Fall Prevention in the Elderly: Start by Retraining Balance

Fall prevention in the elderly is a critical part of care because over 33 percent of adults over 65 years old fall each year, and most adults who fall are more likely to fall multiple times.1 Falls are associated with a decrease in function, and most people do not return to their previous level of functional status after a fall; thus why a fall prevention strategy is essential.2

Common risk factors of falls include muscle weakness, balance deficits, and gait instability.3 Increased age is associated with the increased center of pressure displacement and sway velocity during both bilateral and unilateral stance, demonstrating changes in sensorimotor and neuromuscular systems and a decline in dynamic postural control.4

Retraining a Balance System to Prevent Falls

With falls being such a problem, the question then comes down to how to best train balance systems. When looking at the balance system, there are many different subsets for different balance conditions.

The main classes are:

  • Static balance, which is simply balancing while standing or being still.
  • Dynamic balance, which is moving balance, or balancing while moving around.
  • Proactive or reactive balance, which is the automatic strategy used when balance is interrupted and helps the person react to stimulus and catch before falling. This is an automatic process and works under the anticipation of movement.

Each of the systems and types of balance can be trained with eyes open or closed, and on even or unsteady surfaces, to help improve balance and decrease falls.5,6

So, the question becomes: What is the best way to train balance?

Aerobic vs. Resistance Exercise for Balance

Both resistance and aerobic exercise programs have been shown to improve balance; however, only a resistance exercise program helps improve balance. Resistance exercises can help increase the muscle strength, neural function, and force control required to maintain balance. While it seems counter-intuitive to use resistance exercises to improve balance, decreased muscle mass is associated with decreased gait velocity and delayed response to perturbation.4

The effect of resistance exercises alone on balance is still being debated, and it is recommended that balance and resistance exercises together are used together for greater benefit. Aerobic exercises, such as walking, have also been shown to be beneficial for balance training, and these also involve much real-life training.3

Dosage for Balance Exercise

The ideal dosage for balance programs is fairly simple. More frequent and short-duration practice is shown to be better than long blocks of practice. Working on three sessions at 20 to 45 minutes leads to 90 to 120 minutes of balance training per week, which has shown improvements over 11 to 12 weeks, and even larger improvements over six months. While there is limited research looking beyond six months of practice, it seems that more consistent training is better than bursts of training, and will serve to equip our elderly patients with a consistent fall prevention strategy.1,4

Ideal Exercises Programs for Fall Prevention

Balance training should be a mix of static, dynamic, proactive, and reactive balance. Typically a more diverse routine including all aspects of balance, resistance, and aerobic exercise three times per week will help to create greater muscle mass and improvements in balance that lead to reduced falls.1,5,6

A balance training program should be well-rounded and diverse, including strength training, multiple types of balance system training, and aerobic fitness—the key to helping prevent falls.

To learn more about the importance of balance training, MedBridge instructor J.J. Mowder Tinney offers this three-course series on how to properly assess for balance and the various interventions available to address your patients specific needs.

  1. Gschwind, Y. J., Kressig, R. W., Lacroix, A., Muehlbauer, T., Pfenninger, B., & Granacher, U. (2013). A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC Geriatrics13, 105. https://doi.org/10.1186/1471-2318-13-105
  2. Fuller G. F. (2000). Falls in the elderly. American family physician61(7), 2159–2174.
  3. Marques, E. A., Figueiredo, P., Harris, T. B., Wanderley, F. A., & Carvalho, J. (2017). Are resistance and aerobic exercise training equally effective at improving knee muscle strength and balance in older women?. Archives of Gerontology and Geriatrics68, 106–112. https://doi.org/10.1016/j.archger.2016.10.002
  4. Lesinski, M., Hortobágyi, T., Muehlbauer, T., Gollhofer, A., & Granacher, U. (2015). Effects of balance training on balance performance in healthy older adults: A systematic review and meta-analysis. Sports Medicine (Auckland, N.Z.)45(12), 1721–1738. https://doi.org/10.1007/s40279-015-0375-y
  5. Gerards, M., McCrum, C., Mansfield, A., & Meijer, K. (2017). Perturbation-based balance training for falls reduction among older adults: Current evidence and implications for clinical practice. Geriatrics & Gerontology International17(12), 2294–2303. https://doi.org/10.1111/ggi.13082
  6. Reactive Balance Training. Physiopedia. (n.d.). Retrieved April 11, 2022, from https://www.physio-pedia.com/Reactive_Balance_Training