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“What can the average senior do to improve his or her balance?”

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This question was recently posted by Gary Jader, and it is a really important one. Let’s get directly to it and then fill in some details below for those interested. Here are some basic simple low-tech advice for the healthy average senior to improve or maintain your balance function.

First, if you experience sudden noticeable changes in your balance function, contact your doctor to figure out what is going on. Is it simply regular healthy aging or something else, a medical condition, vision problems or maybe some medications causing it? Get help figuring it out.

So here we go:

  1. Stay physically active on a regular basis, preferably daily. Anything is better than nothing. Walking and running is ok but specific balance exercises described in this article and Tai-Chi is much better (more on that below).
  2. Find ways to challenge your balance safely. You either “use it or lose it”. This means you cannot sit in a chair and exercise your balance using elastic exercise bands (many think so and no, it does not work!), nor can you stand up on one leg and hold on to something to stabilize yourself, the challenge is not sufficient. Make sure you feel it is somewhat difficult to keep balance during your exercise.
  3. If you don’t have the motivation or discipline to exercise balance on your own, find a training partner or join a gym or an exercise group. Make sure they offer specific balance training classes or have an exercise class that involves balance challenges.
  4. Exercise your mind during training, find ways to multitask. Studies have shown that individuals who react slowly during multitasking have a higher risk of falling. You can improve your multitasking skill with training.

This discussion ties into a recent post and a paper we published entitled “How to improve gait and balance function in elderly individuals – compliance with principles of training”. The paper describes a basic framework for balance training that can be adopted to essentially any individual or level of balance skill, be it old frail grandma, patients who are prone to fall, or even athletes. It also provides a review of previous studies that targeted balance function. Some of these did not comply with principles of training and therefore showed little or no improvement in function. For example, only improving strength is not likely to improve your balance, unless it is a limiting factor of your performance. For those interested I refer to the above article for further details. The conceptual framework described in the article has since been adopted and used in several research studies on subjects including healthy elderly individuals, fallers, those with fear of falling and patients with osteoporosis. More about those results in a later blog.

So what are some of these principles of training? Plenty of articles and books have been written about them and the intention here is not to go into much detail but rather point out a couple of important ones that may be particularly relevant for balance training. Overload is an important principle essentially meaning that challenging the body just beyond what it currently can do leads to a compensation and gradual adaptation to that overload. Continuity, periodicity and progression are pretty self-explanatory; training should be continuously ongoing, be periodic and include cycles of overload and rest, and over time the training challenge must increase progressively. Specificity is a very important principle, essentially you have to practice the skill you want to improve. Swimming is not going to improve your balance and neither is training strength training, unless it includes an element of balance. For example, a great simple exercise that challenges strength and balance is lunges, especially if you step on to a foam surface.

I have a background in Exercise Physiology and coaching; I helped elite athletes improve their performance including the physical, technical as well as emotional/psychological dimensions of their performance for many years. Improving performance in athletes is a matter of constantly pushing the boundaries of what you are able to do based on a detailed understanding of what is demanded in your specific event. Matching the profile of your capabilities across all dimensions of performance with the specific requirements of the event reveals “gaps” in your performance profile that are likely to be areas where improvement can be achieved. In principal, improving balance, mobility and physical function in non-athletes and even patients is pretty similar and this is where “compliance with principles of training” comes in. An intervention must adhere to principles of training to have the intended effect on performance.

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Falls – the “often overlooked epidemic”, and what Dr. Sanjay Gupta forgot…

By Dr. Lars I.E. Oddsson, PhD.
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Have you seen this video? It is a nice report by Dr. Gupta of CNN about falls and injury? It is a few years old but still highly relevant, maybe even more so today as we are moving into the age of the “Silver Tsunami”.  You should take a couple of minutes to check it out here.

There are several important facts in the report such as:

“30 percent of seniors who break their hip die within a year.”,  “get rid of rugs” (people tend to trip on them and fall), and the importance of exercise to improve balance is mentioned. But the good Dr. Gupta actually forgot something important when he was asked this question by Katie Couric:

“What are the causes of these balance problems among the elderly population?”

This is a complex multifactorial problem and Dr. Gupta sort of looks like he is put on the spot! He refers to the patient in the story, Diane Schraeder, and that she happened to have an “inner ear problem, something that can be treated”. Sure, it is true that inner ear balance problems can be treated but that does not mean that they can be cured. Then Dr. Gupta replies that causes of balance problems can be dementia (not sure about that one…), “some vision problems” (yes!) and “some motor problems or just a little bit weak” (muscle weakness may not be a cause of balance problems but it may make it more difficult to correct balance). Dr. Gupta then correctly states “it can even be a new medication” that causes balance problems. Yes, it is well known that certain medications, on their own or in combination, can cause balance problems and increase the risk of falls. If this is something you experience you should review your medications with your doctor. Most of the time this can be mitigated.

So what did Dr. Gupta forget to mention as an important cause of balance problems? Peripheral Neuropathy! Something millions of patients suffer from!

Patients with Peripheral Neuropathy gradually lose sensation in their feet and foot pressure is a very important part of our sense of balance. In an upcoming blog we will discuss emerging technology that can help replace lost foot pressure sensation and provide new tactile sensory cues for balance!