40. Fall Prevention & Get Moving with Dr. Mariana Wingood

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Welcome back to Ask Dr.

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Mia podcast.

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Today I have Dr.

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Mariana Wengood with me.

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She is a physical therapist, but not only a physical therapist, but a board certified geriatric specialist.

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She also works at Wake Forest University School of Medicine within both the department and the section of gerontology and geriatrics.

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geriatric medicine, but also in the Department of Implementation Science.

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Dr.

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Wingood is very much focused on empowering older adults to be more active, and that's been her research focus, and that she holds multiple leadership roles within national physical therapy organizations, as well as presentations, manuscripts, book chapters.

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with her research.

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So welcome to the podcast, Thank you.

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Thank you so much for inviting me to be part of this really important podcast.

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really honored to be Thank you.

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So one of the first questions that I want to ask you is, you know, I'm just curious, how did you get interested in physical therapy and especially in geriatric physical therapy?

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Yeah, I actually am one of those few people that knew that I always wanted to work with older adults.

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My grandma was a really big part of me growing up and my development of life.

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And I never got the chance to thank her.

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So I wanted to go into geriatrics to provide my services to older adults in a way to thank all older adults.

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for all that they have done for us and our society.

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And the reason I chose PT is because I love exercise and physical activity and I love that we can use exercise and physical activity for so many health benefits, both physical and mental.

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So just made sense that I should go into PT and geriatrics particularly.

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That's wonderful.

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Yeah, I think we both share the influence from our grandparents.

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I was raised in China, grew up with my grandparents until I was 12.

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And I feel like so many people who are interested in geriatrics have such fond memories from either their own family or older adults in their life who really influenced them in formative years.

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So we're glad that you're also in geriatrics as well.

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But that relates to another question, which is, You you're someone who have always been interested in physical activity, but I know not even older adults, but just people in general oftentimes find it so hard to get motivated, to get moving.

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And a lot of times I hear both from older adults themselves, but even from their families as to how do I get myself or get my loved ones to move Yeah, you know, whenever I work with older adults who are struggling to get moving, the number one thing is really learning what is important to them, what matters for them, and really using that as their motivator.

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For example, a lot of my patients, their number one goal is be independent and be able to take care of themselves.

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So we talk about the things that are essential to do that.

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And a lot of times that means getting up out of a chair, being able to walk around the house.

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And so to do that, there are specific exercises that people can do to maintain that.

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So we kind of really focus on what matters to them.

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And go that route, but the other piece is also what interests them I hand out the I am NOT a dancer of any kind but a lot of my patients like dancing so we create physical activities related to dancing I have some patients that love gardening may not be in a raised garden bed or a garden bed that's on the ground You know, how can we incorporate that into physical activities?

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So it doesn't have to lifting baits or going to a gym.

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It can be done in the home or outside whatever environment they prefer.

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So just picking what matters to them and what they enjoy.

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That's amazing.

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I've never heard of incorporating physical therapy into gardening.

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What would be an example of an exercise with, I mean, I know it's a lot of being on your feet and on your knees.

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Yeah, you go Yeah, a great example, mean, especially if they are on a raised bed, one thing people can do is, for example, rise up on their toes as they're reaching for something.

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So that's a good way to incorporate toe rises or heel rises, I mean.

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Another piece that they can do is if they're picking up something from the ground to put on to the raised bed, squatting down a few times to pick up that, before they pick it up and put it onto the raised bed, incorporating it that way, or working on reaching to work on people's balance, standing at the raised bed without holding on, reaching as far as you feel comfortable, and then coming back to the middle.

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Those are some pieces of strength and balance.

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That's a great, those are great examples.

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I'm not a gardener, but I know a lot of people love gardening and I, for very little, you know, vegetable garden that I have, I do feel like there's a whole lot of bending and squatting and you know, those are very important muscles for older adults.

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I see as well when I say, you know, your quads are the thing, the muscles that are going to be weak.

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And if you fall and your quads are weak, you can't get back up.

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So when put in those terms, feel like they're, nobody wants to be a burden and fall down and not be able to get back up themselves.

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yeah, those are great.

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So to summarize, to find something that is a motivating factor for the person who's trying to get more exercise and to incorporate something that they would find enjoyable or fun.

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Yeah.

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Okay.

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And then, sorry, I was just gonna add one other piece is some people socializing and having a social aspect is really essential and for some individuals that's not something they prefer.

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So learning about if that's a preference they Gotcha.

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Yeah, I feel like there may be a lot of exercise classes that incorporate that social aspect for people who are fairly functional and maybe want to improve their physical endurance.

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But I think it's a little harder to find or maybe you can tell me if I'm incorrect.

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It seems to me a little harder to find for people who lower in terms of their endurance or functional ability and are trying to either recover some physical function that they lost or you know really have very little endurance to to be able to do like a regular exercise class.

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Yeah, there's actually a lot of great options through local community centers or senior centers, as well as parks and recreational departments.

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Like I know a really popular one here in Winston -Salem is chair volleyball, where you sit in a chair and you play volleyball over a net and people love it.

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And, you know, there's matter of balance is a great way to get into exercise when people are fearful of falling.

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There's also a lot of great Tai Chi programs and there are programs available.

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They can be challenging to find.

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A good place to start is the senior centers and libraries and churches.

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Those tend to have some great programs available.

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What was the second one you mentioned matter of balance?

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Matter of balance, yeah.

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So a matter of balance is an evidence -based program that's been really shown to address fearfulness of falling, particularly.

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And then it also incorporates some exercises to do for your fall risk.

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it is an evidence -based program that's put on a lot of times by state aging associations, as well as falls coalitions.

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fall free coalitions and the state.

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know in North Carolina they got a big grant not too long ago to really disseminate the Matter of Balance program and I know here within our county we have about six of them I believe.

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So there is a good number of them and I unfortunately heard that one did not happen this month because there was just not enough interest for it.

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And I don't think it's a lack of interest.

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think just people don't know about it because it's not really well advertised Yeah, Yeah, exactly.

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That's great.

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And I can also include some matter of balance information in the show notes for the audience who's listening.

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So that kind of relates to another very common thing, which we both see people who fall and may have done a period of physical therapy, whether it's outpatient or in the home.

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And then it seems like they're their improvement plateaus and that they may be interested or their family might be interested in continuing some sort of physical activity, but because insurance stops paying, then it becomes much harder for those older adults to kind of stick with an exercise regimen.

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Yeah, I really, really hope that whatever PT they're seeing has created a plan for them to follow after PT services are done.

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But if that's not the case, think going back to would they prefer to do it in a social setting, something such as matter of balance, enhanced fitness, or Tai Chi.

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or would they like to prefer to do it at home by themselves.

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There are Go4Life, which is put on by National Institute on Aging, has great videos on exercises and recommendations for older adults regarding that.

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That's a great resource for people to turn to.

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On YouTube, there's also wonderful fitness classes for a variety of levels of mobility.

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So finding something on there is also an option.

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So there is some options out there, but I really hope that their physical therapist provides them with a program after they are done.

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Yeah, yeah.

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And I think most physical therapists do provide sort of a home exercise program.

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I think, you know, as human beings, when we have the accountability of another person, like whether it's physical therapist or personal trainer, we're much more accountable to actually do it than if we, you know, don't have that accountability.

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Yes, and family and friends can help as accountability buddies as I like to call them.

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One, mean, I am naturally a runner and I know a lot of people running is not a thing they enjoy, but there's still days where it's hot outside or freezing cold outside and you don't want to go out.

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But hey, you told your friend Sarah that you would meet them for a run.

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Now you really can't back out even though you want nothing to do with the 99 degrees and 100 % humidity or negative 20 degrees, whatever, you may be.

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So having accountability buddies I think is always helpful.

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Absolutely.

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And this weather, feel like as soon as I step out, I start sweating.

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I don't even have to run.

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is telling me that it's 100 % humid out right now.

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That's right.

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Another big fear for a lot of my patients is injuries, you know, and it doesn't take a whole lot sometimes to be injured, sometimes even just stepping wrong on the curb can spring an ankle.

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What can older adults do if they want to sort of minimize injuries, particularly if they may not have the financial resources to say hi or personal trainer or have sort of one on one type tips.

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Yeah, so number one way to avoid injuries is to be active and build muscle, which seems counterintuitive at times, especially if you're afraid of getting injured by being active.

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One way to start is to start doing things seated initially and then progress to standing with a safe counter or stable surface in front of you.

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Sometimes I tell people if they're afraid of getting injured or falling even to do their exercises in a corner of their house or room.

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So that way they have two walls behind them and they can have a chair in front of them so they're supported in a circle and nothing can happen to them in that way.

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So creating an environment where they feel comfortable and slowly progressing to more challenging things as they feel comfortable.

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or doing exercises in front of a bed.

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If you fall backwards, the worst place you're gonna end is on your soft bed.

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Then the hardest part may just be getting back out of the bed.

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Because I don't know about you, but when I lay down at night, I am out like a light.

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Because I'm usually very tired from the day.

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But so those are some options to help with that fear of injury.

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Gotcha.

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And also I think after people are injured, getting back into exercise is also challenging.

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Any advice you have as people kind of recover from injury?

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Yeah, I mean, I'm slightly biased as a physical therapist, but one way is to go and work with a physical therapist.

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Ask your primary care provider for a potential referral or reach out to your physical therapist, local physical therapist to see about setting up an appointment.

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It is covered by Medicare services, so most older adults do have benefits related to physical therapy services.

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Great, yeah, and I certainly have ordered physical therapy, whether it's at home or outpatient, even when I'm not the primary care.

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I see a lot of people in memory clinic and there's a lot of cognitively associated fall and balance problems as well.

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So it doesn't have to be your primary care, but can be by other specialists as long as they've seen you in person.

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Oftentimes those require some sort of face -to -face type clinical encounter to justify the ordering of physical therapy.

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Sorry, that paused a little bit.

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Can you hear me okay?

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Okay.

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for a little bit, yeah.

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But I'm so happy that you're able to provide orders for people even if you're not directly seeing them.

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Thank you for caring.

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Yeah, I just get all of the home health orders follow up, which is the, you know, the other side of assigning all those orders.

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But those are, you know, yeah, they're not they're not a whole lot of work.

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And so in terms of some of the resources that you mentioned, you know, besides ordering physical therapy, I know a lot of YMCA's have silver sneakers.

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going to the senior centers locally.

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There's eldercare .gov, the website can, you can plug in your loved one or your zip code and find the senior organizations in your local area.

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I'll include that in the show notes as well.

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What other types of resources you mentioned, there are some on YouTube, Matter of Balance.

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Are there other ones that you particularly like or commonly tell your patients about?

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Yeah, so there's the go for life, which is on NIA, which is the National Institute on Aging's website.

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They have some great they have even like documents regarding five tips to help you stay motivated and worksheets for physical activity.

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And they have great.

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YouTube videos for 15 -20 minute exercise classes.

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And then there are a number of YouTube videos for individuals that want to start by doing sitting exercises.

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Finding just sitting exercise videos is a good way to start moving to standing videos.

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And I don't have particular favorite ones.

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It really depends on the person.

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I usually type in sitting exercises in the search bar and then ask people what the time that they're willing to do the exercises for.

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You know, five minutes, 10 minutes, 15 minutes.

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There used to be a lot of promotion of that exercise needs to be in 10 minutes or more bouts.

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But really we have found that even spreading it out throughout the day in one, two minute bouts is really beneficial.

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So it's really what is the individual able to do as well as what they want to do.

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I have a very short attention span outside of exercise.

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So I understand for some individuals doing something for 15 minutes can be hard.

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So just keeping that in mind that we can decrease Yeah, yeah.

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And I think that's reassuring to hear that, you know, I don't have to work out for an hour or three times a week to get the benefits of exercise or physical activity, even small amounts of increments.

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And I know there are studies even looking at how much time during the day that we're standing or moving versus sitting.

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And I don't know the research as well as I'm sure you do as to the benefit of Not sitting.

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yeah, breaking down sitting time or breaking down sedentary time is actually a lot of times we start with people who are very frail and really are unable to start exercising, but just breaking apart sitting time is really essential.

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So that's one way to start.

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And when you say breaking up sitting time just by getting up to do something, go to the bathroom, get, yeah, okay.

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glass of water or tea.

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If someone watches television, sometimes I set a timer for initially an hour and then every time the timer goes off, just getting up and just even stretching and standing a little bit.

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And then I tend to have people progress to every time there's a commercial break or an ad that comes You know, when that comes up, it's a good time to just stand up and then sit back down.

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So yeah, just breaking up the amount of time, the length of the time you spend sitting.

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And Mariana, tell us a little bit about what kind of research you're doing in this space and what you're excited Yeah, I have a number of projects happening.

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My number one focus is providing actually physical therapists and health care providers with tools that can help older adults be empowered about their physical activity.

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A lot of it is related to setting goals and plans to accomplish the goals and to discuss barriers related to physical activity and finding solutions that are individualized to the person.

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In healthcare, unfortunately, we just don't get a lot of training in that area.

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So I try to develop material and tools that healthcare providers can use to empower their patients.

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That's really my number one thing that I really love talking about.

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just in general, my goal is to try to prevent frailty and falls among older adults.

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So making sure that people are screened early.

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and those things are addressed before they really become an issue.

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Yeah, and you're right.

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We really don't get a lot of training and motivational interviewing or, or, you know, increasing people's sense of self -efficacy when it comes to behavioral change.

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And I think hopefully the medical school curriculum and training environments are changing.

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But I know also a lot of times there's the limitation of time in that, you know, when it gets down a personalized individual motivating factor, it does take time to kind of get down to what is it something that is both feasible and motivating and can be measured and increased over yeah, 100 % agree.

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And that's one reason I've started a physical therapist because they have more points of contact with older adults.

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They see them for longer periods of times and more frequently during those six to 12 weeks that they see physical therapy versus a primary care provider who they may only see once a year.

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Mm hmm.

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Yeah.

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And a lot of things can definitely happen within that interval of time.

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Anything?

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Well, I think your work is always important and especially important in, you know, our health care environment now where there is so little time that we really need to do the best we can in terms of encouraging healthy behaviors and physical activity.

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Anything else that you'd like to share with the audience based on what we talked about today?

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Yeah, I think my only parting thoughts are that every step and every movement you do really does matter.

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No matter what really your goal is, physical activity and exercise can help with it.

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And to not get discouraged when things are hard.

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To just try maybe the next day, never give Yeah, thank you, Mariana.

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feel like that's personally applicable to me right now because I have skipped out my - I said I was going to work out two days ago and then I said, no, I couldn't do it and then I was gonna do it yesterday and then I couldn't do it for various reasons.

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I'm like, okay, I'm gonna do it today.

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after I talk with Mariana because we had a whole conversation about physical activity.

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So I'm gonna go work out now.

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I be your accountability buddy and I will email you later on to see if you did it.

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Okay, we'll do.

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Thank you.

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So thank you for joining me on this episode of Ask Dr.

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Miya Podcast.

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