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San Diego, California - March 23, 2011 - 

How can Exercise Training Reduce Loss of Balance and Falls in the Elderly?

By Kevin D. Brown, PT, MPT

What happens when seniors fall?  A closer look at the biomechanics of falls in older adults reveals how the details of walking, and reacting to balance loss, is different from that of younger adults. More importantly, people’s reaction during slips and trips give us clues to how to better train people to prevent from falling when they slip or trip. There are other physiological reasons for falls, such a drop in blood pressure, low blood sugar, transient ischemic attacks or infection for example. However, two main aspects of performance that help one recovery from a slip or a trip include:

• Detecting loss of balance and 
• Reacting with sufficient strength and skill to restore balance.

The first important aspect of physical performance related to fall prevention is the ability to detect loss of balance. Detection involves use of our sensory systems including the vision, vestibular and proprioception systems. Each system provides our nervous system information about the body’s relationship to the environment around us: 

Vision - reference to the horizon, to objects around us, and to obstacles;

Vestibular - reference to gravity and movement of the head and 

Somatosensory - reference of body to the ground, joint position sense and movement of limbs. 

Normal aging is associated with a general decline of all of these systems. Particularly after 60 years of age, there is a decrease in the ability of the brain and nervous system to transmit and process information. Various diseases can also effect sensory systems leaving a person with decreased coordination and higher risk of falling. There are other neuropathways and physical means of the body compensating, however some loss of coordination is expected. 

 Second, one must have the ability to react successfully when slipping or tripping in order to keep the feet on the ground and not tumble to the ground.

This requires adequate strength and rapid reaction speed. More specifically, one must make a recovery step and keep the body’s center of mass controlled over the feet (base of support).  Laboratory Research out of the Biomechanics Research Laboratories  at the University of Illinois at Chicago uses high-tech motion detectors to record what happens when someone is unexpectedly tripped and loses balance. In one study (1), they found falls were related to lack of trunk control. The angle of the torso, after a loss of balance, was significantly greater (42%) in older adults (65 years of age and older) who were not able to recover their balance compared with those older adults who did recover. 

Another study (2) looked at the detection of balance loss and the recovery processes of slip and fall events in the laboratory. They found that both younger and older adults slipped, under laboratory induced conditions, but the older adults could not control their slips and ended up falling. Those people who fell showed increased speed (velocity) of slipping and increased distance slipped, which lead to more falls. Along with decreased reaction time they also found that vision impairments and leg muscle strength were important for predicting balance loss and subsequent falls in the laboratory setting. 

Reaching outside of base of support also leaves one prone for falls. Examples may include reaching down to pick up the newspaper or even reaching to the side to turn off a light. A person’s limits of stability are often limited, leaving them prone for falling when their center of gravity moves past this stability limitation. At a basic level, this can be tested by having a person safely (with a solid chair or sofa arm near) lower themselves and then rise up from the floor. If this difficult or unsteady? 

Investigations of falls suggest that exercise targeting the strength, balance, and reaction time of specific muscle groups  may be important to reduce the incidence of falls. Exercise programs for seniors tend to be more general than specific, and I question if the level of intensity is close to the moderate-intensity training recommended by the American Heart Association (3). Possibly by training toward the “limits of function” and training a person to control and stop the momentum of the body during balance training, older adults may acquire the skills to carrying out their every day lives with less risk of injury. 

People are more motivated to engage exercise when they see  “this is what I need to improve” and that change is possible. Working on the components of stable walking such as strength, stepping and stance stability will give seniors the balance and confidence they are looking for. 

Kevin Brown, PT, MPT  is a physical therapist with more than 20 years of experience in home health and sports medicine. He works with the San Diego Fall Prevention Task Force to increase awareness of fall prevention interventions and is author of the evidence-based book Balance for Every Body. For more information, visit www.balanceforeverybody.com or contact Kevin.

Contact:
Kevin Brown

PO Box 230049

CA Encinitas 92023-0049
kbrown@persistentperformance.com
Ph: 760-889-1502

1. Grabiner MD, Donovan S, Bareither ML, Marone JR, Hamstra-Wright K, Gatts S, Troy KL. Trunk kinematics and fall risk of older adults: translating biomechanical results to the clinic.J Electromyogr Kinesiol. 2008 Apr;18(2):197-204.

2.Lockhart TE, Smith JL, Woldstad JC. Effects of aging on the biomechanics of slips and falls. Hum Factors. 2005 Winter;47(4):708-29.

1. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.Med Sci Sports Exerc. 2007 Aug;39(8):1435-45

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