fitt principle for elderly

 

tai chi group of Wolf et al. J Am Geriatr Soc 56(12):2234–2243, Shumway-Cook A, Silver IF, LeMier M, York S, Cummings P, Koepsell TD (2007) Effectiveness of a community-based multifactorial intervention on falls and fall risk factors in community-living older adults: a randomized, controlled trial. https://creativecommons.org/licenses/by/2.0 FITT principle for older adults in muscle strength and endurance. However, exercise programme characteristics vary between studies and are often not clearly described in studies of multifactorial interventions. It may also render comparison with studies using prospective methods invalid. Age Ageing. FITT Principle Jim Grizzell, MA, MBA, MCHES, ACSM-EP-C, F-ACHA jimgrizzell@healthedpartners.org, (909) 856-3350, www.healthedpartners.org Page 2 * Frequency (aerobic) To insure regular physical activity adults and older adults should consider doing 5 or more days each week of moderate-intensity exercise. BMJ 325(7356):128, Donald IP, Bulpitt CJ (1999) The prognosis of falls in elderly people living at home. J Am Geriatr Soc 47(12):1397–1402, Davison J, Bond J, Dawson P, Steen IN, Kenny RA (2005) Patients with recurrent falls attending accident & emergency benefit from multifactorial intervention: a randomised controlled trial. A strong negative correlation between exercise bout duration and adherence has recently been demonstrated in older women [60] and must be considered when designing an exercise programme for older adults. Approximately one in four people aged 65 years and over fall annually, with this proportion increasing to almost one in two among those aged 85 years and over [36]. Total fitness! It is important to know your FITT Principles so that you gain health benefits for your heart. Before you make a workout plan. What Is The FITT Principle? Defining an optimal intensity for balance training is problematic, since there is currently no standard measure by which to express the balance training intensity. No consistent relationship between bout duration and the effectiveness of an intervention was observed, although the majority of effective interventions included some bouts of at least 60 min or more. In: Vincent ML, Moreau TM (eds) Accidental falls: causes, prevention and intervention. Arch Intern Med 170(2):179–185, Lamb SE, Hauer K, Becker C (2007) Manual for the fall prevention classification system. Recent guidelines from the American and British Geriatrics Societies [54] state that exercise is an essential intervention for preventing falls in community-dwelling older adults, but do not recommend precise exercise characteristics for this purpose. The FITT Principle (or formula) is a great way of monitoring your exercise program. The first author wishes to acknowledge Dr. John Nelson and Dr. Pepijn Van De Ven, University of Limerick, for their supervision and guidance. Although the purpose of this review was to examine the evidence relating to exercise interventions only, studies in which falls prevention education was provided in the manner of a population-based health promotion intervention, i.e. The authors have no conflict of interest to disclose. J Am Geriatr Soc 47(7):850–853, PubMed  Our findings advocate that a combination of supervised group exercise in a convenient centre and individual home-based exercise is optimal for preventing falls while achieving psychosocial benefits which may support uptake and adherence. Table 2 summarises the characteristics of the exercise programmes studied and their influences on falls. Accessed 9 Mar 2011, Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K (2004) The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial. The former includes running, swimming, bike riding, and hiking. These features will be described in terms of the FITT principle, i.e. Available at: http://www.stuff.co.nz/national/health/3000214/ACC-pulls-fall-plan-support Accessed 10 Oct 2011, Reinsch S, MacRae P, Lachenbruch PA, Tobis JS (1992) Attempts to prevent falls and injury: a prospective community study. endobj Other lower risk forms of endurance training, e.g. <> BMJ 340:c2102, Lord SR, Tiedemann A, Chapman K, Munro B, Murray SM, Gerontology M, Ther GR, Sherrington C (2005) The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial. Age Ageing 36(6):656–662, Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM (1999) Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. In other cases, additional factors such as exercise type and intensity may have been influential [29, 32, 42]. ... of home based exercise to prevent falls in elderly women. 4 0 obj J Am Geriatr Soc 52(9):1487–1494, Clemson L, Singh MF, Bundy A, Cumming RG, Weissel E, Munro J, Manollaras K, Black D (2010) LiFE pilot study: a randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults. Based on these criteria, the majority of reviewed studies which included balance training may be classified as ‘highly challenging’. [17] observed a reduction in falls incidence and improvements in balance with a comprehensive programme which is comprised of 30–35 % balance training. doi:10.1093/ageing/afr103, Rankin J (2009) ACC pulls fall plan support. BMJ 315(7115):1065–1069, Carter ND, Khan KM, McKay HA, Petit MA, Waterman C, Heinonen A, Janssen PA, Donaldson MG, Mallinson A, Riddell L, Kruse K, Prior JC, Flicker L (2002) Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. Further research investigating participants’ continuing exercise behaviours upon completion of short-term interventions is required. However, Rubenstein et al. One study even found that the FITT principle was useful in helping researchers and healthcare professionals create the right exercise regimen for people who had just had a stroke. Valerie Power 1 & Amanda M. Clifford 1 European Review of Aging and Physical Activity volume 10, pages 95–106(2013)Cite this article Flexibility and endurance training may also be included as part of a comprehensive programme. However, a factorial study [17] demonstrated that exercise was effective singly and in combination with home hazard modification and vision correction. Current ACSM blogs and articles. FITT Principle The third FITT factor is time. Similarly, Day et al. In fact, combining all three interventions was found to bring about the greatest reduction in falls rates. Age Ageing 33(1):52–58, Nyman SR, Victor CR (2011) Older people’s participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review. endobj What counts as light activity? BMJ 322(7288):697–701, Robertson MC, Gardner MM, Devlin N, McGee R, Campbell AJ (2001) Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. Longer bouts, e.g. Supervision and format (i.e. Set a plan with specific goals and log your workouts and progress. The FITT Principle by Jesse de la Cruz. How best to ensure adherence remains unclear, although methods of exercise programme delivery may be influential. Article  J Rehabil Res Dev 45(8):1135–1152, Cumming RG, Thomas M, Szonyi G, Salkeld G, O’Neill E, Westbury C, Frampton G (1999) Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. Based on your own goals and circumstances fill in a FITT Principle chart. Other inclusion criteria included recording falls incidence as an outcome measure, examining a community-dwelling population aged 60 years or over and implementing exercise as a single intervention in at least one group. F 2 or more days per week I 60 - 70% 1 RM -- when 1 RM is not measured - 5 - 6 moderate intensity and 7 - 8 vig intensity. Freiberger et al. Manawatu Standard. A convenient location and accessibility via transport links are vital, as these were cited by participants as major contributing factors to dropping out of a programme [39]. J Clin Nurs 19(7–8):959–968, Inokuchi S, Matsusaka N, Hayashi T, Shindo H (2007) Feasibility and effectiveness of a nurse-led community exercise programme for prevention of falls among frail elderly people: a multi-centre controlled trial. The findings of this review agree with current falls prevention guidelines which state that older adults at risk of falling should be offered an exercise programme incorporating balance, gait and strength training, with flexibility and endurance training as adjuncts [54]. It stands for Frequency, Intensity, Time, and Type, all in reference to exercise. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Cochrane Database Syst Rev (2):CD002759, Lin MR, Hwang HF, Wang YW, Chang SH, Wolf SL (2006) Community-based tai chi and its effect on injurious falls, balance, gait, and fear of falling in older people. Follow the FITT principle to design and implement a safe and effective program you will enjoy. [17] reported exercising approximately twice per week outside of group sessions. Finally, programmes which lacked exercise progression were also ineffective in preventing falls [42]. Reference lists of relevant articles were also searched. Adherence may be further supported by implementing programmes which incorporate the exercise characteristics discussed while minimising time demands for participants. 11. Open Access Thus, its reporting in the studies reviewed was vague and inconsistent, with descriptions including ‘demanding’ [17], ‘challenging’ [53] and of ‘appropriate and increasing levels of difficulty’ [9] being used. As such, it is clear that effective, low-cost interventions to prevent falls must be implemented. Strength training in combination with balance training is effective in preventing falls. J Am Geriatr Soc. Am J Phys Med Rehabil 84(4):238–250, Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C (2007) Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. BMJ 322(7288):701–704, Robinson L, Dawson P, Newton J (2008) Promoting adherence with exercise-based falls prevention programmes. The type of physical activity you choose lies at the heart of the FITT principle. Time spent exercising may be considered in numerous ways: the duration of each exercise bout, the duration of the intervention or the total exercise volume, i.e. Since poor uptake and adherence will render an intervention ineffective regardless of the programme design and content [40], factors relating to exercise programme adherence will be identified and discussed in this review also. Available http://www.cdc.gov/injury/wisqars/index.html. Certain characteristics were common to ineffective programmes: firstly, the lack of a balance training component [32, 63]. negate this [65]. Application of FITT principle in exercise rehabilitation focusing on common sports injury among Malaysian Athlete. The FITT Princilple applies to any type of resistance training, whether it be for strength, speed strength, aerobic strength. Oxford Centre for Evidence-Based Medicine, Oxford, Huang HC, Liu CY, Huang YT, Kernohan WG (2010) Community-based interventions to reduce falls among older adults in Taiwan: long time follow-up randomised controlled study. Age Ageing 32(4):407–414, Brawley LR, Rejeski WJ, King AC (2003) Promoting physical activity for older adults: the challenges for changing behavior. statement and 1 0 obj https://doi.org/10.1007/s11556-012-0108-2, DOI: https://doi.org/10.1007/s11556-012-0108-2. Since older adults’ fall risk profiles and levels of physical function vary according to residential status [48], this review aims to examine the literature pertaining to community-dwelling older adults only in order to identify the optimum features of an exercise intervention to target that group’s specific risk factors [54]. Dublin, Heyward VH (2010) Advanced fitness assessment and exercise prescription, 6th edn. If you are new to exercise, remember, work your way up. Nova, New York, pp 283–298, Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. 2: controlled trial in multiple centres. [1], there is a need to clarify the optimum frequency, intensity, type and duration of exercise for falls prevention. All other aspects of the model revolve around it. [47] showed some association between exercise—which included walking—and increased falls risk. 2011) were included. J Epidemiol Community Health 54(3):227–232, Suzuki T, Kim H, Yoshida H, Ishizaki T (2004) Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women. Google Scholar, Centers for Disease Control and Prevention (2011) Injury prevention & control: data & statistics (WISQARSTM). The total duration of the exercise programmes varied greatly. The minimum effective frequency reported was twice per week [61], although this effect was noted in the short term only and was not supported by studies of longer duration [10, 22, 35]. A workout that is too long will increase your risk for injuries. However, empowering individuals and encouraging self-regulated behaviour change are recommended to gain long-term motivation and exercise participation [3, 45]. The literature search was conducted in June 2011. An inactive person could start with a walking Walking may expose older adults to greater fall-risk; thus, we recommend that clinicians consider other endurance training activities for individuals at high risk of falling. Total exercise volume also varied; even among interventions of equal duration, e.g. All studies in which guideline intensities were explicitly not met did not significantly reduce falls incidence [28, 29, 42, 55]. doi:10.1002/14651858.CD007146.pub2, Haines TP, Russell T, Brauer SG, Erwin S, Lane P, Urry S, Jasiewicz J, Condie P (2009) Effectiveness of a video-based exercise programme to reduce falls and improve health-related quality of life among older adults discharged from hospital: a pilot randomized controlled trial. A well-rounded exercise program can improve your health in a number of ways. Our findings agree with those of previous reviews [1, 14, 50, 51] on a number of aspects. Guidelines recommend a comprehensive programme of balance, strength, endurance and flexibility training for all adults aged 65 and over [38]. the frequency of exercise, the target intensity, the . This highlights that strengthening and endurance exercise must be of an appropriate intensity to achieve training effects and the ensuing clinical benefits. These results suggest that balance training should constitute at least one third of the total programme content and be given at least equal emphasis compared to other components for optimum fall prevention. In the studies reviewed which included a walking component [2, 8, 9, 20, 30, 43, 44, 47, 65], walking was not consistently associated with the effectiveness of the intervention. A FITT program, whether for fitness or weight loss, should be approached with continuous improvement in mind. Reporting the immediate effects of short-term interventions may show reductions in falls incidence, but falls may occur infrequently, thus participants must be observed over an extended time period to detect true changes. Attributions: References: Figure \(\PageIndex{1}\): Group exercise class photo by Anupam Mahapatra on Unsplash (license information) Becoming and staying physically fit is an important part of achieving optimal health. [62] spent 64 h exercising compared to approximately 11 h for the balance training group, despite both interventions lasting 15 weeks. Clin Rehabil 23(11):973–985, Hannan MT, Gagnon MM, Aneja J, Jones RN, Cupples LA, Lipsitz LA, Samelson EJ, Leveille SG, Kiel DP (2010) Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study. For example cardiovascular and strength or weight training programmes. In general, subtract your age from 220 to get your maximum heart rate in beats per minute (bpm). This can be your starting point. Frailty and injuries: cooperative studies of intervention techniques. CAS  The duration of a single bout of exercise varied from approximately 15 to 120 min in the studies reviewed. [52] and is successful in both preventing falls and gaining adherence [57]. Age Ageing 39(6):728–733, Freiberger E, Menz HB, Abu-Omar K, Rutten A (2007) Preventing falls in physically active community-dwelling older people: a comparison of two intervention techniques. Frequency (how often you are physically active in a week) It is recommended that you strength train your muscles at least two times per week. Remember, some activity is better than no activity. The FITT principle There are four ways to progress the amount of activity you do: Frequency – increase the that you are active Intensity – walk that little bit faster, cycle that little bit harder, or dig harder in the garden Time – increase the amount of time you spend on … Specific balance training at a sufficiently challenging intensity is vital for falls prevention. Age Ageing 35(Suppl 2):ii37–ii41, Rubenstein LZ, Josephson KR, Trueblood PR, Loy S, Harker JO, Pietruszka FM, Robbins AS (2000) Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. individual/group sessions) may be two such factors. the frequency of exercise, the target intensity, the time spent exercising and the type(s) of exercise undertaken [25]. FITT Principle for cardiorespiratory endurance Frequency – Exercise 3-5 times per week Intensity – Train at 60-85% of target heart rate zone/70-85% of one’s maximum heart rate Time – 20-60 minutes per session Type – Any aerobic activity that keeps heart rate within your target heart zone FITT Principle for Flexibility: N Engl J Med 337(18):1279–1284, Visek AJ, Olson EA, DiPietro L (2011) Factors predicting adherence to 9 months of supervised exercise in healthy older women. The OEP involves approximately half the volume of exercise of that prescribed by Shumway-Cook et al. In the USA, falls are the leading cause of fatal and non-fatal injuries to those aged over 65 years [11]. Overall, effective interventions comprised of at least 40 h of exercise over the course of the intervention, slightly less than the cutoff of 50 h suggested previously [50, 51]. BMJ 315 (7115):1065-1069 . Manage cookies/Do not sell my data we use in the preference centre. Generally speaking, cardio and resistance training are the two most common types of exercise. European Review of Aging and Physical Activity [2] found that only 13 % of participants were exercising daily at home, with the vast majority (91 %) exercising just once per week outside of group exercise classes. using the FITT principle Valerie Power & Amanda M. Clifford Received: 15 November 2011 /Accepted: 3 December 2012 /Published online: 4 January 2013 # European Group for Research into Elderly and Physical Activity (EGREPA) 2012 Abstract This review aims to identify the optimal exercise intervention characteristics for falls prevention among Aust Occup Ther J 57(1):42–50, Costello E, Edelstein JE (2008) Update on falls prevention for community-dwelling older adults: review of single and multifactorial intervention programs. 1: randomised controlled trial. Many studies stated that their programmes met these guidelines in relation to one or both types of training [4, 30, 32, 35, 47], but most did not provide sufficient detail of exercise intensity. N S W Public Health Bull 22(3–4):78–83, Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JCT (2008) Effective exercise for the prevention of falls: a systematic review and meta-analysis. Accessed 1 June 2011, Latham N, Anderson C, Bennett D, Stretton C (2003) Progressive resistance strength training for physical disability in older people. FITT – Frequency, Intensity, Time, and Type of Activity Everyone: • Try to stay active for at least 10 minutes without stopping. Available http://www.profane.eu.org/documents/Falls_Taxonomy.pdf. Gerontologist 32(4):450–456, Robertson MC, Devlin N, Gardner MM, Campbell AJ (2001) Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. ; Emerging research suggests that dynamic resistance exercise may also serve as an efficacious strategy to lower blood pressure to levels similar to aerobic … In addition, participants’ adherence to the recommended daily home exercise programme was poor despite being able to complete this in their own homes. Although it did not reach significance, their fitness group—in which strength/flexibility, balance and endurance training each comprised 33 % of the programme—experienced a trend towards a reduction in falls incidence, while the psychomotor group—in which strength and balance combined comprised just 40 % of the programme—did not. For example, if you are 30 years old, your maximum heart rate would be 220 - … N Engl J Med 331(13):821–827, Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. The initial search yielded 518 articles. Exercising for a minimum of 1 h/week for at least 40 h over the course of an intervention is required to successfully reduce falls incidence. Shumway-Cook et al. Providing individualised home exercise programmes with limited one-on-one supervision, as in the OEP, may also allow similar benefits to be attained, but the cost-effectiveness of this approach does not compare well to group programmes [41]. When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week (for example, 30 minutes a day, 5 days a week) because of chronic conditions, they should be as physically active as their abilities and conditions allow. Exercising once per week appears to be inadequate for falls prevention, with only one pilot study reporting a short-term reduction in falls incidence at that frequency [65], although it may be sufficient to produce some balance and functional improvements [39]. This may lead to inaccuracy in reports of falls incidence rates where retrospective methods are used. Articles for inclusion were sourced by searching the Academic Search Premier, AMED, Biomedical Reference Collection: Expanded, CINAHL Plus, MEDLINE and SPORTDiscus databases with the key words ‘falls’, ‘prevention’, ‘exercise’ and ‘community’ and via reference lists of relevant articles. • Aim for a total of at least 30 minutes of activity throughout the day. Falls are a global concern. Exercises which encouraged reducing or leaning beyond the base of support, shifting the body’s centre of mass, minimising upper limb support, coordinating single or dual-task movements, altering sensory feedback and functional activities were commonly used in balance training. C 13 – 15 , 18 , 19 Rest at least one to two days in between working the same muscle groups again. Cochrane Database Syst Rev. [50, 51] have conducted systematic reviews and meta-analyses to determine the effects of exercise on falls and to identify determinants of these effects. The FITT principle can be used as a simple tool to remind clinicians and patients to pay attention to the 4 key elements of physical activity: frequency, intensity, timing, and type.This study is a research review on the effectiveness of time training to the patient. A seven-step screening process was used to determine the eligibility of articles for review (Fig. J Am Geriatr Soc 53(8):1296–1304, Lord SR, Ward JA, Williams P, Anstey KJ (1993) An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. In the UK, the annual cost of falls among those aged 60 and over was estimated at £981 million in 1999 [49]. The databases searched for articles for inclusion were Academic Search Premier, AMED, Biomedical Reference Collection: Expanded, CINAHL Plus, MEDLINE and SPORTDiscus with the key words ‘falls’, ‘prevention’, ‘exercise’ and ‘community’.