Get Active, Get Creative: Lessons from MOVE by Caroline Williams

By Rachel Glaser Cherewaty, PT, MSPT, and Mary Wiseman, PT, DPT, CVT, GCS

Do you remember when it was torture to sit still? We dreaded the long days of school, bleary-eyed from fluorescent lights, waiting to run out as soon as the bell rang. Even our parents seemed to understand the necessity of getting outside and would prompt us to “GO OUT AND PLAY.” Do you still have moments when you just need to move? Perhaps you table a thought and go for a walk, exercise, or get a coffee? 

As physical therapists, we know how important movement is when it comes to treating our patients. When we get up, move, and change our environment, our brains are stimulated and work better. Movement helps our brains. Our brains, bodies, and minds are interconnected. The book we are exploring, MOVE by Caroline Williams, explains how.

The Importance of Movement for Older Adult Patients

Movement frees us from boredom and sparks new thoughts. We know that movement is good for everyone, especially our patient population of older adults. Loss of physical activity and declining cognition are interrelated. We are aware of this with our older adults, but it is also occurring in younger populations. IQ scores are dropping for the first time in 100 years. How can we not see the relationship? Aerobic capacity increases blood flow to the brain by 20-25% and doing it standing adds another 10-15%! We must use it or lose it!

Bearing weight causes our bones to release osteocalcin. Osteocalcin crosses the blood-brain barrier to improve memory and thought processes, and tells the muscles when to move. Standing up wakes our brain and gets it ready for incoming information. This helps to keep us safe. 

6 Pro Tips for Clinicians Who Want to Help Patients Move

1. Play Music to Get Your Patients Moving to the Beat

STAND UP! You’ve got to move it, move it! Our brain activity synchronizes sound with movement. Have you ever heard a song that you just couldn’t help moving to? We are designed to match our steps to 120 beats per minute (bpm) for ideal brain and mood-boosting power! “Don’t stop believing” that this can work for you! I bet “the DJ who got us falling in love,” knew this to be true! We can raise our glass to that! (Journey, Usher, and Pink knew how to get us grooving.) 

Dancing or running to match that 120 bpm opens up our emotional connections, builds bonds with other people, and moves us away from our conscious thoughts. Interestingly, music also calms us by operating on altering our brain waves.

Again, aim for 120 bpm. There are playlists on the internet! Groove is in the heart (and brain!)

When we ask our patients which muscles were the first to go, they often answer their legs and then their arms. Is this true? We see quite a number of people walking with increased trunk flexion, sometimes using a device. Why are they not standing upright? Sometimes it’s pain, but often it’s due to loss of core strength. Lose the core muscles and one starts to “hang from their hips” by their ligaments. Thus, causing pain, which worsens when the spine fixates to this position and they no longer can stand upright. Without strong core muscles, the person has to focus on keeping their upper body upright. If they are focusing on their posture, they will have a harder time with cognitive processing. 

2. Movement Promotes Positivity

Have you ever asked your patient a question only to find that they needed to sit to respond or they stare at you blankly as if trying to figure out what you are saying? The core muscles are weak and they can’t think to answer your question because their thoughts are focused on staying upright and not falling.

Of all the people you have met, do you recall knowing someone with strong core muscles, active, but simultaneously was suffering severe stress, depression, and anxiety? One would venture a guess to say far and few between. In the last ten years, a neural pathway was found connecting core muscle movement control with the adrenal glands of the kidneys. 

In short, activating the core affects the adrenal medulla found inside the adrenal glands. Also connected to the adrenal glands is cognitive thinking, emotional regulation of the prefrontal cortex, and even the muscles that enable a person to smile “all the way to their eyes.” How can we fit this into the treatment for our patients? Find an activity that makes them smile or even laugh, but also engages their core. Positive relaxation and stress relief will follow. Even fake smiling will help!

You can even actively encourage positivity by telling jokes! Belly laughing is a great way to engage the core! Work on strengthening the core to reduce mental health deterioration. Stronger core, more confident the person! 

3. Stop Sitting

What position do we find most of our patients? Sitting. What happens while sitting? Our psoas muscle shortens. This muscle connects the lumbar spine through the groin to the thigh bone. Tight psoas muscles contribute to lower back pain and groin pain and give us a hard time standing upright. Eventually this shortened muscle will contribute to difficulty walking because it can’t effectively contract further to flex the hip to get the foot off the ground. 

Furthermore, as this is the muscle that gets activated when we need to walk or move away from something, having it constantly turned on creates a low-level stress response. Constant stress instigates anxiety, depression, and adrenal fatigue, which can limit muscle strengthening and stamina, especially in cases of respiratory impairment or oxygen deficits. Can prolonged sitting cause stress? YES.

The population, especially our aging adults, shows increasing statistics of anxiety, depression, and low levels of self-worth or confidence. If we were able to get our patients on their feet (increasing blood flow to the brain), moving forward in any form of aerobic capacity (literally as this creates a positive mood and even better if a high stepping or springy gait) and boost their memory protection with a release of hormones, this would increase their physical state, improve their cognition, and make them happy! Want to make them even happier? Have them throw their hands up in the air. Phenomenal mood boost! Big amplitude movements up and down (moving the arms or jumping), walking or moving with lightness on your feet (not shuffling), and repetitive rhythmic movements all improve moods.

4. Don’t Think, Just Move

Our patients want to feel needed and useful. With age and decreased physical activity, the body does not do what it used to do and the person’s confidence and usefulness fades with it. Without movement, we lose our proprioception and interoception. 

Have you ever had a patient try to complete a movement and you wondered, “What are they doing?” Without physical capabilities, our older adults are getting more “into their heads” and their thoughts. The result is decreased awareness of what their body is doing. How many patients have you had that stare at their feet to see where their feet are being placed? Proprioception is declining. How many patients have you had with orthostatic hypotension from moving sit to stand? Interoception is fleeting. Our patients need to get out of their heads and into their bodies.

5. Get Your Patients Stretching, Jumping, or Bouncing

Have you ever had a patient with poor flexibility? Myofascial releases are manual techniques that can help untangle this fascia. Fascia holds every memory that the body has experienced whether the person had a fall, improper posture due to bad mood, a car accident, and so forth. Fascial tightness can cause pain, irritate nerves, and affect the body in mysterious ways. Fascia likes to move and the best way to keep it moving is to keep the body moving. 

Stretching can improve flexibility. Movement can return the strength and spring (elasticity) to the fascia. When was the last time you asked a patient to jump? Precautions in mind, try having the patient hold onto a counter and jump. See how their body responds. This will give you an idea of what the fascia is doing and not just the muscles. Can they land lightly on their feet? It will make them happy when they can. If the patient is not able to stand well or if they’re too nervous, have them sit on their bed and try bouncing. When was the last time you as a therapist skipped, hopped like a frog, bounced your bed? If you are going to have your patient do it, and you SHOULD, then just be sure you can do it first.

6. Encourage Sleep and Rest

Our bodies are meant to be thoughtful athletes. Our bodies are meant to be calm and relaxed unless there is danger nearby. Our bodies are also meant to rest. This is not strictly regarding nighttime sleep, but daytime rest, too. 

Rest does not have to be sitting with our eyes closed. Rest can be as active as you like or are able. The difference is that sleep puts you through REM cycles. Rest can be going for a hike or reading a book. The rest activity has to take you away from the stress even if that stress is in your mind.

Movement is Important for Clinicians and Patients Alike

Movement is essential to maintaining a healthy body. But that’s not just true for our patients. As we’ve mentioned throughout this article, clinicians also need to be mindful of how often they’re moving. It’s easy to get stuck in a routine, but by following these pro tips, you can make life better for not only your patients but yourself as well. 

For more tips on movement, be sure to check out MOVE by Caroline Williams.