Life with more balance

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.


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.

A 2002 report published in the Journal of the American Geriatrics Society pooled the results of four separate trials of such individually prescribed balance training. Data from 1,016 men and women ages 65 to 97 showed that the exercises were equally effective for men and women, reducing the number of falls and the number of fall-related injuries by 35%.

Of the group classes they analyzed, the Cochrane Collaboration found that a 15-week group tai chi class was the best at preventing falls. And a 2007 study of about 700 people ages 60 and older found that those who participated in tai chi classes for one hour a week for 16 weeks had a 50% reduced risk of multiple falls -- a difference that persisted eight weeks after the study concluded. Tai chi participants also performed better than the control group on measures of balance, such as how much they swayed when standing on the floor or a foam mat.

Though group classes and self-directed home exercises can be a good option for healthy people looking to maintain or increase their balance, Cox and Johnson recommend that anyone who has fallen or is having difficulty with mobility see their physician for a referral to a balance clinic or physical therapist before starting any kind of exercise program. People already experiencing balance problems could be injured if they attempt a group class without being properly evaluated first.

Ellen Corman, injury prevention coordinator at Stanford Hospital and director of Farewell to Falls, a program for seniors who have recently fallen or are at risk of falling, says it can be difficult for some older adults to understand the importance of exercise. Many do not realize how active they once were maintaining a household or raising children, she says.


Preserve fitness levels

But the benefits of balance-promoting exercises are not just limited to older people. The best way for younger people to avoid falls as they age is to enter their older years in the best shape possible.

That could amount to a substantial societal savings. The National Institute on Aging projects that the 65-and-older population will double between 2000 and 2030, growing from 35 million to 72 million. By 2020, the cost of treatment, plus indirect costs such as disability and dependence on others, is expected to reach more than $40 billion a year, according to the Centers for Disease Control and Prevention.

Preserving or regaining balance takes commitment. You can't just take a class or work with a physical therapist for a few weeks and call it quits: Balance exercises must be done regularly -- at least two to three times a week, according to the American College of Sports Medicine -- and continued through life.

"Think of balance like dental care," Cox says. "It requires regular, daily work to keep it quick and functional."




More information

Here are some resources where you can learn more about balance disorders and balance training.

Vestibular Disorders Assn. (VEDA):, (800) 837-8428.

National Institute on Aging:, (800) 222-2225. The institute's document "Preventing Falls and Fractures" can be read online at

The Centers for Disease Control and Prevention's document "Preventing Falls Among Older Adults" can be read online at /preventadultfalls.htm. (800) 232-4636.

AARP's document "Better Balance Prevents Falls" can be read at _prevents_falls.html. (888) 687-2277.

-- Erin Cline Davis



How to avoid spills

In addition to staying fit to maintain balance or getting specialized balance training with a therapist to restore it, there are other steps you can take to avoid falls. Here are some tips from the National Center for Injury Prevention and Control.

Make your home safer:

Have handrails and lights installed in staircases, and grab bars installed next to your toilet and in the tub or shower.

Remove from stairs and places where you walk things you can trip over.

Remove throw rugs or use double-sided tape to keep rugs from slipping.

Keep items you use often in cabinets you can reach easily without having to use a step stool.

Use nonslip mats in the bathtub and on shower floors.

Improve the lighting in your home.

Keep floors dry.

Change your behaviors:

Don't lean on towel bars or furniture for support.

Use handrails on all stairs.

Wear nonskid shoes or slippers.

Carry a smaller load.

Have your medications reviewed:

Let your doctor or pharmacist review all the medications you take, even over-the-counter remedies. Some medicines, or combinations of medicines, can cause sleepiness or dizziness that may lead to falls. Notable among them: certain antidepressant, anti-anxiety and blood pressure medications, and antihistamines.

-- Erin Cline Davis

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