Today we are going to talk about how to improve balance in the elderly and seniors. Balance is probably the most important skill for injury prevention in old age.
Without good balance it’s easy to stumble and fall. As you surely know, falling is especially dangerous for older people as bone and muscle health deteriorates as we get older.
A simple clumsy loss of balance while cleaning for example can end up with a broken wrist or in the worst case a broken hip or skull.
Injuries like these can leave you bed ridden for weeks or months, which is catastrophic for your strength and health when you are old.
Furthermore fractures and other bone injuries in seniors are very slow to heal and might never fully recover. That’s why injury prevention is key when it comes to good health in old age.
Balance is a skill that we learn first as toddlers when we learn to walk. We master the skill as we grow up and all through our adult life. After you have the skill, you don’t think about it or notice it until one day you realize you are having problems with it.
There are several reasons why are balance gets worse as we grow older. Balance is dependent on muscle strength and coordination. Our central nervous system and cognitive abilities are responsible for controlling our muscles and balance.
Unfortunately all of these deteriorate as we get older. Fortunately it’s possible to slow that deterioration significantly and improve your balance no matter what your age is!
How balance works
The way we maintain balance is a surprisingly complicated system. It’s a combination of sensory information, skill, mobility and strength.
Our central nervous system has several points of information it uses to gauge our position in space. That information is used to determine how to move our body to maintain balance.
How well this system works depends on practice and strength. Like you know, toddlers have to developed the skill of balance and enough strength to be able to stand and walk. Both of these have to be maintained and both can be lost.
In our day to day life we don’t really think about maintaining the skill of balance unless we are professional athletes or circus performers. The average Joe goes through life simply doing daily chores and moving to places on their feet. This is all it takes as an young adult to keep your balance sufficient (but not optimal).
The way we develop the skill of balance is by exercising as kids and young adults. When we learn a new balance skill the movement patterns are ingrained in our muscle memory, which will last for a lifetime to some extent.
Riding a bicycle or skating are good example of this. If you learned the skill as a child, you ran relearn or perform it as an adult even if you haven’t done the activity in decades. Sometimes it takes a bit of practice because your body weight and relative strength will be very different, but usually it’s a breeze, or as the saying goes, like riding a bike.
Balance is also specific. If you know how to walk, run and ride a bike, it doesn’t mean you know how to skate or ski. This is because the fine motor skills required for different forms of movement are specific to the movement. That said, if you can skate and ski, it’s likely that learning to snowboard will be much easier for you than to someone who doesn’t know how to skate and ski. It’s all about similarity of the movement.
Learning balance skills is much faster as a child. This is because when we are growing up, our central nervous system is primed for learning new skills. The same skill that might take weeks or months as an adult to learn might only take days or even hours as a child.
This is why it’s important to improve as many balance skills as possible when we are young, so we have more leeway as adults when it comes to balance.
So, to hone and improve this skill we need to perform versatile exercise and activities that challenges our balance. To maintain balance in more challenging and extreme positions we need strength and mobility. Finally, for our balance to operate correctly, our sensory systems needs to function correctly.
For most seniors all these three component will have some level of deterioration. Let’s start by looking at the sensory system our brains use to determine balance.
The sensory system
Our brains balance control center, the cerebellum is located at the back of the head, where the brain meets the spine. The cerebellum receives information about the position of the body from the eyes, inner ear and muscles. It uses this information to send messages to the muscles to do required adjustments to maintain balance.
The cerebellum combines the information from all your sensory systems to determine the position, speed and acceleration of your body and it’s extremities. This information is then used to control the fine motor movements that allow your body to remain in balance while moving.
It’s truly a miracle that our brain can accomplish this in real time all through our life without actually having to think about it.
Let’s take a closer look at the three sensory systems that tell our central nervous system how to maintain balance and where the body is in relation to space:
Eyes and vision
Eyes are on of the most important reference points for our brain for determining balance. Visual information like the horizon is used to determine which way is horizontal and which way is vertical. Visual information also gives our brains cues on where our limbs are relative to the space.
Our vision also warns us about situation that might challenge our balance. You will automatically bent your knees and hips slightly to lower your center of mass to better maintain balance when you see something that might challenge your balance.
This might be seeing ice on the ground under your feet or simply a fast moving object coming towards you. Our central nervous system has automated reflexes for maintaining balance and these will fire any time we are in danger of slipping, prepare for impact, dodge something or get startled.
The cerebellum uses the visual information from the eyes to asses the position and speed of the body in relation to the surroundings and sends commands to the muscles to anticipate movement to maintain balance.
When our eyes are open, actually around half of the brain is used for visual processing. The vision is so strong sense that it can even override information from other senses. When the visual system is not working correctly, providing false or incomplete information to the cerebellum, this can cause problems with balance. This is especially true if the positional information is in conflict with the positional information provided by the inner ear.
As you surely know, aging generally causes our vision to deteriorate. Balance is one of the key reasons why it’s important to take care of any treatable vision problems and get the correct prescription for your glasses. Having good vision will improve your sense of balance.
Probably the most important sensor for balance in our body is the vestibular system located in the inner ear. It’s essentially a spirit level located in your head.
The vestibular system consists of three semi-circular canals and two pockets (otolith organs), which together provide constant information to the cerebellum about the position of the head in all three dimensions.
Each of the canals is oriented differently, so the inner ear detects movements in every direction like nodding, rotating, etc. Each canal has fluid inside and tiny hairs that detect the movement of the fluid and send the information to the cerebellum through the vestibular nerve.
The otolith organs contain small crystals that move during movement in relation to gravity which in turn tells the cerebellum the position of the head in relation to gravity. This way our brain can also sense movement like tilting, leaning, lying down and if the body is moving in a straight line.
The vestibular system is so crucial for balance that if there are any problems with it’s functioning, you will almost instantly become dizzy and suffer vertigo with nausea. This is a common and scary but completely benign condition that becomes more common as we age.
This is because the fluid within the canals start to form crud that than in impair the free movement of the fluid or cause the tiny crystals to get stuck. If this happens, there are special exercises you can perform to get them moving again. It’s important to get checked by a doctor if you develop these symptoms because they can be caused by something much more severe like a stroke or a hemorrhage.
Sensory feedback from your muscles and skin (Proprioception)
The sensory feedback from your muscles is the last source of information the cerebellum uses to keep you in balance during movement.
The positional sensing of our body’s position and movement is called proprioception and it sometimes referred to as the sixth sense. There are mechanically sensitive proprioceptor neurons in your muscles, tendons and joints.
The cerebellum uses the information from these proprioceptor neurons, combined wit information from the vestibular system and the eyes to form an overall representation of movement, position and acceleration of the body.
Proprioception is critical for performing movements without visual information. It is what allows us to maintain balance while walking in complete darkness for example. When you learn any new skill or sport that requires the use of your body, it’s necessary to first learn some proprioceptive tasks.
Without proprioception it would not be possible to drive a car because the driver wouldn’t be able to look at the road ahead while steering and using the pedals. Same goes with playing the guitar or painting a canvas. You get the picture.
Proprioception deteriorates with age just like the other sensory systems for balance. Proprioception can also deteriorate if your bodyweight changes significantly or if you lose a limb due to accident or disease. This is because it takes quite a bit of time for the proprioception to readjust to the changed environment.
Fortunately proprioception can be trained with the same exercises we use to train our whole balance skill. It’s essentially muscle memory and muscle memory is fortunately very long-standing.
This study actually showed that elderly people rely more on proprioception than vestibular or visual cues for postural motor control. They also identified a delay in challenging the feedback systems stability in seniors and a decline in the amplitude of the motor feedback. They concluded this was likely due to weakness of the motor system. Motors meaning muscles.
This is one of the reasons it’s very important to both hone your balance skill and keep your muscles strong. Let’s look at how strength affects balance in seniors next.
Why strength is important for balance in seniors
One of the greatest causes for weak balance in the elderly is lack of strength and mobility in the legs and back. Weak legs combined with too much weight is especially problematic as it puts your center of gravity higher.
This requires more strength and mobility from the legs in case of emergency (loss of balance).
The legs are responsible for keeping us upright. When our balance is compromised (stumbling or slipping for example) our reflexes take over. We spread our arms to acquire more control of our center of gravity and instinctively reach for anything that might offer support.
We instinctively drop our center of balance lower by bending from the knees and hips and slouching our torso. This also serves to lower the impact in case our bodies attempt to maintain balance fails.
Simultaneously our legs are moving very fast to try to find firm point of support that’s beyond our center of gravity in the direction of falling. This would likely prevent the fall.
At this point the strength and mobility of your legs determine if you can recover balance and avoid the fall.
If our leg muscles are weak all this can be simply too much for them. Mobility issues can also prevent you from moving you legs far enough to regain balance. All this happens very fast and stronger legs are also faster legs.
As you can see maintaining muscle strength especially in the legs is very important for balance. Without strength and mobility no amount of skill will help you in case of emergency.
Strength training is the most important part of improving balance in seniors because strength deteriorates faster than your actual balance skill and the ability to maintain balance and proprioception.
While activities like walking and cycling are good for maintaining a base level of strength, you need to do actual strength training to improve your balance optimally. This is because walking and cycling aren’t really good for improving hip and knee mobility and strength in extreme positions.
When strength training is performed properly, you will improve strength with full range of motion in your limbs. This allows you much more leeway in maintaining balance in case of slipping or falling.
Effective strength training will also teach you the correct way of activating your hips which is critical for balance, back health and mobility. With limited hip mobility and activation your lower body can never reach it’s strength potential.
Correct form of strength training
Many people, especially seniors, have misconceptions of what strength training actually is. Maybe thinking about big young guys in the gym bench pressing a ton or fitness girls taking Instagram photos in trendy gym outfits.
There is even this common misconception that lifting weights means you are a dumb meathead and a narcissistic body builder who likes to watch themselves in the mirror.
This couldn’t actually be farther from the truth. Strength training improves your health and functionality incredibly well and doing it correctly teaches you perseverance, regularity and dedication. It also allows you to see the incredible potential of your body. You are stronger than you think.
Real strength training is actually about learning the proper biomechanical movement patterns for moving your body and external weights as efficiently as possible. It’s never about trying to lift as much as possible with questionable form, risking injury, in an effort to impress others.
This kind of activity doesn’t have any other purpose than to stroke your ego and it’s typical for young insecure guys. Surprisingly I have seen many older people, mainly men, trying to lift way more than they can safely handle. This likely stems from insecurity, lack of knowledge and misconceptions that men are automatically strong.
This is why understanding how strength training works is important before going to the gym. It’s all about learning the proper techniques, lifting as little as needed to cause adaptation and progressively increasing the weights over a long period of time. It’s not a race it’s a marathon.
Building serious strength takes years but in the beginning your strength gains will be the fastest. Doing strength training for just a month will improve your strength and mobility immensely, if you have been inactive and sedentary in the recent years.
So now you know strength training is incredibly important for maintaining balance but for your overall health and functionality as well. This is why you should start strength training as soon as possible. To get started, you can download my free beginner strength training program designed for seniors from the form below.
Give it a try and make the decision to not give up before the 4 weeks is over, and I promise you will see results!
What causes balance problems in the elderly
There are several causes for the deterioration of balance as we age. The important thing to know is that we are talking about gradual decline in balance that happens over years.
If you are suffering from sudden loss of balance that has happened within hours, days, weeks or even months, it’s very important to consult your doctor. This because there are several illnesses and conditions that cause problems with balance.
- Parkinsons disease
- Middle ear infections
- Multiple Sclerosis
- Brain tumors and hemorrhages
That list might seem scary but like we said, if your balance issues are very sudden and severe it’s important to consult your doctor. If you have other symptoms like vision problems, nausea or vomiting confusion, fatigue and changes in blood pressure and heart rate it’s extremely important to contact a medical specialist immediately.
Now that we have that important stuff out of the way, lets look at what causes the gradual age related decline in balance.
The most important things are:
- Sarcopenia (loss of muscle mass)
- Loss of muscle strength
- Lack of mobility
- Decline in neural and cognitive function
- Injuries and pain
As you can see there are several factors that affect your balance as you get older. Fortunately most of those factors can be fought against.
Strength training can prevent and reduce the age related loss of muscle mass, known as sarcopenia. It will also make the muscle mass you have left much stronger by improving the neural signaling.
When strength training is combined with full range of motion and mobility exercises, you can vastly improve your mobility even in old age. Strength training also improves and prevents osteoporosis.
Strength training and exercise is also good for cognitive ability and neural function. It can in some cases even cure chronic pain and reduce the amount of medications you need, as it can help control things like type 2 diabetes, high cholesterol and lower back pain.
As you can see strength training is pretty awesome for balance and you overall health!
7 fun balance exercises for elderly and seniors
Besides strength training your legs, you can improve and maintain your balance by doing simple balance exercise. The most important thing for balance and leg strength is daily activity.
Things like walking, cleaning, carrying groceries and doing yard work for example are superior to any single balance exercise. Since balance is a skill that uses coordination of pretty much all of the muscles in your body it’s important to get as diverse movement as possible.
Remember, strength enables balance but you have to practice the skill to put it in use.
That said, if you are having mobility issues due to illnesses or injuries for example or can’t be very active for some other reason, these simple exercises will help you improve and maintain your balance.
You can do them for few minutes every morning and evening for example. That is enough to improve your balance.
One leg stand
Probably every person has tried this one point in their life. Nothing tests and challenges your balance more effectively and simply than by standing on one foot.
While we don’t typically thing about how much balance standing on two feet actually takes, most people will find standing on one leg for longer than few seconds surprisingly difficult.
You simply stand straight, preferably next to a table or other stable point of support, and raise your other leg.
You immediately notice that body starts to do microscopic movements to maintain balance. You can feel this especially in the sole of your standing foot and the ankle. It usually helps to spread your arms a bit and tense your glutes.
The idea is to try to stand on one foot as long as possible without using any support. Once you start to lose balance you simply lower your other leg. Always stand next to something, so you can assist with your arms in case of sudden loss of balance.
If you want to make the exercise more difficult, you can close your eyes like in the video. This will take your vision out of the equation so your body will have to maintain sense of balance through the vestibular system and proprioception.
The balance board is a simple round board that has a single point of gravity on the center. When you stand on a balance board, your body has to work much harder to maintain balance than when standing on two feet.
You use the board simply stepping on it, finding a balance over the board and trying to keep board level. Once you can stand on the board for over a minute you can make the exercise more difficult by including movement like shown in the video below.
Balance boards are great for balance because they challenge your balance in a simple and effective way. It’s like an easier version of learning to walk on a rope. Once you get the hang of it, your balance will improve very fast.
Don’t get discouraged if finding balance on the board seems hard at first. Take hold of the side of a table or something else sturdy so you can support yourself on your arms.
Then slowly try to find the balance over the board, once you find the balance, slowly lighten your support from your arms. You will notice this will immediately challenge your balance on the board. Continue letting go with your support until you can stay in balance without holding on to anything.
The body weight lunge is both a great leg strength exercise but also a great balance builder. This is something you should only try if your legs are strong enough to do several full range body weight squats like shown here.
You can start with a supported lunge demonstrated on the video below:
The supported lunge is just like a regular lunge but you assist your balance by holding on to something sturdy. The supporting arm can also help you a bit in getting up if you find out you don’t have enough strength.
When your strength and balance improves enough, so that you can perform several supported lunges with ease, you can try unsupported lunges.
Lunges are great for balance because the require both strength and coordination as well as mobility. If you can perform several unsupported body weight lunges on both sides, your leg strength and balance are actually pretty good.
The reason lunges are so effective for balance is because you challenge your normal standing posture by bringing your feet in opposite direction and also in relatively extreme range of motion.
This kind of stance is less stable than a typical squat. This requires your cerebellum to work hard to maintain balance and to tell your muscles to use correct movement patterns.
One leg stand from a chair
The one leg get up is a great test of balance, leg strength and health. It was originally introduced my the Singapore Geriatric Society as a test to determine if middle aged people would be able to walk unassisted by the time they hit 70.
Their conclusion was that if you can’t get up from a chair on one leg when you’re 40 or 50, it’s likely you will lose the ability to walk by 70 unless you improve your leg strength.
There has been some debate since if the test can accurately asses your ability to walk at 70 but it’s definitely a good test for general assessment of strength and functionality of your legs, hips and core.
The test simultaneously challenges your lower body strength, balance and coordination. On the other hand it can tell if you have joint problems because they will likely prevent you from even trying to get up.
The one leg get up activates all the lower body muscles, especially the quads, glutes and hamstrings. Abdominal and lower back muscles are activated as well as you control your center of balance. Performing the exercise requires good control of the core and the hips.
Getting up with one leg is relatively challenging movement and it requires quite a bit of balance in addition to strength. It also puts more strain on your joints than getting up with two legs and you need sufficient range of motion in your joint just to be able to try it.
The test is performed by sitting on a sturdy chair. The higher the chair, the easier the movement is to perform. Cross your arms on your chest and hold one leg in front of you. Then you simply get up by leaning forward a bit to move your center of balance over your support foot.
When you try this first time it’s wise to do it in front of a table or something else sturdy you can grab hold of in case you lose balance.
If you find out you can’t perform the exercise, don’t worry, many can’t. You can improve your leg strength with our free exercise program you can download below and try again after you have completed it. We would love to hear about your results!
One other way to train for the one leg stand up is by doing get ups from a chair using both legs. It’s essentially a variation of the squat. When you can do around 20 regular get ups with ease, you should be able to perform at least one one leg get up if you don’t have joint issues.
Playing catch with medicine ball
Playing catch with a medicine ball is a fun balance exercise you can perform with your partner or a friend. It involves throwing and catching a medicine ball with your partner.
It’s a simple and fun exercise you can do outside on your yard or in the park for example. Playing catch with a medicine ball might seem like easy and simple but it’s actually great for challenging your balance and coordination.
Throwing the ball happens through explosive hip extension and activates your back, abdominal, leg, arm and shoulder muscles.
Walking along a straight line
This is a very simple exercise you can do anywhere. Walking in a straight line might seem like a simple step, but it actually challenges your balance quite effectively.
I’m of course not talking about just walking in a straight line with you typical gait but walking on an actual line on the ground by stepping one foot in front of the other. It’s essentially a safer version of walking on a beam or a rope.
Because you have to put your foot in the same line on each step, this challenges your balance, coordination and hip strength surprisingly well. This is one of the easier exercises but don’t write it off until you have tried it. It might surprise you.
To perform this exercise, you will need some thick tape on a pavement or indoors, or you can simply draw a straight line on gravel. You then go the other end of the line, spread your arms and start walking along the line by stepping one foot in front of the other without stepping to either side of the line at any point.
Once you reach the end of the line, you simply turn around and perform the walk to the other direction. Do this for 5 to 10 repetitions several times a week and your balance will benefit from it.
Our final movement is the bodyweight squat. A full range bodyweight squat is something every healthy adult should strive to be able to perform, no matter what your age.
Squatting is a functional movement pattern that is used in many daily tasks. Correctly performed squat allows the muscles of your lower body function optimally. The instruction: Lift with your legs, not your back essentially means to squat the weight instead of bending your back.
Learning to squat will save you from back and knee pain and injuries. Bodyweight squat is a perfect exercise for improving balance because it teaches you to use your hips correctly, improves strength and requires mobility, balance and coordination to perform correctly.
The biggest problem with squats is that most seniors (or younger people) can’t perform them with good form without some practice and mobility work.
The correct technique and form is shown in the video above but if you want even better tips on how to learn the correct hip activation pattern, check out my free workout routine for seniors.
The main tips are:
- Turn feet out slightly
- Hinge from the hips
- Keep a flat back
- Push your knees OUT, don’t let the cave in
- Use a support when first learning this exercise.
The bodyweight squat is great for improving leg strength and the correct functioning of your legs and hips. Learn how to perform the squat and do few reps every day and you can be sure you will keep your ability to walk and move individually as long as possible. If you can squat, you can walk.
We hope you enjoyed reading about these tips on how to improve balance in the elderly. When doing exercises to improve balance, always remember to be careful.
Make sure there are no sharp corners or anything dangerous to fall on to and do these exercises on a padded floor in an exercise hall if possible to minimize risk of injury.
If you do them at home, make enough room around you and always have something stable to grip for support in case you lose your balance. Ask another person to assist you if you feel like it. It’s always wise to not do exercise alone, especially at old age since there is always risk of injury involved.
We here at Elder Strength always recommend minimizing any risks associated with exercise. Since our aim is for you to become stronger and to live a healthy and active life as you get older, getting injured really doesn’t support that goal. So please always be careful and think things through before doing them.
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Thanks you for reading and see you next time!