercise

The Critically Ill Benefit from Mild Exercise

Tuesday, October 5th, 2010 by American Senior Fitness Association   View This Issue of Experience!

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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SFA Workshops and Graduation

Friday, September 17th, 2010 by American Senior Fitness Association   View This Issue of Experience!

Nineteen activity professionals and volunteers from 10 different senior service organizations came together for two weekends at the Aquatic Park Senior Center in San Francisco for SFA’s third annual Senior Fitness Instructor workshops.

These sessions were led by University of San Francisco’s Dr. Christian Thompson, a member of SFA’s National Advisory Board, who has been educating the community on older adult fitness leadership for more than 10 years.

Participants learned how to structure safe and effective exercise programs for older adults and had the opportunity to practice effective exercise leadership strategies including how to provide appropriate cueing, feedback, and how to track progress through regular assessment. This year participants got additional training on leadership through Dr. Thompson’s Falls Prevention Exercise Program, a 12-week program for older adults who have sustained recent falls. This program has been recognized as a best practices exercise program for falls prevention and has been featured at several national fitness conferences.

The 19 participants are now actively involved with leading exercise as a part of the Always Active program — a citywide program in San Francisco that provides exercise and health promotion classes at nine senior centers throughout the city. The Always Active program, funded through a generous grant by the City of San Francisco, has served more than 1,000 older adults since its inception in 2007.

As a part of the Always Active Spring Celebration on May 28, 2010, the 19 course participants were honored as graduates of SFA’s Senior Fitness Instructor program.

More than 200 seniors attended the celebration held at the Aquatic Park Senior Center on the beautiful waterfront in San Francisco. Participants were treated to a Wellness Walk along the waterfront, lunchtime dance entertainment, a keynote talk by Dr. Christian Thompson, and a raffle with some great prizes. Following a light snack, Dr. Thompson presided over the graduation ceremony for SFA’s graduating class. The graduates were saluted by the large crowd and presented with their SFA certificates by the Director of Aging Services for the City of San Francisco, Ms. Anne Hinton.

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Cardiac Patients Help Out Lucky Shelter Dogs

Thursday, July 1st, 2010 by American Senior Fitness Association   View This Issue of Experience!

Cardiac Friends is an outstanding program under way in Waukesha, Wisconsin, that enlists heart patients as volunteers to take dogs, who are housed at a local shelter, on regular walks healthful for both the human and canine participants. As reported by HealthDay News, the program is a partnership between the county’s Humane Animal Welfare Society and ProHealth Care (PHC), involving medically approved cardiac patients of PHC’s Waukesha Memorial Hospital.

These dog walkers have undergone procedures such as angioplasty, stent implantation and open heart surgery. Regular exercise with their canine companions lowers their risk for another cardiac event, helps control cholesterol levels, reduces blood pressure, helps counter depression and provides an opportunity to be needed and to make a difference.

From a shelter dog’s point of view, getting out of the kennel often to enjoy some physical recreation with a friendly, attentive visitor helps the animal stay mentally and physically fit while waiting for his or her new "forever home."

At this time, all of the patient-volunteers in the Cardiac Friends program (now approximately one year old) are men in their seventies. They visit the shelter three times per week, for an hour or longer, to get outdoors with their canine buddies, play fetch and walk along an enticing foot-path through an adjacent meadow.

Shelter coordinator Sara Falk told HealthDay News that the Cardiac Friends volunteers are among her favorites thanks to their reliability and since "… they are taking longer walks than a lot of the other walkers because they have fitness in mind."

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Knowledge for Group Fitness Instructors

Tuesday, June 15th, 2010 by American Senior Fitness Association   View This Issue of Experience!

A sample older adult workout designed by Janie Clark, president of the American Senior Fitness Association (SFA), appears in the new edition of the textbook Fitness: Theory & Practice, which is published by the Aerobics and Fitness Association of America (AFAA).

This fifth edition of the book (2010) comes in hardcover and contains 519 pages. Not intended for senior fitness professionals only, it provides a comprehensive resource for group instructors of clients in all age ranges. It features an excellent chapter on older adult fitness written by Laura Gladwin, M.S., which includes Clark’s sub-chapter: a basic workout routine illustrated with photographs of an older adult exercise participant.

Clark’s work has appeared in every edition of the textbook. For more information about Fitness: Theory & Practice, click on http://www.afaa.com/604.afa.

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Walking and Stroke Risk

Tuesday, June 15th, 2010 by American Senior Fitness Association   View This Issue of Experience!

A nearly 12-year follow-up study of 39,315 women (average age 54) has found that women who walked two or more hours per week had a significantly lower risk for stroke than non-walkers. Those who usually walked at a brisk pace also had a significantly lower risk than women who didn’t walk. The study’s results were recently published in Stroke: Journal of the American Heart Association (AHA).

Compared to women who did not walk:

  • Women who walked two or more hours per week had a 30 percent lower risk for any type of stroke.
  • Women who walked two or more hours per week had a 57 percent lower risk for hemorrhagic (bleeding) stroke.
  • Women who usually walked more than two hours per week had a 21 percent lower risk for ischemic (clot-related) stroke.
  • Compared to women who did not walk, those who usually walked at a brisk pace had a:

  • 37 percent lower risk for any type of stroke.
  • 68 percent lower risk for hemorrhagic stroke.
  • 25 percent lower risk for ischemic stroke.
  • In the study, walking pace was categorized as:

  • Casual — about 2 mph,
  • Normal — 2 to 2.9 mph,
  • Brisk — 3 to 3.9 mph, and
  • Very brisk — 4 mph.
  • Lead researcher Jacob Sattelmair of the Harvard School of Public Health in Boston offered this practical advice for pacing oneself: "If you cannot talk, slow down a bit. If you can sing, walk a bit faster."

    Forms of physical activity other than walking were also addressed by the study. The women who were most active in their leisure time activities were 17 percent less likely to have any type of stroke compared to the least active women. Sattelmair said, "Though the exact relationship among different types of physical activity and different stroke subtypes remains unclear, the results of this specific study indicate that walking, in particular, is associated with lower risk of stroke."

    It is still unclear how walking, specifically, affects stroke risk in men. For substantial health benefits, the AHA recommends that all adults perform at least 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity, or a combination.

    To see the AHA news release on this study, click here.

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    Fibromyalgia and Exercise

    Monday, May 17th, 2010 by American Senior Fitness Association   View This Issue of Experience!

    As reported by HealthDay, a recent Norwegian study found that physical exercise and weight control may help ward off fibromyalgia. Researchers at the Norwegian University of Science and Technology followed 16,000 Norwegian women for 11 years, during which time 380 developed fibromyalgia. Below are several important findings from the study:

  • Women who exercised at least four times a week had a 29 percent lower risk for fibromyalgia, compared to inactive women.
  • Women who exercised two to three times a week were approximately 11 percent less likely to develop the condition.
  • Women who were overweight (with a Body Mass Index of 25 or more) had a 60 to 70 percent higher risk for developing fibromyalgia, compared to women with a healthy body weight.
  • However, overweight women who exercised at least one hour per week were less likely to develop fibromyalgia than were inactive overweight women.
  • Since this investigation did not prove a direct cause and effect between exercise or body weight and fibromyalgia, more research is being called for. Patrick Wood, MD, of the National Fibromyalgia Association told HealthDay that exercising regularly and maintaining a healthy weight may be helpful in avoiding the condition, and that doing both are especially prudent for people with a family history of fibromyalgia.

    This research was published in the American College of Rheumatology’s journal Arthritis Care & Research (62:12). To read the abstract, click on http://www3.interscience.wiley.com/journal/123268508/abstract.

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    Let’s Get Outdoors!

    Monday, May 17th, 2010 by American Senior Fitness Association   View This Issue of Experience!

    At the Colchester Campus of the UK’s University of Essex, research conducted by Dr. Jo Barton and Professor Jules Pretty has shown that a small amount of daily "green exercise" — for example, taking a stroll through a pleasant park or garden — will improve people’s mood, self-esteem and mental health. In fact, they found that just five minutes of such nature-based physical activity produced the greatest positive effect.

    Prior work by the two researchers had already reinforced connections among nature, exercise in green environments and health benefits. In the new study, all natural environments were seen to be beneficial, including urban green spaces. Natural settings that included the presence of water generated especially desirable results.

    To read the University of Essex news release about this study, click on http://www.essex.ac.uk/news/event.aspx?e_id=1588.

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    Phone a Friend for Fitness

    Monday, May 3rd, 2010 by American Senior Fitness Association   View This Issue of Experience!

    Here’s a tip for incorporating more physical activity into your daily schedule. American Senior Fitness Association (SFA) president Janie Clark suggests that, instead of sitting down for a long "gab-fest" with absent friends and family, you make a "walk and talk" phone date. You can coordinate with your sister in Seattle, your old roommate in Cleveland or your mother in Boca Raton to "meet" for a walk at a pre-set time.

    Describing your surroundings as you walk may even help to create new conversation topics and shared experiences of nature and the great outdoors. Plus, differing fitness levels won’t be a factor.

    Janie recommends utilizing a phone with a headset to allow for freedom of arm movement and selecting a safe walking environment where neither traffic nor the occasional distraction might put you at risk of injury. Health-fitness professionals, you may wish to pass this idea along to the clients you’ve been encouraging to do some walking on their own between scheduled fitness sessions under your direction.

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    Exercise and Knee Replacement

    Monday, May 3rd, 2010 by American Senior Fitness Association   View This Issue of Experience!

    It may make common sense that the pain relief gained through knee replacement surgery would instigate more physical exercise and, thereby, better weight control. But that is not what researchers found when they tracked 106 patients for two years following their knee replacements. Instead, 66 percent of the subjects had gained an average of 14 pounds.

    The good news is that the other one-third had lost, on average, approximately four pounds. In those who lost weight, no decline in quadriceps strength was seen, whereas the quadriceps had weakened in those who gained weight.

    Researchers explained that, after surgery, single knee replacement patients have a tendency to place more weight on the knee that wasn’t replaced. The added load of weight gain can compromise both knees and, in particular, may hasten the progression of osteoarthritis in the non-operated joint.

    In summary, knee replacement patients should take care to maintain a healthy body weight. If knee pain persists following the surgery, such patients may wish to consider swimming, pool aerobics or other joint-sparing workouts designed to control weight and promote heart health.

    This research was conducted at the University of Delaware. Click here to read the university’s report on the study.

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    Weightlifting and High Blood Pressure

    Monday, May 3rd, 2010 by American Senior Fitness Association   View This Issue of Experience!

    The Mayo Clinic has some sound advice for persons with high blood pressure who are interested in taking up weightlifting, as follows:

  • Consult with your physician before beginning any exercise program in order to adopt a plan that is individualized to your needs and medical status.
  • Note that weightlifting can cause a temporary rise in blood pressure; how much is mainly dependent upon the amount of weight lifted. However, regular physical exercise (including moderate weightlifting) leads to health benefits outweighing the risk for most people and can lower blood pressure in the long-run.
  • If you have high blood pressure, lift lighter weights. Heavy weight causes more strain and, in turn, a higher spike in blood pressure. To challenge your muscles using lighter weight, increase the number of repetitions you perform.
  • Never hold your breath while weight training. Breath-holding can raise blood pressure dangerously. Do breathe naturally and continuously throughout every lift.
  • Use proper form to minimize the risk for accidental injury.
  • Stop activity if you experience severe shortness of breath, dizziness, chest pain or chest pressure.
  • SFA guidelines call for notifying one’s physician at once in the case of chest pain or pressure, and in the event of recurring breathlessness or dizziness.

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