Thirty percent of adults over the age of 65 will experience a fall. This number is predicted to increase with the alarmingly increasing frailty among this growing population (Montero-Odasso et al., 2022). Falls can lead to a variety of emotional and economic costs. Injuries, such as fractures related to falls, can incur hefty healthcare costs and decrease an individual’s independence. Decreased self-reliance may lead to increased caregiver costs and can be detrimental to one’s mental and overall health.
Those with osteoporosis are especially vulnerable to falls. According to the Bone Health and Osteoporosis Foundation, around 50% of women will experience a fracture due to osteoporosis-related falls in their lifetime. Overall health, history of previous falls, and bone mineral density significantly determine one’s risk for fall-related fractures (Barron et al., 2020).
All of these factors can be improved with lifestyle changes, particularly exercise. In this article we’ll go over the top fall prevention exercises so you know which strengthening and balance exercises can decrease the likelihood of a fall.
Osteoporosis and falls
Those with osteoporosis or osteopenia are more vulnerable to falls for several reasons. Muscle weakness can decrease one’s ability to navigate their day-to-day environment. Muscle weakness can cause one to fatigue quickly, making them more likely to fall or lose balance, especially when faced with more complex tasks (longer walks, stairs, walking while carrying something, etc.).
Kyphosis, or forward rounding of the spine, is typical in those with osteoporosis and osteopenia. This posture shifts one’s center of gravity forward. This, coupled with decreased postural control, can increase the chances of falling (Meyer & Hajek, 2019).
On top of that, those with osteoporosis or osteopenia have low bone density, making a fall especially detrimental to bone integrity. Even the simplest of falls can cause fractures in brittle bones.
Risk factors for falls
Risk factors for falls include:
- Decreased muscle strength
- Decreased balance
- Orthopedic conditions, such as osteoarthritis, cause pain and alter movement patterns.
- Nerve conditions, such as neuropathy, decreasing sensation in the feet
- Forward posture
- Impaired vision
- History of previous falls
- Low blood pressure upon standing
- Decreased or compromised cardiovascular health
How to prevent falls
Exercise can tackle many of the risk factors mentioned above. Muscle strengthening, postural exercises, and balance exercises are beneficial for fall prevention. Improving all of these factors will decrease the likelihood of falling.
How do balance exercises work?
Balance exercises focus on challenging the ability to remain upright in several ways. Over time, they build resilience against obstacles and situations that may cause a loss of balance and a fall. Exercises such as balancing on one leg, stepping over objects, or turning quickly are examples of ways to “throw off” one’s balance. After practicing these things repeatedly, there will be an improvement in the ability to do these things in real life.
Important muscles for balance
Many muscles are responsible for maintaining an upright posture while standing and walking. Some critical muscles involved in balance are:
- Gluteus medius and maximus: These muscles are responsible for keeping the hips extended or upright. They are the prime movers of the legs and play a key role in walking, standing up and sitting down, and going up and down the stairs.
- Quadriceps and hamstrings: These muscles are located in the thighs and are significant in walking and transferring on and off a chair and stairs.
- Gastrocnemius: Also known as the calf muscle, the gastrocnemius helps propel the ankles while walking. Since the feet are the only body part in contact with the ground, the calf muscles play a significant role in maintaining balance, especially on uneven ground.
- Abdominal muscles and erector spinae: Commonly known as “the core,” this group of muscles helps stabilize the trunk. When the core is weak, standing or sitting upright can be difficult.
All of these muscle groups are active in the below-mentioned balance exercises.
Top balance exercises for fall prevention
1. Single Leg Balance
Single leg balance is the most basic and easy-to-do balance exercise to practice. It works on maintaining an upright posture while on one leg. We spend part of the gait (walking) cycle on one leg. The need for good single-leg balance is particularly noticeable when we lift our other leg to get into/out of a car or go up and down stairs.
- Start by standing normally. You may stand by a railing, wall, or countertop for balance if needed.
- Lift one leg off the floor (knee to the front of your body or foot slightly behind you).
- Hold for as long as you can, working up to a 30-second to 1-minute hold.
- Switch sides.
- Perform 2-3 sets on each leg.
This can be done daily and even during everyday tasks like brushing your teeth.
2. Tandem Balance
Tandem balance, also known as heel-toe stance, is another balance exercise that challenges the body to stay upright with a smaller-than-normal base of support. If you can balance with a narrow stance, balancing with your feet spaced apart normally will be much easier.
- Start by standing normally. You may stand by a railing, wall, or countertop for balance if needed.
- Place one foot in front of the other, lining up the heel of the front foot with the toes of the back foot.
- Hold for as long as you can, working up to a 30-second to 1-minute hold.
- Repeat on the other side.
- Perform 2-3 sets on each side.
3. Heel-Toe Walking
Heel-toe walking challenges your balance by narrowing your base of support while moving. Imagine walking along a plank or a tightrope. Although those might not be everyday activities, practicing this will make regular walking easier.
- Start by standing normally. You may stand by a railing, wall, or countertop for balance if needed.
- Place your right foot directly in front of the left foot, touching the heel of your right foot to the toes of your left foot.
- Now step your left foot in front of your right foot.
- Continue to walk forward by stepping one foot directly in front of the other, like you are walking on a tightrope.
- You may place your arms out to the sides for balance.
- Perform this for 20-30 seconds using the space you have available.
- Rest for 30 seconds. Then, perform 2-3 more sets.
To make this more challenging, you can hold a weight in one hand to alter your center of gravity.
4. Squat
The squat is a popular strengthening exercise, but it also challenges balance. It strengthens the muscles of the legs but also requires you to maintain an upright trunk as you move from a standing to a sitting position.
- Start by standing upright with your feet shoulder-width apart. You may stand in front of a chair to have a target to aim for.
- Slowly lower your hips down and back to the chair.
- Stop just before your hips hit the chair (most challenging), tap the chair (medium difficulty), or sit all the way down (easiest).
- Do this 10-15 times in a row.
- Rest for about 30 seconds.
- Repeat this for 2-3 sets.
Holding weights in one or both hands can make this more difficult.
5. Stationary Marching
Stationary march (or Standing Alternate Hip Flexion) aims to maintain balance while your center of gravity shifts from side to side. Your legs will move similarly to walking but with increased time spent on only one leg, which is more challenging than walking. The goal is to improve your balance during that single leg balance phase and ultimately improve your balance during activities such as walking or going upstairs.
- Start by standing upright with your feet hip-width apart. Stand near a chair or countertop if needed for balance.
- Lift your right foot off the floor until your knee is at hip height. Hold for 1-2 seconds before slowly returning your right foot to the floor.
- Next, do the same on the left leg.
- Do this repeatedly until you have performed 10-15 repetitions with each leg.
- Remember to move slowly and with control while maintaining an upright trunk.
- Rest for 30 seconds.
- Perform 2-3 more sets.
You can hold a weight in one hand to alter your center of gravity and make this exercise more challenging.
6. Balance with Eyes Closed
Many people rely on vision to balance. However, other systems in our body contribute to balance. When you close your eyes, you eliminate your visual system and improve the other systems to balance.
- Start by standing normally. Stand by a railing, wall, or countertop for balance. Keep your hand on or hovering over this surface, as you may need it.
- Lift one leg off the floor (knee to the front of your body or foot slightly behind you).
- Once you feel balanced, close your eyes.
- Hold for as long as you can, working up to a 30-second to 1-minute hold.
- Use the support, place your raised foot down, or open your eyes if you feel like you may fall.
- Switch sides and have a steady balance before closing your eyes.
- Perform 2-3 sets on each leg.
Summary
It is no question that if you practice balance exercises and strengthen your muscles, you will build resilience against a fall. A well-rounded exercise program that addresses these factors, such as Wellen, is a great way to prevent falls and avoid fractures.
