By Lisa Desrochers PT, CSCS
An astounding statistic researched by the National Institute of Health (NIH) has shown that 1 out of 3 adults age 65 and older fall once a year. Other statistics estimate that 34-45% of otherwise healthy community dwelling adults will have a fall once a year accounting for 689,000 hospitalizations (in 2011 according to the Center for Disease Control). These falls and fall related injuries can seriously impact an individual’s quality of life and potentially the ability to live independently. Even if an injury is not sustained during a fall, there are still consequences that may develop further affecting one’s balance and postural control.
Often, post fall, an individual’s confidence with movement and walking decreases. They may widen their base of support slightly (the space between feet when standing and walking) or crouch to gain what they may feel is a safer posture. They may also further limit their activities in and out of the home for fear of falling again. All of these ultimately impact an individual’s reaction time to even small perturbances to their balance such as walking from wood floor surfaces to carpeted surfaces or reaching into a closet to place a coat on a hanger. It is my goal with this post to educate you on the importance of implementing a balance program as part of your exercise routine BEFORE falls occur as a preventative measure and way of maintaining the complexities of the balance system much the way we maintain our muscle and cardiovascular systems through traditional exercise.
Maintaining balance requires the fine coordination of input from multiple sensory systems in the body including input from the vestibular system, commonly referred to as the inner ear, the somatosensory or proprioceptive system (tells us where we are in space) and the visual system as well as their components in the brain and muscular system. These systems receive signals that are then sent to the brain where the information is integrated into a response which monitors our upright postural control through well timed balance reactions. Age related decline in our ability to receive, coordinate and respond to this information such as a change in support floor surface, small perturbances or destabilizing forces contributes to a delay or loss of balance reactions. As complex as it is, the good news is that balance is a functional skill that can adapt with training and experience!
Performing a balance program weekly will heighten your proprioception, the sense of knowing where your body parts are in space both at rest and with movement. These exercises will aid in your reaction time to disturbances in balance. As a secondary benefit, controlled balance shifts such as those performed in this exercise program, will activate the deeper core stabilizing muscles which will help strengthen and tighten your abdominal region. This should provide you with even more encouragement to begin a balance exercise routine. Although you may feel your balance at this stage in your life is not an issue, practicing these exercises will keep it that way and prevent a decline in your balance recovery reactions. The idea is to use it before you lose it!
As always, please check with your doctor before beginning any new exercise program. Balance exercises require mindfulness. Throughout the exercises, ask yourself where is my weight on my foot? Too far to the toes? Too far to the heels? On one foot more than the other? Try to keep weight balanced from the ball of the foot to the heel and do not clench your toes. Ensure that you are upright and tall throughout trying not to lean even slightly from the hip or bend the knees to maintain balance.
During exercise hold a chair or counter with 2 hands. As you get better, hold with 1 hand then with just your fingertips and, finally, without support. Doing the exercise with your back facing a corner about 1 foot away is also a safe place to perform the routine. If you are unsure, have a healthy second person next to you for safety. Progress slowly, starting by standing on both legs, then on one leg. After mastering the exercise on the firm floor, you can add a 4” foam pad like the Airex cushion, placed on a nonslip surface.
Feet should be under the hips NO WIDER.
(1) Rocking on feet forward and back (as far as you can without feet lifting off floor). Perform 1 set of 10 reps (1 x 10)
(2) Rocking on feet side to side (as far as you can without feet lifting off floor). 1x 10
(3) Circle your body on your feet in one direction then reverse direction. Don’t just move your hips, initiate from the ankles. 1 x 10
(4) Marching: March knees up and down while in place. 1×20
(5) Hip abduction: Raise right leg directly out to the side, away from the body. Try not to allow the leg to move forward. Shift fully onto standing leg. Do not lean body. Stay tall! 1x 10. Repeat with left leg.
(6) Hip extension: Raise right leg directly behind body. Do not lean forward. 1 x 10. Repeat with left leg.
(7) Leg clocks: Envision you are standing in the center of a clock. Extend your right leg out to touch the imaginary # 12 on the floor as far in front of you as you can, then the # 3 to the side of you, the # 6 behind you, and the # 9 by crossing your leg and bending the knee to reach to the outside of the left foot. 1x 5 Repeat with the left foot reaching for 12, 3, 6, and 9 o’clock in the same manner. As this becomes easy, try to keep the foot from touching the floor as you reach for the clock numbers.
(8) Sit->Stands: Sitting on a firm surface, stand up without allowing your knees to touch, if not using hand support, raise both arms over your head and stand fully erect.
Return to sitting position without allowing the knees to touch. For added challenge, hold a weighted ball out in front of your body or light dumbbells as you reach overhead. 1 x 10
(9) Back Reaches: Stand with back facing the corner about 1 foot away, further if you
have mastered this distance. Reach with the right hand as far as you can behind you, as high up on the right wall as possible. Your trunk will need to rotate to perform this, but do not allow the feet to take a step.
Advanced pad exercises
Perform with your back to the corner about 1 foot away from wall.
(1) Double stance (stand on 2 legs) for two minutes controlling the sway.
(2) Bicep curls on pad: Holding light dumbbells in each hand with elbows straight bring weights to shoulders by bending at the elbow with palms facing you while keeping elbows close to side of the body. 2 x 10
(3) Military press on pad. Hold light weights in hands, palms facing away from you, elbows fully bent. Raise weights overhead and try to touch them together then lower to start position. 2x 10
(4) Broom stick or umbrella rows on pad. Hold umbrella or broom at chest height with palms facing away from you. Push the stick away from the body until the elbows fully straighten then return to start position. 1x 20 reps
* exercises with weights can be done without weights as well.
For an extra challenge:
Since cognitive attention is required for each underlying neural control system for balance try counting backward from 100 by 3 for some of the exercises. Vary counting challenge each session, for example: count back from 60 by threes eg: 60, 57, 54, 51, forward to 88 by fours or spell each family members names.