Balance Training Prevents Falls

In my health care practice, I see many elders who are ‘superagers'. These are people typically in their 60s and 70s (occasionally in their 80s) who exercise hard every day; some run or lift weights, others swim or bicycle.

Consequently, the physical agility of superagers isn't merely above average for their age, but is on par with healthy, active 50-year-olds. But superagers have one health concern in common; they tell me that their balance isn't what it used to be, in fact, it has become quite wobbling.

As we age, balance declines. There is no single reason for this, but weakening eyesight and muscles, and physical changes in the brain, all play a role. You can be otherwise perfectly healthy, without any diseases, but still unable to maintain balance. So, despite having a rigorous exercise program, many superagers are at fall risk; and some do fall with awful consequences (injuries, restricted mobility, etc.).

Balance 101

The ability to maintain balance is a complex process that depends on three major components:

• The sensory systems. This provides accurate information about a person's body position relative to the environment. The sensory systems include the sense of touch (feet, ankles, joints), eye sight and inner ear (vestibular) sensors. For instance, we rely on our feet and joints to tell us if the surface we are standing on is uneven or moving. We rely on our eyes to tell us if the environment around us is moving or still. And we rely on our inner ears to tell us if we are upright or leaning, or standing still or moving.
• Muscles and joints. They coordinate the movements required to maintain balance. Muscles must be strong, flexible, and work in synchronized fashion to help stop the body from falling. With age, muscle mass and strength in the hips and legs decreases, mobility in the ankles, knees and hips is reduced, and reflexes and reaction times are slower, leading to the reduced ability to “catch” oneself when falling.
• The brain. The sensory systems of touch (feet, ankles, joints), sight (eyes) and inner ear motion sensors work together in harmony with muscles and joints. This activity is coordinated by one's brain. The risk of developing a degenerative brain disease, such as Alzheimer's disease decreases the ability to preserve balance.

Individuals with a balance disorder have a problem in any one of these systems, or in multiple systems.

As well, chronic health conditions can make balance problems worse; common conditions include:

• Diabetes
• Parkinson's disease
• Arthritis

Any decline in balance can be an important indicator of health problems.

However, diseases are not the only reason that balance may be compromised:

• A history of injuries (such as concussions, ear infections, or serious sprains or fractures), may contribute to a loss of balance control over time.
• Additionally, various combinations of medications, both prescription and over the counter, can be detrimental to our senses or brain.

Preventing Balance Problems

The first step is to identify if you have a balance disorder.

Try these simple maneuvers and find out:

• Walk along a straight line, touching heel to toe with each step.
• Walk figure eights in a similar fashion.
• Stand on one leg.
• Turn completely around in a full circle. Pause. Then turn a full circle in the other direction.
• Close your eyes and stand still for 10 seconds.

If you lose your balance while attempting these maneuvers or are unable to perform the maneuvers, your balance may need some fine-tuning.

Common symptoms of balance disorders include:

• Dizziness or vertigo
• Lightheadedness
• Feeling as if you were going to fall (or falling)
• Blurred vision
• Disorientation

The second step in preventing balance problems is to not only exercise, but engage in activities that work specifically on strengthening balance. Many elders who exercise on a regular basis often feel that they're safe from balance problems and falling. But being fit may not be enough to avoid balance loss. There appears to be little relationship between how many hours a person spends exercising and how well they do on balance tasks.

To reduce fall risk, people need to specifically work on their balance. The best balance exercises for any individual are based on the person's health conditions and balance inadequacies. This discussion needs to occur between the elder and their doctor, who might also ask a physical therapist for additional exercise advice.

Specific exercises to improve balance include:

• Strength training
• Stretching
• Movement exercises (such as tai chi and yoga)

Additional benefits of balance training include:

• Better coordination and faster reaction time. This helps keep individuals upright if they start to fall by putting out an arm quickly to grab something stable.
• Stronger muscles. This can buffer the impact of a fall, providing some protection to bones and joints.
• Stronger bones. Strong bones are more resistant to fractures.
• Better brain function. Clearer thinking may help avoid situations that increase the risk of falling.

Rein Tideiksaar Ph.D., PA-C is the president of FallPrevent, LLC, Blackwood, N.J., a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr. Tideiksaar is a gerontologist (healthcare professional who specializes in working with elderly patients) and a geriatric physician's assistant.