keep older adults on their feet
with balance training
With falls being a leading cause of injury, and even death, in people over the age of 65, the importance of balance training cannot be overstated, says Paula Todd.
Our ability to balance is both precious and fundamental to every move we make as humans. Sadly, it begins to deteriorate naturally from about age 40. Unless this deterioration is halted or slowed, it will lead to losses of mobility, confidence and independence, with falls being a leading cause of injury and death in people over 65.
We know that sedentary lifestyles are largely responsible for our society’s very high rates of cardiovascular disease, type 2 diabetes, obesity and osteoporosis, but not moving enough will also hasten the loss of balance abilities due to lessened muscle strength, decreased flexibility, slowed neuromuscular response and poor postural habits. As fitness professionals we are ideally placed to help people maintain and improve their balance by addressing all of these issues, either in group exercise classes or one-to-one personal training.
The ability to balance well also depends on a healthy, well-functioning vestibular system, healthy vision, good proprioception, good righting reactions (maintaining correct orientation) and coordination and joint mobility. With ageing and a lack of exercise, each of these elements tends to decline, sometimes quite rapidly.
How fitness training can help
The good news is that a lot can be done to improve and fine-tune balance and stability in older adults. It is important to understand that both static and dynamic balance need to be trained. Not many older people fall over when standing on one leg in a controlled environment – falls typically occur when people are on the move. So it follows that balance training needs to be functional: you need to include dynamic as well as static balance exercises with clients.
In terms of strength training for balance, we need to target three major muscle groups: the quadriceps, the gluteals and the core musculature (this is not to say that other muscle groups are not involved, as toe flexors, calves, shin muscles, hamstrings and hip flexors also play a significant role in balance.)
Suggested actions: squats, single leg squats, lunges and leg presses.
Flexibility and mobility
Reduced flexibility and mobility will lead to deterioration in active and passive posture, which in turn affects balance. It is important, therefore, to help your participants and clients remain as flexible as possible and to encourage spinal mobility as well as mobility at the hips, knees and ankles.
Suggested actions: spinal flexion, spinal extension (with care), lateral spinal flexion, spinal rotation; stretching the muscles of and around the hip, adduction, abduction and rotation of the leg at the hip joint; quadriceps and hamstring stretches; ankle rotations as well as dorsi and plantar flexion at the ankle.
Encourage all your clients to have good postural habits. Start from the pelvic floor and work up: pelvic floor and abs lightly contracted, pelvis in neutral, sternum lifted, shoulders down, chin retracted and stand tall.
It is also very important to pay attention to seated posture: sitting tall, but without spinal extension or anterior tilting of the pelvis, with shoulders down and back, and chin retracted. Remind clients to avoid the dreaded ‘slump’ as much as possible.
The neuromuscular system has to be challenged in order to improve. Think of ways you can get your clients to respond quickly. If they are quite unsteady on their feet, sit them down in chairs to begin with and maybe start with catching bean bags or balloons. As their balance improves, get them up and moving, gradually increasing the challenge, but always keeping safety as your priority.
Suggested actions: coordination activities; encouraging quick reactions; mental challenges while moving (e.g. counting backwards in 3's from a random number while tandem walking).
Static balance training
Static training is valuable in terms of building strength as well as fine-tuning the vestibular system. Postural correction can be carefully managed, along with core musculature activation.
- Single leg stand: variations include knee lifted to front, leg held out to rear, star pose, tree pose
- Tandem stand (feet in line, heel to toes)
- BOSU stand (two feet or one foot)
- Mat folded two or three times, to form a spongy base on which to perform moves
- Working in bare feet – balancing without those supportive shoes and orthotics can be a real challenge!
- Feet together, heels lifted
- Duradisc (with board) and wobble boards – single and two-leg stands
- Single leg squats
Dynamic balance training
Training balance and stability while clients are moving is the most valuable form of training in terms of functionality, and typically presents the biggest challenge for older adults, particularly those who are older and frailer.
- Tightrope walk (aka tandem walk) – slowly, with heel to toes
- Take two big steps, then step again and hold steady – forward, sideways, diagonally, backwards
- Agility ladder
- Step ups onto BOSU
- BOSU step (or jump) arounds.
The most important consideration when training balance
It is critically important that all balance training activities are progressed or regressed to suit the individual client. This is essential in all training circumstances: on the gym floor, when personal training older adults and particularly in the group fitness setting, where close supervision of individuals can be difficult.
The key is to select exercises that will challenge the client sufficiently while not putting them at unnecessary risk – this is where the experience and skill of the trainer becomes paramount. The most efficient and effective way to do this is to take the base moves (listed above), then regress or progress them using the following techniques:
To regress an exercise
- Have more contact with the floor – constant or intermittent
- Take a wider base of support (typically, feet wider apart)
- Hold a steady gaze
- Use external support, e.g. the wall, the back of a chair
- Have arms abducted
- Position a Swiss ball between the lumbar spine and the wall for lunges, squats and single leg squats
- Instead of agility ladder, use chalk markings on hard floor or ribbons on carpet (diminishes trip hazard).
To progress an exercise
- Lessen the points of support on the floor
- Take a narrower base of support (feet closer together or move to only one foot)
- Stand on an unstable base such as a BOSU, Duradisc, wobble board, high density sponge
- Alter the gaze
- Move the head – side to side or up and down
- Rotate the body
- Add elevation with step – this provides a psychological challenge
- Add some external weight. Note that the challenge is further increased by holding the weight a greater distance from the body
- Close the eyes (be very cautious with this one as the challenge is dramatically and suddenly increased when the eyes close)
- Place the front foot on Duradisc or BOSU for lunges
- Add a mental challenge (e.g. count backwards in 3s from a random number)
- Move more slowly.
|Be mindful of medications|
Remain mindful that some medications can adversely affect our delicate balance mechanisms. Ask your client to check with their doctor if any of their medicines might be diminishing their ability to balance. Similarly, if you suspect there may be something organically wrong with your client, because all the training you are facilitating is getting them nowhere, refer them back to their doctor for medical follow-up.
Putting it all together
Balance is integral to every activity, which is why it is so important to keep it functioning as well as possible. Challenging your clients effectively, while keeping them safe, may require you to call upon all your skills and knowledge as a trainer, but you can be confident that you are creating life-enhancing, and often life-changing, experiences.
|Group Fitness for the Young at Heart|
A specialist in exercise for older adults, Paula has written an online Network Education course (5 CECs pending) to facilitate first class group exercise class design for this demographic. The course teaches you how to:
• Design a group fitness class for older adults
For more information visit www.fitnessnetwork.com.au/cecs
Paula Todd, BSW
A fitness professional for over 18 years, Paula brings a wealth of knowledge and experience to her educational presentations. She is a group exercise instructor, gym instructor and personal trainer with a passion for working with older adults. Paula has also worked as a professional counsellor and social worker.