// Managing balance and falls in older people

by Stephanie McLennan

Falling over is an ever-present threat to the safety of older people, especially the very old and/or frail elderly. Falls are a major cause of disability and loss of independence within this demographic. 

Research, common-sense and experience tell us that active people who are confident movers and who move a lot, in many different settings and for many different reasons are much less likely to trip, stumble or fall than their sedentary peers. We also know that if they do stumble or trip, their motor responses, reflexes, strength and speed are more likely to keep them upright and able to regain their footing. We can also assume that if ‘active’ folk do fall over they will be more able to withstand the consequences of the fall and probably have a better chance of recovering from any injuries. 

As fitness professionals, we have an opportunity to promote this message and keep the ‘young old’ (people between 60 and 75 but in reasonably good health) upright and active until they are the ‘old old’ (usually 75+ but with poor health and limited mobility). 

THE RISK FACTORS 

There are a number of identified and often interrelated risk factors for falls, some of which can be addressed through appropriate strength and balance and general exercise programs, and others which cannot. The table below identifies the risk factors on which personal trainers and fitness instructors can focus attention. 

INTERVENTION WITH EXERCISE PROGRAMS 

Extensive research conducted through Otago University Medical School in New Zealand has focused on individually tailored strength-training programs, particularly for the legs, and balance retraining in an effort to reduce falls in older people. This research has resulted in a falls prevention program in New Zealand called ‘The Otago Programme’. Like many other international programs, this is individualised and run by physiotherapists, but personal trainers, fi tness instructors and group exercise instructors have a huge opportunity to be involved in promotion and prevention strategies relating to strength and balance training for older people. In many parts of the world community-based programs have been shown to be successful, not only in prevention of falls but also in helping rebuild movement confidence after a fall. As with any community program, the critical factors of access, sustainability, cost, timing and sourcing suitable fi tness professionals to instruct come into play. 




GENERAL STRATEGIES FOR BALANCE TRAINING AND MAINTENANCE OF BALANCE 

The purpose of balance training is to minimise the risk of falling. The likelihood of successfully achieving this one aim can be increased by several means; 

1. Providing a range of movement experiences. 
2. Building movement confi dence. 
3. Providing training in core stability and control. 
4. Practicing speed variations, stopping, starting, changing directions. 
5. Prescribing strengthening exercises for the whole body, but especially the quads, lower limbs and trunk. 
6. Ensuring programs work on flexibility and range of motion of all joints. 
7. Working on aerobic fi tness. 


More specifically, these objectives can be reached through:

• wobble board activities (variations in support surfaces) 
• yoga, Tai Chi or variations 
• lateral movements (obstacle courses) 
• hip and ankle flexibility and mobility 
• standing and moving with the eyes shut – even just a few steps 
• having the head held in different positions while walking 
• moving while carrying objects 
• providing opportunities for clients/ participants to practice getting up off the floor 
• providing opportunities for clients/ participants to practice and become confident at lowering themselves to the fl oor and getting back up again. 

Balance retraining need not be ‘rocket science’, but a few basic guidelines should be followed to ensure the improvements that you want to see in your elderly clients; 

• Balance needs to be ‘stressed’ to improve. 
• Dynamic balance is recommended rather than static balance training. 
• Always think ‘functional’. 
• Start with a very easy level and progress slowly. 
• Strength exercises should be done at least three times a week and to help achieve overload participants should perform all the leg exercises in one session rather than scattered throughout the day. 
• Balance exercises can be successfully practiced throughout the day, eg; standing on one leg while waiting for the kettle to boil or zig-zag walking down the driveway. 
• Adherence is an issue – to some extent this can be improved through a community program that is fun and social. 
• Safety is paramount as many older people will perform the exercises alone. 
• Establish objective and subjective methods of measuring improvements, eg; confidence increase, strength increase, better performance on basic balance tests. 

Let’s not wait until folk are 75+ before we address their balance and falls issues – we should be working with the ‘young old’ and ensuring that they understand the need to ‘use it or lose it’. By doing so, we can increase our repertoire of skills and our client base while improving the quality of life for older members of our community.

 

Stephanie McLennan
Stephanie has been involved in the health and fi tness industry for over 30 years and is the project manager of Energize, a school-based healthy lifestyle project in 150 New Zealand schools. She is also a fitness instructor and coordinator and has written two books about exercise, one for primary school teachers and the other an ‘at home’ exercise guide.

NETWORK • AUTUMN 2009 • PP43-44