Taking charge

A new, award-winning Minnesota-based program known as Juniper is putting seniors back at the helm of their own health and well-being.

Stay Active and Independent for Life (SAIL)
Juniper offers a range of classes to help people manage their health, get fit and prevent falls, including this Stay Active and Independent for Life (SAIL) class in Minnesota.

We’re living in treacherous times. A slip becomes a fall, a fall becomes a broken hip and suddenly everything has taken a serious turn for the worse.

Here in the land of 10,000 sidewalks that can remain dangerously icy through April, it can be easy to feel as if you’re at the mercy of raging elements and a faltering body.

But the folks at Juniper have a different idea: You really can live well, even with health challenges brought on by aging.

Juniper, a new program from the Arden Hills-based nonprofit organization Innovations for Aging, takes its name from the long-living, hardy evergreen that’s known for its interconnected structure. Just like the iconic plant, Juniper is becoming known for helping foster long-lasting resilience and stabilizing connections.

Juniper, in partnership with Area Agencies on Aging, acts as a hub for community organizations, health-care organizations and instructors to offer wellness classes statewide.

The goal?

Help people take an active role in improving their health and quality of life through fitness and fall-prevention classes as well as small-group classes on preventing and/or living well with diabetes, chronic pain and other conditions.

Since 2016, 16,000 Minnesotans have participated in one of Juniper’s evidence-based classes, which are verified as effective by researchers in clinical studies.

In Juniper’s case, the classes offered have been proven to promote self-management of chronic health conditions, to prevent falls and to foster individual well-being.

Slo-mo for staying power

One of the most popular Juniper classes in Minneapolis is the tai ji quan balance-training sessions.

Inside a sunny community room at East Side Neighborhood Services in Northeast Minneapolis, Carmel San Juan leads a group of through a series of tai ji quan exercises. Looking in on the activity, it’s like watching people who are moving through water, or seeing a film run in extreme slow motion.

With soft, fluid movements, the class members, all over age 60, follow San Juan through a series of motions with names like “Part the Wild Horse’s Mane” and “With Hands Like Clouds.” The tai ji quan forms are interspersed with what San Juan refers to as “mini therapeutic movements.” They’re the kind of motions we all take for granted, until, often suddenly, we can’t do them — things like getting up from a chair alone, balancing on one foot or moving an arm high across the body to reach something overhead.

While the exercises look dreamlike and beautiful, they’re so much more. According to a 2018 study, supported in part by the National Institute on Aging and published in JAMA Internal Medicine, a randomized clinical trial showed that among older adults with a high risk of falling, a 24-week therapeutically developed tai ji quan balance-training class resulted in a significant reduction in the incidence of falls.

There’s increasing evidence, the study said, that such intervention programs are popular in senior communities and represent “a promising approach to low-cost and easily implementable fall-prevention programs.”

Across Minnesota

The results of that study are being borne out locally, said Julie Roles, communications director at the Metropolitan Area Agency on Aging (MAAA) and vice president of engagement at Innovations for Aging, the nonprofit subsidiary that operates the Juniper program in partnership with community organizations. (East Side Neighborhood Services, where San Juan’s class is held, is one of Juniper’s partners.)

In fact, the Juniper program recently received recognition from the National Association of Area Agencies on Aging (n4a) with an Aging Innovations Award, the highest honor presented by n4a to member agencies.

For Roles, one of the most important things about Juniper’s organizational structure is that it reaches across the state.

“We roll out classes to people in smaller cities and rural communities, not just the metro area,” she said. “The idea of learning and creating action plans alongside one’s neighbors often leads to friendships being formed among class members.”

That’s important, Roles said, because there’s significant evidence to show that an ongoing support system is crucial to making health changes.

“We’re learning more all the time about how much strong social connections are a determinant of health,” Roles said.

Falls: A $50 billion problem

Falls are not only scary and painful, but they’re also often accompanied by significant personal and financial costs. They occur with alarming frequency among those 65 years or older, with approximately 28% reporting a fall each year. An estimated 38% of those falls result in injuries leading to emergency department visits, hospital admissions or death.

Among Medicare beneficiaries, the average cost for treatment following a fall is more than $9,000. Astonishingly, the average hospital cost for a fall injury is over $30,000.

In 2015, the total medical costs for falls among people age 65 or older in the U.S. was more than $50 billion.

With 20% of the U.S. population soon to be age 65 or older, it’s more important than ever to find ways to help people prevent falls or to recover more quickly after a fall.

Juniper is stepping into this fraught situation with a real-world, workable solution. Rachel Von Ruden is a program developer for Juniper.

She believes the tai ji quan classes are so popular because they seem accessible and not too intense.

“It’s a way for people to take charge of their health,” she said. “And I think that’s good for everyone.”

San Juan said her students have told her the exercises have helped them develop “muscle memory” that can come to the rescue when they get off balance in daily life.

“We’re helping people recognize what the edge of stability is as we move from stability to instability and then back again,” she said.

Finding strength

Shirley Porter, 72, has been living with the repercussions from a fall. She entered San Juan’s class while leaning on a walker, and she kept it nearby during the class. Still, she joined along with all the exercises, first leaning forward in a chair, then getting her balance to pull back, then doing the same exercise while standing and tipping her pelvis forward, then back in place.

“My main goal is to get off the walker,” Porter said. “This is my second session of the tai chi quan classes, and I came back because I do feel a difference. I know my balance is better.”

A participant in one of the Matter of Balance classes offered this testimonial on the Juniper website: “I learned how to integrate strengthening and flexibility into my everyday life. Now I flex my ankles as I stand in line at the bank and incorporate strengthening activities in things I do throughout my day.”

East Side Neighborhood Services
At East Side Neighborhood Services in Minneapolis, an instructor leads a group through a series of tai ji quan exercises — which can be performed seated or standing — as part of Juniper, a statewide program for seniors. Photos courtesy of Juniper

What happens in class

Each session includes warm-up exercises, teacher-led movements and cool-down exercises. The slow, percussive movements are intended to engage the mind and build the body. Over the course of each 12-week class, the movements and routines progressively build upon one another, which dynamically enhances strength, balance and flexibility.

The exercises, San Juan said, build awareness of what it feels like to be off balance, and then strengthen the muscles that allow for a recovery of balance.

There are other benefits, too.

“One of my students has struggled with asthma, but she told me the class really helped with her breathing,” San Juan said. “She was able to get off one of her asthma medications, and she credited that to the work we’re doing in class.”

Participants don’t even need to be able to stand, San Juan said.

“You can do the whole class seated if that works better for where you are today,” San Juan said. “It’s really for everyone.”

Some students mistakenly believe there is a religious or cultural element to the movements.

But San Juan assures them: “It’s purely exercise.”

What’s ahead

Roles said Juniper already has a contract with Blue Cross and Blue Shield of Minnesota to help some of their members take classes for free. She hopes more area health insurance providers will consider adding Juniper to their list of member benefits.

“Our long-term goal is to work collaboratively to get the right information to people who could really benefit from it,” she said.

Roles understands: Taking that first step to walk through the door of a classroom can be challenging. But, in the end, it’s worth it: “About 70 percent of our health outcomes are based on our behaviors,” she said. “We have people who come into tai ji quan class using a cane, and they are able to stop using it after taking the classes. That allows people to regain their independence, which is so important.”

Roles is clearly committed to doing whatever she can to help people connect with each other, build their confidence and live a full life, despite the health challenges they face. She also is aware of the many, often negative, misconceptions about aging, and she’s determined to fight them.

“Ageism is alive and well, and negative perceptions are all around us,” she said. “We allow those stereotypes to become negative self-perceptions, and that has a significant impact on our physical and mental health.”

In the end, it’s simple: There are ways to live better and stay fit.

“There are evidence-based programs out there, and we know they work,” she said. “If we can get more people to access them, it’s good for all of us.”


What’s Juniper?

Juniper is a statewide program designed to create a culture of health in which prevention and wellness are the norm. Health insurance providers, such as Blue Cross and Blue Shield of Minnesota, are adding Juniper to their list of member benefits for seniors. Learn more at 855-215-2174, info@yourjuniper.org and yourjuniper.org. Class topic areas include:

LIVE WELL

  • Diabetes Prevention Program
  • Living Well with Chronic Conditions
  • Living Well with Chronic Pain
  • Living Well with Diabetes

GET FIT

  • Arthritis Foundation Exercise Program
  • Stay Active and Independent for Life (SAIL)

PREVENT FALLS

  • A Matter of Balance
  • Stepping On
  • Tai Ji Quan: Moving

What’s tai ji quan?

Tai Ji Quan: Moving for Better Balance is a research-based balance-training regimen designed for older adults at risk of falling and people with balance disorders.

Fuzhong Li, a senior scientist at Oregon Research Institute, developed the program, which represents a significant shift from tai ji quan’s historical use as a martial art or recreational activity to a method for addressing common — but potentially debilitating — functional deficits.

So far, agencies in Minnesota, Washington, Florida, Maryland and New Hampshire have adopted the regimen for older adults.


Julie Kendrick is a contributing writer for many local and national publications. She lives in Minneapolis. Follow her on Twitter @KendrickWorks.