I received an email from a long time student saying, “ I was surprised to hear that most elder falls cannot be helped by balance exercises as they occur while the person is in motion.”
That was obviously received as pretty scary news.
Agreed and I sure hope I didn’t really say this in class!
I believe I was saying that dynamic balance exercises ask us to maintain postural stability while moving, transitioning from one movement to the next, performing two motor tasks at once, or responding to external stimuli without falling.
So dynamic balance exercises probably have more capacity to help us maintain postural stability because most falls occur when we are in motion.
Before writing this post I did a bit of a deep dive into the scientific literature/studies to make sure what what I write here is valid.
So….. let me be perfectly clear about balance and what evidence based science suggests will help increase our capacity to maintain postural stability as we age, potentially helping to mitigate falls.
Here are the the things that we know may help us maintain or even increase our postural stability/balance control.
Physical activity and exercise
Hands down, probably the most important one, folks!
The decline in physical performance and cognitive capabilities with age causes progressive impairment of muscle strength, coordination, and balance, exposing us to a higher rate of falls.
BUT….we can bend this progressive aging curve by staying physically active and participating in structured exercise as we grow older! This is absolutely indicated as positively influencing the risk of falls and fractures among older adults.
There is accumulating evidence correlating physical active and participation in structured exercise with maintenance of an independent lifestyle by maintaining postural stability (balance), strength, endurance, bone density and functional ability, and in so doing, may prevent falls and injuries associated with falls in older age.
Physical activity is body movement that substantially increases energy expenditure. Activities of daily living like walking, heavy housework, and gardening and leisure activities like cycling, dancing, swimming, pickleball, or exercise opportunities in gyms/classes.
Physical exercise is defined a bit differently as planned and structured activities where repetitive body movements are produced, improving and maintaining components of fitness. A good example of this is strength training.
There’s obviously a bit of a crossover between physical activity and physical exercise.
I’m hoping this encourages you to keep being as physically active as you are and/or to increase that activity.
Motion is lotion not only for our joints, but also for our ability to maintain balance and function.
Static and Dynamic Balance Training
In static balance training your body remains stationary while keeping your center of mass over the base of support.
This could be standing on both feet with the heels raised (plantar flexion), standing on one leg and holding the other leg off the ground, or a yoga pose such as tree pose.
Dynamic balance is required while your body is in motion and tends to mimic real life situations like moving from one limb to another.
Consider the transition between triangle and half moon pose, standing on one leg while moving the arms in a pattern, tossing a ball and walking, standing on one leg and moving the other leg forward, out to the side, or behind us to tap the floor.
I read a systematic review and meta analysis from 2020 where balance training was shown to lead to higher confidence in the participants’ ability to perform various daily activities without falling, better overall mobility and safety while moving at increased speeds, greater ability to perform balance-related tasks, and less difficulties with activities of daily living.
I’ll continue to push for more and more dynamic balance activities in my own practice and that of my students and clients, but both static and dynamic balance practice have been shown to help with postural stability, confidence, and quality of life.
Lower Limb Strength
There’s an absolute correlation between strength of our lower limb and postural control.
The lower limb consists of the leg, ankle, and foot.
In terms of physical activity, strength is the ability to carry out work against a resistance. It’s the maximal force you can apply against a load.
Your lower limb carries and supports your pelvis, spine, trunk, and head whether you are standing still or moving through space.
In order to help maintain our center of mass over our base of support, we need strong lower limbs from our toes to the tops of our thighs.
In order to build and maintain strength we need to carry out work against a resistance – our body weight or adding weight as in strength training. In order to increase strength, we will have to add resistance or weight (lift heavy stuff).
In my opinion one of the greatest ways for all of us to increase our capacity to balance and decrease falls and fractures is to strength train on a regular basis.
And I’ll add that building strength and mobility in the 33 joints of the foot and the ankle is imperative. Your feet and ankles are filled with cells called proprioceptive mechanoreceptors that have an ongoing conversation with your brain so that the brain can make muscles move bones to keep us upright, move through space, and balance.
Regular strength training and regular foot and ankle training are “musts” in my book.
So, I hope this helps and I hope I was perfectly clear – physical activity, balance activities (especially dynamic), and lower leg strength can all help prevent falls as we age.
And if we do fall, we may recover more easily due to the fact that we have worked on our bone health, mobility, flexibility, strength, and self confidence prior to the fall.
We truly can bend our aging curve.
