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Are you off-balance? Here's help

8:47:25 AM CDT - Thursday, February 12, 2004

By Shannon Littlejohn

Photo1.gif (21,173 bytes)
Above, one balance
exercise is the full tandem
stand, in which an
individual puts one foot in
front of the other, heel to
toe.
Most of us take our sense of balance for granted at least until we fall down. And the older we get, the harder we fall.

For an elderly person, not only is a fractured hip costly in price and quality of life, it is often a death sentence, says Michael Rogers, associate professor of kinesiology and sport studies at WSU.

"A third of older adults will fall," says Rogers, "and there are about 35 million older adults, so that's well over 10 million falls a year." That calculates to a potential for 300,000-plus hip fractures.

"What you have to do is prevent the fall from occurring," says Rogers, "and in turn you can prevent the fractured hip."

Rogers, who is the research director for WSU's Center for Physical Activity and Aging, became focused on balance and aging in graduate school when his grandfather took a fall. Rogers had been impressed by his grandparents' active life as they aged.

Then, at 94, Rogers' grandfather stepped out of his house one icy day, slipped and broke his hip.

"He never stepped foot back in his house," says Rogers. His grandfather was hospitalized, then sent to a nursing home. He was prescribed general physical activity that really didn't improve his balance. He died about a year later.

That experience coincided with Rogers' own back surgery about the same time. Spending time flat on his back gave him an even deeper personal sense of what it's like to have a poor quality of life.

"As we get older and our bone mineral density declines, the chances of breaking a hip increase. But only about 2 percent of falls are caused by osteoporosis," says Rogers. In those cases, the fall resulted from a spontaneous broken hip because the bones are so weak, he says.

Most of the time, falls result from a loss of balance.

That's why the Center for Physical Activity and Aging offers exercise classes at WSU's Heskett Center and outreach programs in senior centers that focus solely on improving balance and sensory system responses.
While the CPAA focuses on aging, balance exercises can be helpful at any age; the programs CPAA uses can also be used in motor control for young people, Rogers says. They're good preventative measures, too, as people approach their middle ages.

Photo9.gif (21,462 bytes)

In the semi-tandem
stand, one of the first
exercises in a balance
program, your feet are
almost in a stepping
position. Standing on
foam stimulates the
somatosensory system,
which is your sense of
touch, pressure and
vibration. That sensory
system is one of three
that helps control balance.

There are three sensory systems that control balance visual (clarity, contrast, depth perception, etc.), vestibular (in the ear) and somatosensory (touch and pressure). Diminished responses in these sensory functions are common as people age and often are obvious by the early 60s. Diminished balance capabilities follow. The balance programs are geared toward stimulating the sensory systems.

Instructors start with exercises on the floor because it's the most stable surface. For people who are unable to do the standing exercises, a chair-based balance-exercise program can be used.

"Once they gain the ability to stand, we get them into a standing position with that sturdy chair in front of them at all times," Rogers says. "From there it's just a progression to make it more difficult. Like any exercise, you've got to challenge the body a little bit for the body to adapt and become better.
"Standing on one foot is pretty challenging for most people, to be honest," he says.

Instructors start the standing exercises with the feet together. Instead of going directly to a full tandem stand (one foot in front of the other, heel to toe), they'll suggest a semi-tandem stand where the feet are almost in a stepping position, trying to shrink down that base of support from having the feet way apart.

Class participants may be able to stand on one foot, but not close the eyes at the same time, Rogers says. "So we'll move back to something like feet side-by-side or semi-tandem position and have them close their eyes to stimulate the visual system."

The vestibular system, in the ears, is the one that makes you feel a little dizzy if you spin around, he says. To stimulate the vestibular system, instructors ask participants to move their head side to side, look up to the ceiling, look down or turn the whole body.

The third sensory system is the somatosensory, your sense of touch, pressure, vibrations, Rogers says.
Imagine your foot falling asleep (from sitting cross-legged or in one place too long), he says, and trying to walk across the room.

"This is a good example of what that system does; it gives you feedback about the surface you're on," says Rogers.

That's why as people improve, they are asked to try the exercises on various thicknesses of foam, which stimulates that sensory system.

The classes also incorporate elastic bands and big exercise balls.

"One of the challenges we have with working with an older population is they have a fear of falling," says Rogers, "and one of the ways that they deal with it is to sit and be inactive."

Becoming extremely sedentary speeds up the decline of the sensory components and puts people at an even greater risk for falling, he says.

To reduce their fear and risk of falling, people don't really need the formal setting of a class, says Rogers; they can do the exercises for 30 minutes three times a week in their homes. The exercises can also be performed throughout the day, standing in line, standing doing the dishes, etc., as long as the environment is safe and secure with something to hold on to, if necessary.

The balance programs are solid evidence-based successes not only in exercise science, says Rogers, but among physical therapists and doctors.

There is no doubt that Rogers loves his work with older adults. Not only does he enjoy the wisdom they have to share, he says, it's fulfilling when he can help them and see improvements relatively quickly.
"It's almost never too late to see some improvement," he says.

A research paper by Michael Rogers on balance, which includes illustrations of the exercises, can be viewed online at www.ncpad.org/whtpprs/balanceandflex.htm.



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