Be Fit For Life

with Ellen Cohen-Kaplan

Balance – how it works and what we can do to improve it

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I went to a very useful workshop yesterday after my bike ride. It was about how cognition is linked to balance, why balance diminishes as we age, and how to maintain and improve it.  I’ve talked in past blog posts about how exercise has a positive effect on brain function, but today I’ll focus on balance. Balance is an extremely important aspect of your fitness. There are 3 basic systems involved with balance:

1. Your somatosensory system

2. Your vestibular system

3.  Your visual system

As we age, our vision declines. Our depth perception, an essential aspect of our eyesight, gets worse, and we perceive objects to be closer than they actually are. This  is why stepping over and around things can be tricky, and many falls occur on steps, where depth perception is vital. We can work around this by ensuring we have the right prescription for eyeglasses and using extra caution stepping over and around things and on the stairs.

Our vestibular system, which is comprised of fluid-filled semicircular canals in our ears becomes more sensitive as we get older. This is why you won’t see many people who are middle-aged or older on ferris wheels or other amusement park rides. When we’re  young, we crave that type of rotary motion so this system can mature; when we get older, it can easily make us nauseous. Another manifestation of our changing vestibular system is an increase in episodes of dizziness, which may range from full-blown vertigo, to just fleeting moments, or anything in between. Be sure to change your head position slowly, especially when getting up from lying down or even sitting.

Our somatosensory system is comprised of nerve receptors (proprioceptors) located in our muscles, tendons, joint ligaments and in joint capsules . These receptors sense pain, temperature and touch. As we age, these receptors also become less sensitive , but at a slower rate than the other two balance-related systems. This is the one system we can train to improve our balance. Sensory exercises, strength training, and range of motion exercises can all be used to enhance our balance through improving sensation, muscle activation and joint movement.

The main objective of balance training is to avoid falling.  The most dangerous place in the house for falling is the bathroom, and the most dangerous pathway is from the bed to the bathroom. This is because when you go from one to the other you’re likely to be half asleep and less alert. In addition, it may not be well-lit, there may be obstacles in your way and/or changes in floor surfaces which can be hazardous. If there’s a change in floor surface height of even 1/8″, it’s a tripping hazard. Thresholds, uneven floors in old homes, where tile meets carpet, and entryways to various rooms are major areas for caution. Throw rugs, chew toys for pets, and darkness present additional hazards.

One of the main contributors to balance impairment is medication. The following ones in particular have been found to impair balance.

  1. antidepressants
  2. anti-anxiety drugs
  3. antihistamines for allergies
  4. blood pressure and other heart medications
  5. pain relievers, both prescription and nonprescription, especially narcotics
  6. sleep aids, (over the counter, and prescription) especially when taken after midnight

If you combine alcohol with any of the above, your fall risk is multiplied.

Another major hazard is your shoe type– you should avoid walking in any shoes that you cannot run in.  Avoid flip-flops, high heels or shoes that don’t fit well, all of which are very unstable. One other major culprit to poor balance is dehydration. Even if you’re not thirsty,  drink at least half your body weight in ounces of water per day – consume even more in hot weather and if you’ve been sweating.

If you do feel yourself falling, the best body area on which to fall is your buttocks.  You can break your fall with your arms and hands, and tuck your chin to prevent hitting your head. The second best way is to fall forward on hands and knees. Breaking a wrist, elbow, or kneecap, while not pleasant, will heal more quickly and not be as disabling as a hip fracture or concussion. Avoid falling on your side in order to protect your hip.

Once you fall the first time, chances of falling again are greatly increased. Some of the best ways to insure that balance doesn’t decline with age is by doing lower body strengthening exercises.  Start with your toes and work up to your gluteal (butt) muscles.

Here are some sample exercises for strengthening those muscles:

Strengthen toes  -Toe scrunches, bunch up paper towel on floor under toes

Strengthen calves –   standing heel lifts

Strengthen glutes and hamstrings (back thighs) – chair squats, standing knee curls

Strengthen quadriceps (front thighs)  – lunges, clock lunges, squats against wall

Strengthen core muscles  – abdominal crunches, supermans

Strengthening exercises should be done with function in mind. Here are some functional activities related to the 6 basic movements of the human body. All of these use just body weight and the task at hand, so no special equipment is needed.

Squat – Getting out of a chair, and off the toilet (in old homes, the toilets are built lower)

Lunge – Getting out of the bathtub, getting up off the floor

Deadlifts- Picking up groceries, laundry baskets or children

Push – Pushing a mower, or opening doors

Pull – Raking leaves, removing clothes from dryer

Rotate – shoveling snow, getting things from the backseat of car

Another major way to prevent falls is to increase range of motion in those same areas- the hip, knee, ankle and toe joints are the major players in maintaining your balance. Your back also plays a role. Perform daily stretches for the following by swinging your leg from front to back as high as you can go, bending and straightening your knees, flex and extend your ankles, and flex and extend your toes. The range of motion exercises and strengthening exercises above go hand in hand. (or toe in ankle!)  _________________________________________________________________

So what are some go-to exercises you can do to enhance your balance?  Also, what’s the best way to progress from basic balance exercises to more complex ones? Go from the top to bottom of this list.

  1. Seated
  2. Seated on an unstable surface (pillow or soft cushion)
  3. Standing
  4. Standing on unstable surface
  5. Standing on one leg
  6. Walking onto and/or around unstable surfaces
  7. Walking on unstable surfaces

One good way to assess your balance  is to stand on 1 foot for 10 seconds on a stable surface; if you can’t manage that, you should be practicing regularly- ideally daily!

There are many take home messages from the blog today: Balance can be trained with the right exercises. Strength,  range of motion, and sensory exercises should be practiced during the week to maximize your balancing skills. Environmental hazards are a major cause of falls, so take precautions to make the most dangerous areas of your house, like your bathroom, more fall-proof by installing grab bars, using a night-light, eliminating obstacles on the way to the bathroom from the bed, and assessing floor height differences Medication, alcohol, dehydration and footwear all play an important role in preventing falls. Specific body weight exercises and balance progressions can greatly aid in keeping you on your feet. Check out next week’s blog which will feature ways to maintain and improve cognitive function. Also, I’ll be teaching a core, posture and balance class in the fall, so stay tuned!

 

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