Blog

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

2011-03-17T16:18:00Z

FOR IMMEDIATE RELEASE:

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.

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

###

965 words

Building Physical Reserves Maintains Independence -Part II

2010-12-01T06:01:00Z

Exercise- the "Fountain of Youth"

Regular exercise is one of the few things we can do for ourselves to build our physical reserves; to increase our overall health, well-being, and independence. Exercising helps us age more gracefully and may be the sought after “fountain of youth.” For fall prevention, exercises should target coordination and strength. Training that includes mobility and endurance will provide additional benefit.

Train the Muscles

Strength training provides the stimulus to promote change in the structure and function of the body- at any age. Working the muscles, to a moderate level of exertion, not only gives the body stimulus to build muscle (and to a lesser extent bone ) but also revs up important “growth factors”, increases metabolism and helps keep the blood sugar at normal levels. Different forms of strength training include the use of machines, stretch bands or functional exercise, such as squats and lunges. Exercises done while sitting are not enough.

Train the Nervous System

You need to include some SAFE exercise in standing to improve coordination. Some aspects of coordination important for better walking and preventing falls include single leg stance, stepping, and quick reaction time. Re-learning how to move more gracefully when out of balance can give you peace of mind.

How to Get Started

How can you get started building a routine that is right for you? One solution is to join a local exercise class that is designed for seniors. These can be found at some hospitals, senior centers, or YMCAs. Those who are uncomfortable in a group setting can try an exercise book or video. My book, “Balance for Every Body”, is a step-by-step guide that teaches you how to build your abilities and identify key points to safely get results. This evidence-based guide takes the guesswork out of selecting the right exercise for you and is designed for seniors with varied levels of ability so that you can start to feel and move better. You will also learn about health issues related to decreased balance and discover easy-to-do tests to assess balance and abilities. Order now at www.balanceforeverybody.com and be sure to always check with your doctor before starting an exercise program. Check out the rest of this blog for other valuable information and video examples!

Does “Specificity of Training” Pertain to Healthy Aging?

2010-12-01T05:53:00Z

If you want to improve your coordination or ease of walking, it may be best to get out of your seat and on your feet for exercise — even at 80 years of age.

Athletes know the importance of daily practice of their sport and working on every component of their performance. This pursuit of optimal performance is just as important for seniors when it comes to maintaining your independence and abilities, and this idea of targeted training can focus your time and efforts.

An individual will show the greatest improvement in a specific action when they train their muscles in a manner that closely simulates that activity. In addition, desirable adaptations occur only in muscles that are recruited during an exercise session, with little or no adaptive changes occurring in other muscles. Just imagine how different the core and leg muscles work in standing versus in sitting?

This idea of “specificity of training” has also been a consistent theme in research routines for fall prevention. In many of the successful study protocols, the exercises included functional movements such as:

Lunges;

Squats;

Side stepping, and

Tandem walking.

These are activities that become difficult for many seniors, but improve with specific training.

To start easy and introduce a functional exercise, an older adult can limit the range of motion, use support of a counter or helper, then hold that position for 10-20 seconds (see photo). This should be repeated on each side for 1-2 repetitions to start. This will gradually reeducate and strengthen the muscles without having to complete the entire movement.

The routine described in the book "Balance for Every Body" incorporates these functional movements with modified yoga poses to work the entire body safely. Take a Closer Look at www.balanceforeverybody.com, and

Buy the Book.

Remember it is always important to see with your doctor before starting any exercise.

_________________________________________________________________________________________

Balance Training for Elderly — Start with Ankle Strength

2010-11-16T06:52:00Z

Seniors are often encouraged to exercise, but many don’t have the resources or stamina to jump into a full-blown training program. Many people are looking for that magic bullet that's 100% guaranteed to restore some aspect of health. In reality, research demonstrates that “functional” training can improve balance and reduce the risk of falling, which becomes more prominent in adults over age 65.

Tips:

Many valuable exercises can be completed while standing. The toe raise exercise is helpful for promoting strength needed for propelling the body when walking, for keeping the body over the center of balance and for general circulation.

Begin with hands on a counter top, both feet on the ground. Shift weight to the front of the foot, then slowly raise both heels, if able. Gradually use less assistance with the hands until you are challenged slightly.

Keep your chest up and knees straight.

Complete 5-10 repetitions initially.

Focus on breathing in for 3 seconds as you raise up slowly, and out while returning to the starting point.

This is a good warm up exercise and actually opens up the body, from the bottom up.

What do you think about balance training for seniors? Let us know.

See this link to learn more about choosing the right balance program for older adults.

http://www.persistentperformance.com/five-principles.html

On the home page you will also see the new “foot support scale” that allows you to find the right challenge while at the same time feeling safe in your balance training.

Also see my other blog posts for valuable information and tips, and video examples.

Building Physical Reserves Maintains Independence -Part I

2010-10-12T15:52:49Z

When you are running low on reserve fuel, you know you’re in trouble. It’s best to have a large reserve just in case. The same is true for your physical reserves. You don’t want to be functioning near your maximal ability level during your typical daily activities.

Let’s say, for example, that Joe can lift 30 pounds maximum, but he works on an assembly line moving 25 lb boxes. You can imagine that he wouldn’t be able to keep up very long. But if Joe had more strength and the ability to lift 100 pounds, it would take a lot less effort to lift that 30 pounds throughout the day.

How do you know if your loss of function is reaching critical levels?

If it takes maximal effort for you to just stand up from a chair and walk to your car, you may be running low on your physical reserves. You may feel you are tapping into your reserves when you strain to get up a step, become fatigued when walking in a store or when you lose balance after turning quickly or walking on uneven ground. In many communities, fall risk screenings are available, usually at local senior centers or health fairs, that can identify fall risk. In addition, some tests can be found in my book, in my book “Balance for Every Body”, showing people how to assess themselves at home.

Your Physical Reserves

Your physical reserves include your strength, endurance, coordination and even your immune response. Almost everyone knows the sort of loss we face when aging – decreased vision, stiffness in joints, muscle loss, balance problems, less endurance and heart and lung problems. As we age, there is also a normal decrease in nerve cell functioning that causes decreased coordination and weakness. Because our aerobic capacity decreases as we age, older adults are forced to exercise closer to their maximal capacity, thus a previous level of activity may feel more fatiguing. Certain medications can also affect balance and energy levels.

Managing Reserves

Chronic disease, injury, poor nutrition and unhealthy environments magnify the typical problems seen with aging. These chronic diseases often don’t just ‘appear’ but are the result of years of unhealthy behaviors, poor lifestyle choices, or just inactivity. Consequently, one must eat right, exercise and get appropriate rest for a prolonged period (3 to 9 months) to see big changes. Consistent exercise, often prescribed by your doctor and/or physical therapist may be necessary to maintain precautions for special disease states. Regular exercise is one of the few things we can do for ourselves to build our physical reserves; to increase our overall health, well-being, and independence. Exercising helps us age more gracefully and may be the sought after “fountain of youth.” The challenge of exercise provides stimulus for many changes in our body including cell growth and regeneration - at any age! For fall prevention, exercises should target coordination and strength. Training that includes mobility and endurance will provide additional benefit.

Part II of of this post will include specific solutions for building your physical reserves

Practical Balance Exercise to Improve Walking

2009-12-23T06:19:00Z

This is an interesting example because it illustrates multiple levels of safety and challenge. This participant moves smoothly, in a manner that she can keep her balance, then pauses to work on more stability. For those who are frail, or with poor balance, it is good to do the exercise in front of the kitchen counter, and here you can see a caregiver standing by just in case. In order to increase flexibility, and strength (stability) we increase stride length (step length) or narrowing the base of support (distance between the feet). For more challenge, note shifting weight off back leg and onto front leg. She is an inspiration for many because not long ago she was unable to walk or get out of bed without help. She now walks confidently and continues to improve.From the new routine, Balance for Every Body. This practical exercise can improve reflexes needed for walking and fall prevention, as well as increase strength, flexibility and posture. There are various levels of safety and challenge presented here. You can learn more at www.balanceforeverybody.com and purchase the new book here or on Amazon.com

Balance Training for Elderly — Functional Exercise for Healthy Aging

2009-10-05T05:05:00Z

For those over 65 years of age, exercise is essential for ensuring your independence and and to keep you feeling good. For seniors who are very de-conditioned, most any activity that challenges the body will improve strength, but what kind of exercise should one choose? A recent study including 111 trials and 55,000 people concluded that targeted exercise reduces the risk and rate of falls in seniors (1). This review emphasizes the necessity of exercise that is multifaceted, including at least two of the essentials:

Strength;

Balance;

Mobility (flexibility and posture); and

Endurance

One easy way to include all of these components, and save time, is to participate in appropriate “functional” exercise. Let’s take the squat, for example. This movement is necessary for rising from a chair or toilet, and getting out of the car. It uses multiple muscles of the lower body and actually requires some complex neuromuscular control to execute smoothly. Depending on how far down you are able to move comfortably, you may even stretch some of the back of the ankle and hips.

For those unfortunate enough to suffer through injury or chronic disease, this exercise can be modified. For example, limit the bend in the knees and focus attention on moving the hips back. Sure, there are exercise machines and other resistive exercise that can help strengthen these areas, but to really improve balance, it is best to stand, contend with gravity and move in all three planes space, as we do on a daily basis.

What do you do to improve your coordination and promote healthy aging? Let us know.

To learn more, get your FREE down load of Chapter 1, Balance for Every Body:

lhttp://www.persistentperformance.com/free-download.htm

(1) Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009 Apr 15;