FINDING BALANCE ALGORITHM
Once assessed for the physical factors leading to impairments, exercise prescription must be appropriate for the deficits identified and the health profile of the client. As the level of risk increases and overall health of the client deteriorates, exercise prescription becomes more focused, more time intensive and more tailored to the needs of the client.
As the level of risk increases, a tailored exercise program needs to be part of a multifactorial approach to falls risk reduction. Exercise prescription must account for safety, and it must specifically challenge balance.
Challenging balance requires decreasing the base of support and decreasing the use of the upper extremities for support. Strengthening of upper extremities is also important in the overall risk management for the individual.
Exercises need to be of sufficient duration and intensity; it has been suggested that 50 hours over 12 weeks is appropriate. Progress toward standing exercises as the client’s health profile allows. Seated exercises cannot address standing balance.
Community and in-home exercise have been shown to be effective. Encourage continued participation in a maintenance exercise program after a formal treatment program has been completed. Incorporating discussion of behaviour modification into an exercise program helps establish goal setting for continuing engagement in physical activity.
Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis