Benefits of a stable balance
Good balance is absolutely essential to prevent falls. Reliable balance also assures an optimal comfortable walking pace. Results of clinical trials tells us that strength and balance exercises will definitely help us avoid falls and get us safely from point A to point B. In other words, you can minimize your risk of falling and improve your walking pace through a proven exercise program (given below). On the other hand, ignoring these exercises will guarantee a high risk of falling and bring on an abundance of unwanted consequences.
Balance depends on biology that changes with age
Balance deteriorates with age. There are many reasons for this. Firstly, declining sight and hearing contribute to poor balance. Secondly, years of poor posture exacerbated by weak back muscles and loss of bone mass produce a compressed spine or a “hunched” back that reduces upright stability. Thirdly, the sense of touch and the sense of muscle/joint position decline and hence need to be retrained. Reduced sight and hearing may be readily improved with correctives lenses and hearing devices but sadly these are often ignored. Other decrements are best minimized through resistance and balance exercises. Age-associated decline in balance is modifiable; modifications will definitely build longevity by lengthening the health span.
The cost of a fall is high
Approximately thirty percent of elderly fall at least once a year. Avoiding a fall is of paramount importance because the consequences of a fall are all negative. The least negative might be a sore muscle but more commonly, it is a broken bone e.g. hip. Broken bones require hospitalization, medical expenses, and significant recovery time that limit independence. Hip fractures are especially harmful since they are associated with an elevated risk of dying, a risk which persists for years after the fracture. Another outcome after a fall is onset of an unavoidable psychological mentality called “fear of falling”. This plays a role in producing a slower, more cautious gait that unfortunately is incredibly damaging in the long run.
The cost of slowed gait is high
Poor balance leads to an unsteady, hesitant walking gait. This compromises posture and reduces further the existing poor balance. This downward cycle favors a fall. Slowed gait also limits mobility and independence. Performance of daily tasks take more time and therefore, become more difficult.
Balance exercises are part of the 4-Prong Exercise Program
Previous blogs discussed progressive resistance exercises, aerobic exercises, and stretch exercises. Additionally they discussed the validity of these exercises to modify various age changes, to increase the health span and to build longevity. The final essential exercise to add to the preceding 3 is balance. Balance exercises are critically important for retraining the sensory perception pathways in the joints and muscles of the feet, ankles, legs. Balance exercises need to partner with specific resistance exercises to be totally effective in optimizing balance and preventing falls.
Evidence to show balance exercises works
Results of several clinical trials provide evidence that specific balance exercises coupled with moderate intensity lower limb resistance exercises improve balance stability and reduce the risk of falling. These trials (both sexes, community dwellers, 65 years and older, one study with women with osteoporosis) employed several standardized tests to measure balance before and after the interventions (resistance and balance exercises for 6-12 months) and traced the incidence of falls in the control and exercising groups.
Exercises to improve balance; balance type
Here are the balance exercises used in the clinical trials mentioned above. Balance exercises are initially practiced for 10 seconds and increased over time. The more practice, the better the improvement in balance.
(1) standing with one foot directly in front of the other;
(2) walking placing one foot directly in front of the other;
(3) walking on heels;
(4) walking backwards, sideways and turning around;
(5) stepping over objects;
(6) bending and picking up an object;
(7) stair climbing in the home;
(8) rising from a sitting position to a standing one;
(9) knee squat.
Exercises to improve balance; resistance type
Here are the resistance exercises used in the clinical trials noted above and shown to be successful in improving balance in the elderly and decreasing risk of falling. They are the (1) hip extensor, (2) hip abductor, (3) knee extensor, (4) knee flexor, (5) inner quadriceps, (6) ankle plantar and (7) dorsiflexor muscle exercises. These exercises are fairly simple to do and are described below. They should be initiated without ankle weights and one set of 10 repetitions. When ready, add an ankle weight of 1 pound and progress up to 6 pounds; increase the number of sets. The greater the weight and the number of sets, the better the improvement in balance. The combination of balance and resistance exercises are performed a minimum of 3 times a week for approximately 30 minutes.
Specific resistance exercises proven to improve balance
1. Hip Extensor
stand 12-18 inches from table
bend at hips: hold onto the table
slowly lift one leg straight backwards; hold position
slowly lower leg
repeat with other leg
2. Hip Abductor
stand near table; hold onto table
move straight leg sideways away from body; hold position
slowly lower leg
repeat with other leg
3. Knee Extensor
sit in a chair with your back and hips against back of chair.
keep knees at 90 degree angle, resting toes on ground
in a 1-2 up count, extend your left leg straight out parallel to the ground
pause for 1 second
in a 1-2-3 down count, slowly lower your leg back to 90 degrees
4. Knee Flexor
stand behind chair, resting hands on back of chair, facing forward, keep head in line with spine, place feet shoulder-width apart, pelvis level with knees slightly bent
in a 1-2 up count, bend left leg to bring up heel toward buttocks as high as possible
pause for 1 second
in a 1-2-3 down count, lower left heel to ground
5. Inner Range Quadriceps
sit on ground with knee bent over a rolled up towel
tighten up knee muscles and lift heel off ground; keep knee on rolled up towel
hold for 5 seconds, getting heel as high as possible
start with large rolled up towel and gradually decrease size of roll
6. Ankle Dorsiflexor
sit on chair with feet touching floor
leave heel on floor and tap toes up and down
Alternative – using elastic stretch band of comfortable resistance
sit on the floor with legs straight out in front
anchor elastic band to a chair or table leg and wrap around foot
pull toes toward you and slowly return to start position
7. Ankle Plantar Flexion
sit on chair with feet touching floor
leave toes on floor and lift heel up and down
Alternative with elastic band
wrap elastic band around foot and hold the ends in your hands
gently point toes and slowly return to start position