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TOWN OF WAPPINGER
RECREATION COMMITTEE
P.O. BOX 324
20 M/DDLEBUSH ROAD
WAPP/NGERS FALLS. N. Y. 12590-0324
CONSTANCE O. SMITH
Supervisor
Telephone: (914) 297-0720
May 15,2000
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MEMO TO: RALPH 1. HOLT, CHAIRMAN
FROM:
KATHI DE LISA, SENIOR CITIZEN DIRECTOR
RE: SIPP PROGRAM
The Senior Injury Prevention Program (SIPP) study sponsored by the Office of the
Aging, has been successfully completed. The SIPP program is a progressive weight training
program designed to increase strength, improve balance and even to increase bone density and
counteract the effects of osteoporosis.
The Office of the Aging provided the weights and the training for this program.
Now that the study is complete, the OFA has donated the weights so that we may continue the
program on an ongoing basis. Eileen Manning, Regina Waldron, Maria Borges and I have all
been trained to teach this program.
We feel that this program is beneficial to the health and welfare of our Seniors.
We are continuing the program and have added some Seniors who were on the waiting list for
this. Since there is a large interest in this program, we have adjusted the OF A release form,
doctor's approval forms, etc. to read Town of Wappinger. (See attached)
This has proven to be a very successful program.
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KD
KD :eam
cc: Supervisor Constance Smith
Town Board Members
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TOWN OF WAPPINGER
RECREATION COMMITTEE
P.O. BOX 324
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, N.Y. 12590-0324
CONSTANCE O. SMITH
Supervisor
Telephone; (914) 297-0720
The Senior Injury Prevention Program (SIPP) is a progressive weight training and balance
improvement program designed for seniors. Participation in this exercise program will lead to
improvement in balance, mobility, muscle strength and independence.
SIPP will consist of two classes a week. Each class will last one (1) hour. There is no cost: the
classes are free and equipment will be provided.
Each participant will be asked to complete a brief medical history and obtain their doctor's
consent for participation.
If you are interested, please fill out the attached forms and return it to the Senior Center. Call
297-3670 if you have any questions.
jZ~y~~
Kathi DeLisa
Director Senior Center
.
,
SENIOR INJURY PREVENTION PROGRAM (SIPP)
PROGRESSIVE WEIGHT TRAINING PROGRAM
Dear Dr.
Your patient, has requested enrollment in an
exercise program designed to reduce injury among older adults. Based on a pilot Osteoporosis
Prev~ntion Program undertaken by Miriam Nelson, M.D. from the Human Physiology Laboratory
at Tufts University and the Massachusetts Department of Public Health, this program indudes
exercise, education and group support. It is specifically tailored for older women, taking into
consideration each woman's health concerns and physical limitations.
. The class consists of two one-hour sessions each week and includes 15 minutes for education and
group discussion during one of the hours. The exercise component includes:
o balance exercises
o weight exercises with leg Cl.1ffs and hand weights, starting with 1 lb. pellets and increasing
as participant feels able
o strength exercises using body weight for resistance
o overhead arm lifts
Ankle cuffs with removable pellets and one pound hand weights allow for individualizing the
exercises for each participant and tailoring their progression with their comfort level. These
exercises improve strength, flexibility and balance and may help to maintain bone density, all of
which will help prevent falls and make broken bones less likely.
Your approval is required before participation can begin.
r give consent for
to participate in a supervised progressive weight training program.
Comments/restrictions:
Signed
Date
.
SENIOR INJURY PREVENTION PROGRAM
PROGRESSIVE WEIGHT TRAINING PROJECT
\.
Name
Date of Birth
Address
City
Zip
Phone
Insurance Info
F:amily/friend contact (name & phone)
Primary Physician
Phone
MEDICAL HISTORY
Cardiovascular disease
Diabetes
Hypertension
Rheumatoid arthritis or osteoarthritis
Stroke in the past six months
surgery in the past six months
Cataract surgery in the past six months
Fractured bones in the past six months
Hernia or abdominal aortic aneurysm
Memory loss/dementia diagnosis
Lyme Disease
Chronic dizziness
yes no
yes no
yes no
yes no
yes no
yes no
yes no
yes no
yes no
yes no
yes no
yes no
SIGNIFICANT HEALTH EVENTS {past 3 months}
Chest Pain or tightness, neck or jaw pain, indigestion, shortness of breath,
lightheadedness, nausea, palpitations during exertion
Falling, tripping
Dizziness
Painful joints
Muscle pain or back pain
Involuntary weight loss or gain {+ or - 5 Ibs,)
Any new medications or dosage changes
Evaluation or treatment of newly diagnosed condition
Under care of medical doctor, chiropractor, physical
therapist, or other doctor in past 6 months
Explain
yes
yes
yes
yes
yes
yes
yes
yes
no
no
no
no
no
no
no
no
yes
no
LEGAL RELEASE: I will choose the level of activity which will not harm me, In consider-
ation of my participation in this wellness/exercise program, I hereby release the Town of
Wappinger and Landlord of this exercise facility from any liability or claims, for personal
injury or otherwise, arising out of or in any way connected to my participation in this
wellness/ exercise program,
Signature
Date