Why do Falls Happen? (1. Drugs + Alcohol)

Why do Falls Happen? (13/5/15 – Drugs and Alcohol)

Falls happen for several reasons. Some of these are to do with our own body such as poor balance and some causes are outside ourselves such as slippery surfaces. Some of these causes are within our control and we can do something about them. These are the ones I’m going to concentrate on here.

It is useful to look at both causes for falls and risk factors. So what is the difference? Causes are factors mostly responsible for the fall, whereas risk factors don’t cause a fall but make one more likely to happen. Some of both causes and risk factors are controllable by us so I’ll discuss both – but first the CAUSES…..

Most causes can be categorised using the acronym DAME. D = Drugs and alcohol. A= age related physiological changes. M=Medical. E= Environment


Drugs and Alcohol: many prescribed drugs can contribute to poor postural stability and higher risk of falling especially sleeping tablets, antidepressants, antipsychotics, topical eye medications, diuretics (water tablets), vasodilators – for conditions like high blood pressure. If you are on 4 or more medications of any type you are at higher risk of a fall (NICE 2004). If you are on medications it’s a good idea to keep a list of them with details of what they are for, when prescribed etc. you can download a form here that you can use. Keep this list handy and bring it with you on any visit to any health practitioner. It’s also a good idea to have your medications reviewed regularly – so mention this to your GP. Let your exercise instructor know of any changes in your medications.


Heavy drinkers are more likely to fall for obvious reasons. In addition to the  immediate effects of alcohol on balance there can be long term effects. The cerebellum of the brain can be damaged resulting in muscle coordination problems. http://m.livescience.com/16091-alcoholics-long-term-balance-problems.html



There are many different definitions of what constitutes “a heavy drinker” but all the definitions are scarily low levels of drinking by most people’s standards, e.g more than 4 drinks in one day, occurring more than 5 times in last month. So many of us might unknown to ourselves be “heavy” drinkers” and should really try to moderate for all kinds of reasons.



The recommended weekly alcohol limits for both men and women have been cut by Irish experts.

It is now recommended that men should not drink more than 17 alcohol units over a week. Previously, the limit had been set at 21 units.

Women should not consume more than 11 units of alcohol over a week. The limit was previously 14.

A unit of alcohol is a “rough measure of the drink amount that will provide about 10g of alcohol.

For instance, a half pint of beer, a pub measure of spirits and a small glass of wine,” according to guidelines contained in new document from the Food Safety Authority of Ireland (FSAI).

– See more at: http://alcoholireland.ie/home_news/health-chiefs-cut-limits-on-safe-drinking/#sthash.URI0Lky6.dpuf


For those of us who like a glass of wine it’s worth noting that a bottle contains approx 10 units, so if you’re not getting 10 servings out of your bottle – your glass is too big and you’re consuming more units than you think. Use small wine glasses, and always check the alcohol % of your wine. I think 10-12% is high enough for white wine and no higher than 13% for red. The wine is a better wine if it’s not relying on high alcohol and sugars for taste. If you find any really good but low alcohol wines let me know.

Consequences of Falls

Consequences of Falls

Falls do not just cause possible pain and injury which the faller has to suffer and recover from they also have social, psychological and financial effects for the faller, their family and carers and costs to the health service.


Falls can cause cuts, bruises, soft tissue injuries, sprains, dislocations, fractures, increase in pain in existing joint conditions and in the worst cases serious head injuries. 20% of injurious falls result in fractures[ix].


Falls and instability contribute to 40% of nursing homes admissions. Most people want to maintain their independence and continue living in their own home, a fall can have an impact on this as family and friends strive to ensure their loved ones safety and are afraid of the consequences of a fall. This is especially true for older adults living alone.

A fall can result in post fall syndrome or fear of falling where the person has a lot of anxiety associated with falling. They will limit their activities often to the point where their body becomes so deconditioned that they lose function and can no longer walk or carry out their daily activities of living. Reduction in activities can result in social isolation, they may no longer be going out to meet people, and this in turn is associated with decline in mental ability (cognitive impairment). Lack of activity and social contact will affect mood and can result in depression. It is thought that the fear of falling can even be post traumatic stress disorder[x] Fear of falling can be directly responsible for causing an actual fall as fear causes the person to change their behaviour and their gait. ‘Fear’ of falling may be too strong a word, even if the person is aware of THINKING about their moving and walking before they do it, it indicates some level of anxiety.


Even a fall that has caused no injury at all can have serious consequences. In fact a seemingly minor fall can be fatal if the person is unable to get up from the floor or summon help. This can result in what we call a ‘long lie’ – where the faller is on the floor for over 1 hour.  We know that a lie of more than one hour is associated with an increased risk of dehydration, hypothermia, pneumonia, depression, kidney failure and pressure sores (Tinetti, 1993 and 1994).

Lying on the floor for a long time after falling is more common among the “oldest old”, one study[xi] shows that in the over 90’s 80% of fallers were unable to get up after a fall and had a ‘long lie’.

Coming next……………

Who gets an injurious fall?


Risk Factors for Falls


A fall is any slip, trip or fall where you lose your balance and land on the ground, floor or lower level[i]. So it can include a fall downstairs, a fall going up the stairs, a fall to the floor from sitting or lying, sliding out of bed, falling off a kerb or over uneven surface.


Why do we care about Falls?

We all have falls, some of us more than others. My last fall was off my bike a few weeks ago outside Toughers in Naas when I somehow forgot to unclip out of my pedals, luckily only my pride was bruised. In the main there are two types of fallers – those who are relatively young and active who take risks and those who are more vulnerable due to being older or having a condition which makes them more likely to fall. This second group are more cautious, they may be frightened of falling and can even get into a vicious circle of reducing their activity to prevent a fall, which in turns reduces their movement, strength and balance making it more likely for them to have a fall. For example women who spend less than 4 hours a day on their feet (i.e. reduced activity) are twice as likely to fracture their hip compared to those who spend more[ii]. Falls can have significant consequences and for this reason we are concerned with doing all we can to prevent them.

How Common are Falls?

We have  some information from health services about the incidence of falls, however these are just the falls that are actually reported,  falls that don’t actually cause an injury at that time (between 75-80% of falls) are never reported so the full incidence of falls and their medical, physical and psychological effects will never be fully known.

From reported falls, what is known is that 1 in 3 women over 65 will fall each year. For men the no.s are 1 in 5. As we get older it gets worse with 1 in 2 men and women in the over 85’s falling each year[iii].

A study in 2000 (Bandolier) showed that in the UK there is a wrist fracture every 9 minutes and a hip fracture every 10 minutes. It is likely that this even higher now as there are higher no.s in older age brackets. In Ireland today around 11% of the population are aged 65 years or over and this is expected to increase to 18% by 2031[iv]. The prevalence of falls here has increased from 19.6% in 2011 to 22.2% in 2013[v]. The annual cost of falls in Ireland is estimated at €400 million[vi] The falls problem has been identified and many initiatives are in place around the world to tackle it and we can see that it is a growing problem in Ireland also.


We often think that we are safe in our homes and that we need only be concerned about falling outside. This is not the case; 40% of falls in over 65’s occur in the home, and in the over 85’s it goes up to 85% (DTI, 1997). In the 65 to 74 age bracket the kitchen is the most likely place for a fall in the home, whereas in the over 75’s the most common place for falls in the home is the bedroom. Men are more likely than women to have a fall outdoors, women are more likely to have a fear of falling which means they are probably less likely to venture into the ‘less safe’ areas outdoors[vii].


Wrist fracture is the most common fracture in falls in the younger old but later on as we maybe lose strength and speed of response we can’t get our hands out quickly enough and our hips take the brunt of the impact. Wrist fractures have better outcomes, unfortunately hip fractures result in only 20% regaining the mobility they had before the fall (Lord,1992), and 6 months after hip fracture surgery 50% of patients will have died, or entered a nursing home or are back in hospital.


We expect that falls will become more common as our population ages however we wouldn’t necessarily expect that fall related injuries would increase at an even greater rate but this seems to be the case[viii] . This suggests that although we may be living longer our skills in strength and balance are not lasting correspondingly longer so we may be living longer but if we are having injurious falls our quality of life is reduced.



[i] Lamb, S.E. et al., 2005. Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus. Journal of the American Geriatrics Society, 53(9), pp.1618–1622. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2005.53455.x/abstract [Accessed November 29, 2014].

[ii] Cummings, S.R. et al., 1995. Risk Factors for Hip Fracture in White Women. New England Journal of Medicine, 332(12), pp.767–774. Available at: http://dx.doi.org/10.1056/NEJM199503233321202 [Accessed April 28, 2015].

[iii] O’Loughlin, J. L., Robitaille, Y., Boivin, J. F. & Suissa, S. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am. J. Epidemiol. 137, 342–354 (1993).


[iv] Department of Health, (2013). Health in Ireland, Key Trends 2013. Available from http://health.gov.ie/wp-content/uploads/2014/03/key_trends_2013.pdf. [Accessed 29/11/14]

[v] The Irish Longitudinal Study on Ageing TILDA, Trinity College Dublin, University College Cork, (2014), http://tilda.tcd.ie/assets/pdf/Wave2-Key-Findings-Report.pdf

[vi]National Steering Group on the Prevention of Falls in Older People and the Prevention and Management of

Osteoporosis throughout Life, (2008), http://www.hse.ie/eng/services/publications/olderpeople/Strategy_to_Prevent_Falls_and_Fractures_in_Ireland%E2%80%99s_Ageing_Population_-_Full_report.pdf

[vii] Fleming, J. & Brayne, C. Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90. BMJ 337, (2008).

[viii] Kannus, P., Niemi, S., PArkkari, J., Palvanen,M., Vuori,i., Jarvinen,M., (1990), Hip Fractures in Finland, Lancet

[ix] alexander, B.H.F.P. Rivera, and M.E. Wolf, The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health, 1992. 82 (7): p. 1020-3.

[x] Bloch, F., Blandin, M., Ranerison, R., Claessens, Y.E., Rigaud, A.S., Kemoun, G., 2013. Anxiety after a fall in elderly subjects and subsequent risk of developing post traumatic stress disorder at two months. A pilot study. J. Nutr. Health Aging 18, 303–306. doi:10.1007/s12603-013-0415-y


[xi] Fleming, J. & Brayne, C. Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90. BMJ 337, (2008).

Falls Prevention and Improving Well-being

Falls Prevention and Improving Well-being

What: Free interactive Talks – Falls Prevention and Improving Well-being

Where: Scouts Hall Kilcock. As part of Open Door group – but all are welcome.

When: 12 noon Friday 25th April – Session 1 Falls + Falls Prevention

12 noon Friday 2nd May – Session 2 Falls Prevention + Physical Activity

Who: The sessions are aimed at the over 60 age group but anyone is welcome, especially if you have had a fall or are at risk of falling and would like some more information.

By: Fionnuala Corcoran. P.TH M.I.A.P.T (Kilcock Therapy)

Future Plans:

May – August 2014 – Create awareness, Needs Assessment and planning

August 2014 – Special Falls Assessment Month

September 2014 – Physical Activity Programme (yet to be determined, but likely to be twice weekly classes based on evidence based interventions such as the Otago programme (2003))

Full text of Plan


Some of the physical problems affecting the 60+ age group include a reduction in aerobic capacity, flexibility, strength and development of urinary incontinence all of which are implicated in gradual loss of independence and higher risk of falls. Approximately 19% of men, 25% of women and 30% of individuals aged 75 and over have fallen in the last year. Almost 10% of the over 50s population have had an injurious fall (i.e., requiring medical treatment) in the last year.  (TILDA 2014)

Urinary incontinence (UI) is a common problem that can seriously affect an individual’s quality of life, can be embarrassing and consequently go unreported. (NICE, 2013).

Studies have shown that the prevalence of any UI tends to increase up to middle age, then levels off, rising to 35% in 85 year olds. (EPINCONT survey as cited in NICE 2013).

The NICE guideline for management of urinary incontinence in women recommends supervised pelvic floor muscle training (PFMT) as a primary intervention for women with stress or mixed UI. PFMT leads to improvement or cure in two-thirds of patients and there are no adverse effects. Despite this only 20% of those affected seek help for the problem. (EPINCONT survey as cited in (Sjöström et al., 2013).

Physical activity has been shown to be the best intervention for addressing flexibility, strength and falls prevention (Hughes et al., 2009) and it also has the added benefit of having a positive impact on emotional and social well-being.


This proposal is for the development of a programme aimed at the over 60 age group, to initially raise awareness, assess needs and if appropriate progress to delivering a physical activity programme. The programme will incorporate screening and assessment and evidenced based physical activity.(GetIrelandActive n.d.). It will be implemented in a way that enables building capacity and increasing participants control over their health and well-being in accordance with principles of the Ottawa charter(World Health Organization, 1986). It will incorporate a PFMT programme and will be undertaken in a fun and sociable environment. A recent study (Pelaez et al., 2014) shows that incorporation of PFMT into a physical activity programme can prevent UI.

The planning model used for this proposal is from Scriven (2010).



Identify needs, assets and priorities

A normative need has been identified in relation to urinary incontinence prevalence (NICE, 2013)(Lucas et al., 2012)(Buckley and Lapitan, 2009). McCarthy et al (n.d.) report the prevalence of urinary incontinence in Ireland at 33%. General Practitioners in local medical centre have mentioned a need for pelvic floor muscle training.  Kildare Baseline Study (n.d) identifies the prevalence of exercise drops sharply once respondents reach their eighties. The Kildare Baseline study (n.d) also notes that the over eighties seem generally more satisfied with facilities and services than the fifty to eighty age group, although they are also generally less involved in activities. The study shows a strong motivation among the over eighties for maintaining independence. There may be a requirement for creating awareness of the importance of physical activity, the required type of physical activity and its correlation to maintaining independence. Use of behaviour change models like stages of change (Prochaska and Velicer, 1997) and techniques such as reframing (“Main Section | Community Tool Box,” n.d.) may be used to assist in creating this awareness. Further needs assessment will include gathering the views from other health professionals and the target group.  Group work, buzz groups (Scriven, 2010) and other participatory methods (Dempsey et al, 2012) will be used to facilitate participants in identifying individual and group needs, setting priorities, decision making, planning and implementing the programme, thereby empowering them through ownership and control of their own endeavours. (World Health Organization, 1986). Discussion items can include the need for the programme, timing of programme, facilities, transport, access, structure of programme, communication of programme, sustainability, equipment, environment etc.


Aims and Objectives

The project aims are to raise awareness of the importance of physical activity (including PFMT) in the older adult population and to involve them in determining and delivering an optimum physical activity programme that would meet their needs.



Participants will be able to describe the importance and relevance of physical activity for the older adult.


Participants will be able to identify their own current levels of function and performance in basic functional assessments and how these relate to activities of daily living.


Participants will be able to perform physical activity skills for strength, endurance, flexibility, coordination, balance.


Participants will be able to apply physical activity skills learned, to improve functional daily activities at home.


Participants with UI may experience an improvement in their condition and in their quality of life.


(Hughes et al., 2009)(American College of Sports Medicine, n.d.) shows that the above objectives are realistic and achievable. The measurement outcomes are mainly functional tests which participants will become familiar with and will easily understand.


Types of validated measurement outcomes that will be used include:

  • Self-efficacy for exercise (Lorig et al.)
  • Outcome expectations for exercise: using a 17-item scale developed by Seymour (2006).
  •  Exercise adherence self-efficacy: McAuley (1992) barriers scale to assess self-efficacy for exercise adherence in the face of barriers.
  • Lower-extremity muscle strength: a timed sit–stand test to assess lower extremity muscle strength (Rikli et al 2001).
  • Upper-body strength: arm curl test to assess upper-body strength (Różańska-Kirschke et al, 2006 as cited in Hughes et al, 2009).
  •  Upper-body flexibility: back scratch test to assess upper-body flexibility (Rikli, 2001)
  • Aerobic Fitness: Six-minute distance walk (Rikli, 2001) or the 2 minute step in place test (Jones and Rikli, 2002).
  • Urinary Incontinence and Quality of Life Measures: ICIQ-UI SF, ICIQ-LUTSQoL(“ICIQ International Consultation on Incontinence Modular Questionnaire,” n.d.)


The target population is older men and women who need and would like to increase their physical activity in a scientific, evidence based, fun and sociable group setting. Research shows that older people can be very good attendees at group exercise programmes (Manchester Metropolitan University, et al., 2005).

Stakeholders include the participants, participants’ families, local medical centre, participants GP’s, other health care professionals and the practice/practitioner developing the programme.

Addressing inequities, ethical aspects and other considerations

This proposal is to provide a service that currently is not available.(“GetIrelandActive ” n.d.) Participants should have informed choice, the aim is not for compliance. (Scriven, 2010).


Hughes et al (2009) demonstrate that this type of physical activity programme is successful even for participants that are overweight or obese, and have co-morbidities.


Kildare Baseline Study (n.d.) reported that cost is not perceived locally as a barrier to availing of services, and the area is not one of social deprivation (Burtenshaw Kenny Associates, 2012) however the costs will be kept to a minimum to ensure that poverty is not an exclusion factor, and where cost is a barrier for an individual this will be handled discretely to allow participation.


The setting for this proposal (Kilcock Co. Kildare) is a village serving a rural hinterland.  Many older adults (68%), have difficulties making their own way to appointments (Kildare Baseline Study, n.d.). This issue will need to be addressed with the participants and resolved if the programme is to be successful.


Integration of ethnic minorities is an increasing issue within the area (Burtenshaw Kenny Associates, 2012) although this is more relevant in the younger population it will be considered in developing and communicating the programme.




Assets and Resources


In the Kilcock area there is a lack of basic recreational amenities, but there are plans to develop a multi-purpose community facility (Burtenshaw Kenny Associates, 2012) which could be a good location for the planned programme. In the meantime there are other facilities in the Kilcock area which could be used. Local knowledge and being personally known to many in the area is an advantage.


The planned programme fits well into the national age friendly counties programme; whose overarching goal is that “every county in Ireland will be a great place in which to grow old”.(“National Age Friendly Counties Programme Ireland,” n.d.). Contacts will be established to see what resources may be available.


The practice currently collaborates with GP’s in the local medical centre. It is hoped that the medical centre will recommend the programme to patients.


Finance: The financial outlay for the programme will be low, the main investment being in equipment.

Financial Budgeting and planning Skills: Practitioner has extensive financial experience and training.

Marketing: Some limited marketing experience and training.

Equipment requirements: (therabands, balls, chairs, forms to record measures etc.). All of these will need to be researched and procured.

Competence in teaching and delivery of programme: Practitioner has extensive experience and training in teaching and learning.

Knowledge and Research: Practitioner has knowledge and training (IPTAS Level 8 and IPTAS level 7).

Personnel Assistance: Assistance will be required for the initial session.



Achieving the Aims – Methods and Strategies

Research demonstrates that the aims and objectives are best achieved by a group based physical activity programme (Hughes et al., 2009) (Manchester Metropolitan University, et al., 2005), however methods will depend on the needs expressed at needs assessment, views of stakeholders and available resources.


An initial health educational session will be held to raise awareness and assess needs. This will include a talk, question and answer session, facilitated group work (using group work principles – Ch. 13 (Scriven, 2010)).


Initial ideas for the programme based on a study by Manchester Metropolitan University, et al.(2005) are as follows:

  • A structured group programme of two or three sessions per week.
  • Multiple components including educational elements, warm-up, aerobic exercise, strengthening, co-ordination, balance and flexibility.
  • Individual progression, provision of regular feedback on fitness/strength improvement.
  • Provision of ‘exit routes’ to other opportunities should the programme close.
  • Led by a professional able to communicate respectfully, be supportive and who creates an enjoyable, welcoming and social atmosphere.
  • Regular individual attention in order to reassure, build confidence, and make participants feel ‘wanted’.
  • Paying close attention to participants perceptions and needs.
  • Developing a sense of duty and programme ownership among participants by involvement in design of programme elements, their own progression and recruitment of new members.
  • Takes place in an accessible facility, in well-lit, welcoming surroundings with appropriate music.


Literature for the programme needs to be developed using principles of health literacy,  “40% have inadequate or problematic health literacy” (“Health Literacy,” n.d.)


The practitioner will keep abreast of research and initiatives that can inform the programme.



Communicate / Market Action

A range of communication skills (Dempsey et al, 2012) will be utilised in developing, marketing and delivering the needs assessment and the programme.

Kildare Baseline Study (n.d.) reports that television (97%), newspapers (87%) and national radio (81%) remain the most popular sources of news and information among Kildare’s older people and that only 10% rely on the internet. This suggests that it may be challenging to reach the over 80’s using lower cost marketing and communication methods. Most of this population however will have family and friends who access social media and internet. The practice can make use of its database of previous patients, collaboration with the medical centre and will consider other methods (e.g parish newsletter, post office, ICA and other older adult groups, local newspaper etc.).

Evaluation of Process and Outcomes

A feedback questionnaire can be used to assess participant’s awareness. Group discussions, rounds, safe revelations (Scriven, 2010) or questionnaire could be used to assess the participants’ views of the impact of the session, and the process of the needs assessment work. Feedback should also be sought from facilitators involved in the group work session.

The physical activity programme can be evaluated for effectiveness using the outcome measures previously described. The overall process should be evaluated by questionnaire and/or group discussion, capturing elements such as the overall enjoyment of the programme, facilities, environment, timing etc.

Efficiency of the resource usage needs to be evaluated including all costs, time and donations.

All measures will be recorded, analysed, reported to stakeholders, used to inform the development of the programme, may result in resources being made available and can be shared with other health professionals.


The action plan details each task identifying completion date and responsibility. It includes steps for reviewing aims and priorities, networking and reporting and includes milestones to measure progress. Change control process and management of communications are included in the action plan. A draft of the plan is in appendix 1.



American College of Sports Medicine, Exercise and the Older Adult. Available at: http://www.acsm.org/docs/current-comments/exerciseandtheolderadult.pdf.

Anon, Kildare Baseline Study, Amarach Research, Ageing Well Network. Available at: http://agefriendlycounties.com/images/uploads/downloads/Kildare_AFC_Final_Baseline_Report.pdf

Buckley, B.S. & Lapitan, M.C.M., 2009. Prevalence of urinary and faecal incontinence and nocturnal enuresis and attitudes to treatment and help-seeking amongst a community-based representative sample of adults in the United Kingdom. International Journal of Clinical Practice, 63(4), pp.568–573. Available at: http://doi.wiley.com/10.1111/j.1742-1241.2008.01974.x [Accessed March 4, 2014]

Burtenshaw Kenny Associates, 2012. Integrated Services Programme Kilcock. Phase I Area Research & Plan 2012-2016 , Available at: http://www.kildare.ie/kilcockceltic/images/ISP%20Kilcock%202012%20to%202016.pdf.


Community Tool Box. Available at: http://ctb.ku.edu/en/table-of-contents/advocacy/encouragement-education/reframe-the-debate/main [Accessed March 5, 2014].

Dempsey, C., Battel-Kirk B., Barry M.M. and the CompHP Project Partners (2011), The CompHP Core Competencies Framework for Health Promotion. IUHPE, Paris


GetIrelandActive. Available at: http://www.getirelandactive.ie/get-info/brochures/ [Accessed March 5, 2014].

Ghoniem, G., E. Stanford, K. Kenton, C. Achtari, R. Goldberg, T. Mascarenhas, M. Parekh, et al., 2008. Evaluation and Outcome Measures in the Treatment of Female Urinary Stress Incontinence: International Urogynecological Association (IUGA) Guidelines for Research and Clinical Practice. International Urogynecology Journal and Pelvic Floor Dysfunction 19, no. 1: 5–33. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2096636/ [Accessed February 27,2014].


Health Literacy. Available at: http://healthliteracy.ie/ [Accessed March 5, 2014].


Hughes, Susan L., Rachel B. Seymour, Richard T. Campbell, Nancy Whitelaw, and Terry Bazzarre., 2009. Best-Practice Physical Activity Programs for Older Adults: Findings From the National Impact Study. American Journal of Public Health 99, no. 2 362–368. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622796/ [Accessed March 5, 2014].


ICIQ International Consultation on Incontinence Modular Questionnaire. ICIQ. Available at: http://www.iciq.net/structure.html [Accessed February 27, 2014].


Lorig KR, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum. 1989;32:37–44.


Lucas, M. G., JLHR Bosch, F. R. Cruz, and European Association of Urology. 2012. Guidelines on Urinary Incontinence.  European Association of Urology Guidelines. Available at http://www.uroweb.org/gls/pockets/english/16%20Urinary%20Incontinence_LR.pdf.[Accessed February 27, 2014].

Manchester Metropolitan University,, UK (Project Co-ordinators) University of Pavia, Italy, Free University of Brussels, Belgium  , University of Burgundy-Dijon, France , King’s College, London University, UK , University of Milan, Italy , and University of Bristol, UK ., 2005. Guidelines for Exercise Programming for the Frail Elderly The Results of the European Commission Framework V Better Ageing Project. Available at  http://www.laterlifetraining.co.uk/guidelines-for-exercise-programming-for-the-frail-elderly-better-ageing-project-2005/

McAuley E, Lox C, Duncan TE. Long-term maintenance of exercise, self-efficacy, and physiological  change in older adults. J Gerontol B Psychol Sci Soc Sci. 1993;48:218–224.


McCarthy, G. et al., Pulling the plug on containment, Available at http://www.euronuk.com/uploads/Resource-Handbook.pdf [Accessed March 6, 2014)


National Age Friendly Counties Programme Ireland. Available at: http://www.ageingwellnetwork.com/AWN-joint-initiatives/age-friendly-counties [Accessed March 5, 2014]


NICE, Urinary incontinence in women. NICE. Available at: http://www.nice.org.uk/ [Accessed February 13, 2014]


          Okamura, K. et al., 2002. “Quality of life” assessment of urination in elderly Japanese men and women with some medical problems using International Prostate Symptom Score and King’s Health Questionnaire. European urology, 41(4), pp.411–419. Available at: http://www.sciencedirect.com/science/article/pii/S0302283802000611 [Accessed February 23, 2014].

Pelaez, Mireia, Silvia Gonzalez-Cerron, Rocío Montejo, and Rubén Barakat. 2014.  Pelvic Floor Muscle Training Included in a Pregnancy Exercise Program Is Effective in Primary Prevention of Urinary Incontinence: A Randomized Controlled Trial. Neurourology and Urodynamics 33, no. 1 : 67–71. Available at: http://onlinelibrary.wiley.com/doi/10.1002/nau.22381/abstract [Accessed February 6, 2014].


Parry, S. W., N. Steen, S. R. Galloway, R. A. Kenny, and J. Bond., 2001. Falls and Confidence Related Quality of Life Outcome Measures in an Older British Cohort. Postgraduate Medical Journal 77, no. 904: 103–108. Available at: http://pmj.bmj.com/content/77/904/103 [Accessed February 27, 2014].

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Sjöström, Malin, Göran Umefjord, Hans Stenlund, Per Carlbring, Gerhard Andersson, and Eva Samuelsson. Internet-based Treatment of Stress Urinary Incontinence: a Randomised Controlled Study with Focus on Pelvic Floor Muscle Training. BJU International 112, no. 3 (2013): 362–372. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11713.x/abstract [Accessed February 6, 2014].


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Cyclists – and Baby Oil

This is for all you cyclists who like your shiny legs and coat them with baby oil! You know who you are! Use Grapeseed oil instead.

A Special Note on Mineral Oil *
Mineral oil is present in the vast majority of body care products because it is incredibly cheap. Mineral oil, as well as paraffin and petrolatum, are petroleum products that
coat your skin like a sheet of plastic wrap, clogging pores and creating a build -up of toxins. This skin sludge can accumulate and lead to dermatological issues. It is a fallacy that mineral oil moisturizes your skin.
In fact, it interferes with your body’s own natural moisturizing mechanism, leading to dryness and chapping. Manufacturers continue to use it because it is so inexpensive. Mineral oil can be found abundantly in most baby products. In fact, conventional baby oil is just mineral oil and fragrance.
Dr. Mercola. (2011). Does Your Skin Care Product Contain These
Chemicals?. Available:
http://wwwhttp://www.mercolahealthyskin.com/organic-body-butter.aspx. Last

Physical Activity Guidelines

So, Are you getting it for 30 mins, 5 times a week?

Physical Activity Guidelines

The National Survey of Lifestyles Attitudes and Nutrition (SLÁN 2007) showed that only 41% of Irish adults took part in moderate or strenuous physical activity for at least 20 minutes three or more times a week. This level of activity has not changed much over the past ten years – 40% in 2002 compared with 38%in 1998.

In Ireland, 61% of all adults and 25% of 3-year-olds are overweight or obese; 26% of 9-year-olds have a body mass index outside the healthy range. Three in four people over fifty in Ireland are either overweight or obese.

The incidence of heart disease, cancers, type-2 diabetes, (including type-2 diabetes in children and adolescents) is set to increase.  Obesity is the leading cause of cancer in non-smokers.[

We clearly need change. Part of that change is to increase our Physical Activity. Here’s what we should be doing at minimum to keep ourselves healthy……


Guidelines for adults (aged 18–64)

30 mins x 5 days

Strength + Endurance x 2 days


At least 30 minutes a day of moderate activity on 5 days a week (or 150 minutes/2 ½ hours  a week).

American guidelines give an alternative of one hour and 15 minutes a week of vigorous-intensity aerobic activity.

This does not sound like much to you? Or it sounds like a lot? Either way most of us failing to do even this much and that this is a MINIMUM recommended amount. We really are designed to be physically active.

Every adult should be active. Some physical activity is better than none, more is better than some, and any amount of physical activity you do gains some health benefits.

You can count shorter bouts of activity towards the guidelines. These bouts should last for at least 10 minutes. Add activities which increase muscular strength and endurance on 2 – 3 days per week.


Examples /Ideas on how to fulfil the minimum:

  • Take a brisk walk for 30 minutes on five days (moderate intensity); exercise with resistance bands two days (muscle strengthening).
  • Take a brisk walk for 30 minutes two days (moderate); go dancing for an hour one evening (moderate); mow the law for 30 minutes (moderate); do heavy gardening two days (muscle strengthening).
  • Do 30 minutes of an aerobic dance class (vigorous); do 30 minutes of running one day (vigorous); take a brisk walk for 30 minutes one day (moderate); do calisthenics (sit-ups, push-ups) on three days.
  • Bike to and from work for 30 minutes on three days (moderate); play softball for 60 minutes one day (moderate); use weight machines two days.
  • Play doubles tennis for 45 minutes two days (moderate); lift weights one day; hike vigorously for 30 minutes and go rock climbing one day (muscle strengthening).

Other Tips:

  • Get it done early in the day – you can then feel smug ALL day long
  • Keep at it  – it has to become a habit – so that you feel odd if you miss it – like going out without brushing your teeth
  • Build it in to your work commute or schedule
  • Have walking meetings – we don’t always need to sit
  • What works for you?……



Guidelines for children and young people (aged 2 –18)

60 mins x 7 days

Strength + Endurance x 3 days

All children and young people should be active, at a moderate to vigorous level, for at least 60 minutes every day.

Include muscle-strengthening, flexibility and bone-strengthening exercises 3 times a week.


Guidelines for older people (aged 65 +)

30 mins x 5

Include strength and balance

At least 30 minutes a day of moderate intensity activity on five days a week, or 150 minutes a week. Focus on aerobic activity, muscle-strengthening and balance.



  1. Healthy Ireland, A FRAMEWORK FOR IMPROVED HEALTH AND WELLBEING 2013 – 2025. Department of Health, (2013).
  2. Get Ireland Active, Promoting Physical Activity in Ireland, The National Guidelines on Physical Activity for Ireland, Department of Health.



Useful Resources to get you Active

http://www.irishsportscouncil.ie/About_Us/  General Information on Sports at all levels in Ireland plus many useful links.

http://www.getirelandactive.ie/ : This website gives general tips and details of events by county

http://ageandopportunity.ie/  Age & Opportunity is the national not-for-profit organisation that promotes opportunities for greater participation by older people in society through partnerships and collaborative programmes.

Sports Partnerships

An initiative of the Irish Sports Council. There is a Sports Partnership site for every county. Their mission is to increase the number of people participating in sport, exercise and physical activity.  Includes focus on young people, teenage girls, women, people with disabilities, minority groups and older people. I’ve listed some of the links below, if your County is not listed simply search County name and Sports Partnership. These sites give information on events and programmes going on in your county. These will be of interest to you and helpful in promoting Physical Activity for your clients.

http://www.sdcsp.ie/ South County Dublin Sports Partnership

http://www.kildare.ie/kildaresp/  This website provides an overview of the background to the establishment of the Kildare Sports Partnership, a clubs directory, an events calendar, details of programmes being rolled out through the Partnership, details of funding available to clubs, local news, publications of interest and useful links.


Other Physical Activity related sites and documents:

http://www.irishtrails.ie/ Coordinates and drives the implementation of an Irish Trails Strategy to promote the use of recreational trails in Ireland.

http://www.getirelandactive.ie/content/wp-content/uploads/2011/12/Get-Ireland-Active-Guidelines-GIA.pdf National Guidelines on Physical Activity for Ireland

http://www.healthpromotion.ie/ The HSE site on Health Promotion

http://www.irishheart.ie/ The Irish Heart Foundation is the national charity fighting stroke and heart disease.
Their vision is that every person living in Ireland will live a long, active and healthy life free from heart, stroke and blood vessel disease. Provides information on heart health. Provides heart health programmes, Co-ordinates the training of medics and the public in emergency lifesaving skills (CPR). Supports research, education



Do you want to combat Musculoskeletal problems?


Musculoskeletal Disorders (MSD’s) are the most commonly reported cause of work-related ill health in Ireland.

The direct cost is estimated to be at least £750 million.

Ireland spends more per capita (40.9%) on sickness and healthcare benefits than 24 other countries featured in a Europe-wide study.

714,000 people in Ireland have arthritis;

25% of all GP visits each year are attributable to arthritis or other MSDs and of these 40,000 people have rheumatoid arthritis.

Arthritis Ireland estimates that the annual cost of lost productive time due to RA and other forms of arthritis was £1.6 billion.

From 24th April 2013 Fit For Work Forum in Dublin Castle – A pan European Strategy.



Arthritis Ireland advocates ‘Movement as the best Medicine’

From IPTAS National Physical Therapy Conference 20th April 2013 http://physicaltherapyconference.wordpress.com/

If you would like more information, treatment or advice on your Musculoskeletal Disorder – Contact me on 087 2848409.

If you want to know how to organise your office to help your body, how to sensibly and easily incorporate movement and exercise into your day and how to generally help yourself combat MSD’s – get in touch.