1. health and fitness
2. exercise

Vol. 9 No. 3 May-June 2011
®
Exercise and activity for healthy aging
Table of contents
Actions and exercises to
improve posture
1
by Kathy M. Shipp, PT, MHS, PhD
Actions and exercises
to improve posture
by Kathy M. Shipp, PT,
MHS, PhD
14
You got rhythm and
your clients do, too!
by Kat Fulton, MM
20
Building a music
program
21
Client handout: Make
half your plate fruit and
vegetables
iStock/Michael Krinke
It is true that gravity takes its toll as we
age. The pull of gravity on our bodies over
decades of living can result in body
alignment that brings the head, shoulders
and upper back forward. These changes
occur gradually, so often people do not
realize the changes have occurred and
have become fixed; a person may suddenly
realize that bringing the head up and back,
pulling the shoulders back, and reducing
the forward curve of the spine is not
possible.
Fortunately, attention to good alignment
throughout every day and targeted
exercise can prevent poor posture with
aging. Even those with long-standing poor
alignment can improve to some extent.
22
Comment:The amazing
hosts of Active Aging
Week
• avoid stretches and strengthening
exercises that could cause a vertebral
fracture
Fitness professionals can promote better
posture in multiple ways for the clients
they serve. They can:
• refer to physicians and physical
therapists when a client is having pain
or cannot tolerate group-exercise
classes
• teach older adults about good posture
and how to find the best postural
alignment
Benefits of good posture
• teach older adults cues and strategies
to use throughout the day that will
make keeping good alignment easier
during daily activities
Without attention to good alignment, the
slumped forward/stooped posture that is
associated with aging can occur in anyone
(1), but people who have had spinal
fractures from osteoporosis are most at
risk of developing this posture.
• include targeted stretching and
strengthening exercises that improve
posture in exercise classes
Continued on page 2
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Up to 1.5 inches (3.8 cm) of height loss is
normal and can occur from the
accumulated height loss in the 23
intervertebral discs that rest between the
individual bones (the vertebrae) that stack
one on top of the other to make the spinal
column (see illustration), but 1.5 inches
or greater height loss during the adult
years is an indication of osteoporotic
vertebral fracture (2, 3).
Glossary
Sternum:
Long flat bone in
middle of chest
between the ribs,
known as the
breatsbone
Spinal/vertebral fractures cause height loss
because the fractured vertebral bodies
compress. Most osteoporotic vertebral
fractures cause height loss either from a
full compression fracture (where the entire
vertebral body compresses) or a wedge
fracture (where the front of the vertebral
body is most compressed). With either of
these types of fracture, the natural curve
toward the back of the body in the middle
back (thoracic spine) increases
(hyperkyphosis) and the natural curve
toward the front of the body in the low
back (lumbar spine) decreases
(hypolordosis) (4).
Iliac crest:
Top of the pelvic bone
Ischial tuberosity:
Bony protuberance at
base of pelvis that
bears the weight of the
body when sitting
Hyperkyphosis:
Excessive outward
curve of the spine
Hyperlordosis:
Excessive inward curve
of the spine
Thus, after spine fractures from
osteoporosis, the middle back curve
increases and the lower back curve
decreases resulting in the head, shoulders
and upper back being positioned more
forwardly. Neither the height loss in the
intervertebral discs nor the height loss in
the bone after a fracture can be recovered,
but attention to posture and targeted
exercise can prevent worsening posture.
The benefits of good postural alignment
include:
• less strain and discomfort on the neck,
shoulders and back
• reduced pressure of the upper body
on the abdomen, so taking a full breath
is easier and the internal organs are
less crowded
• balanced loading on the back bones
so a person with osteoporosis may be
less likely to have a vertebral fracture
(5, 6)
• improved appearance
• better fitting clothes
How to find good posture
We all can recall relatives and teachers
admonishing us as children to “sit up,”
“don’t slump,” and “pull your shoulders
back.” Unfortunately, how to do this
effectively was rarely shared.
You can help your older clients improve
their posture by integrating posture training
into physical activity classes or as a standalone workshop. In addition, model and
teach good alignment when sitting or
standing. For both sitting and standing,
start with the surface on which the body
is resting and move toward the head.
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Finding good posture when sitting:
Pelvis. Whether sitting with back support,
such as in a chair, or without back support,
such as sitting on the side of the bed, be
aware of sitting up on the lowest part of
the pelvic bones, the ischial tuberosities.
A good way to find this position is to sit
on the front part of a chair seat, hands on
the top of the pelvic bones (the iliac crests)
and think of the pelvis bones like a bowl.
Appropriate for
Athlete
Active
now
If the iliac crests turn forward because of
sitting on the front of the ischial
tuberosities, water in the “bowl” of the
pelvis will spill to the front (picture 1). If
the iliac crests turn backward because of
sitting on the back of the ischial
tuberosities, water the in the “bowl” of
the pelvis will spill to the back (picture 2).
The best position is with the pelvic “bowl”
balanced so water would neither spill
forward or backward (picture 3).
Getting
started
Needs a
little help
Needs
ongoing
assistance
Lumbar spine. Once this balanced pelvic
position is achieved, the spinal column—
attached to the pelvis at the sacrum—can
be in a balanced (neutral) position without
much work. Notice how, for most people,
the low back has a gentle forward curve
when the pelvis is aligned well. A good
cue to give for best lumbar alignment is
that the low back should have a “gentle
hollow” and neither be rounded nor
arched forward.
To maintain balanced pelvic alignment
without back support, a person will use
muscles in the abdomen and low back. If
this is a new position, these muscles fatigue
easily, so a good exercise is simply to find
the position and maintain it for several
minutes.
Lumbar support in a chair. When
sitting with back support, most chairs
cause people to sit on the back of the
ischial tuberosities with a rounded low
back. To counter this, give the cues:
1. Avoid: Iliac crests turn forward, water
in the “bowl” of the pelvis spills to the
front
2. Avoid: Sitting on the back of the
ischial tuberosities, water in the
“bowl” of the pelvis spills to the back
3. Good posture: pelvic “bowl”
balanced
• Move your buttocks all the way back
in the chair.
• If the feet do not touch the floor when
the buttocks are all the way back,
either find a chair with a less deep
seat or put the feet on a small stool.
• Find the balanced “bowl” pelvic
position with the “gentle hollow” at
the low back.
• Put a small pillow at the low back to
support the “gentle hollow.”
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Continued from page 3
Thoracic spine. Once the pelvis and
lumbar spine are in good alignment, the
thoracic spine can come into good
alignment using the cue to “lift the chest
so the sun can shine on the chest from
the breastbone to the shoulders.” This
gets the spine itself in good alignment and
the shoulder girdle complex (collar bones,
shoulder blades and arms) falls into place
without having to inefficiently use muscles
to pull the shoulders back.
4. Ineffective: Slouching in chair and
pulling shoulders back.
To illustrate this, have the class slouch
forward badly in the chair, then have
everyone “pull your shoulders back.”
Without first getting the pelvis and spine
in alignment, pulling the shoulders back
does not decrease the forward posture
(picture 4).
Head and neck. To align the neck and
head, think of the crown of the head. Lift
the crown up and to the back slightly
(picture 5). Note that when the crown is
up and back, the chin is down.
Relax and breathe. Finally, advise clients
to take several deep breaths and relax the
jaw and the shoulders. This is the best
position for doing any task in sitting,
including exercises in sitting.
5. Good posture: Align the neck
and head by lifting the crown up
and slightly to the back.
To unlock the knees, you can give the cue
to “soften the knees” and/or externally
rotate the hips a little. A good cue for this
is to think of the thighs as being like the
old style hand-operated egg beaters. To
unlock the knees, make the egg
beaters/thighs turn a little to the outside.
Finding good posture in standing:
Feet. First, stand with the feet a little
apart and directly under the hips joints
with toes pointed straight ahead. Body
weight should be evenly distributed
between the right and the left foot, and
there should be an even distribution of
weight between the balls of the feet and
the heels.
Knees. Check to see if the knees are
locked. Locked knees affect the alignment
of the pelvis and the spine, usually by
causing too great an arch in the low back
and tilting the pelvis so water would go
out the front of the “bowl.”
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Pelvis, spine and head. Now, go through
the steps for pelvis, spine and head
alignment as outlined under sitting
alignment.
How to move and accomplish daily
tasks
Finding good postural alignment when
sitting and standing is useful, but what
cues might help people maintain good
alignment during moving and daily
activities? The National Osteoporosis
Foundation’s publication “Protecting Your
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Functional U® May-June 2011
Continued from page 4
Fragile Spine” and web page “Moving
Safely” have excellent information on this
topic and are free to download from the
NOF website (7, 8). In addition, the
following instructions and cues can be
practiced.
Reading and knitting
Sit in a comfortable chair with good
posture, including using a small pillow at
the low back. To keep from slouching, put
two to three bed pillows in your lap and
rest your elbows on the pillows. This
brings the work (book or knitting) up
toward the eyes (picture 6).
To look down, avoid lowering your whole
head; instead turn the face downward
from the top of the neck. The top of the
neck (last vertebra of the spine) is located
at the level of the earlobes. Notice how
it’s possible to turn the head from this
position and look down without “diving
forward” with the head.
6. Good posture: Bring the work
toward the eyes.
7. Hands locate the hip joint where the trunk
meets the legs.
Sit-to-stand and stand-to-sit with hip
hinge
Scoot the hips to front of the chair and
sit erect with pelvis balanced and spine
aligned with a “gentle hollow” in the low
back, chest lifted, and the crown of head
up and back. Find where the hip joints
are located—they are deep in the crease
where the trunk meets the legs (picture
7). Note that the hip joints are quite low
and not where in school we put our hands
when instructed to “put your hands on
your hips” (picture 8). The bones you can
feel with arms akimbo are the iliac crests
of the pelvis.
Now, move a little only from the hip joints.
In other words, keep the trunk stable
while moving all in one piece from the
ischial tuberosities to the top of the head
(picture 9). You might think of an image
8. Hands on the iliac crest of the
pelvis (not on the hip joint).
9. Good posture: Standing up or sitting
down, move trunk as a unit from the ischial
tuberosities to the top of the head,
“hinging” at the hip joints.
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Functional U® May-June 2011
Continued from page 5
of your trunk being a door with a hinge
at the hip joints. The door closes toward
your thighs.
Next, maintain good trunk alignment as
you hinge forward and shift your weight
through your legs into the balls of the feet
and press into the balls of your feet as
you stand up. The chest stays lifted but
has to go forward over your knees. It may
help to engage your abdominal muscles
by pulling in (hollowing) the abdomen
between the pelvis and your rib cage.
To sit down, be sure you are close to the
chair and perform the reverse motions.
Press the balls of the feet into the floor
and bend your knees as your rear leads
toward the chair surface. Again the
movement is fully from the hip joints, the
chest stays lifted and goes forward toward
the knees.
Walking
Find good standing alignment as described
above, then with every step feel like the
crown of the head lifts toward the sky so
the spine lengthens and the torso pulls
away from the pelvis. The arms just hang
“like a suit of empty clothes” and swing
naturally.
Brushing teeth
Since people brush their teeth twice a
day, this is a good activity to use to practice
maintaining best posture.
Face the sink squarely (shoulders, pelvis,
knees and feet pointing toward the sink)
with feet a bit apart. Bend the knees and
let the rear lead while lowering a stable
trunk as described for sitting down using
the hip hinge. Put one hand on the sink
or vanity for balance. Use the other hand
to brush the teeth (picture 10).
10: Good posture: brushing teeth.
Lifting from a moderately low
surface
Much of the lifting done during the day
requires arms to reach above the head (a
kitchen cabinet or medicine cabinet) or
to about the level of the knees (getting
items out of the refrigerator or stove).
Instruction on safe lifting from surfaces
that are higher than arm’s length or lower
than the knees is beyond the scope of this
article. A physical or occupational therapist
can be consulted for this information.
However, an exercise can help people
practice correctly lifting items above the
knee and within arm’s length. Put a small
pillow, a towel or papers on the seat of
a chair. Face the chair squarely (shoulders,
pelvis, knees, and feet pointing toward the
chair) with the feet a bit apart. Bend the
knees and let the rear lead as you lower
your stable trunk (as for sitting using hip
hinge). Reach with both hands for the
object on the chair seat. Bring the object
toward the belly button, then straighten
the knees and trunk.
Put the object back on the chair seat by
reversing these steps. Although the pillow,
towel or papers are light in weight, it is
good to get in the habit of bringing objects
close to the middle of the body as you
place them down to, or lift them up from,
a lower level.
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Exercise to improve posture
Specific muscle groups should be trained
to improve postural alignment. Muscle
groups that typically need to be
strengthened include the:
• deep cervical flexors (9);
• deep paraspinal muscles, particularly
the multifidii from the cervical to the
lumbar spine (10);
• spinal and hip extensors (11);
• abdominals, particularly the transversus
abdominus (12); and
• posterior scapular groups, including
lower and middle trapezius and the
rhomboids (13).
Stretches also need to be targeted.
Spending hours every day sitting in a flexed
posture tightens anterior shoulder and
trunk muscles as well as the hip flexor
and hamstring groups. Unless these areas
are stretched, the postural muscles will
not be recruited normally and training
will not yield improved alignment.
There is evidence from controlled prepost trials and randomized trials that
exercise can improve posture (14-17).
This article presents a typical beginning
program of exercises to improve posture
that most people with mild to moderate
osteoporosis can perform safely in a group
setting. All of these exercises were used
in a clinical trial that investigated six months
of group exercise delivered three times
per week to older women (mean age 81
years) who had prevalent vertebral
fractures. The participants improved their
trunk extension strength by 24% to 45%
in six months (18).
The exercises depicted in this article focus
on mobility for the warm-up, strengthening,
and stretching. When leading these
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exercises, make certain that individuals
move slowly with control, maintain
excellent head and trunk alignment,
maintain shoulder external rotation any
time the arms go above 90 degrees flexion
or abduction, and are using a level of
resistance from elastic bands that is
moderately fatiguing at 8 to 10 repetitions.
Exercise to avoid
Research on loads on the spine has
demonstrated that flexion produces high
loads on the vertebral bodies and could
cause new osteoporotic vertebral fractures
(19-21).The loads in sitting are the highest,
so flexion from a sitting position
particularly should be avoided.
In addition, rotation with the spine in a
loaded position (sitting or standing) puts
high loads on the vertebral bodies at the
end range of the motion, especially if the
movement is ballistic or if there is a weight
in the hands or the movement is against
resistance.
Exercises to improve posture take the
body in the direction of more erect
alignment or into extension of the thoracic
and lumbar spine. Range of motion for
flexion and rotation of the spine need to
be maintained, but these exercises should
never be done in sitting or standing.
For example, exercises to avoid include
toe touches, forward bends with rounded
shoulders, abdominal crunches and
extreme rotation. Instead, perform gentle
spine flexion or rotation in a sidelying
position.
Time to refer
If an exercise participant complains of pain
with the simple postural exercises
discussed in this article, that person could
Continued on page 9
Functional U® May-June 2011
Exercises to improve posture
Levels 1– 3 indicate level of difficulty, from easiest to hardest.
Exercises listed in order performed in clinical trial (18).
Choose the number and level appropriate for your clients.
Mobility – Warm-Up
• 10 repetitions
Exercise
descriptions
begin on page 10.
• No resistance
Chin tuck
Standing back bend
X to V
W
Money
Stretch
• Hold for 60 seconds or longer
Wall arch stretch
Strengthening
• 3 sets, 8-10 repetitions
• Elastic bands for resistance
• Intensity: moderately fatiguing
at 8-10 repetitions
• Move slowly with control
• Maintain excellent head and
trunk alignment
• Maintain shoulder external
rotation any time the arms go
above 90 degrees flexion or
abduction
Chin tuck (level 1)
Resisted chin tuck (level 2)
X to V (level 1)
X to V with elastic resistance band (level 2 - 3)
X to V prone (level 2)
X to V prone with weights in hands (level 3)
W exercise (level 1)
W with elastic resistance band (level 2 – 3)
W prone (level 2)
W prone with weights in hands (level 3)
Money (level 1)
Money with elastic resistance band (level 2 – 3)
Money prone (level 2)
Money prone with weights in hands (level 3)
Isometric trunk extension (level 1)
Prone trunk lifts (level 2)
Prone trunk lifts with weights in hands (level 3)
Prone leg lifts (level 2)
Basic abdominal exercise (level 1)
Basic abdominal exercise with leg slide (level 2)
Basic abdominal exercise with arm raise (level 2)
Lean backs (level 1 – 2)
Chair rises (level 1 – 2)
• The Money exercise is so named to help the participant remember to maintain shoulder
external rotation through the movement. The cue is to keep the palms up (open to the
ceiling) such that coins held in the hands would not drop to the floor. Try this and you
may find it is difficult to perform even for younger people who sit through the day
working on a computer.
• The chin tuck, V, W, and Money can be done in prone, thereby increasing the difficulty
because the muscles are working against gravity. To further increase the load on the
muscle, weights can be held in the hands for the scapular exercises (V, W and Money)
and the prone trunk lifts (see picture on page 12).
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Continued from page 7
benefit from referral to the primary care
provider and a physical therapist.
It is important, also, to observe the ability
of the participant to maintain good
alignment during these exercises. If, for
example, during the “X to V” exercise the
participant’s spine flexes, this indicates that
the paraspinal and abdominal muscles are
too weak to effectively and safely perform
the exercise. Participants who are very
weak would benefit from first receiving
rehabilitation under the guidance of a
physical therapist before participating in
group classes.
Well worth the effort
Good postural alignment can help older
adults be more comfortable, breathe
deeper, and look better all day long. In
addition, all exercises will be less stressful
on the body and less likely to cause injury
when first there is attention to finding
good postural alignment and maintaining
good alignment while performing the
exercises. By helping your clients find good
posture and modify their everyday activities
to support the best possible alignment,
you can have a positive impact on their
lives.
In my clinical practice working with people
who have had osteoporotic vertebral
fractures, minor changes in sitting taller
and walking more erectly have had major
effects on quality of life and pain control.
As range of motion, strength and muscle
endurance improve, good posture becomes
easier to maintain. With practice, the habit
of good alignment becomes automatic.
Teaching your exercise participants about
good alignment will be like a gift that keeps
on giving.
Kathy M. Shipp, PT, MHS, PhD, is Assistant
Professor in the Division of Physical Therapy,
Department of Community and Family
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Medicine at Duke University Medical Center.
She studied sociology at Oberlin College (BA
1976), physical therapy at the University of
North Carolina at Chapel Hill (BS 1985),
biometry at Duke University (MHS 1998) and
epidemiology at the School of Public Health
at the University of North Carolina at Chapel
Hill (PhD 2001).
As a physical therapist, Dr. Shipp specializes
in management of chronic diseases of older
people, particularly osteoporosis, Paget’s
disease, chronic pain, and prevention of falls
and frailty. As an epidemiologist, she is a Senior
Fellow at the Duke Center for Aging. Her
research focuses on acute and chronic effects
of osteoporotic vertebral fractures, exercise
for people with osteoporosis, and preventing
falls and increasing function and physical activity
in the elderly. She serves on the Scientific
Advisory Council and the Education
Committee of the National Osteoporosis
Foundation, is a consultant to the NIH
Osteoporosis and Related Bone Disease—
National Resource Center, and was a
contributing author to “Bone Health and
Osteoporosis: A Report of the Surgeon
General (2004).” She was a founding member
and remains on the Board of Trustees of the
North Carolina Osteoporosis Foundation.
Written in cooperation with the National
Osteoporosis Foundation.
References
1. Takeda N, Kobayashi T, Atsuta Y, Matsun T, Shirado
O, Minami A. Changes in the sagittal spinal
alignment of the elderly without vertebral
fractures: a minimum 10-year longitudinal study.
J Orthop Sci 2009;14:748-753.
2. Vogt TM, Ross PD, Palermo L, Musliner T, Genant
HK, Black D, Thompson DE. Vertebral fracture
prevalence among women screened for the
Fracture Intervention Trial and a simple clinical
tool to screen for undiagnosed vertebral fractures.
Mayo Clin Proc 2000;75:888-896.
3. Vokes TJ, Gillen DL. Using clinical risk factors and
bone mineral density to determine who among
patients undergoing bone densitometry should
have vertebral fracture assessment. Osteoporo
Int 2010;21:2083-2091.
4. Lyles KW, Gold DR, Shipp KM, Pieper CF, Martinez
S, Mulhausen PL. Association of osteoporotic
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Functional U® May-June 2011
Exercises
These descriptions of the exercises are used in the Duke University Medical Center
PT/OT Department and many have been adapted, in part, from “Boning Up on
Osteoporosis: A Guide to Prevention and Treatment,” published by the National
Osteoporosis Foundation. This book is an excellent resource that can help people
with osteoporosis understand more about the disease and how to take steps to
prevent further bone loss and live fully even if they have had fractures.
Appropriate for
Athlete
Chin tuck
Purpose: Correct forward head posture
Active
now
Sit or stand erectly.
Pull in your chin while looking straight ahead
(not up or down).
Feel the stretch in the back of the neck and
a flattening of the upper back.
Hold 1-2-3. Relax. Repeat.
Getting
started
Needs a
little help
Chin tuck with resistance
Sit or stand erectly.
Pull in your chin in while
looking straight ahead
(not up or down).
Place palms against back
of the skull (not the neck)
and push forward
without letting your head
move.
Build up a resistance and
count 1-2-3, then slowly relax. Repeat.
Wall arch
Purpose: Strengthen abdominals; stretch
shoulders; restore healthy lower back curve;
decrease rounded upper back
Face a wall with chest,
abdomen and toes touching
the wall.
Place palms and arms against
wall with elbows bent.
Either your forehead is
touching wall or head is
turned to side.
While keeping arms and
chest in contact with wall,
move feet a short distance
away from the wall.
Take a deep breath as you
stretch your arms up the wall. Count 1-2-3.
Lower arms and gently press away from wall.
Start over for next repetition.
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As you become more flexible, you will be able
to move your feet further away from the wall.
Standing back bend
Purpose: Restore healthy lower back curve;
decrease rounded upper back
(No photo)
Keep your abdominal muscles pulled in during
each stretch.
Place hand on lower back.
Arch backwards slowly with chin down.
Count 1-2-3. Return to neutral position.
Repeat, placing hands slightly higher on midlower back.
Repeat again with hands moved up a little
higher on back, as comfortable.
X to V
Purpose: Strengthen the lower trapezius
muscle; stretch shoulders
Sit or stand erectly.
Start with elbows straight and wrists crossed
in front of the body.
Raise arms overhead into the V position,
thumbs leading.Take arms as far toward the
back as possible.
Count 1-2-3. Relax.
Lower arms to starting position. Repeat.
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Continued from page 10
X to V with elastic resistance band
Sit or stand erectly.
Hold resistance band
at the ends with arms
down at your sides.
Turn one hand so
thumb faces front and
lift that arm straight
out to the front and
up, keeping elbow
straight.
Other arm stays
down at your side to
anchor the band.
Hold 1-2-3 with top arm near your head.
Lower arm in front of you, controlling pull of
band.
Repeat with opposite arm lifting.
W exercise
Purpose: Strengthen rhomboid muscles; stretch
shoulders
Sit or stand erectly.
Place arms in a “W”
position with
shoulders relaxed.
Pinch shoulder blades
together.
Take arms as far
toward the back as possible.
Hold 1-2-3. Relax. Repeat.
W with elastic resistance band
Sit or stand erectly.
Hold resistance band
toward the middle,
leaving a tail of band
at each end.
Place arms in W
position with
shoulders relaxed
(not hunched).
Bring elbows back,
pinching shoulder
blades together.
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Money
Purpose: Strengthen middle trapezius muscles;
stretch shoulders
(No photo)
Sit or stand erectly, arms held at shoulder level
with elbows straight, palms up.
Bring arms back, thumbs leading, pinching
shoulder blades together.
Hold 1-2-3. Relax. Repeat.
Money with elastic resistance band
(No photo)
Sit or stand erectly.
Hold resistance band near the ends.
Start with arms in front, elbows straight, palms
up. Bring arms out to the side and to the back
with thumbs leading.
Pinch shoulder blades together. The band
should be at the level of the collarbone.
Hold 1-2-3.
Resume starting position, controlling pull of
the band. Repeat.
Isometric trunk extension
Purpose: Strengthen back muscles
(No photo)
Sit in a tall straight-back chair, with hips all the
way back.
Put a bed pillow or folded towel lengthwise
behind back if needed for comfort (not a
lumbar support).
Push back into the chair back with your upper
back and shoulders.
Hold 1-2-3. Relax. Repeat.
Prone trunk lifts
Purpose: Strengthen back muscles
Hold 1-2-3.
Resume starting position, controlling pull of
band. Repeat.
Lie on your abdomen with hands at your sides.
Place a towel under your forehead and a pillow
under your abdomen for comfort.
Keep the abdomen pulled in, feet down and
head in a normal position.
With hands at sides, lift your upper back while
Model: Bernadette Morgan
Location: Mission Valley YMCA, San Diego
Continued on page 12
C h a n g i n g t h e Way We A g e ®
Functional U® May-June 2011
Continued from page 11
pinching shoulder blades together.
Keep the upper back and neck aligned; do not
tilt your head back.
Hold for 1 to 3 seconds. Relax and repeat.
Inhale going up and exhale going down.
Prone leg lifts
Purpose: Strengthen lower back and buttocks;
stretch hip flexors
Advanced prone
trunk lift
Add hand weights
Lie on your abdomen with hands at your sides.
Place towels under your forehead and
shoulders and a towel or pillow under your
abdomen for comfort..
Bend your right leg slightly and lift your thigh
off the floor. Keep the foot relaxed.
Lower and repeat 10 times.
Lower the right leg, lift the left thigh. Repeat
10 times.
To progress, add an ankle weight that is heavy
enough that you cannot lift it more than 10
times. If this causes back pain, try adding
another pillow under your abdomen.
Basic abdominal exercise
Purpose: Strengthen abdominals
(No photo)
Lie on your back with knees bent and feet
flat on the floor with a small pillow under
your head. There will be a little space between
the floor and the arch of your low back.
Pull in the abdomen to tighten the muscles.
Think about pulling your navel in toward your
spine. Try to keep the space between the floor
and the arch of your low back.
Hold for 2 seconds.
Relax. Repeat 10 times.
To progress, add the leg slide or arm raise.
Basic abdominal exercise with leg slide
Perform the abdominal pull-in exercise.
Slide one leg out as far as you can, keeping
your abdomen pulled in.
Return to the original position while keeping
your abdomen pulled in.
Relax. Repeat 5 times with each leg.
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C h a n g i n g t h e Way We A g e ®
Basic abdominal exercise with leg slide
Basic abdominal exercise with arm raise
Perform the
abdominal pull-in
exercise.
Keeping your
abdominal
muscles pulled in,
bring one arm up over your head with your
elbow straight, while squeezing your shoulder
blades in, and then return it to your side.
Keep your abdomen tight and your back in
the starting position without letting it rise off
of the floor as you move your arm.
Relax. Repeat 5 times with each arm.
To progress: Once you can do this without
your back lifting off the floor, raise both arms
at the same time.
Lean back
Purpose: Strengthen abdominals
(No photo)
Sit erectly near the edge of a chair.
While engaging the abdominal muscles (good
cues include hollowing/pulling in, tightening
like pulling up a zipper on a tight pair of pants,
pulling the bellow button toward the low
back), lift one knee.
While exhaling, lean back 5 to 10 degrees
while keeping good alignment from the ischial
tuberosities to the top of the head.
Repeat, alternating legs.
Chair rises
Purpose: Strengthen legs; help prevent falls
Sit on the front edge of a chair and rise to a
standing position and gently sit back down
without using your arms. It may be helpful to
cross your arms on your chest to prevent
using them.
Keep your knees and feet hip width apart at
all times.
Use the strength of your legs to stand and sit.
If you are not able to do this without using
your arms, place a pillow on the chair.
The goal is to stand and sit 10 times in a row.
To progress: Use a lower chair.
Functional U® May-June 2011
Continued from page 9
vertebral compression fractures with impaired
functional status. Am J Med 1993;94:595-601.
5. Shipp KM, Guess HA, Ensrud KE, Nevitt MC,
Kado DM, Cummings SR. Thoracic kyphosis and
rate of incident vertebral fracture. J Bone Miner
Res 2002;17:S174.
6. Roux C, Fechtenbaurn J, Kolta S, Said-Hahal R,
Briot K, Benhamou CL. Prospective assessment
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7. http://www.nof.org/osteoandyourspine
8. ww.nof.org/aboutosteoporosis/movingsafely/
moving
9. Jull GA, O’Leary SP, Falla DL. Clinical assessment
of the deep cervical flexor muscles: the
craniocervical flexion test. J Manipulative Phyiol
Ther 2008;31:525-533.
10. Tsao H, Druitt DR, Schollum TM, Hodges PW.
Motor training of the lumbar paraspinal muscles
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in patients with recurrent low back pain. Amer
J Pain 2010;11:1120-1128.
11. Sinaki M, Itoi E, Wahner HW, Wollan P, Gelzcer
R, Mullan BP, Collins DA, Hodgson SF. Stronger
back muscles reduce the incidence of vertebral
fractures: a prospective 10 year follow-up of
postmenopausal women. Bone 2002;30:836-884.
12. Tsao H, Hodges PW. Immediate changes in
feedforward postural strategies following
voluntary motor training. Exp Brain Res
2007;181:537-546.
13. Bennell KL, Matthews B, Greig A, Briggs A, Kelly
A, Sherburn M, Larsen J, Wark J. Effects of an
exercise and manual therapy program on physical
impairments, function and quality of life: a
randomized, single-blind controlled pilot trial.
BMC Musculoskeletal Disorders 2010;11:36.
14. Bautmans I, Van Arken J, Van Mackelenberg M,
Mets T. Rehabilitation using manual mobilization
for thoracic kyphosis in elderly postmenopausal
patients with osteoporosis. J Rehabil Med 2010;
42:129-135.
15. Katzman WB, Sellmeyer DE, Stewart AL, Wanek
L, Hamel KA. Changes in flexed posture,
musculoskeletal impairments, and physical
performance after group exercise in communitydwelling older women. Arch Phys Med Rehabil
2007;88:191-199.
16. Greendale GA, Huang MH, Karlamangla AS,
Seeger L, Crawford S. Yoga decreases kyphosis
in senior women and men with adult-onset
hyperkyphosis: results of a randomized controlled
trial. J Am Geriatr Soc 2009;57:1569-1579.
17. Ball JM, Cagle P, Johnson BE, Lucasey C. Lukert
BP. Spinal extension exercises prevent natural
progression of kyphosis. Osteoporos Int
2009;20:481-489.
18. Gold DT, Shipp KM, Pieper CF, Duncan PW,
Martinez S, Lyles KW. Group treatment improves
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Spine 1981;6:93-97.
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21. Bouxsein ML, Myers ER, Hayes WC.
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Resources
Bone Health and Osteoporosis: A Report
of the Surgeon General
US Dept of Health and Human Services
www.surgeongeneral.gov/library/bonehealth/
Boning Up on Osteoporosis: A Guide to
Prevention and Treatment
103 page PDF
Protecting Your Fragile Spine
16 pp PDF (consumer resources)
professional resources
National Osteoporosis Foundation
www.nof.org/
Move It or Lose It: How exercise helps to
build and maintain strong bones, prevent
falls and fractures, and speed rehabilitation
www.icaa.cc
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C h a n g i n g t h e Way We A g e ®
International Osteoporosis Foundation
www.iofbonehealth.org/publications/moveit-or-lose-it.html
Protect the spine through exercise
Article by Karen Kemmis, PT, DPT
Sept-Oct 2010 Functional U
International Council on Active Aging,
articles archive
www.icaa.cc
Stand Tall Exercise Program
Wendy Katzman, PT, DPTSc, OCS
DVD of a group exercise class
American Physical Therapy Association
Section on Geriatrics “Online Store”
www.geriatricspt.org
Functional U® May-June 2011