Best Exercises for Preventing Falls in Older Adults

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Fall causes and risks Getting older increases the chance of lots of health problems, such as heart disease, dementia

Fall causes and risks

Getting older increases the chance of lots of health problems, such as heart disease, dementia and diabetes. And here’s another major health risk in our golden years: falls. One in 4 people age 65 or older suffers a fall each year, and 3 million wind up in the emergency room for taking a spill. Why is falling so common once we reach a certain age?

It’s typically due to a number of factors. “Side effects from prescription medications can cause drowsiness and dizziness, resulting in falls,” says Tim Schuckers, a physical therapist based in Portland, Oregon. “Gradual muscle weakness in the lower legs from sedentary lifestyles can also result in legs giving way easily when walking and standing.”

Other fall causes can include:

— Underlying conditions, such as arthritis or neuropathy (pain, numbness or tingling in the extremities that makes it hard to sense the ground).

— Balance problems.

— Declining reaction times.

— Vision problems.

— Hearing loss.

— Environmental hazards, such as floor clutter, throw rugs or slippery bathroom floor tiles.

Fall consequences are alarming. The Centers for Disease Control and Prevention notes that 1 in 5 falls results in a serious injury, such as a broken hip or traumatic head injury. Falls also cause 32,000 older adult deaths every year.

So what can you do to prevent falls in older adults? You’ll need to talk to your doctor about treating underlying conditions. You may need an eye exam or a hearing test. You’ll need to remove fall hazards in your home. And you’ll have to start a regular exercise program.

Get an evaluation.

Before beginning an exercise routine, it’s a good idea talk to a health care professional. It could be your primary care doctor or it could be a specialist — for example, if you have an orthopedic surgeon or rheumatologist on your medical team.

Or you could go to a physical therapist. In some states, such as Florida, you can simply contact a physical therapy group and make an appointment, since a doctor’s referral is not needed for an evaluation.

“Please consult a physical therapist if you have a history of falling, feel fearful or unsafe or have not been exercising in some time. It is very important to begin such a program at the appropriate level and that the source of the problem is identified,” says Palak Shah, a physical therapist based in Rocklin, California. “Let the professional PT help you identify the issue and provide the right treatment to improve your balance and decrease the likelihood of a fall.”

Your physical therapist will customize a routine that will likely include the following nine exercises.

A corner stand

Physical therapists recommend challenging your balance daily to maintain it. Balance depends on input from many body systems, such as your eyes, ears and nerves in your limbs and feet.

“When children play, they are constantly challenging their vestibular (balance) system by twisting, turning, flipping and running in every which direction. As we age and become more sedentary, we slowly lose our balance skills. Unfortunately, this is typically an insidiously slow process that goes unnoticed until a fall occurs,” explains Libby Bergman, a physical therapist based in St. Augustine, Florida.

A corner stand is a good way to test balance regularly. “Stand with your back in a corner of a room,” Bergman advises. “Put a sturdy chair in front of you. You shouldn’t be able to feel the wall or the chair when standing, but they should be close enough to steady your balance if needed. Try narrowing your stance and closing your eyes.”

Bergman says to hold the position for at least a full minute without bumping into the walls more than twice.

A tandem stance

Another great balance exercise is a tandem stance. “You can do this with one foot in front of the other, as if you were trying to balance on a beam,” Schuckers says. “If this is too difficult, then spread your feet slightly further apart until it is challenging to balance, yet you can do it successfully. At any time you can use your hands to touch or tap the sink or counter to maintain your balance.”

Schuckers advises holding the stance for 30 seconds and repeating it three or four times.

Tandem walking

A more advanced tandem exercise is tandem walking. It’s a little like walking on an imaginary tightrope. If you feel you’re at risk for falling, make sure you have a buddy with you before you attempt this exercise.

“Walking with one foot directly in front of the other, heel to toe, changes your center of gravity and trains your balance,” Shah explains. “Count how many steps you are able to walk this way without losing balance. You can work up to doing this for short distances with the eyes closed to further hone your visual balance system.”

Sit-to-stands

Strong legs are also important to prevent falls. One simple strengthener is a sit-to-stand. It works many muscle groups, such as the abdominals, gluteals in the buttocks and thigh muscles.

“Start by sitting on a sturdy chair that will not slide or roll,” says Kimberly Smith, a physical therapist based in Chicago. “You should be able to sit comfortably with your feet flat on the ground. You can also have a countertop in front of you in case you need it for support. Sit forward in the chair so your buttocks are toward the front of the seat. Push your weight, evenly distributed, through your feet as you rise to a standing position. Slowly sit back down, trying not to plop down. Repeat five times. The goal is to not use your hands. But if you need to push up from the chair seat or arms at first, go ahead.”

Standing dual heel raises

Another good strengthener works the lower legs. “This exercise specifically strengthens the calf muscles that are important for walking,” Schuckers says. “You can perform this exercise easily while standing next to a kitchen countertop. Place both hands on the counter. Stand with both feet shoulder-width apart and press through the front part of both feet, raising both heels up off of the ground.”

Ten dual heel raises in a row is considered one set. Schuckers recommends performing three sets, three or four times per week.

Step ups

Step ups strengthen the muscles in the buttocks (the gluteal muscles) and the upper legs (the quadriceps in the front of the thighs and the hamstrings in the back of the thighs).

You can use a small step stool for this exercise or simply stand on the bottom step of a staircase that has handrails to grab in case you fall.

“Begin by placing your right leg up on the step and follow with the left leg, then return the left leg to the floor. Keep the right foot on the step the entire time,” Smith says. “Do 10 repetitions on the right foot, then switch to the left foot (for another 10 reps). This exercise can be made easier or more difficult by changing the step height. A shorter step is easier, and a taller step is harder.”

Supine straight leg raise

You’ll have to lie down on your back for this exercise. It beefs up the hip flexors, quadriceps and core muscles.

“Tighten up your core muscles by bracing your abdomen as if someone had tossed a ball at you and it was about to hit your stomach,” Schuckers says. “While holding this abdominal brace, lift the straight leg up toward the ceiling until it is parallel with the bent leg. Pause at the top, then lower it back down to the starting position and repeat. Perform two to three sets of 10 repetitions, three or four times per week.”

Schuckers advises resting for about 30 seconds in between sets.

Bridges

Another floor exercise you can do while lying on your back strengthens the gluteal muscles in the buttocks, which help stabilize your hips.

“Bend both knees equally and keep your feet a shoulder-width apart. Squeeze your buttocks muscles as you lift your hips up towards the ceiling. Try to focus on squeezing the buttock muscles to drive this motion. Pause at the top, then lower back to the starting position,” Schuckers advises. “Perform three sets of 10 repetitions, three or four times per week.”

Schuckers advises resting for about 30 seconds in between sets.

A back stretch

Stretching your muscles is important to keep them supple and flexible, which will help improve your reaction to encountering uneven pavement that could make you trip.

After a workout, try a routine that gently stretches all of your muscle groups, including your back, shoulders, arm and leg muscles.

A simple back and hip stretch is a child’s pose. You can do it by getting on all fours on the floor, with your palms facing down. Move your buttocks back to rest on top of your heels. As you lower yourself backward, lower your forehead to the floor, then hold the position for about 10 seconds. Take a few deep breaths — inhale and exhale. Then slowly rise back up to being on all fours.

A back stretch can help your posture, which can improve your overall balance.

How often should you exercise?

When it comes to doing exercises that specifically improve balance or strength, Shah recommends aiming for two or three times per week.

But remember that regular physical activity is important every day. The guidelines recommend 150 minutes per week of moderate-intensity exercise, such as brisk walking. “And this requirement does not decrease with age,” Shah points out. “It really is not that much time — 30 minutes per day, five days per week on average. It’s been demonstrated to have significant improvements in balance and conditioning to decrease the incidence of falling.”

And, of course, regular exercise is essential for maintaining health and staving off many kinds of chronic diseases, such as heart disease or diabetes, which increase the risk for falling.

Best exercises for preventing falls in older adults:

— A corner stand.

— A tandem stance.

— Tandem walking.

— Sit-to-stands.

— Standing dual heel raises.

— Step ups.

— Supine straight leg raise.

— Bridges.

— A back stretch.

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