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Balance Training for Older Adults

According to the Centers for Disease Control and Prevention, falls account for the highest number of accidental injury deaths in adults 65 years and older. To address this concern, more and more fitness facilities are offering balance training for their older members. Should you?

Balance Training Benefits. “We know that loss of balance is the number-one reason older adults fall,” says Kelly Bridgman, MS, associate executive director at the Crosby YMCA Wellness Center in Winter Park, Florida. According to Ken Alan, who has served as a fitness consultant for Cedars-Sinai Medical Center in Los Angeles, “Younger people get bruised when they fall; older people get broken bones when they fall. You can train the nervous system by practicing how to fall.”

Goals of Balance Training. When designing balance training for this population, Alan says, you should focus on exercises that improve lower-body muscle strength, visual acuity, neck flexibility and ankle dexterity. Linda Freeman, a personal trainer and group exercise instructor at the Bellin Fitness Center in Green Bay, Wisconsin, designs programs that “strengthen the feet, ankles, legs; improve proprioception; train core strength and alignment in various positions; and enhance reaction and focus.” At the Vista del Monte Active Retirement Community in Santa Barbara, California, fitness, aquatics and vitality director Peggy Buchanan, MA, addresses the variables that cause seniors to fall. “Internal variables include posture, strength, vision, medication and current health status,” she says. “External variables include obstacles, unsafe walking surfaces, stairs and lighting.”

Class Formats. While many instructors include an element of balance training in their regular senior sessions, some offer special balance classes for this population. Vista del Monte offers a roster of balance-specific classes, such as “No Falls Approach to Balance,” “Strike a Balance” and “B.Y.O.B. Better Balance.” Freeman runs personal training sessions and group classes under the umbrella of “S.A.F.E.,” which stands for Seniors and Functional Exercise. Karl Knopf, PhD, president of Fitness Educators of Older Adults and a professor of adaptive fitness at Foothill College in Los Altos, California, offers a cable TV class called “Don’t Fall Into Poor Health.”

Formats for these classes can be different than for other classes. Tammy Jones, who teaches seniors at several clubs in Vancouver, Washington, includes abdominal movements and exercises that strengthen the core. “I also incorporate some yoga-type moves and stretching exercises done on the floor or in chairs,” she says. Kathleen Burlage, fitness coordinator at the Huntington, New York, YMCA, has found 2-pound medicine balls are effective; she also includes t’ai chi moves in her warm-up and cool-down sessions. Freeman recommends that classes be “slower paced, with more time spent on functional strength, stability and flexibility rather than killer cardio and mega strength sets.”

Instructor Qualifications. “We require expertise with special populations, in addition to basic group exercise experience,” says Vista del Monte’s Buchanan. Bellin Fitness Center offers staff in-house workshops that focus specifically on working with seniors. Jones recommends taking continuing education classes on topics such as seniors’ medical conditions and common medications. (Some universities, like California State University in Fullerton, offer certificate programs in gerontology and related topics.) Knopf, however, has reservations about fitness clubs offering these types of classes. “Most fitness [professionals] think that teaching the stork stand is all that is needed,” he says. “But balance training is a complex series of biomechanics that should [involve] gait training, vision training, meds assessment and so much more.”

Marketing Suggestions. “Marketing is always a challenge,” says Bridgman. “But we have seen positive results by categorizing our classes [according to whom] we want to attract. For example, we include an active older-adult section in our program guide, and this is where we list these classes.” Alan recommends using subtle humor in marketing materials. “Play off popular songs or familiar commercial tag lines. For instance, try names like ‘Balance: Don’t Leave Home Without It’ or ‘Balance: What Becomes a Woman Most,’” he advises. In her marketing collateral, Buchanan stresses the benefits of balance in simple terms. “Use wording that the layperson understands, like stamina instead of cardiovascular health.” She also advises using euphemistic language like older adults rather than seniors. Freeman has her staff promote balance training in all sessions that target older adults.

As for when to schedule these classes, mornings and early afternoons appear to be the times of choice. “Seniors don’t want to go out much after dark,” says Alan.

Overcoming Challenges. Despite proper marketing, some have not had success with these classes. “Balance classes are not popular, because [participants] see improvements in such small increments,” laments Burlage. Several of those interviewed cited safety as a primary concern. In fact, Alan has stopped teaching balance classes because it was too difficult to teach older adults balance in a group setting. “There is no question—this is done better on an individual basis,” he says. Others feel balance training can be done safely in a group, but you need to accommodate a wide variety of fitness levels. “In the same class, you can easily have very active and very frail seniors,” says Bridgman. One way to increase safety is through adequate staffing. “Line up volunteers to help those who are a little wobbly,” Buchanan advises. Freeman concurs. “If you can find an older volunteer, you can also use that person as an inspiration for others. Seniors want to see that someone their own age can do the exercises.”

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