Diabetes Forecast

Balance Training Helps Prevent Falls

By Tracey Neithercott , , ,

The word "balance" conjures images of tightrope walkers teetering on a wire, precariously stacked Jenga pieces, and gymnasts tumbling on a thin beam. What most people don't think of: exercise.

Yet balance training is a critical aspect of fitness, especially for older adults. "As we age, we typically lose muscle mass," says Shirley Archer, a spokesperson for the American Council on Exercise, who teaches senior-friendly exercise classes. "As a result, we lose strength." That's usually compounded by other factors, such as vision loss, mental decline, and inner ear disorders. "As early as our 30s, we start to lose the sense of where we are in space," she says.

Certain diseases and conditions are known to impair balance, too, stroke and Parkinson's disease among them. For people with diabetes, the risk is even greater because nerve damage, a complication of diabetes, may make it hard for people to sense where their feet are. And vision damage from retinopathy can make seeing the ground or what's around you difficult.

So what's the problem with a little wobbling? Well, the instability itself isn't really the issue. But being off balance can put you at risk for falling, and that's where the real harm is done. It can lead to broken bones, brain injury (if you hit your head), and even death. Because 1 in 3 adults over 65 experiences a fall each year, according to the Centers for Disease Control and Prevention, balance training is crucial.

Target: Core

Your core (your torso, including your chest, abdomen, back, and buttocks) gives your entire body stability. "If you're weak in the core, you're going to have less ability to access strength in your extremities," Archer says. Consider this scenario: You've strengthened your arms until your biceps bulge, but your core is weak. Your arms might be able to lift that heavy box, but you won't be able to carry it if you can't stabilize your spine.

To prevent this and improve your balance, it's important to do exercises that target your core. That doesn't mean you have to do 50 crunches a day. Simple balance exercises will work the core, provided you mind your posture. Aim to lengthen your spine: Imagine a cord runs through the center of your body and out the top of your head. Now imagine someone is pulling that string until you're standing tall. Another key element of good posture is relaxing your shoulders. Once you start to pay attention to your shoulders, you'll realize they often hunch up when you're stressed or busy or even cold. By relaxing your shoulders and lengthening your spine while exercising, you'll ensure your core is kept in balance, too.

Target: Legs

Strengthening your legs is a necessary element of balance training. According to Debra Rose, PhD, director of the Center for Successful Aging at California State University–Fullerton and codirector of the Fall Prevention Center of Excellence, people with muscle weakness, especially in the legs, are four times as likely to lose balance and fall as their stronger peers.

There are easy ways to build muscle in your lower body, including tai chi, yoga, indoor biking, and water aerobics. Plenty of exercises can be done at home, too (above and opposite). Standing on one leg is one of the best beginner's exercises you can do, and it's easy to fit into your daily routine: Do it while you brush your teeth, placing a hand on a counter or wall as necessary for balance.

For strong calves, Archer likes doing calf raises when waiting at cash registers or elsewhere. (To do them, rise to the balls of your feet and then lower yourself, repeating the process 10 times. You can also do this one leg at a time.) "I will stand in line and I'll just put one foot around the other ankle and do calf lifts," says Archer.

Target: Feet and Ankles

Your feet and ankles support your entire body, so keeping them strong is essential. Start by writing the alphabet in the air with one foot while seated; then use the other foot. Or, while seated and with your feet flat on the floor, lift just your heels off the ground. Repeat the exercise about 10 to 15 times.

To Stand or Sit

The goal of balance training is to stay slightly off balance while exercising so you can train your body to stabilize. So, seated exercises aren't as helpful as standing ones. That said, if standing balance training is too difficult, seated exercises are a good place to start.

Upping the Ante

As it becomes increasingly easier to perform exercises, shake things up. If you normally stay seated, stand. If you grip the counter while balancing, try using only one finger. When that becomes too easy, don't use your hands at all. Another way Rose challenges people's balance: She takes vision out of the equation.

Our senses work together to keep us steady—sight, touch, the sense of where we are in space gleaned from our inner ears. When one sense stops working, balancing becomes harder. That's why people with retinopathy are more likely to stumble and fall. And it's why Rose has her clients practice balance with reduced or no vision. That way, when they're in a situation where visibility is reduced (say, a trip to the bathroom in the middle of the night), they'll be prepared. If you're a beginner, challenge yourself with this exercise: While standing still with both feet on the ground, close your eyes and pay special attention to feeling where your feet are.

Another way to kick your balance training up a notch is to destabilize yourself. A firm surface, whether it's a wooden chair or tile floor, makes balancing easier. Unstable surfaces, such as couches, mattresses, carpet, and grassy ground, and balance equipment, such as BOSU balls and balance cushions, can all make your training more challenging.

Finding Help

All balance programs aren't created equal, and some can be dangerous for older adults or people with serious medical conditions who need specific care. "If you have significant balance problems, talk to a doctor and request a referral to a physical therapist," says Rose. Or check out programs in your community that specify "fall prevention."

Also important: Look into a fitness instructor's qualifications and pick a program that asks for a medical history and individually assesses you. Getting to know you will help an instructor figure out which exercises will help you the most—and, more important, won't harm you.



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One-Leg Stand

Beginners can perform this with one hand on a sturdy chair, wall, or counter. To make the exercise more difficult, use only a finger to steady yourself or avoid using your hands at all. When you can manage the latter with ease, try the exercise with your eyes closed.

1. Stand with feet hip-width apart.

2. Shift your weight through the hips toward your left leg. Your belly button should be over your left foot. Keep shoulders aligned with your hips (avoid dropping your shoulders to either side of your body or cocking your hips).

3. Bend your left knee slightly and lift your right foot for up to 30 seconds.

4. Repeat on the right side to complete one set.

Do: three to five sets

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Wall Touches

It's important to maintain good posture—spine lengthened, shoulders relaxed—throughout this exercise. To increase difficulty as your balance improves, stand farther away from the wall.

1. Stand tall with your back 6 to 8 inches away from a wall and feet hip-width apart. Focus your gaze on an object at eye level.

2. Shift your weight backward through your right hip until it touches the wall. (Adjust your distance from the wall so that your hip is able to reach it.)

3. Return to the starting position.

4. Shift your weight backward through both hips until your buttocks touch the wall.

5. Return to the starting position.

6. Shift your weight backward through the left hip until it touches the wall to complete a set.

Do: three to five sets


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