September 16, 2010

USA: Avoiding falls is a learnable skill

NEW YORK, NY / The New York Times / Business Day / Retirement / September 16, 2010

Staying on Balance, With the Help of Exercises
Falls are a risk for older adults, but avoiding them is a learnable skill. Andrea Mohin/The New York Times

By John Hanc

STONE-FACED with determination, Margot Luftig was trying hard not to fall. She was standing on a foam cushion with her left knee raised about four inches, attempting to stabilize herself on the right leg, which was sinking into the squishy surface of the thick pad.

“Come on, Margot!” urged her personal trainer, Robert Morea, who was at her side. “You can do it.”

Her eyebrows furrowed and she threw an “easy for you to say” glance his way.

Over the loudspeaker at Mr. Morea’s studio — Great Jones Fitness in the NoHo section of Manhattan — Mick Jagger sang “This Could Be the Last Time,” as if challenging Ms. Luftig. A week earlier, Ms. Luftig (who gives her age only as “55 or over”) was unable to maintain this one-legged pose, stumbled off and got frustrated. This time, she nailed it, holding herself upright and strong for about 45 seconds with each leg. She then stepped gracefully off the cushion and back onto the gym floor.

“Great job, Margot. You really showed up,” said Mr. Morea. “You didn’t lose your balance.”

Ms. Luftig, a retired buyer for B. Altman’s department store, cast another baleful eye at him. “That’s the point, isn’t it?” she responded.

As a matter of a fact, it is. Balance is a critical issue to older people. And more and more, at one-on-one training facilities like Mr. Morea’s or at larger health clubs, whether in yoga and Pilates studios or adult-education exercise classes for older adults, balance training is becoming a priority.

With good reason.

Unintentional falls among those 65 and older are responsible for more than 18,000 deaths and nearly 450,000 hospitalizations annually in the United States, according to the Centers for Disease Control and Prevention in Atlanta. Most of these falls are caused by a decline in that complex and multidimensional human skill known as balance.

To remain upright and sure-footed, explained Dr. David Thurman, a neurologist with the center and a spokesman for the American Academy of Neurology, “there are several components of the nervous system, as well as motor or movement functions, that need to be intact.” These include the vestibular system of the inner ear, vision and proprioception, the ability to sense where one’s arms, legs or other parts of the body are without looking at them, as well as the strength and flexibility of bones and soft tissue.

“All of these,” Dr. Thurman said, “tend to degrade with age, particularly as people move into their seventh and eighth decades.”

Yet, unlike many effects of aging, balance can be improved, and the age-related declines can be delayed or minimized with proper training.

“The preponderance of evidence,” Dr. Thurman said, “shows fairly convincingly that strength and balance training can reduce the rate of falls by up to about 50 percent.”

Hence, the Department of Health and Human Services in revising its national physical activity guidelines, issued in 2008, added a recommendation for the elderly to include balance exercises as part of their overall physical activity regimen.

The problem, said Michael Rogers, an exercise scientist at Wichita State University, is that while most major public health agencies recommend 30 minutes a day of cardiovascular exercise for the heart and two or three sessions a week of strength training, “there is no real exercise prescription for balance.” So activities that promote balance tend to become integrated into other activities. Mr. Morea does this with older clients like Ms. Luftig in twice-weekly, 30-minute strength-training sessions.

Of course, while it is good to have supervision by a certified fitness professional, not to mention the benefit of a gym full of balance toys (and there are many these days, including wobble boards, balls and cushions), one does not have to work out with a personal trainer to get the benefits of balance training.

“You can do it anytime, anyplace,” said Mr. Rogers, who is research director at Wichita State’s Center for Physical Activity and Aging and teaches exercise classes to older adults. “You don’t have to be involved in a systematic program.”

He added, “You don’t have to be standing on one foot, which is often too difficult for some older people. You can challenge your balance while brushing your teeth.” Simply put one foot in front of the other while you brush, or stand with your feet closer together.

Balance training is often seen as part of a larger trend called functional fitness exercises, which are geared to helping one handle the physical challenges of day-to-day life. Around holiday time, for example, Mr. Rogers tries to prepare the elderly in his class for crowded shopping malls. He has them walk between narrow gaps, occasionally getting brushed by others. This, he said, “helps give them confidence” to face the holiday throngs.

Trainers like Mr. Morea devise balance training drills for their older clients. For example, a woman was having trouble bending down in her kitchen to reach to the back of a floor-level cupboard and retrieve cooking pots.

So he developed “pot squat and reach” — a movement that basically imitated what she was doing, except on an unstable surface, so that she could develop the strength, neural connections and balance to confidently perform that movement at home.

One of the nice things about balance training is that the results can be evident fairly quickly.

“The nervous system has considerably more regenerative capacity well into the senior years than we used to think,” said Dr. Thurman. “The capacity for adjustment, compensation and even developing new skills remains there.”

Which is exactly what Ms. Luftig, who lives in Greenwich Village, has found. “I feel more confident,” she said. “In my neighborhood, you have bicycles whizzing by you all the time. You could lose your balance when they come so close. But when that happens now, I feel more stable. I have this ability that I didn’t used to have.”

Copyright 2010 The New York Times Company