Dynamic, Integrated Balance Program for Older Adults

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Are your older clients or class participants expressing concerns about falling? Losing balance as they age is preventable. However, their concerns may be well-founded, especially if their physical state is diminishing. Of course, lack of movement also contributes to balance challenges. If your clients have lost muscle mass over the years (sarcopenia), their fall risk rises. Combined with possible hearing loss, worsening vision, or joint issues, it’s no wonder our older members report increased fear of falling. Fortunately, with the right balance program for older adults, you can help clients retain or regain balance and reduce fall risk.

Whether you work one-on-one or with a group, you can design effective, science-based, cutting edge balance workouts. With this in mind, it is important to note that research does not support the mitigation of fall risk  when the training consists of standing on one leg. So instead of static balance moves, you can offer dynamic, integrated, functional tasks and movement challenges.

Over 200 internal and external factors affect our ability to stay upright. We rely on information from our body in space and our surroundings. For instance, we notice where we are in relation to the terrain and anticipate and adjust accordingly. But if the information coming in is compromised—due to weakening senses or poor lighting, for example—balance is compromised.

In order to positively affect balance and programs that make a difference, we need to consider the various systems, senses and functional domains that feed into our ability to stay upright.

Checklist of Criteria to Use for Balance Program for Older Adults

If we consider that the visual, somatosensory, and vestibular systems contribute to balance (see “Three Systems Affecting Balance: Visual, Somatosensory and Vestibular,” below), then the most effective exercise that we can (and should) present are those that rely on the following:

1. an integrated approach
2. a functional approach primarily based on dynamic, not static moves
3. a dual-tasking approach that incorporates the motor, cognitive or sensory domains

As you consider moves, exercises, games, or tasks to add to your sessions, weigh them against the above criteria.

• Does the move have a functional application for your clients’ lives?
• Are you tapping into a dual-task, two-for-one coupon special, such as walking (motor domain) while carrying a full cup of water (sensory domain)?
• Is posture favorably affected as you challenge dynamic balance?
  • Example: balancing a foam yoga block, glider disc, or paper plate on your head while walking or performing squats.

See also: Balance and Stability

Four Integrated Factors to Address: Balance, Posture, Strength, Cognition

The integrated approach recognizes that balance, posture, strength (including speed and power), and cognition are, in fact, integrated. If you affect one factor, you affect the others.

A well-designed and effective balance program recognizes this integration and offers dynamic exercises that enhance the above.

Example 1: standing up from a chair as quickly as possible, performing several repetitions in a row or for a specific duration. Progressions run from using a chair with armrests and rising to a stand to using no armrests and adding a slight jump upon rising. This functional move enhances balance, speed, power, and lower body strength.

Example 2: is to have your client(s) stand on one leg while tapping or floating the other leg to imaginary points on a clock on the floor that you, the trainer or teacher call out. Such moves challenge cognition and dynamic balance. As clients progress, you can speed up the cues, add smaller time increments—starting with just 12:00, 3:00, 6:00 and 9:00, then adding any clock hour—and ask for a floating leg instead of one that touches down with a tap.

Example 3: What about walking while talking? This is the ultimate functional move that has a fall risk, given the distraction of a conversation. Talking while walking requires awareness of the environment (sensory domain), a motor skill (walking) and cognitive stimulation (the conversation). In fact, a strong balance/fall risk reduction program needs to include lots of walking tasks.

Walking: The Ultimate Dynamic, Functional Balance Activity

Walking is our number one functional balance activity. Every leg swing-through requires balance on one leg. Therefore a balance program for older adults needs to offer some form of gait training. If you have time for only a few balance moves, prioritize walking tasks.

Walking examples include:

• walking slowly (very slowly)
• walking quickly (only as quickly as each person feels safe doing)
• walking with stops and starts (think “red light, green light”)
• walking up and down steps
• walking backwards
• walking through, around, and over obstacles, chairs, or step risers
• walking and turning (wide turns, pivots and twirls)
• walking on heels (forwards and backwards)

In order to accomplish these gait tasks, clients will simultaneously improve their posture and/or strength as they follow your cues. Call out turns, squats, hops or small jumps as they walk.

Can your clients walk and talk at the same time? We take this ability for granted, however older adults may start to walk in stops and starts as the cognitive load increases. Challenge them to maintain a constant speed while thinking through a conversation, math problem, recall task, or verbal pattern (such as naming their teachers from kindergarten through sixth grade).

They may also improve their cognition if they are walking while citing their childhood phone number or counting backwards by threes or naming animals in alphabetical order. To challenge their senses, you can dim the lights or play music or cue them to walk in ever-decreasing space without running into each other or anything in the room. Of course, safety is always the first consideration, so choose your variations according to your client’s or group’s abilities.

To challenge their somatosensory and visual senses, ask them to toss a tissue or balloon or scarf in the air as they walk. Right hand toss and catch only; then left; then two-handed. Then have them toss the item back and forth with you or other group members. Instructor check: Do you see where you are also addressing at least two of the four integrated factors with these challenges?

The above walking examples are just a fraction of the tasks, games, and exercises you can use to help your clients with their balance.

See also: Sample Class: Cardio, Core and Balance

Two Key Joints Affecting Balance

Because the pelvis and ankle are the two critical joints involved in balance, incorporate moves that improve their mobility. Look for opportunities to add dorsiflexion, such as marching in place on heels. Cue circling the hip clockwise and counterclockwise, “drawing” figure 8s with the hips, writing one’s name in cursive. All of these hip mobility moves can be done standing or on a stability ball. 

Foot mobility is also crucial for maintaining balance. Consider a session done in bare feet where clients pick up tissues with their toes. Offer seated, standing with support (chair, bar, wall, your arm) and unsupported standing options. Have clients scrunch the tissues, then unroll them; pick them up and transfer them across the other foot; pick them up and deliver them to the opposite hand, for example. While their shoes are off, use tennis balls as tools to roll, press, and massage different parts of the foot, including the toes. Help prevent shuffling and painful stride due to stiff feet and minimally mobile ankles.

Once you apply the concepts of function, dynamic movement, and an integrated approach (see “Exercise Content Criteria Checklist,” below), you will have an almost endless and effective source of exercises for your balance sessions.

Older adults want to ford streams when hiking, climb stairs where no railings exist, recover when they do fall. In short, they want the freedom to move, walk, and balance with confidence and a spring in their (upright) step. You can be the conduit to that freedom armed with the above approach to a balance program for older adults.