Falls are a serious concern for older adults. One third of adults aged 65 and over suffers at least one fall each year--and nearly half of these people fall more than once. Falls are the leading cause of injury-related deaths.
Even when the fall is less serious, it can still cause pain and suffering, and bring a tragic loss of independence. For many older adults, suffering a fall can mean the difference between remaining in your own home and having to go to a long-term care facility.
But there's good news along with the bad. Studies have also shown that many falls can be prevented by a few simple changes you can make in your life. And it turns out that exercise is the most important thing you can do to help prevent falls.
Three systems have to be working properly to keep us balanced and help us not to fall:
- Visual system: Our eyes identify obstacles and tell the brain where we are in relationship to our environment.
- Vestibular system: Our inner ears have special organs that tell the brain about the movement of our head in space.
- Somato-sensory system: Our muscles have special receptors that tell the brain what position our body is in and detect movement and contact with other objects, such as our feet on the floor
With all this information, our brains send constant signals to our muscles that keep us standing in balance and that help us react to changes when we move around. So even with all the right information, we still need muscular strength to keep our balance.
Why does getting older increase our risk of falling?
Some age-related changes are inevitable, and ones that affect our vision, inner ears, receptors, brain, or muscular strength will of course affect our balance.
- Vision can be affected by glaucoma, age-related macular degeneration, and cataracts. These compromise our ability to perceive hazards and anticipate changes in surfaces when walking.
- The inner ear starts to lose its motion-sensing "hairs" as early as age 30. Losing too many can result in postural sway.
- The receptors in our somato-sensory system also decline with age, making it harder to sense contact and body position. The brain's ability to control our muscles declines with age. We don't react as fast to changes. Finally, our muscles can get weaker as we age, making it harder to recover balance when we lose it.
Can we reverse some of these changes, which increase our risk of falling?
The answer is yes! Doing the right kinds of exercises — ones geared specifically for balance, strength, endurance, and flexibility — can improve balance, increase mobility, and reduce falls.
These should include balance-specific exercises, which train your centre of gravity, the three sensory systems, posture, and gait to help maintain and improve your balance. All balance exercises should be done beside a wall, chair, or something else stable in case you lose your balance.
Centre of Gravity Training will reduce your body sway and help you move more quickly. Some of the exercises are done while seated on a stability ball while others are done standing on the floor, a step, a foam pad, or an uneven surface.
Exercise:
Try standing sideways to a wall. Be sure to hang on to the wall. Shift your weight onto the centre of the foot closest to the wall. Feel the floor under your foot by forming a "tripod" with your big toe, little toe, and heel. Lift your arch for extra support. Slowly raise your other foot off the floor until you are standing with all weight on the foot closes to the wall and the other leg bent at the hip, knee, and ankle. Focus on something stationary ahead of you and let go of the wall. Try to maintain your balance for as long as you can with only one foot on the ground. If you can hold this position for more than 30 seconds, your balance is good and you can progress to standing on a foam pad or closing your eyes when doing the exercise. Again, always be close enough to the wall that you can reach it if you lose your balance.
Multi-sensory training will help each of the sensory systems to work more efficiently: the eyes, inner ears, and muscle receptors. Some of these exercises are performed standing or walking, while other are performed sitting on a stability ball or a chair.
Exercise: Walk down a hallway close to the wall and begin placing one foot directly in front of the other, as if walking on a tight rope or balance beam. Notice how much harder your feet and ankles are working when your base of support is narrowed. Now try touching the heel of the front foot to the toes of the back foot. Again, notice how this feels more challenging. Then add sensory deprivation by turning your head from side to side. You will undoubtedly find this very challenging. You have now challenged one of the systems that assists your balance: the vestibular, by turning your head you will throw off the signal coming from your inner ear to your brain. Next try walking heel to toe while holding a book in front of you and reading it. You have now challenged another one of the systems that assists your balance: the visual. By reading something up close you will throw off the signals coming from your peripheral vision that lets your brain know where your centre of gravity is in relation to your base of support.
Postural Training will help to improve the strategies you use subconsciously to correct your posture while you are moving such as ankle and hip correction and your ability to step out quickly to prevent a fall. These exercises are done while standing and require a trainer to support you or move you through space using resistance bands placed around your waist.
Gait Training will help improve your walking gait pattern so that it is more efficient, flexible, and adaptable to environmental changes. The exercises are designed to increase the length of your stride and help you get around obstacles better.
Exercise: Try walking down a long corridor or outside and pay special attention to how you lift your feet. Proper walking should be done where the foot that first comes off the floor (lead foot) is planted heel first onto the floor. Then roll off the ball and toes of the back foot, lifting the foot off the floor then planting the heel of that foot into the floor in front of the other foot. Do this movement in a slow and exaggerated fashion at first, even calling out the movement pattern out loud "heel rolls to toes" until it feel natural. Then you can speed it up into your regular walking pace. This is the safest way to walk and will keep you from shuffling your feet, which puts you at a greater risk of falling.
No exercise program is complete without including strength, endurance, and flexibility training. Of all of the systems that decline with age, the musculoskeletal system is one which benefits the most from exercise and can be improved at any age.
Resistance training
Muscles are made stronger by resistance training. You don't have to lift heavy weights, operate complicated machinery, or join a gym. You can strengthen your muscles with simple exercises using everyday props, stability balls, and elastic bands or tubing in the comfort of your own home. Strong muscles will cause your bones to become stronger as well and reduce wear and tear on your joints. A strong musculo-skeletal system will serve you well in reacting and responding to a situation that may otherwise cause you to fall.
Exercise: A simple exercise to strengthen your thigh muscles, crucial to improving balance and maintaining independence, is the squat.
Stand behind a chair with feet about shoulder-width apart. Grasp back of chair firmly. Inhale as you sit down and back as if you are sitting in a chair behind you. Exhale as you straighten back up. Only lower yourself down enough that you feel the muscles in your thighs but not any pain in your knees. If there is pain your knees, try sitting only part-way down or push your buttocks further back. After 8-12 repetitions, you should feel fatigue in your thighs and it's time to stop. This exercise can be done every other day to strengthen your thigh and buttock muscles.
Exercise: Another simple exercise to strengthen the calf and shin muscles, crucial to improving your walking and stair-climbing ability as well as providing support for the ankle and heel are "heel and toe raises".
Stand behind a chair with feet close together (almost but not quite touching). Grasp back of chair firmly. Rise up onto your toes slowly and slowly lower down. After 8-12 of these, you should feel the calf muscles tiring. Now raise your toes and arch of foot up so that you are standing only with your heels. Lower back down. Again 8-12 repetitions of this should be sufficient.
Flexibility training: Your muscles don't just need to be strong, they must also be kept supple and flexible. Any falls reduction program must also include flexibility training to stretch muscles that have been worked. This will allow you to reach and move with ease without pulling a muscle or causing a painful spasm.
Exercise: A simple stretch for your thigh muscles is the hamstring stretch.
Sit forward in a chair with one knee bent and the other leg outstretched in front, heel into the floor, toes pointed upward. Place both hands on the thigh of the bent leg and lean forward from the hip (top of pelvis) with your chest leading the way outward. You should feel the stretch in the back of the straight leg. Be sure not to bend from the waist but instead from the "hip" or pelvis. This will protect your back against possible fractures if you have osteoporosis.
Exercise: A simple stretch for the calf muscles is done by standing behind a chair with one foot forward under the chair and the other leg stretched way back. Lean into the back of the chair with the forward leg bent at the knee and the back leg straight. Hold the stretch for 20 seconds or so and then switch leg position to stretch the other calf.
