Activities of Daily Living

Activities of Daily Living (ADLs) - Heritage Creek Assisted Living

The activities of daily living, or ADLs, are self-care tasks. These tasks are:

  • Self-feeding
  • Bathing and showering
  • Dressing
  • Functional mobility, or the ability to walk, get in and out of bed, and in and out of a chair
  • Toileting
  • Continence

It goes without saying that we all want to be able to do these tasks as long as possible. It is not true that frailty is an inevitable part of aging. Frailty is the result of inactivity. Exercise is the magic pill that will keep us enjoying the activities of life that are important to us. Certain types of exercise can target ADLs. Your exercise program should include these exercises, especially after age 62 when age related slowing typically begins. But it is never too late to begin! The ADLs have been broken down into the following movement patterns:

  • Push
  • Pull
  • Rotate
  • Bend at the hips
  • Squats
  • Lunges
  • Brace (hold still) and balance
  • Pelvic floor exercises
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Push. We push a grocery cart or a stroller. We push the door shut. We push away from the table when we are finished eating. We push when we use our arms to get up from any position. We push our arms into the sleeves when we get dressed. Exercises that involve pushing include the chest press machine in the gym, dribbling a basketball, and push ups. If the traditional push ups on the floor are too difficult, place your hands on a sturdy bench or couch to perform incline push ups, or try standing push ups against a wall or counter top. In a water fitness class any action where the arm moves against the water in any direction away from the body is a push. A chest press toward the pool floor can be performed in a lunge position using buoyant dumbbells. An incline push up can be performed using a noodle.

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Pull. We pull weeds. We pull a wagon. We pull the car door shut. We pull when we pick something off the floor. We pull laundry out of the washing machine. We pull clothes out of the closet. Exercises that involve pulling include the rowing machine in the gym, biceps curls with weights, and pulling resistance bands. Wrap the band around a banister or sit on the floor with the band around the bottom of your shoes and pull the ends. In a water fitness class any action where the arm moves the water towards the body is a pull. Jogging arms with cupped hands and jumping jacks with the arms moving toward the midline are examples. You can row with drag equipment, such as paddles or Aqualogix bells.

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Rotate. Any throwing or hitting action requires torso and arm rotation. Walking and running involve torso rotation. We rotate to look behind us when we are backing the car out of the parking space, and we rotate to get out of the car. An exercise that involves rotation is to sit in a chair with both hands on one hip and then turn to look over your shoulder. Limit the range of motion if you have osteoporosis. A stretching routine called Controlled Articular Rotations (CARs) uses rotation to improve mobility. To find out more, see Dr. Larissa Armstrong-Kager’s YouTube videos. In a water fitness class you can increase the intensity of a cross-country ski or a high kick by rotating the upper body with the arm swing. Crossing the midline of the body with the arms and crossover kicks involve rotation.

Bend at the Hips. We bend at the hips when we pick something small up off the floor. We bend when we tie our shoes. We bend when we put our pet’s food on the floor. We bend when we towel off after a shower. An exercise that involves bending is a deadlift. With weights in your hands and arms down, bend forward from your hips keeping your back straight and bending your knees slightly; then return to an upright position. We also bend at the hips when doing a hamstring stretch. In a water fitness class we bend at the hips during the up action of a straight leg front kick and during the down action of a straight leg back kick. We also bend from the hips when performing suspended exercises in shallow water, and when performing exercises in the “L” position in deep water.

Squat. We squat every time we sit down in a chair, or on the toilet. The best way to lift something heavy off the floor is to squat and grab the item with both hands and then stand up using the legs. Squats are functional exercises. Stand with your chest lifted and shift your weight to your heels as you lower your hips, as if sitting in a chair. Try not to let your knees go forward past your toes. Then push through your heels to return to standing. Another version of squatting is to sit down in a chair and stand back up again. In water fitness squats do not work the same muscles because the water’s buoyancy makes it easy to return to standing. Standing on an aquatic step so that more of your body is above the water makes the squat more effective. You can work the same muscles with rebounding moves that involving jumping with both feet, such as a tuck jump, a jumping jack and a cross-country ski.

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Lunge. You lunge when you step in any direction, or transfer weight from one leg to the other. Walking and running involves lunging. You lunge when you vacuum the floor. To perform a lunge exercise, take a big step forward with your hands on your hips, and slowly lower your body. Make sure that your front knee does not extend past your toes. If your knees bother you on the lunge, you can lean forward slightly from the waist to reduce the stress on the joints. Press through your heel to bring your front foot back to the starting position. If the lunge is too difficult, take a smaller step forward, or don’t bend your knees as far. You can place one hand on a wall or chair to help you balance. In a water fitness class you work the same muscles by jogging, kicking side to side and doing a rocking horse.

14 Exercises for Seniors to Improve Strength and Balance | Philips Lifeline

Brace (hold still) and Balance. Bracing involves contracting the core muscles to maintain a position. It is important in maintaining balance. The ability to balance greatly reduces the risk of falling. For exercises to improve balance, see my previous Blog post Balance Training at Home. Many of these same exercises can be performed in the pool as well. Another pool balance exercise is the Yoga plank while holding a noodle in the hands under the shoulders.

Pelvic floor exercises. Incontinence is often a problem as we age and the solution is pelvic floor exercise. These used to be called Kegels, but research has changed the way the exercises are done. Keep your shoulders relaxed and breathe normally as you smoothly raise your pelvic floor. Hold for 10 seconds then relax for 30 seconds before performing the next pelvic floor exercise; repeat up to 10 times. Or do 10 quick pelvic floor exercises in succession. For a more detailed description of pelvic floor exercise, see my Blog post Keep Your Inner Core Strong. Pelvic floor exercises can be done in a water fitness class as well as at home.

There is a Functional Core Strength lesson plan and a Balance lesson plan for shallow water as well as a Functional Core Strength lesson plan and a Balance lesson plan for deep water in my book Water Fitness Progressions. The lesson plans demonstrate options for teaching a class focusing on maintaining the ability to perform ADLs. To order the book, click on the link. Many pools are getting ready to reopen following closures because of COVID-19. I hope to see you in the pool soon!

Chris Alexander

Chris Alexander

Balance Training at Home

14 Exercises for Seniors to Improve Strength and Balance | Philips Lifeline

Although the pool is a great place to do balance training, with COVID-19 cases on the rise in many states, we are still being encouraged to shelter in place as much as possible. It is important to stay active during this time, and it’s a good idea to include balance training among your activities. It is especially important if you are older than 60 since balance training reduces your risk of falling.

Exercise Etc. Inc. offered a Balance & Fall Prevention webinar in 2019 describing a variety of balance exercises you can do at home. Some recommended strength training exercises include the following:

  1. Resisted rows for the upper back. If you don’t have a band, do a standing row. From a lunge position, with the R leg forward, pull a dumbbell (or water bottle) in your R hand from your knee up towards your hip, squeezing your shoulder blades. Then repeat on the L side.
  2. Toe scrunches to strengthen the toes.
  3. Standing heel lifts to strengthen the calf muscles.
  4. Deadlifts to strengthen the glutes and hamstrings. Keep your back straight. If you don’t have dumbbells, use water bottles.
  5. Chair squats to strengthen the quads.

In addition to strengthening the muscles that are important for balance, there are some specific balance training exercises you can do. First find your neutral alignment. Sit in a chair up against a wall and put a balloon behind your head. When you are able to maintain that position, try standing up against the wall with the balloon behind your head. Progress from there to walking with a book on your head.

The following exercises are done sitting in a chair:

  1. “The airplane” – Extend the arms to the side and lean slowly side to side.
  2. Alternating heel/toe lift – Lift your heels one at a time while pumping your arms with the elbows bent
  3. Seated crawling – Lift your knees one at a time while lifting the opposite hand as if you were crawling up a wall.

A one legged stand is another recommended exercise. There are a variety of ways you can practice it. At first you may need to hold on to a chair or the wall for support. Next try standing on one leg without holding on for a minimum of 5 seconds, or as long as possible. Always have support available in case you start to lose your balance. Progress to standing on one leg with one arm up. Next stand on an unstable surface, such as a one-inch thick piece of wood about the size of your shoe. You could also stand on a brick or a book. Finally try batting a balloon while you are standing on one foot on your unstable surface.

Besides strength training, practicing neutral alignment, chair exercises and one legged stands, it is important to practice walking fast. The faster you can walk, the lower your mortality rate. Shift your weight from your heel to the ball of your foot to the toes. Keep your spine in neutral and your head level. Your toes point forward and your feet are 3-5 inches apart. Your elbows are bent 90 degrees, your arms are close to your body and they pump for momentum and balance. Don’t forget to breathe! The following are some exercises you can do to improve your gait:

  1. Tap one heel at a time on the floor in front of you. Then tap the toes in front of you. This improves ankle strength and ankle range of motion.
  2. Walk with long steps to improve stride.
  3. Lift knees with arm pumps to improve your arm swing efficiency.
  4. Lift your heels up behind you towards your buttocks to improve hamstring strength.
  5. Walk with one foot in front of the other to improve stability.
  6. March to reduce shuffling.
  7. Walk with head rotations to improve balance.
  8. Walk with U-turns to strengthen hip rotators.
  9. Walk backward.
  10. Place 2 cones (or water bottles) 10-20 feet apart. Walk fast from A to B, pivot and walk fast back to A.
  11. Step sideways from A to B and back to A.
  12. Place a chair 10 feet from your cone (or water bottle); from a seated position stand up, walk to the cone, pivot and return to the chair.

All of this can be done in your living room. Pick several exercises to do at least 3 times a week, or even daily. You can also do some fast walking outside in your neighborhood. If you live in Texas, like I do, you will want to do this early in the morning since it gets too hot in our summer afternoons and evenings. Keep moving!

Chris Alexander

Chris Alexander

Cleaning during the Pandemic

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Cases of COVID-19 are surging in Texas where I live, and in many other parts of the United States. Governors want to avoid lock-down orders and are depending on us to wear masks and practice social distancing. This is because the coronavirus spreads mainly through person-to-person contact and wearing masks has been shown to slow the spread of the virus. It is also possible to touch a contaminated surface and then touch our eyes, nose or mouth and pick up the virus that way. So many of us are trying to keep our homes clean and disinfected. Consumer Reports on Health has a helpful article on “The Best Steps for Cleaning and Disinfecting” in their July 2020 issue.

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Cleaning means removing dirt and germs by scrubbing with a cleaner or soap. Disinfecting means applying chemicals that will kill or deactivate germs directly. It’s important to clean surfaces first because that can physically remove many germs and because disinfectants work best on surfaces that aren’t visibly dirty. Places to clean and disinfect daily include anything that is touched frequently, such as tables, chairs, counter tops, light switches, water faucets, flush handles, refrigerator handles, drawer pulls, door knobs, cellphones, tablet screens, keyboards, your computer mouse, remote controls, steering wheels, gear shifts, car door handles, seat adjusters, and any high touch buttons or touch screens in your car. See more about disinfecting your electronics and car below. Disinfect everything else with an antibacterial wipe or spray. If you can’t find wipes, you can mix 4 teaspoons of bleach in a quart of purified water and soak some paper towels in the solution. Wring the paper towels out with clean hands, or wearing gloves, and store them in a sealed plastic bag. Don’t use “color safe” bleach as it is not suitable for disinfecting purposes. If you can’t find disinfectant spray, you can use 70% alcohol in a spray bottle. An article on the mdanderson.org website, says not to use an alcohol concentration higher than 70% because studies have shown that these products just freeze the outside of the virus instead of killing it. In any case, allow the disinfectant to remain on the surface for at least one minute. Do not combine different disinfectants because the chemical reaction can be dangerous.

Do not use bleach on your electronics. Instead wipe your cellphones, tablet screens, keyboards, your computer mouse and remote controls with an alcohol wipe. Alcohol wipes can be found in first aid kits or with the diabetes supplies in a drugstore. You can also wet a cotton ball or square, squeeze out any excess alcohol, and wipe with that. Remove the batteries before cleaning your remote control. Use alcohol on your car steering wheel, gear shift, door handles, seat adjusters, and any high touch buttons or touch screens as well. Bleach or hydrogen peroxide can damage your car’s upholstery. After disinfecting, use a leather conditioner on any leather surfaces to keep them in good shape.

There is no evidence that fruits and vegetables from the grocery store can transmit COVID-19. Still, it’s a good idea to thoroughly rinse produce before you eat it to help remove pesticides and dirt. You can even scrub hard-skinned items like apples with a soft-bristle produce brush. But don’t wash produce with bleach or another disinfectant because that could make you sick.

It is impossible to completely sanitize all surfaces. That’s why hand-washing is so critical. Scrub for at least 20 seconds, completely washing all parts of your hands. The second picture above shows areas that are sometimes missed in the palm and the back of the hand in purple. The areas in green are more frequently missed. Wash your hands after you’ve been out in public, after you cough, sneeze, or blow your nose; before preparing food and before eating food; and after using the bathroom.

This seems like a lot to keep up with, but during this pandemic it is important to stay safe!

Chris Alexander

COVID-19 and Swimming Pools

Expert: Swimming pool facilities water unlikely to spread ...

Many states have loosened social distancing restrictions in order to get the economy going again. Now, however, we are seeing a rise in Corona virus cases. We would all like to know what to expect with this pandemic, but there is no way to know for sure how it will play out. My doctor’s practice, USMD Health System, has suggested three possible scenarios:

Scenario One — Begins with an initial wave in Spring 2020 followed by a series of smaller waves of infection that last up to two years.
Scenario Two — Begins in Spring 2020 and is followed by a second, larger wave this fall or winter and a smaller one in 2021. If this happens, communities will likely return to quarantines.
Scenario Three — Begins in Spring 2020 and is followed by what the Center for Infectious Disease Research And Policy (CIDRAP) describes as a “slow burn.” That means there’s no clear pattern. This scenario would likely not cause communities to return to quarantines, but infections and deaths would continue.

No matter the scenario, CIDRAP says we should prepare for another 18-24 months of COVID-19. That means we should continue to practice social distancing, wear face masks in public, and wash our hands often.

Our swimming pools have reopened. Lap swimming, swim lessons and water fitness classes are resuming. What should we know about the safety of returning to the pool and what kind of cautious response should we make? Sara Kooperman (the owner of SCW Mania Fitness conventions) and John Spannuth (the president of the US Water Fitness Association) have both asserted that chlorine used to disinfect pool water kills COVID-19. Craig Lord, the Swimming World Editor-in-Chief, agrees that disinfectants, including chlorine, act on viruses and it is reasonable to expect that would include COVID-19. He adds that pool operators also need to observe strict hygiene protocols, including correct maintenance of pool water and air in the facility, as well as heightened levels of cleaning of adjacent surfaces and environments, since the fundamental mode of transmission of COVID-19 is air and not water.

It is likely that if your favorite pool is reopening, the pool operator is aware of the necessary protocols and has trained the staff properly. Those of us who will be using the pool to teach or participate in a water fitness class also need to do our part. Yes Fitness Music has made the following suggestions:

  1. Outdoor pools are safer because air circulation outdoors is better than indoor air circulation.
  2. Our Texas sun and heat often makes an indoor pool preferable. Ask about the air ventilation. Fresh air is better. If the air is recycled, it should go through a filtration system.
  3. Wear a mask.
  4. Maintain social distancing, 6 feet away from the other swimmers or class participants.
  5. Wash your clothing, towels and masks directly after class.

We can all do our part to protect ourselves and those around us. Enjoy the pool safely!

Chris Alexander

Safe at Home

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The governor of Texas, where I live, has relaxed some stay-at-home and social distancing restrictions in order to get the economy going again. Other states are also loosening restrictions. Nevertheless, the risk and danger of getting COVID-19 still remains and it makes sense to continue to stay at home as much as possible, especially if you have a chronic condition or are age 60 or older. We have been doing this for more than 2 months now, so we probably feel like old hands at it. We may also be getting tired of it and are perhaps less diligent than we were at the beginning. So here are some reminders.

Hand washing is still the most important thing we can do to protect ourselves from the Coronavirus. Wash your hands for 20 seconds, or about as long as it takes to sing Happy Birthday twice. Click on this link to see a video of the WHO technique for washing hands. Wash your hands before you start to cook. Wash your hands again if you touch raw meat or eggs while preparing your meal and if you get raw batter on your hands. If you forget to wash your hands and open the refrigerator or oven, the bacteria transfers to the refrigerator or oven handle. Wash your hands after you finish cooking and before you eat.

Sponges

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Sponges can harbor bacteria. Microwaving, boiling and putting the sponges in the dishwasher does not kill the bacteria. Plan to use a new sponge every week. I prefer to use a dish rag that I toss into the hamper at the end of the day, and get a fresh one out in the morning. Cutting boards and the sink both harbor bacteria and should be scrubbed with a cleaning product containing bleach. You can make your own by mixing a tablespoon of bleach in a gallon of water. Wipe down your countertops and the faucet handles with the same solution at least once a day. If you use a spray cleaner, spray thoroughly and let it sit for a few minutes before wiping. Don’t add bleach to a store-bought cleaning product; mixing bleach with a citrus product can be harmful to you and your pets. Disinfectant wipes are another option, but Chlorox or Lysol wipes have not been available for months. To make your own wipes, cut a roll of good quality paper towels in half crosswise with an electric knife. Put the half roll in a round container with a lid. Mix 1 cup of boiling water and 3 tablespoons of bleach. Pour over the towels. Cover and let stand 20 minutes. Remove the cardboard from the center. The wipes can be used to sanitize not only your counters, but light switches, door knobs, faucet handles, toilet handles, stove knobs, washing machine and dryer knobs, and any other high touch surface. Do not use it on touch screens or cellphones though. The alcohol wipes used to clean glasses are safer for these items.

Other times to wash your hands are after bringing groceries into the house, after bringing the newspaper or mail into the house, after handling pets, after feeding the birds, and of course after coughing or sneezing. My favorite soft soap has disappeared from the shelves, including the online shelves. Hopefully I can find a substitute but I may have to use bar soap instead. After all that hand washing, your hands are sure to become dry and irritated, so don’t forget to use hand cream.

I recently learned that when you flush the toilet with the lid up, bacteria sprays 6 feet out. It can land on your toothbrush and towels. Yeah, that’s gross! So always flush the toilet with the lid closed! Even if you protect your towels from toilet spray, damp towels can harbor bacteria, so change the towels every three or four days. Be sure to wash them in hot water and make sure they get thoroughly dry in the dryer.

As long as we’re talking safety, check your home to make sure there are no tripping hazards that might cause a fall that sends you to the emergency room. Sheltering in place provides spare time to declutter your house. Make sure you have plenty of space to walk around. Wear good supportive shoes at home; slippers and flip flops may increase your risk for falls. Rugs should have anti-slipping pads. Electric cords should not lay across any walkways. Check to make sure the cords are not frayed, which is a fire hazard. Use handrails for all staircases. Put items that you use frequently in the kitchen within easy reach, not on a high shelf. Turn on a light if you have to get up during the night so you can see where you are going. Have your air conditioner serviced; seniors are at higher risk of adverse effects due to high temperatures.

We’ve heard it many times before: We are all in this together. So take precautions to safely make it through this pandemic.

Chris Alexander