Later Life training CPD 3 1

Assisted walking and games activities

CPD course 3

Later Life training CPD 3 2

Assisted walking and games activities

Purpose

• To provide choices and variety to participants

• To provide other/alternative ways of moving and progression

• To promote independence and mobility

• To sustain participation

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Learning aims

To provide information about:-• the benefits of assisted walking and games activities

for frailer, older people.• the facilitation of assisted walking and games activities

for individuals or groups of frailer older people as appropriate.

• identification of people for whom these activities are unsuitable.

• the safety points for assisting frailer older people to participate in assisted walking and games activities

• motivation and barriers to assisted walking and games activities for frailer, older people

• planning to implement assisted walking and games activities in specific settings

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Learning Outcomes

By the end of this training participants will be able to:• List the benefits of assisted walking and games activities

for frailer, older people.• Identify a range of assisted walking and games activities

for frailer, older people • Identify the environmental and other safety factors

required for safe and enjoyable assisted walking and games activities.

• Identify the organisational and motivational considerations needed for successful assisted walking and games activities.

• List exclusion criteria for people for whom it would be contra-indicated to participate in assisted walking and games activities.

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Programme for the day

9.30 – 9.50 Introduction to the CPD day 9.50 – 10.15 Introduction to assisted walking activities10.15 – 10.45 Assisted walking activities (part 1)10.45 – 11.10 Refreshments11.00 – 11.45 Assisted walking activities (part 2)11.45 – 12.30 Planning for safety and enjoyment12.30 – 12.45 Review of and planning of assisted walking activities12.45 - 1.30 Lunch1.30 – 1.45 Introduction to games activities1.45 – 2.45 Games activities (part 1)2.45 – 3.00 Refreshments3.00 – 3.45 Games activities (part 2)3.45 – 4.15 Review and planning for games activities4.15 – 4.30 Evaluation and next steps4.30 Close of day and departures

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CPD 3 Assisted walking and games activities

Certificate of attendance

- post event

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Group activity

When was the last time you

played a game and went for a walk ?

Describe what you did and

why you took part ?

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Games ?

• Monopoly, Jenga, Scrabble, chess, draughts

• Sports e.g. golf, soccer “the beautiful game”

• WII and Nintendo• Party games e.g.

charades, pin the tail on the donkey

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Walking

• To work, to the shops, taking grandchildren to school,

• Sunday stroll• Fitness e.g. power

walking• Visiting a museum,

art gallery, garden centre, supermarket.

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Why assisted walking activities ?• Strength and power to

rise from the chair• Balance to remain upright• Balance and endurance to

go walking

The natural progression from Chair Based Exercise and core component of Otago Exercise Programme

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Assisted walking

to provide information about:-• the benefits of mobilising through (assisted)

walking activities.• the safety points for assisting frailer, older

people to achieve effective enjoyable daily assisted walking activities.

• planning regular assisted walking activities in relation to different settings

• identification of criteria for inclusion and those for whom these activities are unsuitable.

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Assisted walking

• By the end of the session, physical activity leaders will be able to

• List the benefits of regular assisted walking activities• Identify the safety, posture and performance techniques

to improve the effectiveness of assisted walking activities• Identify the environmental and other safety factors

required for assisted walking activities• Identify and understand the motivational factors related

to assisted walking activities• List exclusion criteria where assisted walking would be

contra-indicated for participants.

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Assisted walking - course content

• Why assisted walking activities ? • The health and other benefits• Different walking activities• Walking recommendations• Assisted walking techniques and activities• Planning assisted walking activities• Motives, barriers and walking promotion• Evaluation

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Group activity

Make a list of the benefits of assisted

walking those you work with.

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Benefits of walking – (moderate and vigorous)

Prevention and management of • CHD and Stroke• Osteoporosis• Type II Diabetes• Hypertension• Obesity and overweight• Colon and other cancers• Cognitive functioning and some

dementias

Assists with • Improved sleep and digestion

Depression and anxiety• Reduction in accidental injuries

Decreases immobility which can cause:-

• Gravitational oedema• Leg and skin ulcers• Constipation (Faecal impaction)• Joint stiffness • Contractures)• Muscular wastage• Deep vein thrombosis

Increases mobility which can improve

• Circulation• Local muscle endurance• Range of movement and mobility• Co-ordination• Balance• Gait and rhythm

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Benefits of assisted walking - 2• Social inter-action

– Walking with the great grandchildren– Meeting other residents

• Awareness of surroundings– Stopping to smell the roses in the garden– Feel the sun and wind

• Doing the things I want to do– Post a letter, go to church or the pub– Get to the shops– Get to the toilet or dining room easier

• Opening up my world – Visit a museum, arboretum or garden centre– Join an activities class or IT group

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Proportion of women aged 70+ able to walk for different periods of time and lengths of walk,

without discomfort

0

20

40

60

80

100

70-7470-74 75-7975-79 80+80+ 70-7470-74 75-7975-79 80+80+

11//4 4 of a mile or moreof a mile or more

30+ 30+ minmin15,<3015,<30minmin5,<15 5,<15 minmin<5 min<5 min

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Sedentary behaviour in care and residential settings

• 86% of women and 78% of men in care homes are classed as sedentary

• Inactivity levels in care homes are double those in private households (65 and over)

• Half of all people in Local Authority residential homes never or very occasionally take trips outside the home (DOH 2002)

• Residents in nursing homes in the USA spend over 80% of their time seated or lying down

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Walking styles and activities

A continuum of walking activities

– Mobilising through walking

– Health walking

– Fitness walking

– Speed race walking

– Orienteering

– Rambling, trailblazing

– Nordic (pole) or power walking

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What is assisted walking ?

• Low to moderate walking pace on even ground, with frequent opportunities to rest, refresh, take in the surroundings and provides social opportunities.

• Appropriate for very de-conditioned individuals of all ages and those with additional health problems.

• Where frailer older people are concerned, assisted walking is a sensible and recommended way to begin. Some will be unable to progress beyond this assisted walking stage.

• Others may well go on to walk independently, but independent walking is not recommended initially as it has been shown to be unsafe for this group.

Sit to stand as a criteria ?Needs assessment/care plan determines

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How much physical activity (e.g. walking) should we be doing ?

• The aim should be to achieve 30 minutes of physical activity (a brisk walk) on 5 or more days of the week.

• 2 x 15 is a good way to begin (DOH 1999)

This message is now 15 years old !

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(New) physical activity recommendations for older people

• Will include• Strength and balance

exercises (activities) at least twice a week

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Group activity – walking recommendations

Which recommendations/messages about walking are most appropriate

for those you work with ?

Using two different frailer older, people you currently work with as case studies, what

types of walking recommendations would you use ?

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Walking recommendations

• 5 or 10 minutes activity “snacks” or walks

• Reaching the local shops or the post office

• Once around the local park

• Across the recreation room

• To the bottom of the garden and back

Or

• Get up and Go (Where ?)• Out and about (why ?)• Walk with Me (Who ?• Best foot forward (how ?)• One step and at time

(how ?)

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Walking technique

• Upright posture check

• Normal walking action

- Arm swing

- Heel toe strike

- Foot placement

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Assisted walking strategiesIt is recommended that where there may be doubt, work within existing

policies and operational guidelines/procedures.

One arm linkOne arm placementOne elbow supportOne hand to back

Independent walking in close proximityIndependent walking with supervision

Five point turns

The choice of which assistive strategy is to be employed is secondary to the encouragement and promotion of assisted walking.

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Age associated changes in walking and gait

• Decreased velocity and step frequency• Increased stride width (to assist balance)• Increased time in double support (Both feet in

contact with the floor)• Decreased step length and stride length (the

distance covered from one heel strike to the next heel strike by the same foot)

• Increased stance phase (resulting in more flat footed contact)

• Decreased time in swing phase and rotation of the hips

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Key components of planning for assisted walking

Before undertaking any (assisted) walking, consider

• Health status and readiness• Understand signs of distress• Safety procedures• Route planning• Clothing and footwear• Getting off to a good start• Participant motivation

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Signs of distress• Irregular heart beat• Cold sweat• Undue sweating• Pain or discomfort in the

chest, abdomen, back, neck or jaw

• Extreme pallor• Sweating combined with

pallor• Extreme and unfamiliar

shortness of breath or gasping

• Loss of attention or confusion

• Dizziness, fainting or tripping

• Pain in the joints or legs• Nauseous sensation

during or after walking• Extreme stiffness lasting

two or more days• Extreme fatigue

Already covered in CBE and OEP

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Walking is just right when - • Breathing is a little more than usual (but

regular, not holding breath)• The body feels a little warmer and even a little

sweat• Muscles may be pulling gently and begin to

feel warm or tired• Mild stiffness the following morning if starting

walking from scratchEducate the participant as to

what is desirable and normal

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Group activityWhat specific planning requirements relate to the following

organisational settings or walks ? • Day care centre• Sheltered accommodation (with a garden or nearby park)• nursing home (with corridors or garden)• Indoor walking e.g. hospital corridor or ward• To a garden centre or shopping mall/precinct• To an art gallery or museum

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Group activity – barriers to assisted walking

Which barriers to assisted walking are your participants most likely to

present and how can you assist in overcoming these barriers ?

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Barriers to walking

• Intrinsic barriers Fear (of falling, making things worse, hurting myself)

• I couldn’t do this (confidence)

• I don’t have the energy• Can’t be bothered.• Won’t have any effect

• Extrinsic barriers • Pain, arthritis, painful feet, • Pleasant places to walk,

traffic, slippery or uneven surfaces, steep inclines

• Access to benches, chairs, toilets

• Influence of others (partner, family or friends)

• Organisational policies

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Additional barriers to walking for frailer, older people

Reported physical symptoms occurring daily

• Trouble with ears and hearing - 56%• Aches and pains in legs - 45%• Trouble with eyes or vision - 43%• Aches and pains in hands and feet - 35%• Backaches - 33%• Fatigue and tiredness - 32 %• Swelling of upper and lower extremities - 22%• Difficulty breathing - 17%

(Cooper K 2001)

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Motives for assisted walking

• Maintain/ widen their social networks (family and friends) • To get out and about e.g. Stopping to smell the roses in

the garden and walking out with the (great) grandchildren

• Continue to live independently by carrying on with the activities of daily living such as washing and dressing themselves, or looking after their own home

• Getting somewhere they want to visit, e.g. Posting a letter, visit a museum, arboretum or garden centre, getting to the shops, going to church or the pub

• To be able to walk to the dining room or get to the toilet unaided.

These are physical activity goals and targets

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Promotional Strategies

What promotional strategies might be considered that relate to (assisted) walking

in your setting ?

What are the key messages that you wish to convey

What types of promotion might be appropriate ?

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Assisted walking challenges• How may residents can do a walk today or this week ?• Team walks e.g. Resident challenge …. Residents

collectively accumulate distances and walk (equivalent of) certain distances e.g. over certain periods of time. Shorter time-spans better for easier target setting and early achievement

• Walk of the week, select a(n imaginary) walk to a place, beauty spot, historical setting (Great Wall of China)

• Getting “out and About” e.g. Museums, Country Houses, Shopping Centres, ghost walks, Seasonal walks in the garden or park

• Walk with me - Walking buddy scheme• Thematic walks e.g. “Pictures at an Exhibition” along a

corridor, Walk Down Memory Lane, Let’s shop till we (almost) Drop.

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How do we evaluate assisted walking activities ?

• Recording walking - use of diary, chart• Case studies illustrating (increased) frequency

and range• Increasing the circle of life (I can now do X)• I can do X by myself e.g. getting to the shops

I feel straighter !

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Games activities

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Why games activities ?

• Offer

• Choice and variety

• Activity with less structure

• Increased interaction

• Competition with oneself and others

• Challenge

• Skill development

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Games activities – a rationale

“Man does not cease to play because he grows old - he grows old because he ceases to play”

G.B. Shaw

Opportunities for play, self absorption, self expression, relaxation, enjoyment, social interaction and diversion

A unique part of human activity and culture

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Games activities - principles

The key principles of this games component require activities that are:

• Safe and enjoyable (mastery and control)• provide some form of body movement or

physicality• are designed for those with limited mobility• are meaningful, have integrity and are not

patronising

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Content of games activities

Part 1. Introduction to course• Rationale, purpose, learning aims and outcomes

and the benefits of games activities

Part 2. Taking part in games activities• Types of games

Part 3. Planning for safety and enjoyment• Preparation, planning and safety• Equipment, barriers to games activities

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Games activities - aims

to provide information on• the benefits of games activities for frailer, older

people.• the facilitation of simple games activities for

individuals or groups of frailer, older people as appropriate.

• identification of people for whom these activities are unsuitable.

• the safety points for assisting frailer older people to participate in enjoyable games activities

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Games activities - learning outcomes

By the end of this training Physical activity leaders should be able to:-

• List the benefits of games activities and identify the range of games activities

• Identify the environmental and other safety factors required for safe games activities.

• Identify the organisational and motivational considerations needed for successful games activities.

• List exclusion criteria for frailer, older people for whom it would be contra-indicated to participate in games activities.

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Group task.

Why do some people play games and some people do not ?

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Group task.

Why some people play games • To let off steam, have fun• To compete with others and myself• A change from formal exercise• To forget about other things• To interact with other people• As a way of being active• I’m good at it !

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Group task

Why some people don’t play games

• I’m not very good at sport

• It’s what children do, it’s childish

• Can’t see the point !

• Never did like sport

• I feel silly

• What is age-appropriate and who says so ?

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When could I use games activities ?

• A separate standalone games session within an activity programme

• To encourage skill development and overall body movement

• As part of a warm up or cool down (e.g. as a circulation booster)

• To provide variety and interest within a functional programme (e.g. chair based exercise)

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Preparation, planning and safety

At all times ensure • Clear areas and ensure appropriate spacing (layout of

chairs, observe room/space for potential hazards).• Equipment is clean, safe and in good condition..• Equipment is appropriate (e.g. a ball that is soft and easily

seen).• Adequate staffing ratios according to needs of participants

and organisational policy • Tasks set e.g. throwing, catching ball does not introduce

the possibility of over-reaching or toppling sideways and are within the capabilities of participants

• Participants are not over-competitive and cause distress to others or themselves

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Games are just right when -

• Breathing is a little more than usual (but regular, not holding breath)

• The body feels a little warmer and even a little sweat

• Muscles may be pulling gently and begin to feel warm or tired

• Mild stiffness the following morning if participant has been inactive for some time

Educate the participant as to

what is desirable and normal

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Safety and enjoyment

It is important that Physical Activity Leaders understand that they should be consistent in

applying the same safety standards for games as in Chair-Based Exercise and Otago Exercise

programmes.

More playful or less formal activities do not permit a lowering of safety standards

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Criteria for choosing equipment• Colour – e.g. primary colours are both attractive (i.e.

easily recognisable) and helpful in adding to games

activities.

• Design - other markings e.g. numbered e.g. dice

• Accessibility - it’s appropriateness for different groups

e.g. hand grip for people with stroke , visibility

• Safety - durability, washability and cleanliness of

surfaces (foam, vinyl plastic, polyurethane)

• Ease of storage

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Group activity - planning

Use the check/planning list to prioritise key

actions related to individual physical

activity leader’s setting

What do you need to do now ?

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Thank you for taking part and

have a safe journey home

www.laterlifetraining.co.uk