November 24, 2021

Benefits of Balance Training in Older Adults

Written by: Amanda Cheong, M.D.

Our bodies are not built to last forever. Eventually, bones would turn fragile and brittle; eyesight would deteriorate; reflexes become slow; maintaining balance becomes harder. This is the perfect storm for someone to get injured.

 

Falls are the most common cause of injury in older adults. Nearly 30% of adults older than 65 years sustain a fall each year. These low impact falls in the elderly can still result in fragility fractures. This translates to around 29 million fall episodes and 7 million injuries in a year.[1] We haven’t even gone into how much the hospital stay would cost or the decrease in the injured senior’s quality of life.

 

While increasing age remains a large factor in these accidents, there are also other modifiable risk factors. There lies the biggest tragedy of it-- these falls can be prevented.

 

Certain risk factors are a little harder to change than others. Nearly 70% of older adults have more than two chronic conditions that need to be medicated.[2] At times, these chronic conditions can increase the risk for a fall-- particularly foot and ankle problems, poor eyesight, neurological balance problems. Other times, it’s the sedating medications that cause problems. When you ought to be awake and alert but you’re taking medicine that causes dizziness, this might end in a fall.[1]

 

A healthcare professional can balance the benefits and risks of these conditions. Even tripping hazards, common in most households, can be addressed by a visit to an occupational therapist.[1] There are, of course, certain things we can manage on our own.

 

Balance training in older adults to prevent falls

When a particular topic is heavily studied, each research may not always give the same answer. To resolve these and to create stronger claims, researchers would pool data together to see the effects of a particular intervention across multiple studies.

 

One such pooling of data looked into the effectiveness of exercises on fall and fracture prevention. The researchers gathered 12 studies that assessed 4784 elderly adults who engaged in different exercises. These researchers found that strength exercises and balance training were effective in lowering the risk of falls. Meanwhile, resistance and jumping exercises decreased the risk of getting a fracture from these falls. These older adults engaged in these effective exercises from as little as 5.5 weeks to as much as two years.[3] There is even utility in this exercise for people who are above the age of 80! [4]

 

Another review noted that balance in the elderly can be increased by several different kinds of exercises. It mentioned balance training-- specifically a regimen of 12 specific balance exercises lasting for 60 seconds followed by a brief rest. Both balance training and tai chi were found to increase balance by up to 15% in elderly individuals who participated in the intervention. But beyond balance training, the review also mentioned that resistance and aerobic exercises, wobble board training, aerobic step and stability ball training also increased balance in elderly individuals.[5] This begs the question--

 

What is balance training?

 

There is no set definition or criteria for what counts as balance training. Each research tends to employ a different set and standard with different intervals and durations. But the main component involves decreasing the person’s base of support. That shifting of the center of mass while trying to stay upright is essential in keeping balance. Balance training is not only limited to a steady subject but may include movement where the participant steps up and down a set of stairs in quick succession with minimal hand-held support. This would keep them focused on staying upright and balanced. They can also do the tandem walk where people place one foot directly in front of the other as if you’re walking on a tightrope. Weak balance can sometimes cause people to step out of that thin imaginary tightrope to broaden their base.[3]

 

There has been research on specific balance training programs that have been studied and were noted to be fun and engaging by the participants. One such program was studied by Halvarsson and colleagues.[6]

 

Each session starts with a five-minute warm-up where the older adults march in place or stand on one leg. Sometimes they lunge forward, catching themselves on one leg without going off balance. The warm-up is followed by 15 minutes where they sit on a ball. This allows for the constant shifting of the center of gravity to help test their balance. Then 15 minutes of walking or standing exercises. Dual-task performances were also involved to simulate natural daily activities. These specially designed exercises would have different components incorporated for participants who engaged in basic level, moderate level, or advanced level exercises.[5]

 

This particular research sets an example by which balance training can be done. Halvarsson and colleagues note that modifications should remain grounded in its purported theory-- focusing on balance control, basic exercise principles, and dual-task performances.[5]

 

Sometimes, despite our best efforts at prevention, falls can still happen. Does balance training have a role in this?

 

Balance Training in hip fracture patients

 

Through reviewing 9 studies that analyzed a total of 872 patients who already had a hip fracture, WU, and his colleagues showed that there was still benefit in balance training after an injury. These participants showed improved physical functioning. Their legs had more strength, they walked better, and they had a better quality of life than those who did not undergo balance training.[7]

 

The benefits of balance training for older adults extend through different kinds of training, different durations of training, different ages, and even for those who were already injured. This may represent a small action we can take to prevent fall injuries and improve functioning in those who are already injured.

 

References:

  1. Dellinger A. Older Adult Falls: Effective Approaches to Prevention. Curr Trauma Rep. 2017;3(2):118-123. doi:10.1007/s40719-017-0087-x
  2. Salive ME. Multimorbidity in older adults. Epidemiol Rev. 2013;35:75-83. doi:10.1093/epirev/mxs009
  3. Wong RMY, Chong KC, Law SW, et al. The effectiveness of exercises on fall and fracture prevention amongst community elderlies: A systematic review and meta-analysis. J Orthop Translat. 2020;24:58-65. Published 2020 Jun 1. doi:10.1016/j.jot.2020.05.007
  4. Zhao R, Bu W, Chen X. The efficacy and safety of exercise for prevention of fall-related injuries in older people with different health conditions, and differing intervention protocols: a meta-analysis of randomized controlled trials. BMC Geriatr. 2019;19(1):341. Published 2019 Dec 3. doi:10.1186/s12877-019-1359-9
  5. Thomas E, Battaglia G, Patti A, et al. Physical activity programs for balance and fall prevention in elderly: A systematic review. Medicine (Baltimore). 2019;98(27):e16218. doi:10.1097/MD.0000000000016218
  6. Halvarsson A, Dohrn IM, Ståhle A. Taking balance training for older adults one step further: the rationale for and a description of a proven balance training programme. Clin Rehabil. 2015;29(5):417-425. doi:10.1177/0269215514546770
  7. Wu JQ, Mao LB, Wu J. Efficacy of balance training for hip fracture patients: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2019;14(1):83. Published 2019 Mar 20. doi:10.1186/s13018-019-1125-x
Article written by Amanda Cheong, M.D.
Dr. Amanda Cheong spent her formative medical years within the walls of the Philippine General Hospital, a high-volume tertiary institution built to serve the underserved. After graduating with a degree in medicine, she went on to write, edit, and compile healthcare stories from the start of the COVID-19 pandemic for an online anthology. Currently, she is involved in medical research as well as volunteer telemedicine consults. She enjoys writing fiction on the side when she’s not tending to her plants and three pet turtles.

Leave a Reply

Your email address will not be published.