May 29, 2021

Upper and Lower Limb Strengthening Exercise to Reduce Falls in Older Adults

Written by: Zaakir Shakoor, MSc
Reviewed by: Mubashar Rehman, PHD

What causes older adults to fall?

As we age, we can experience a gradual decline in vital bodily tissues and functions that contribute towards mobility and balance (1, 2). These include; muscle mass, bone density, tendon elasticity, and joint strength (1, 2)

The extent of degradation (loss) can increase fall risk after the age of 65, One out of five falls cause serious injury that needs medical attention. Every year, around 800,000 seniors are admitted to the hospital because of a fall injury. Hip fracture accounts for around 300,000 admissions; falls are almost always responsible for traumatic brain injuries in seniors (4)

Exercise can be utilized to minimize the loss in these vital functions by promoting muscle protein synthesis (tendon and muscle strengthening), ossification (bone strengthening), and coordination/movement patterning. Within this article, I will highlight some examples of upper and lower body exercises that may, in turn, reduce fall risk (3)


My 6 ‘go to’ exercises to revive mobility and reduce fall risk in the older adults 


Exercise #1: Seated Dorsiflexion  

Step 1: Sit upright on a chair, if possible.

Step 2: Place your feet flat on the floor to create a stable base. 

Step 3: Place your palms on the thighs.    

Step 4: While keeping the heels in the ground, flex the mid/front of the foot to point the toes up.

Step 5: Bring the foot back to its original position.

Step 6: Make sure you are breathing throughout the exercise.

Step 7: Repeat the movement 20-30 times for 2-3 sets.

Additional information: The reason I have selected this exercise is due to its practicality and ability to revive adequate mobility. Imagine prior to taking a step the foot is always in the dorsiflexed position. The muscles used in this movement are the tibialis anterior which is located at the front of the lower leg. If you would like to add resistance you may be able to press down with your hands or request support from a physiotherapist or qualified trainer. 


Exercise #2: Seated Plantar Flexion   

Step 1: Sit upright on a chair, if possible 

Step 2: Place your feet flat on the floor to create a stable base. 

Step 3: Place your palms on the thighs.    

Step 4: Press from the front of the foot to create a step motion.

Step 5: Bring the foot back to its original position.

Step 6: Make sure you are breathing throughout the exercise.

Step 7: Repeat the movement 20-30 times for 2-3 sets.

Additional information:  This is another practical exercise that engages the stepping muscle (gastrocnemius) found at the back of the lower leg. Once again, you can press down with your hands or request support from a qualified professional to add some resistance. 


Exercise #3: Seated Knee extensions   

Step 1: Sit upright on a chair, if possible.

Step 2: Place your feet flat on the floor to create a stable base. 

Step 3: Place your palms on the thighs.    

Step 4: Straighten the leg at the knee (knee extension).

Step 5: Draw the leg back to its initial position.

Step 6: Make sure you are breathing throughout the exercise.

Step 7: Repeat the movement 15-20 times for 2-3 sets and ensure that you alternate the legs. 

Additional information: While walking, the knee extension is the 2nd extension of the kinetic chain of the lower extremities (legs). This movement activates the quadriceps muscle groups located at the upper leg. To increase the intensity, you can attach some low elasticity resistance bands around the ankles and the chair leg, creating additional positive pressure while extending the lower leg.  


Exercise #4: Seated hip flexion 

Step 1: Sit upright on a chair, if possible.

Step 2: Extend one knee (straighten the leg) without lifting it yet so that your toes are facing the ceiling, whereas the other foot will be flat against the ground at a 90-degree angle.  

Step 3: Grip the side of the chair for support.

Step 4: Lift the straightened leg (knee extension position). Try to raise the extended leg at the hip as high as possible

Step 5: Hold for a moment before lowering and doing the opposite side

Step 6: Make sure you are breathing throughout the exercise.

Step 7: Repeat the movement 15-20 times for 2-3 sets and ensure that you alternate the legs. 

Additional information: Hip flexion is also required while walking, which focuses on the hip flexor muscles. 


Exercise #5: Seated-standing-walking 

Step 1: Sit upright on a chair, if possible.

Step 2:Place your feet flat on the floor to create a stable base. 

Step 3: Place your hands to the side of the chair.    

Step 4: Exhale, press the ball of the foot, simultaneously extending at the knee and hips to stand up.

Step 5: Take 2-3 steps forward while producing some arm swing, and then step back to draw back into your seat 

Step 6: Repeat the movement 8-10 times for 2-3 sets and ensure that you alternate the legs.

Additional information: This movement replicates activities that will be required in everyday life, engaging both the upper and lower body.


Exercise #6: Seated front deltoid raises 

Step 1: Sit upright on a chair, if possible.

Step 2: Grasp some light weights in each hand, i.e., 0.5kg dumbbell or water bottles, if possible.

Step 3: Place the feet flat on the floor to create a stable base with the knees at a 90 degrees angle.

Step 4: Exhale, raise your arms vertically (straight in front) up to eye level.

Step 5: Inhale and bring them back down to the initial position.

Step 6: Repeat the movement 8-10 times for 2-3 sets.

Additional information: This movement will target most of the upper body's muscles, like the front of the shoulder and chest.


Conclusion

Movement is important to revive some of those lost age-related tissues and functions. I have highlighted some exercises that not only work both lower and upper body but are practical to everyday activities such as walking, standing up, and reaching up to place an item on top of a shelf. These exercises may in turn reduce the risk of falls.

References

  1. Laurent, M.R., Dedeyne, L., Dupont, J., et al. Age-related bone loss and sarcopenia in men. Maturitas, 2019; 122 (1): 51- 56
  2. Granacher, U., Muehlbauer, T., Bridenbaugh, S., et al. Balance Training and Multi-Task Performance in Seniors. International Journal of sports medicine, 2010; 31 (5): 353 –358
  3. Kannus, P., Parkkari, J., Koskinen, S., et al. Fall-induced injuries and deaths among older adults. The Journal of the American Medical Association.1999; 281(20): 1895-1899
  4. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Disclaimer: all of the information within this article is for educational purposes and is NOT intended as a personalized exercise prescription. No one can be held liable under the circumstances of damages, reparation, or monetary losses as a result of the information.

Article written by Zaakir Shakoor, MSc
Zack Shakoor Kayani was born and raised in the South East of England/London. Zack has attained a bolus of knowledge regarding biosciences through academia and his career experiences. In terms of his educational background, he has a Bachelor of Science in Kinesiology (Hons.), a Postgraduate diploma in sports nutrition with the International Olympic Committee, and a Master’s of Science in Nutritional Sciences. Zack has been fortunate enough to apply his Exercise Science and Nutrition Knowledge to aid Hundreds if not Thousands of Patients and Athletes, providing 1-1 consultation, Personal training, Information sheets, offering recommendations to collate nutrition and exercise programs, etc. Not to mention, in 2020, he authored a book called ‘Obesity Decoded’

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