Seniors’ Fear of Falling: How You Can Help

With the Baby Boomer population aging, movement professionals have to become more prepared to meet the needs of older adults. And while it may be tempting to think seniors need less when it comes to program development, clients of advanced age actually need more.

It’s not enough to modify the intensity or safety of their fitness programs. It’s also essential to understand how the mindset that older clients bring to a session—in this case a fear of falling—can influence their exercise needs. Older adults can greatly benefit from strengthening specific hip muscles, learning gait-related motor programs and understanding how their thoughts affect their bodies. Armed with this article, trainers can help seniors accomplish all three.

In Your Client’s Head

Many personal trainers overlook the mind’s impact on movement mechanics. Research shows that our thoughts affect the particulars of gait pattern, which in turn can influence injury risk while exercising. This is why it’s so important for trainers to bone up (pun intended) on their knowledge of balance, hip strength and the mechanics of normal gait, and to understand how these all relate to fall risk in senior clients.

Which Comes First, the Fall or the Fear?

If we make a list of “who” falls, it is easy to put “old people” at the top of the list. And yet, while falls are one of the most serious health issues for the elderly, age is closer to the bottom of a long list of risk factors for falling (Rubenstein & Josephson 2006). Top risk factors for falls include muscle weakness, gait deficit and balance deficit, all of which are easily remedied with a thoughtful training program.

This might seem like an issue of semantics. After all, if older people are weaker and their weakness leads to wobbly walking, isn’t age really the risk factor? The answer is, no, not really. Muscle atrophy in the elderly population is, in general, not a result of aging as much as it is a result of decreased movement over a number of years—meaning, people typically stop moving and then get weak, not the other way around.

Unraveling the Fear Factor

Our understanding of the risks of falling improved dramatically when research demonstrated that fear can actually cause people to fall. Researchers wondering whether the fall begets the fear, or vice versa, found that those who had not fallen, but who had reported a fear of falling, were more likely to fall in the future—despite a significant decrease in their activity levels (Friedman et al. 2002). Studies over a longer time (2 years) found that while a feeling of unsteadiness coupled with previous falls was a large contributor to fear, 18% of the “fearful” group had a large fear of falling even though they had not fallen themselves (Lach 2005).

Just Shuffling Along

From a distance we can recognize that unmistakable turtle-paced shuffle of the senior brigade. But it may come as a surprise to learn that gait patterns identifying someone as a senior citizen—short stride lengths, shuffling feet and low velocities—usually have no mechanical cause (Herman et al. 2005). In fact, research has found that gait disorders of this kind—in healthy seniors with no disease, no history of falls and no more muscle weakness than their counterparts—are largely a response to fear alone.

It turns out that fear-induced alterations in gait patterns can have a profound impact on the muscles used while walking. Timid walking tends to mean less clearance of the foot from the ground (shuffling), bent knees to lower the center of mass and a reduction in the natural arm swing that balances the movement of the legs.

Introduce This Issue

When teaching exercise that is specific to gait, balance or strength, initiate dialogue on the general fear of falling; this can increase confidence and encourage clients to continue with their program. Here are a few more suggestions to fuel your senior programming creativity:

Get Down on the Floor

With beds, couches and chairs abundant, many people have lost the strength to get off the floor because they just don’t get down there anymore. Getting down and back up again requires joint mobility and muscular strength. Have your clients practice doing it without using their arms and with one arm at a time. Make sure they can get up using their nondominant leg as well as their dominant one.

Create an Obstacle Course

Keeping a debris-free living space is obviously beneficial to the fall-risk group, but always moving in an obstacle-free environment will result in an atrophied ability to deal with nuances in the environment should they arrive. This ounce of prevention, then, can end up becoming the actual cause of a fall later on. The best approach is, as usual, one of moderation. While it is wise not to increase fall risk with clutter, it is also smart to train for obstacles. Consider creating a safe and supervised obstacle course, or have your clients practice walking with one foot up on a curb and one on the ground. You can even end each session by having them get down on the floor, roll onto their backs and get back up again.

For more information, please see “Addressing the Fear of Falling” in the online IDEA Library or in the May 2013 issue of IDEA Fitness Journal.

For the latest research, statistics, sample classes, and more, "Like" IDEA on Facebook here.

Katy Bowman

IDEA Author/Presenter
July 2013

© 2013 by IDEA Health & Fitness Inc. All rights reserved. Reproduction without permission is strictly prohibited.

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Article Comments

teri chadwick
On Jul 09, 2013
Excellent article! It answers some big questions for me since I had never considered the fear of falling to be a such a large factor influencing the odds of an actual fall. Great ideas on the actual programming as well. Thank you. (PS-- I plan to address this with my parents who are both in the 80s but who are still very active! An ounce of prevention is worth a pound of cure, right? They may not even know that a fear of falling is rumbling around in their gray matter. Likewise, I can extrapolate this to my own athletic pursuits. I was stand up paddleboarding for the first time just the other day. When I would start to consider how much I didn't want to fall into the water, I started getting wobbly; when I focused on simply performing the mechanics and enjoying the movement, I was fine! In other words, I knew what to do, but fear was sometimes getting in the way of me be able to do it.)
Mac Dodds
On Jul 10, 2013
Great article, it's a real concern and easy to address.
Vicki Gold
On Jul 12, 2013
Great article - now more on "mindset." Techniques I've used in my 40+ years as a PT:
Use "self-speak" to empower: Try expressions such as, "I have fear. I am controlling it. It isn't controlling me." (The mere acknowledgement, as stated in the article, opens the mind to positive change.)
To facilitate more normal gait: "I am tall, strong and confident." (Improves posture and mindset.)
"I am tall, strong and sexy!" (Don't laugh. "Sexy" facilitates a more natural pelvic rotation and weight-shift, which helps improve swing-through and stride-length.)
"I am" followed by the behavior or attitude you want to encourage - changes the body's physiologic ability to respond as suggested.
Back to laughing: Humor and an attitude of play, vs exercise, helps relax an individual. This enables equilibrium and balance reactions to occur more easily. I hope this is useful.
Heidi Rhoades
On Jul 15, 2013
As someone who works with seniors, this is a very real scenario and concern...in fact I had a client just last week scared to death to sit on a fitness ball because of her fear of falling. My own grandmother's health deteriorated to her eventual demise because of a fall. This article is timeless and very much appreciated! Thank you!
David Hart
On Jul 15, 2013
Well done article. In working with those that are subject to falls, I find them sitting on a physio ball helps. Typically, they have a hard time just sitting on the ball. For safety, best to have a structure they can grab on one side (handle of some sort) and you, the trainer, on the other side or behind them. Have a mat near them if that's what it takes. Once they can sit on the ball with good balance, have them close their eyes, or move the ball under them slightly. All about progression and safety. Another tip is to build up those hamstrings and glute muscles. Most state that their legs 'just gave way' which I have found was due to very weak hamstrings and glutes.
Lisa Reed
On Jul 30, 2013
Very interesting article! I am training a 73 year old client right now who has to get up and down from the floor when we use the power plate. He struggles, but now I know this is actually helping him with his strength. He does have a bad knee but we work around it.
Lisa Reed
On Jul 30, 2013
Very interesting article! I am training a 73 year old client right now who has to get up and down from the floor when we use the power plate. He struggles, but now I know this is actually helping him with his strength. He does have a bad knee but we work around it.
Lisa Reed
On Jul 30, 2013
Very interesting article! I am training a 73 year old client right now who has to get up and down from the floor when we use the power plate. He struggles, but now I know this is actually helping him with his strength. He does have a bad knee but we work around it.
Lisa Reed
On Jul 30, 2013
Very interesting article! I am training a 73 year old client right now who has to get up and down from the floor when we use the power plate. He struggles, but now I know this is actually helping him with his strength. He does have a bad knee but we work around it.
Lisa Reed
On Jul 30, 2013
Very interesting article! I am training a 73 year old client right now who has to get up and down from the floor when we use the power plate. He struggles, but now I know this is actually helping him with his strength. He does have a bad knee but we work around it.

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