Physical therapy for the elderly

                I Express my gratitude to the Department of labour and   
                social protection of population of Moscow for your help
                and support in the development of the program in
                physical therapy for the elderly.               
                Special thanks to the Moscow pensioners, who
                actively attended classes in physical therapy and               
                executed all program requirements. Objective health
                data, indicators and functional state of their health,               
                contributed to the choice the ideas and direction in the
                development of this Wellness program.
                Developed recreation complexes of exercises are the
                intellectual property of the   author of this program
                and may only be used citing the authorship.
                The exercises are in the photo and video materials for
                the period from August 2014 to February 2016.

                Tatiana Onishchenko.
 
                July 2016

Physical therapy for the elderly
Author program

Author:
Onishchenko Tatiana
Trainer, exercise physiologist
July 2016.

Explanatory note
Therapeutic exercise is an integral part of sports and recreation activities aimed at improving motor activity of man. It is the primary tool in the prevention of diseases and restoration of health. It is based on the data of anatomy, physiology, hygiene, biochemistry, pedagogy, theory and methodology of physical education. Physical therapy has no contraindications to its application, since the first days of birth to old age. Human movement can and should be used in order to stimulate, develop and support its functionality. Pedagogical expediency of physiotherapy is the method of treatment uses means of physical culture with therapeutic and preventive purposes and for faster recovery of health. Therapeutic exercise is closely linked with the medical educational process, it produces in the conscious use of physical exercises, requires the performance of hygienic procedures, involves active human involvement in the regulation of its General modes, in particular modes of movements, stimulates the involved in the hardening natural factors of nature, supports the ability to work, the right attitude to life and behavior in society.
The issue of ageing was occupied by man since ancient times. The first definition of aging and its causes date back to the ancient era. The great Greek physician Hippocrates (V-IV century BC) believed old age is the result of leakage of natural heat and drying of the body. The philosopher Plato pointed out that aging particularly affects the way of life in middle age. In different years of its development the science of aging has gained new knowledge. They were created by specialists of various branches: physicians and psychologists, philosophers and biologists, psychologists and sociologists, historians and legal scholars.
During the development of the human organism from birth to adulthood, the possibilities of all the functional systems increases and reaches a peak in 20-25 years. The period from 25 to 35 years is the most stable state of functioning of all human systems. But after 35 years there is a steady loss of vitality of the body.
To 60-65 years the health and functional activity of all organs and systems is reduced. Physical activity becomes less disturbed the habitual way of life and thinking that has developed over many decades. The meaning of existence is quickly lost if you don't have to take yourself in a fist to make a living on. Active perception of reality is replaced by a sedentary lifestyle, immersion in yourself and in your "sore". The immune system is weakened if there is no struggle for "survival".
Hippocrates said, "Nothing depletes the body as physical inactivity”. Lack of exercise brings great harm, including the elderly.
Generalized scientific data show that the lack of balanced physical activity in the elderly older than 65 years accelerates the aging process and may also cause the development of many diseases.
Numerous studies show that a significant number of people have about ten diseases. There are people who have more than 10 diseases. Most often, it is hypertension, diabetes, diseases of the nervous system. (Hypertensions, diabetes, diseases of the nervous system are most often.) Circulatory disorders that cause heart disease, vision loss and depression, are often also. Almost every elderly person suffers from tooth decay, back pain or headaches. Physiological causes of human diseases connected with his General mental state.
Despite this depressing situation with the listed problems in the elderly, it is not all hopeless. The doctors indicate the need for an integrated approach in solving problems, raising questions about the quality of recreation, occupational therapy, physical and sporting loads.
A healthy diet rich in vitamins and minerals and an active lifestyle are beneficial for the prevention of certain diseases and successful treatment of existing pathologies. We are not talking about radical change in this matter. Modern science and medicine focuses on prevention and relief already developed abnormalities, elimination of pain factor and help in adapting to life in society
Scientific evidence has confirmed that regular physical activity yields large and lasting benefits for the health of the elderly, slowing down the involution processes. Physically active older people are much less susceptible to common causes of death. They have a higher functional level of the cardiovascular, respiratory, muscular systems, good bone, and weight and body structure.
Plutarch said, "The Movement is pantry life." To preserve the health of the older person should follow the principle of balanced physical activity that should be available on its kinetic and dynamic characteristics. It is also necessary to consider the General regularities and individual peculiarities of organism and personality.
An important role in maintaining the health of older people plays a therapeutic exercise, which, by acting on the body by means of physical exercises, contributes to the overall strengthening of the body and allows you to maintain a fairly high level of functional activity of all organs and systems in both physical and mental terms.
Socio-psychological and biological factors influence the process of human aging. Knowing the characteristics of this influence, it is possible to make directed changes in the conditions and way of life of the elderly for a more optimal functioning of the personality. Occupation of new business, establishment of friendly contacts, the preservation of the ability to control your environment, generate satisfaction with life and increase life expectancy. Thus, it has a chilling effect on the aging process.
This program provides a comprehensive approach to the solution of psychophysiological tasks at the lessons of physical therapy by targeting cardiovascular, respiratory system, musculoskeletal system and thought processes during lessons.

The goals of physiotherapy exercises:

– To promote active lifestyle;
– To contribute to the overall strengthening of the body;
– To maintain a fairly high level of functional activity of all organs and systems in both physical and mental terms;
– To change the conditions and way of life of the elderly for the optimal functioning of the personality of the elderly person;
– To provide a restraining influence on the aging process;
– To develop the habit of regular activities and promote the integration of physical activity into the daily lifestyle;
– To bring to the classroom a greater number of older people;
– To expand the geography, to strengthen the friendly relations between neighboring cities and countries.

Tasks of physiotherapy exercises:

– To support the physiological activity of all body systems, supporting better mental and physical health;
– To improve vital skills in walking, swimming in combination with breathing;
– To diversify the movement, adding physical exercise, gymnastics, outdoor games, dancing;
– To combine the level of physical preparedness level of basic physical qualities: strength, speed, endurance, coordination and flexibility;
– To learn the complexes of Wellness and corrective exercise, control the exercise load and the functional state of the organism in the classroom;
– shaping a sustainable interest in physiotherapy exercises.

Form of exercise therapy.

Form of exercise therapy is:
– Elements of physical therapy in the mode of the day (walks, path, dosed swimming, boating, elements of sports games, near Hiking, excursions, elements of dance and sport);
– Self-contained exercise;
– Morning gymnastics;
– Therapeutic gymnastics.
Therapeutic exercises are the main form of the application of physiotherapy.
Classes are held in the form of training that should be carried out under strictly differentiated load, taking into account individual well-being of the students.
Group to practice physical therapy is 10-15 people. The frequency of sessions is 1-3 times a week for 30-45 min. The most appropriate to complete these groups with regard to the state of health, degree of fitness and activity elderly people. Classes are held in the sports hall or in a specially equipped room. Regular physical activity during the week develops a habit of regular classes, and promotes the integration of physical activity into the daily lifestyle.

Exercise therapy methods.
 
Physical exercises are the primary means of physical therapy. These include exercises for coordination, power, speed-strength, corrective gymnastic exercises, and the exercises that are performed in a state of static tension, relaxation, balance, resistance, etc.
Exercises of natural character are the movements that are performed in everyday life. Walking, running, throwing, elements of dance are basic movements of these exercises. Among the different types of physical activity, walking is a universal healing tool.  Walking ordinary, Express, sports.
Walking is used in the treatment of hypertension, dystonia, post-infarction conditions, infarction, endarteritis, varicose veins, and diseases of the respiratory system, gastrointestinal tract, and metabolic disorders.
Walking provides significant health benefits by raising the functional level of the cardiovascular, respiratory, and muscular systems; the strengthening of the bones, proper weight.
Special complexes of gymnastics are used to strengthen the function of respiration, the cardiovascular system, to preserve the mobility of the spine, joints of the upper and lower extremities; to exercise the functions of balance and coordination, normalization of function of gastrointestinal tract and metabolism.
Dancing is the easiest way to improve coordination. Dancing is a wonderful means of emotional effects on the body. The dances have a positive effect on both physical and mental condition of the person.
Sports types of physical exercises are used sparingly in the classroom physical therapy with the elderly. Exercising should correspond to the functional indications of the body. There can be used a simple relay, some sports games or their elements, swimming, skiing, and elements of athletics.
Reasonable use of physical exercises of sports and dance elements increases the interest to the class, creates positive emotions, helps to achieve a certain level of efficiency, to correct the violations.
Outdoor games low mobility there are games that are held in the initial positions (sitting, reclining, lying down, standing up). Chess, checkers, Board games are outdoor games low mobility. Billiards, table tennis, tennis, Golf, "Gorodki" are the games medium and large mobility. Games are hard to dose. It must be remembered. Fatigue and overload, both physical and emotional, can occur unnoticed during the games. To avoid this, you must carefully choose the games; limit the time for the game and to monitor the status of the elderly.

Selection of means of physical therapy
The indication for the choice of means of physical therapy is the coincidence of the mechanism of therapeutic action of these funds with the expected impact on the affected organ or system. It is necessary to consider physical activity and mental state of the elderly person, choosing a means of physical therapy, to perform medical tasks.
Selection of therapeutic exercise means in accordance with treatment objectives.
Special tasks are tasks specific only for this disease.
Common tasks are tasks associated with changes in protective forces. It is necessary to form the motivation for regular physical exercises to practice various available sports activities, is necessary for hardening, recovery and psychological events.
Selection of means of physical therapy must be carried out in accordance with the age characteristics and the physical and psychomotor status of the elderly person, which often changes due to the disease.

 Methods of dispensing physical activity depend on:
– Start positions;
– The complexity of the exercises;
– Alternation of muscular stress;
– Number of involved muscles;
– The number of repetitions of each exercise;
– The nature of the exercise (active, passive, etc.);
– Pace;
– Range of motion;
– Power load;
– Breathing exercises;
– Emotional factor.

 Basic principles for use of means of physical therapy
The principle of regularity is a leading. This is a continuous, systematic, constant use of any means of physical therapy in various forms. Due to this, physiological changes occurring in the body under the influence of physical exercise are fixed. This leads to the fixing of compensatory-adaptive reactions. A break in physical therapy leads to the loss or weakening of the conditioned-reflex connections, changes the dynamics of adaptive reactions.
The principle from simple to complex implies an increase in the level of requirements for a body. It provides an adaptation to increasing load and solves educational tasks.
The principle of individual approach to each person
Increasing workloads and the changing nature of the exercises should be conducted individually, since the adaptation of different people going at different speeds.
The principle of accessibility
The level of exercise should coincide with the level of psychomotor development, health condition, physical experience, physical condition and the condition of the musculoskeletal system of the elderly person.
The principle of alternation
It is necessary to prevent fatigue. Means of therapeutic physical training must be combined so that the muscles performing the movement, gave way to work other muscles, leaving the possibility for recovery.

The principle of consciousness and activity

Conscious attitude of the elderly for physical therapy gives them an interest in the lessons and allows escaping from the thoughts of biological and socio-psychological nature. All therapeutic measures are carried out with optimism. Attempt independent action must be taken carefully and kindly.

Group of physical therapy

For the purposes of a differentiated approach to the organization of classes with older people, it is advisable to create groups of physical therapy. Lessons in these groups have their own curriculum. Classes have a different scope and structure of physical exertion. Requirements to the level of development of the material have differences as well. The program in physical therapy may become a part of the educational program on protecting the health of the population. The departments of social protection of the population can do this work.
The recruitment for the groups of physical therapy
A medical facility provides data for the recruitment for the groups of physical therapy. The head of the organization that will carry out therapeutic exercises with the elderly, issues an order on the staffing groups. When forming groups it is necessary to consider the diagnosis of the disease, data on the functional status of involved, the level of their physical preparedness, which is determined by motor tests. As a test, it is permissible to use only those exercises that are not contraindicated to the students.
 
Parts of the lesson

The introductory part is a preparation for the increased load. The elderly in the classroom of physical therapy must be organized and attentive. This is achieved by using instructional techniques such as drill exercises; perform a variety of steps in place and in movement, exercises in attention and coordination. Then include exercise, contributing to the rapid transition from a low level of physical activity to the level of intense physical activity. We use the walk and its variants, gymnastic exercises, combined with breathing. It is known that the higher the level of physical activity of the elderly person, the quicker the body adapts to the increasing load.
The main part is the part which decides the leading medical and medical-educational tasks. For their implementation are included both specific and General developmental exercises, elements of dance. Any forms of physical therapy include General developmental exercises that affect all muscle groups. General developmental exercises follow the principle of alternation and combination with breathing exercises, with corrective and special exercises. General developmental exercises you can perform with objects and without objects.
The final part is the part where physical activity is gradually reduced to the level of the physical capabilities of an elderly person. The exercises used in the final part, should accelerate processes of recovery. For the elderly we give dances with simple repetitive movements and elements of dance to improve coordination. More active elderly people are using the dances with more complex movements and frequent change of the elements.
Physical activity should correspond to the structure of the classes of functional and adaptive capabilities of older people. Physiotherapy instructor must control the load, constantly maintaining contact with the students: measures the pulse, watching the breath, watching the outward signs of fatigue. As physical activity diminishes with age, the majority of the population has a low ability to exercise. You need to give the elderly the burden of medium and low intensity during the whole school year. In this case, achieving the harmonious functioning of the cardiovascular, respiratory, nervous system, musculoskeletal system, formed the necessary skills and abilities. The increased requirements are not for the weak of body. A weak body will not cope with increased requirements.
 
The effectiveness of physical therapy:

Positive dynamics of clinical and functional parameters is the most important criterion which shows the effectiveness of physical therapy.

Monitoring the condition of an elderly person during class:

The observations are divided into objective and subjective. Subjective indicators are: mood, appetite, sleep, desire to exercise, tolerance training, sweating, and violation of the regime. Objective indicators are: heart rate, weight, height, muscle strength, body temperature, breathing rate.

External signs of fatigue (see the document)

2. THE EDUCATIONAL MATERIAL.

2.1. THEORETICAL TRAINING

1. Daily routine and personal hygiene.
2. Rules for the formation of complexes morning exercises.
3. Rules of conduct in the classroom.
4. Rules for the preparation of the place for self-study.
5. Monitoring health during exercise.
6. Causes of injuries during training and injury prevention.
7. Rules for the use of tempering procedures.
8. Physical qualities and physical preparation. Self-control

2.2. PHYSICAL TRAINING.

GENERAL PHYSICAL PREPARATION

General developmental exercises

1. Marching exercises.
2. Gymnastic exercises.
3. Track and field athletics exercises.
4. Exercises for development of speed and agility.
5. Exercises to develop strength.
6. Exercises for development of flexibility.
7. Swimming.

SPECIAL THERAPEUTIC EXERCISES

Breathing exercises. Complexes of breathing exercises combined with General developmental exercises.
Corrective exercises: standing, sitting, relying on the back of a chair, the wall, with sticks.
Stretching exercises on the gym wall.
Exercises with ball: in a different position.
Exercises with sticks: in a different position.

SPECIAL PHYSICAL TRAINING

Restorative exercise: with objects and without objects. Corrective exercises: standing, sitting, relying on the back of a chair, the wall, with sticks.
Breathing exercises in combination with various movements of the head, hands, feet.
Rhythmic gymnastics: implementation of the complexes to the music, using the exercises in different starting positions, with the active use of the breath.
Exercises on development of coordination: goals, mobile games, sports games low mobility. Dance moves.
Exercises with elements of dance: Salsa, Zumba, square dance, Waltz, tango, etc.

ELEMENTS OF SPORTS AND OUTDOOR GAMES

Sports games
Basic skills in the technique of sports games (table tennis, soccer: kick the ball, basketball throws in the ring). Games are conducted on simplified rules.
Outdoor games low mobility: chess, checkers, Board games, and the average mobility: Billiards, Golf, and great mobility: table tennis, tennis, Gorodki.

DANCE TRAINING

Waltz , tango, polka, square dance", "Zumba", "Salsa", "Bachata", "Lambada", etc.

3. THE EDUCATIONAL-THEMATIC PLAN (see the document)

4. TESTING AND EVALUATION OF QUALIFICATIONS.

General endurance can be assessed while running (walking) for 6 minutes. The test can be run at a comfortable pace, going from running to walking and back. The distance traveled is the result of the test.
The strength of the muscles of the arms and shoulder girdle can be assessed with flexion and extension of the arms in the emphasis lying (when the trunk is straightened). Count the number of performed exercises.
Squats, performed in a random pace, to fatigue, allow you to assess the strength endurance. Count the number of completed exercises until failure.
Execution of complex rhythmic gymnastics: Evaluates the correct execution of the exercises. Special attention is paid to posture.
Performance of a complex of breathing exercises in combination with the general developmental exercises. Estimate cardiovascular and respiratory systems. 
The dance: individually, in pairs, in groups. Assesse: the coordination of movements, and emotional state, individual and collective actions. 
Dance complex is a dance consisting of 6-8 segments. Estimate collective action, the speed of switching from one activity to another and emotional state.
Complex of morning hygienic gymnastics: Assesse the independent work carrying out daily.
Tests of physical fitness are held in September, December and April.

An assessment of the preparedness of the elderly, working in groups of physical therapy, can be carried out in the form of competition for available sports and competitions with mandatory implementation: complexes morning hygienic gymnastics, medical gymnastics, rhythmic gymnastics, respiratory gymnastics, dance complexes.
Demonstrations, competitions and contests have a stimulating nature. They are held with the aim: to promote active lifestyle, to bring to the classroom a greater number of older people, to expand the geography, to strengthen the friendly relations between neighboring cities and countries.
When testing and assessing the qualification of older people should: show special tact, and be careful not to humiliate the dignity of the elderly person, to use data in such a way that they contributed to its development, stimulated their further engaged in a medical physical culture.
The final results take into account the dynamics of physical readiness and activity of older people, take into account the theoretical and practical knowledge acquired in the classroom.
The main focus in assessing the achievements of older people should be done on the dynamics of their physical capabilities and persistent motivation to engage in physical exercise. Even the most minor changes in physical capabilities of older people should be marked positively and communicated to all.
Positively has to be noted also that person who has not demonstrated significant progress in the formation of skills, abilities and development of physical qualities, but regularly attended classes in therapeutic physical culture, diligent in performing tasks mastered available skills self-study Wellness or corrective gymnastics, the necessary knowledge in the field of physical culture.

5. KNOWLEDGE AND SKILLS.

Requirements for the quality of mastering of the program material

As a result of low program in physical therapy, the elderly should know and have an idea:
– About daily routine and personal hygiene;
– About the rules of designing complexes of morning exercise;
– About the rules of behavior in the classroom;
– About the rules of training places for personal study.
– About the use of tempering procedures;
– On the causes of injuries during training and injury prevention.
To be able to:
– run complexes morning exercises;
– To perform a complex of medical physical education;
– To monitor indicators of heart rate during exercise;
– To perform individual exercises to develop basic physical qualities in the light of   medical indications;
– To run complexes of respiratory exercises;
– To use the equipment and carry out with their help of independent physical training;
– To organize activities with children, carry with them homework in physical training;
– To carry out tempering procedures;
– To keep a diary of self-observation;
– To provide first aid for abrasions bruises;
– To conduct propaganda works on attraction to occupations of friends and relatives.

6. CRITERIA AND STANDARDS ASSESSMENT OF KNOWLEDGE AND SKILLS.
The correct account of the results of the training process can be carried out only on the basis of a thorough analysis of all aspects of training of older people.
At the end of each phase, period, cycle the Department of social protection in conjunction with the athletic-educational institution summarizes the results of the work done, analyze accounting data, which are based on quantitative indicators: the results of the monitoring exercise, the dynamics of the physical capacity of the organism, the efficiency of the actions involved in the control tasks.

The types of pedagogical control

Preliminary control
Objective: to determine health status and readiness working on to the next lesson. Usually held at the beginning of the school year
Operational monitoring
Purpose: to identify the urgent training effect for one class to evaluate the efficiency of the load. It is based on indicators of well-being, the frequency and depth of breathing, heart rate, etc. Data this control allows you to quickly adjust the dynamics of the load during the lesson.
The current control
Objective: to determine the response of the body engaged in physical exercise on the load after the class. Data of monitoring are the basis for planning the content of upcoming classes and load them.
Stage control
Objective: to obtain information about the cumulative (total) effect of training received in the corresponding period of time. Data from this monitoring allow assessing the feasibility of selecting and using different tools, methods, dosing of physical activity have been proposed.
The final control
Purpose: to determine the success of the implementation of the annual training plan, the degree of the solution of tasks, to determine positive and negative impacts of components of process of physical education. Data from this monitoring (health status of older people who are engaged in a medical physical culture, the successful solution of the tasks facing them, etc.) is the basis for planning the next educational process. It is usually planned for the end of the school year.
The requirements to pedagogical control: timeliness, objectivity, accuracy, reliability, completeness, simplicity, clarity.
Methods of pedagogical control:
– Pedagogical observation (expression of interest, the behavior engaged in, the outward signs of reaction on the physical load, attention);
– Questionnaire or survey (the definition of subjective feelings);
– performing practical tests;
– Simple medical measurements (vital capacity, pulse, body weight, etc.);
– Analysis of documentation.
The basic document of the account is the journal of the educational work of the group and the diaries of well-being of older people. In addition to data about the disease (confirmed by doctor), physical development (height, weight, chest circumference, VC), keep records of changes in the level of physical condition and physical preparedness of students. Also take into account the state of health (heart rate at rest, during exercise, recovery time after the load value of the load, sleep, appetite, desire to do, the presence of pain, the results of functional tests).

7. The list of training and methodological support (necessary for the implementation of this program), teaching and learning AIDS, equipment, sports equipment, tools.
To implement this program you need:
1. Gym or suited to study room, bathrooms, locker rooms, coaching.
2. Gym.
3. Pool.
4. Basketball and football balls, wall bars, gymnastic sticks, jump ropes, etc.
5. Sloping boards, gymnastic benches, tennis balls, floor mats.
6. Technical means to play music (tape, speakers).
7. Computers with Internet access, software, screens, projectors, CD-ROMs with educational material.