By H. Silvio. Louisiana Baptist Universty.

The relapse prevention model was developed to treat addic- tive behaviours cheap 100 mg viagra mastercard erectile dysfunction causes natural treatment, such as alcoholism and smoking (Marlatt and Gordon 25mg viagra visa impotence at age 70, 1985). The model proposes that relapse may result from an individual’s inability to cope with situations that pose a risk of return to the previous behaviour. For example, a former smoker finds himself or herself in a social situation with lots of smokers and is tempted to smoke. Thus, helping the individual to acquire strategies to cope with high-risk situations will both reduce the risk of an initial lapse and prevent any lapse from escalating into a total relapse. Simkin and Gross (1994) assessed coping responses to high-risk situations for exercise relapse (e. The study found that 66% of par- ticipants experienced a lapse (defined as not exercising for one week) and 41% experienced a relapse (defined as not exercising for three or more consecu- tive weeks) over the 14 monitored weeks. Participants who experienced a relapse reported significantly fewer behavioural and cognitive strategies to cope with high-risk situations, compared to participants who did not relapse. These findings suggest that acquiring effective strategies to cope with high-risk situations may prevent relapse. Relapse prevention training (Simkin and Gross, 1994) involves teaching individuals that a lapse from exercising (e. The individual is encouraged to identify situations that are likely to cause a lapse. Potential high-risk situations relevant to exercise can include bad weather, an increase in work commitments, change in routine, injury or illness. Individuals are encouraged to develop a plan to cope with these high- risk situations. For example, increased work commitments could be overcome by rescheduling an activity session or engaging in a shorter bout of activity. Studies have used relapse prevention strategies to improve exercise adher- ence in the general population (King and Fredrickson, 1984; Belisle, et al. Description of how each component of the TTM is addressed during exercise consultation Component of Exercise Consultation Description of Strategy TTM Strategy Decisional balance Decisional balance table Perceived pros and cons of being active Self-efficacy Exploring activity options Providing realistic and setting goals opportunities for success and achievement Experiential Processes Consciousness raising Decisional balance table Providing information about the benefits of physical activity and discuss the current physical activity recommendations Dramatic relief Decisional balance table Discussing the risks of inactivity Environmental Decisional balance table Emphasise the social and reevaluation environmental benefits of physical activity Self-reevaluation Review current physical Review current physical activity status and assess activity status and assess values related to physical values related to physical activity activity Social liberation Exploring suitable activity Raise awareness of options potential opportunities to be active and discuss how acceptable and available they are to the individual Behavioural Processes Counterconditioning Exploring suitable activity Discussion of how to options substitute inactivity for more active options (e. Another study evaluated the effect of relapse prevention techniques to maintain physical activity for six months after completion of a six-month home-based exercise programme (King, et al. Fifty-one sub- jects were randomised either to receive strategies for improving exercise adherence, including daily self-monitoring of activity and relapse prevention, or to a comparison group who underwent weekly self-monitoring of activity. The intervention group engaged in significantly more exercise sessions over the six-month period, relative to the comparison group. Therefore, daily self- monitoring of activity levels and relapse prevention training is associated with exercise adherence. Overall, these behaviour change models have been used to understand exer- cise behaviour change in non-clinical and, to a lesser extent, in clinical popu- lations. These theories have identified factors influencing physical activity participation: exercise self-efficacy, perceived pros and cons, use of cognitive and behavioural processes and ability to cope with high-risk situations. In addi- tion, evidence suggests that interventions based on these models are effective in increasing and maintaining physical activity. CONDUCTING AN EXERCISE CONSULTATION In 1995, Loughlan and Mutrie published guidelines for health professionals on conducting an exercise consultation (Loughlan and Mutrie, 1995). However, more recently it has been adapted for use with clinical populations, including people with Type II diabetes and CR participants (Hughes, et al. This section describes the components involved in delivering the exer- cise consultation to cardiac rehabilitation participants. Counselling skills A key element of the intervention is that the consultation is client-centred, which means that individuals should consider their own reasons for being active and should choose their own activity goals.

The intervention group showed an improvement femoral head seen in subcapital fractures buy discount viagra 50mg on-line erectile dysfunction psychological treatment. This nondisplaced fractures are often treated with internal fix- benefit was lost effective viagra 50 mg erectile dysfunction boyfriend, however, if patients stopped having ation, using nails or pins. In osteoporotic provided in a stroke clinic to 40 patients who were, on patients, subcapital fractures may be treated with average, 3 years poststroke. Significant Weightbearing to tolerance is allowed by the 2nd or 3rd improvements in balance and ADL performance were day. Three months following the intervention, the tion and internal fixation, often using a compression patients’ skills in balance and weight shifting, as well as screw. With this procedure, the patient usually can bear their ADL scores, were maintained. In the patient with a femoral neck fracture who has preexisting joint disease, a total hip prosthesis also may be indicated. Stabilization of Many patients with hip fractures can benefit from reha- life-threatening medical problems should occur before bilitation. If the patient is alert, preoperative payment in hospitals, more patients with hip fracture are evaluation by physical and occupational therapy and sent to nursing homes for longer periods of time. The patient can begin quadriceps contrac- been shown to be cost-effective,73,74 but inpatient reha- tions and, on the 1st postoperative day, can sit up and bilitation has not. Adduction, excessive flexion, and sions per week postoperatively are associated with better abduction at the hip should be avoided if the joint has health outcomes. The patient should support no independence in bathing and transfers, family involve- more than 20% to 25% of total body weight on a cane. Early discharge and home rehabilitation should be considered for those with (1) good health (the absence of significant medical prob- lems), (2) strong social supports (someone who can provide assistance), and (3) adequate performance of ambulation and activities of daily living within 2 weeks of surgery. The remainder may require more intensive therapy that can be effectively provided in a rehabilita- tion nursing facility. Lower Extremity Amputation Although most patients who experience a lower extrem- ity amputation (LEA) are between 51 and 69 years old, the age-related incidence of LEA in persons over age 80 has increased significantly. The older person’s care is more complex after amputation because of upper extremity weakness, underlying cardiovascular problems, skin that is prone to breakdown, and poor balance mechanisms. Older persons are more likely to have subsequent amputations on the contralateral side. The elbow is flexed 20° to 30° crucial role in managing these problems and in helping when holding the cane at the side. In frail older persons, the decision as to level of ampu- tation is often difficult. Stair training begins during the second week 90% success rate for healing a transtibial amputation. Patients need to practice advancing the walker attempts should be made to avoid serial amputations about 20 to 30 cm, then advancing the weak leg, and then (e. Some older persons may find it easier to transfemoral) because prolonged bed rest and its atten- advance the good leg first, but this practice increases dant complications are more likely. Crutches are very difficult for most There are three major types of lower extremity older persons to use. It must be remembered that special amputations: partial foot, transtibial (also called a below- walkers are needed for going up stairs and that it is very the-knee or BK amputation), and transfemoral [above- difficult to carry objects while using a walker. Partial foot amputations generally do walkers with three or four wheels are available that are not require postoperative rehabilitation. Patient acceptance of these walkers is better than of achieving independent ambulation.

The Women’s Health Initiative discount viagra 75 mg erectile dysfunction diabetes, a reducing bone loss at critical periods safe 25 mg viagra erectile dysfunction pump surgery, such as during the multioutcome trial of estrogen use as protective for hip perimenopausal period. This if not more important, were risk factors that contributed finding, plus options now available with other medica- to the fall leading to fracture. Early studies identified tions, have opened the questin of whether estrogen is the those at risk of falling and demonstrated some overlap first-line treatment for osteoporosis. In addition, following the better prospectively establish the role of falling in rela- observation that older men are experiencing a major tion to risk of fracture. The largest of these, the Study of Osteoporotic Fractures, established that bone mineral density and falls Summing Up were both risk factors for fracture. Furthermore, risk factors contributing to both lower bone mineral density, Thus, epidemiologic methods have contributed to a such as smoking, and risk factors contributing to risk of complex and dynamic understanding of risk of disease in falling, such as reduced vision and strength, also con- old age, identifying factors that are related to "classical" tributed to risk of fracture. Tinetti and col- they relate not to one organ system specifically, but iden- leagues identified that risk of falling was modifiable by tify how even small deficits in multiple organ systems can testing an algorithmic approach to diagnosis and inter- contribute to risk of poor health outcomes in old age. Many of these to prevent fracture needed to account for the hetero- contributions have been incorporated in a variety of geneity in the at-risk population, as the goal was to evidence-based practice guidelines, and the possibilities prevent fractures without increasing fear of falling, which for the future are bright. Epidemiology can be an impor- could itself lead to decline in functional independence. The Fracture Interven- and psychologic problems of the elderly, to identify new tion Trial established the efficacy of alendronate first in avenues for intervention and to test these interventions, prevention of vertebral fractures and later for hip frac- and to adapt the interventions to the practical realities of 50 T. In this way, epidemiologic method can func- ing maximum height and distinguishing birth cohort effects tion as an important adjunct in the mission of promoting from actural loss of stature with aged. The dynamics of dimen- of being overweight and change in weight on risk of coro- sions of age-related disability 1982 to 1994 in the U. The therapeutic challenge of systolic hyper- adults: Expanding familiar approaches in the Health ABC tension. Hypertension versus catastrophic disability: a longitudinal view of the dis- and risk of stroke in an elderly population. Five-year findings of the hypertension deterc- Hypotheses about the bottom of the iceberg. Mortality and protective effect of emotional vitality on adverse health morbiditiy results from the European working party on outcomes in disabled older women. Prevention of stroke sectional relationships between religion, physical health, by antihypertensive drug treatment in older persons with social support, and depressive symptoms. Longitudinal tiated and administered by the National Heart Foundation changes in serum cholesterol in man: An epidemio- of Australia. Type of fall and risk of hip and infarction on magnetic resonance imaging and neuro- wrist fractures: the Study of Osteoporotic Fractures. SHEP Cooperative intervention to reduce the risk of falling among elderly Research Group. Effect of derived from relative risks: an analysis applied to the alendronate on risk of fracture in women with low bone population of Sweden. Rela- parison of the effects of raloxifene and estrogen on bone in tive contributions of aging and estrogen deficiency to postmenopausal women. A hypothesis: the causes of hip Women’s Health Initiative clinical trial and observational fractures.