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Life with more balance

Exercises to hone strength and challenge the sensory system can reduce risk of falls.

May 26, 2008|Erin Cline Davis | Special to The Times

Though THE wisdom that comes with age can help navigate metaphorical bumps in the road of life, actual, physical obstacles can cause stumbles and falls. Increasingly, to combat a natural loss of balance that comes with the passing years, many people are turning to balance training classes.

About one-third of Americans age 65 and older fall each year -- roughly 12 million people. Falls are the leading cause of injury deaths and the most common cause of nonfatal injuries and hospital admissions for trauma in senior citizens.

More than 90% of the 352,000 hip fractures that occur each year are the result of falls, and such fractures can be catastrophic. According to government statistics, only one-quarter of such patients make a full recovery, 40% will require at least temporary nursing home care, and 24% of hip fracture patients over the age of 50 die within 12 months.

"Falls can be devastating to the quality of life," says Eric Johnson, associate professor of physical therapy at Loma Linda University. Just the fear of falling can cause seniors to curtail their activities, leading to a loss of their social networks that, in turn, can lead to depression, he says.

Fortunately, studies show that people can keep their balance skills sharp as they age -- even regain skills -- through balance training exercises.

To maintain balance, the brain integrates sensory input from three main sources: the eyes, the gravity-and motion-sensing vestibular system of the inner ear and the somatosensory system (controlling the ability to touch and feel via skin and joint receptors).

"As we age, the balance system slows down. This means that our feet don't feel the variations of the ground as quick, our reactions are a little slower, our muscles aren't as strong, and our brains do not process sensory information as quickly as needed," says Greg Cox, clinical director at the Balance Disorders Institute of Los Angeles, a rehabilitation center that specializes in the diagnosis and treatment of balance disorders.

In addition, several maladies that become more common with age can affect balance. Cataracts or macular degeneration can weaken the visual system. A condition called benign paroxysmal positional vertigo can affect the vestibular system. This can cause a sense of spinning after a position change such as getting up from bed.

Diseases such as diabetes, which can damage the nerves carrying information to and from the brain and spinal cord, can significantly affect a person's balance by interfering with the somatosensory system's ability to communicate with the brain about temperature, vibration, pain and the position of the arms and legs.

Balance training exercises focus on building strength and flexibility while also challenging the sensory systems involved in balance. To achieve all of this, variety is key. "Most people confuse balance as the act of holding still in one position. The reality is that balance is holding your position regardless of activity," Cox says.

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Small steps count

Exercises can be static, such as standing on one leg for 60 seconds, or dynamic, such as reaching activities -- leaning forward over a stable base of support as far as one is able, without taking a step.

Standing on one leg might seem like nothing more than a neat trick to learn, but there are day-to-day activities that rely on this balance element -- such as putting one's pants on while standing, getting in and out of a car, and negotiating curbs or stairs. "If you can't hold a single leg stance, you will ultimately have trouble with these common daily activities," Cox says.

The AARP website lists simple exercises one can do at home to help maintain and improve balance -- such as practicing walking heel to toe, standing on one leg, or simply standing up from a sitting position and sitting back down while maintaining proper posture. To up the challenge, you can try doing these while balancing a paper plate on your head.

"A general guideline . . . is to begin with a firm surface and wide base of support and increase the level of difficulty as appropriate," Johnson says. As balance improves, the challenge can be increased using tilt boards, foam pads and balance beams.

Community groups and health clubs sometimes offer classes with combinations of exercises specifically aimed at improving balance, but tai chi, yoga and weight training in the standing position -- even line dancing -- can all help too, Cox says.

The Cochrane Collaboration, an international nonprofit organization that conducts systematic reviews of healthcare studies, published a report in 2003 on interventions for preventing falls in the elderly. Their analysis of 14 studies that investigated exercise or physical therapy for fall prevention found that the most effective method involves muscle strengthening and balance exercises individually prescribed at home by a trained health professional.

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