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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Focus on Fitness Focus on Fitness
 

Strength, Balance Key to Preventing Falls in Elderly


July 09, 2013

By Howard LeWine M.D.

Brigham and Women's Hospital

More than 30% of older adults fall every year, often incurring substantial personal and financial costs.

Beyond pain and decreased mobility from a fall, the consequences may be much more serious. One in 20 hospitalizations of older people is directly related to falling. A fall can cause hip fracture, bleeding into the brain and premature death.

The annual medical expense for fall-related injuries in U.S. adults over age 65 is greater than $20 billion.

Why Older People Fall

There are many reasons that older people have increased risk of falling. Prevention of falls starts with identifying potentially treatable medical conditions, such as:

  • Side effects of medications
  • Fainting spells
  • Lightheadedness with standing caused by postural hypotension (blood pressure that drops dramatically with standing)
  • Vertigo or other forms of dizziness
  • Persistent pain in any part of the leg
  • Impaired vision & for example, needing new glasses or having cataracts
  • Excess use of alcohol or sedatives

Independent of whether one or more medical reasons is found for falls in an older person, two general strategies can significantly help decrease the risk of a fall & home safety and improved physical conditioning.

Home safety measures include:

  • Good lighting throughout the home, especially in stairwells and hallways
  • Non-slip floors and rugs
  • Hand rails on stairs, next to the toilet and in the shower and bathtub
  • Skid-proof mats or strips in the shower and bathtub
  • Removal of furniture that can slip away if grabbed accidentally for support
  • Supportive non-slip footwear and not walking in stocking feet

Physical conditioning with a structured exercise program that includes balance training is considered the most important component of a general approach to reducing falls. The components of the exercise program should include resistance training and techniques to assist balance, slowly progressing from light to heavier resistance and from simple to more complex techniques.

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Resistance Training

Resistance training to reduce falls is directed primarily at increasing core strength and leg muscle strength. Core strength refers to toning and strengthening of the abdominal and back muscles.

Here is a sample session for a resistance training program:

Warm up with 10 to 15 minutes of light aerobic activity, such as walking on a treadmill or riding a stationary bike with little resistance. The goal is to slightly increase the heart rate without heavy breathing. One way to be sure that you are not working too hard at this stage is to see if you can easily talk in full sentences.

Once you are warmed up, spend the next few minutes on core strength. Start with two simple abdominal muscle exercises that also will help strengthen the back muscles: modified sit-ups and oblique crossovers. Additional abdominal exercises can be added as you get more comfortable. If you feel any strain in your low back, decrease your range of motion during your repetitions.

Next move into some progressive resistance exercises for the legs. This can be done at home with or without ankle weights. However, using the resistance machines at the gym is easier.

The main muscle groups that you will work are the muscles that move the hips in and out, the front and back thigh muscles, and the calf muscles. I advise asking a trainer to walk you through the exercises on the machines. Start with light resistance, making sure that you can complete at least two sets of eight to 12 repetitions before adding more weight on your next workout. Limit resistance training to three times per week.

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Balance Training

With age, a combination of factors decreases balance. The nerve endings in our feet don't detect impulses as readily and the balance control centers in our brain and our ears operate more slowly. Age-related changes in vision and hearing, even when subtle, also contribute to the decline in balance.

The type, duration and intensity of balance exercises is based on what a person is most comfortable starting with and will continue performing on a regular basis. When studied, no specific routine or approach appears to be superior. Unlike resistance training, you can and should do balance exercises daily.

A simple balance exercise:

See how long you can stand on one leg. You will need a stable structure (a doorway is a good choice) to hold on to before you even try to lift the leg. Practice a few times while holding on. Once you are comfortable, lift one leg slowly. Then slowly release your hands while keeping the leg lifted off the ground. Repeat with the other leg.

Measure the number of seconds you are able to keep the leg lifted without needing to grab the doorway or put the leg down. Balancing on one foot is an excellent exercise, and by measuring how long you can hold each leg up, you can keep track of your progress.

Here is a variation of balancing on one leg:

Do the exercise with repetitions. Balance on one foot for 10 seconds, then put the foot down for 10 seconds, and then raise it again. Do four to eight repetitions on each foot. Do this in a doorway or next to something stable that you can grab quickly if needed. After you have mastered this, try it with your eyes closed.

Once you are very comfortable with balancing on one foot, you can advance to the next stage. Balance on one foot, and hold the lifted foot in front of you before lowering it to the ground. You can then practice moving it backward and then sideways. Always stay in control by holding on with your hands as you need to.

Tai Chi, a series of slow, purposeful body movements coordinated with mindful breathing and mental focus, has gained popularity in Western countries as a way to improve balance and also increase muscle tone and strength.

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Bottom Line

Exercises to improve physical conditioning and balance done regularly for at least three months clearly decrease the risk of falls. Studies with programs of six months duration have shown even greater benefits. The specific components of the exercise and balance program are not as important as just doing it.

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Howard LeWine, M.D., is chief editor of Internet publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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