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May 26, 2010

My Mom's Exercises

My mother, who is in her 70s, has been visiting for the past few days. When you live away from your parents, you begin to worry about them as they get older. So, while had her here, I wanted to check a few things for my peace of mind.

First I did a balance assessment: tandem standing with one foot in front of the other for 30 seconds, single leg stance for 30 seconds, 5 times sit to stand, and how long it takes to walk 8 feet. My mother was able to (eventually) do all 4. It took 3 to 4 trials before she could do single leg stance for the full 30 seconds and she was a little slow with 5 times sit to stand. All indicated a bit of weakness that may put her at a slight risk for falling.

So I gave her exercises. My mother is not an exerciser. She believes that pushing a grocery cart around a supermarket is adequate exercise. I doubt it even gets her heart rate up a little. The American College of Sports Medicine recommends moderate intensity exercise. Moderate-intensity aerobic exercise means working hard at about a level-six intensity on a scale of 10. You should still be able to carry on a conversation during exercise. But, hey, at least she's moving, which is more than I can say for a lot of people. So for that reason, through experience, I have found that it is best to give people between one and four exercises to do, or else they won't do any at all.

Tandem standing and single leg stance test balance strategies which, in a young healthy adult, occur at the ankle first, then at the hip. As we age, joint flexibility decreases and ankle strategy for balance diminishes. So it's important to keep the muscles of the lower extremity strong and the ankles mobile. So I gave her an exercise called heel/toe raises to help with strengthening and flexibility. Because she had plantar fasciitis in the past, she already does ankle pumps and draws the alphabet with her feet. This help to facilitate blood flow and works to looses the ligaments around the ankle.

Sit to stand is a category of movement called transfers. Transfers are functional movements that help us get from pone place to another. At the lowest level, lifting the hips and rolling over in bed help caregivers with basic tasks such as toileting and changing bed clothes. Next is sitting up and getting on hands and knees. Kneeling and sit to stand are the next level of transfer, requiring more balance. As you can see, anything that increases gravity's pull on the body and requires more of a demand on postural musculature, also advances movement toward skill.

Since mom was a bit slow in 5 times sit to stand, I gave her a exercise called mini squats. This exercise is great. To do it correctly, shift weight back as though you will sit in a chair. Sink down slightly, then come back up. The weight shift is key during this exercise because it simulates a functional task and strengthens key muscles for getting out of a chair. As strength increases, the squat can deepen. Knees must stay behind toes. An alternate to this exercise is wall squats. Leaning against the wall with the feet about a foot from the baseboard, drop the weight down. This really works the quadrucep muscles and is great for people who are at risk for falling because much of their weight is supported by the wall.

And finally, but most importantly, is an exercise to activate the core of the body. It is called the abdominal drawing in maneuver. What a mouth full! Nobody is going to remember the name of that exercise, so when I teach it, I rename it "suck it to your spine." Draw your navel toward your spine. Lift pelvic floor (as though you are preventing passage of gas) toward navel. Hold 5 seconds. Relax. Repeat. Eventually, once patients learn which muscles they are activating, they will realize these muscles are engaging each time they do any kind of reaching activity, such as getting a coffee cup out of the cabinet. This is the way these muscles were designed to function. Somewhere along the line, we lose anticipatory control of the core musculature. It may be one of the reasons that back pain is so prevalent in industrialized countries.

So that's it. I gave my Mom three exercises. We did them together so that she has a bit of muscle memory about how to do them correctly when she goes home. You know I couldn't really just stop with three. I gave her three more "advanced" exercises to do once these became easy. I haven't seen her do one yet. Maybe when she gets bored with the supermarket . . . .

Posted by linda at May 26, 2010 7:55 AM

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