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Senior woman exercising with trainer

An Intro to Chronic Conditions for the Fitness Professional

With the future of health being unknown, one thing is known — that Americans are living longer and with age often comes a chronic condition. Living with a chronic disease/condition is often an exhausting and frustrating ordeal.  Too often the person may feel burdened and burned out! When the stress of pain and fatigue, coupled with normal life stresses, the client may feel overwhelmed. When the client is overwhelmed, they often don’t take care of themselves and that only contributes to more fatigue and pain.  Just a few weeks of neglecting themselves can contribute to further disability.  What is the goal of the fitness professional – be positive and supportive and don’t contribute to making they condition worst.

The 3 E’s of Fitness Therapy

Your job as a fitness therapist is the 3 E’s: Educate, Empower and Encourage.

Educate yourself and client about their condition and effects their medications may have on exercise performance. Stay abreast of corrective exercise research. Knowledge is power!

Empower clients to be their own best advocate and to take control of their life not become a victim of their condition. Empower them to take the “dis” out of disability.

Encourage clients about ways to be the best they can be. Think of all methods to foster healthy lifestyles, provide hope and set realistic attainable goals

The purpose of this article is that knowledge is power, and the more you know about a condition, the more you will be an equal partner on your client’s health care team. Not every application is perfect for every client. Always stay alert that what is accepted as a “norm” today can change tomorrow with new research. That is why it is strongly encouraged that your client discuss their fitness plan with their medical professionals. You are not expected to know everything, but you are expected to know when to seek advice!

The Fitness Therapist is first and foremost an educator of the psychomotor domain.

Do NO Harm!

Sometimes clients with a chronic condition will be afraid to embark on an exercise program in fear that it will cause them injury or more pain. They may know intellectually that they should, but the apprehension about what might occur can be paralyzing.  They might tell you I know how I feel now and if I feel worst I might not be able to work or take care of my family.  Your first and foremost job as a fitness therapist is to DO NO harm and NOT make matters worse.  This is why having the client get prior approval and recommendations from their health professional can go a long way in motivating the client. In order to overcome a chronic condition, ask your clients to re-define their paradigm and focus on what they can do rather than what they cannot do! Ask them to think about the benefits of your successes.

Unfortunately, many people with a chronic condition are fearful that exercise may aggravate their condition, so they play it safe and do nothing. Too many people give up on an exercise program long before they experience the benefits of what regular exercise can provide. Be sensitive to your client’s concerns. Never minimize their condition, by saying, “You do not have it so bad I have a friend with ______ and she is doing fine.” What might be a small issue to one person could be a major issue to another. Always start the person where they are at and progress with care from there.

Very often improved fitness empowers the person with a chronic condition to live a richer and fuller life. Ask the client to decide what they want as an end goal of their exercise program and then design the program with small attainable steps to match their goals and abilities. Too often when a person with a chronic condition has lost control of their lives, everybody is telling them what medications to take, what to do and not do. Remind the client that they are the Captain of their wellness ship. You, their doctor and their family can be cheerleaders but they are the Captain.

As their personal trainer, do your best to make their body the best it can be. Never make promises that your program will cure them. Stay alert that many chronic conditions will ebb and flow with periods of exacerbations and remissions. While study after study supports that exercise, when done properly and prudently, produces good outcomes, exercise is never a replacement for medical care.

Regular exercise is therapy for the mind and body.

Some experts project that soon the integration of health care, fitness and wellness will intersect. The anticipated model of wellness and healthcare foresee the role of medicine will be to heal and fitness/wellness to restore health and vitality to those who participate in pro-active lifestyle.

Working definition of Wellness includes attention to the mind, body and spirit.

Today, doctors understand the importance of both passive therapies and rehabilitative exercise. While medical science continues to make great advances in surgical and pharmacologic treatments, exercise physiologists are also proving that simple interventions, such as proper body mechanics and corrective exercise, can play a significant role in decreasing the incidence and severity of orthopedic conditions and other chronic conditions. One of the goals of fitness therapy is to maximize the potential for full function and minimize the chance of re-injury.

Keep in mind that not every exercise is correct for every person or every condition. Depending upon diagnosis, certain movements will not be best for your client. Every program for a person with a chronic condition should be individualized and adapted as needed.

One size does NOT fit all in Fitness Therapy. The cookie cutter approach has no place in fitness therapy! Make the corrective exercise session a positive experience so the client will want to continue to make fitness an important aspect of their treatment plan.

It is important to stay mindful that “Recovery” of a condition may take weeks or even months depending upon the diagnosis or severity of the problem. Also, in the case of some chronic conditions, maintaining is all that can be hoped for. Slow and steady is the best approach. Progressing too quickly will only set the person up for re-injury. As the client embarks on the recovery process, you need to encourage clients to be their own health advocate and wellness trainer.

Exercise: The Miracle Cure All?

It can:

  • reduce cardiac mortality by 30%
  • improve self-image
  • reduce prostate cancer progression by 50%
  • assist in decreasing hypertension
  • reduce the risk of type-2 diabetes by greater than 50 %
  • reduce bowel cancer by 45%.

For more information see aomrc.org.uk/publications/reports.

Some General Guidelines for Working with Clients with Chronic Conditions

The world of health and fitness is a complex one. Lack of exercise contributes to diabetes, high blood pressure and other assorted sedentary health concerns, but too much exercise causes overstress and injury to joints and muscles. While exercise can make us feel good, too much can bring on pain and soreness. The answer is to train smart. If a client is hurting, let them know it is OK to back off.

  1. Consider asking the client to consult their health professional for suggestions regarding exercise and their condition. The information given by their health professional supersedes the information in any textbook, because the health professional is familiar with their unique situation.
  2. Perform their exercise program when they are having the least amount of pain/discomfort. Teach the client to listen to your body and heed what it says. Keep in mind the 2-hour rule; if the client hurts more 2 hours post-exercise, back off until they are pain-free, but don’t quit. Avoid any activity that aggravates your client’s condition. If they say, “I am fatigued”, don’t force one more repetition.  If they say, after a workout, “I hurt!” Back off!
  3. Never allow the client to mask pain with pills or lotions. Pain is the body’s way of informing them that something is going on inside. To prevent a re-injury or unnecessary pain, execute motions in a pain-free range of motion with proper form. If you suspect a re-injury, ask them to schedule an appointment with their doctor. If you suspect the person is abusing pain medications, seek advice. The client is more important than any exercise program!
  4. Encourage them to carry ID and medical information with them to sessions.
  5. Always teach and ideal proper posture and proper body mechanics in all movements when possible given their health status.

Exercise Do’s And Don’ts for Your Clients

  • DO carry identification when you exercise.
  • DO check heart rate before, during, and after exercise.
  • DO listen to your body, if it hurts, STOP!
  • Do prepare the body for movement and stretch and relax after a session.
  • DO drink plenty of water before, during, and after each exercise session.
  • DO consider solitary versus social aspects of your chosen program.
  • Do teach mindfulness when exercising.
  • DON’T bounce when stretching, and stop a stretch if it hurts.
  • DONT squeeze a week’s worth of exercise into one day.
  • DON’T overestimate your client’s capacity to exercise. However, DON’T underestimate it either. Remind the client that the body is designed for movement, but let it adapt slowly and gradually.
  • DON’T allow the person to hold their breath during exercise.
  • DON’T allow the person to go directly into a sauna, hot whirlpool (Jacuzzi), or steam bath after exercising.
  • DON’T use perspiration (sweating) as an indication of how good (or bad) your workout is: we all perspire at different rates and in different amounts.

Reprinted with permission from Karl Knopf.

Karl Knopf, Ed.D, was the Director of The Fitness Therapy Program at Foothill College for almost 40 years. He has worked in almost every aspect of the industry from personal trainer and therapist to consultant to major Universities such as Stanford, Univ. of North Carolina, and the Univ. of California well as the State of California and numerous professional organizations. Dr. Knopf was the President and Founder of Fitness Educators Of Older Adults for 15 years. Currently, he is the director of ISSA’s Fitness Therapy and Senior Fitness Programs and writer. Dr. Knopf has authored numerous articles, and written more than 17 books including topics on Water Exercise, Weights for 50 Plus to Fitness Therapy.



Arthritis Today Sept/Oct 2015


Exercise Combats Frailty

Exercise is key to maintaining muscle mass that enables performance of the activities of daily living.

US Census projections suggest that the majority of baby boomers will turn 65 between 2010 and 2030, reflecting the impending need for increasing medical care within this demographic.(1-3)

“Baby boomers are now senior boomers, and just as this group has influenced everything in the past, they will impact tomorrow’s health care services as well,” says Patrick Kearns, MD, a geriatrician at El Camino Hospital in Mountain View, California.

The health and function within this group will range from those who are extremely fit and healthy to those who are physically dependent. How an individual ages is, to some extent, determined by the cards (genes) they were dealt and, to a larger extent, how they’ve played those cards. Research confirms the relationship between living a healthful, active lifestyle and both quantity and quality of life. Proactive steps taken throughout a person’s lifetime may prevent or delay the advent of frailty.(3-5)

The medical profession continues to make significant strides in treating conditions that would have caused death years ago. And while the average life expectancy has increased dramatically since the 1900s, this increase in longevity comes with the possibility of living more years with physical limitations and reduced functional ability.(3,5)

Some studies have discovered that a sizable number of adults over the age of 65 cannot lift a 10-lb bag of groceries, walk a mile, or easily get up from a chair. One study suggests a significantly increased risk of falling for individuals who cannot lift themselves out of a chair at least eight times in 30 seconds.1 But how can frailty be prevented or even reversed?

Identifying the Problem

Anyone, young or old, can experience frailty, which is the loss of some physical function and can result from various causes. Among the most common are a chronic medical condition; loss of a sensory system; changes in medical, mental/emotional, or functional fitness status; age-related muscle loss (sarcopenia); falls; or a sedentary lifestyle.(1,3,5)

Many times a combination of these factors results in a person’s inability to function independently, leading to the classification of frailty. The term “frail elder” often refers to the role age plays in the above conditions. Most of us can visually identify a physically frail person, but currently no definitive criteria exist for defining frailty. However, some professionals are attempting to develop a universal objective definition of elder frailty traits.(3,6)

Often family members, in concert with health care professionals, are the first to recognize an elder’s decline in strength and level of independence. Assessment of diminished balance and muscle strength suggest the need to initiate a comprehensive general conditioning program.(1)

Never Too Late

A recent study published in the Journal of Aging and Health showed that a group of octogenarians involved in a 16-week program of walking or resistance training could improve significantly in strength, flexibility, agility, and balance.(1,7) Of course, prevention is cheaper than treatment, so the intervention of a well-rounded fitness program should begin long before frailty concerns emerge. Some older adults admit that if they had known they’d live so long, they would have taken better care of themselves when they were younger.

Sarcopenia plays a major role in what many believe advances functional loss and contributes to becoming frail. Studies have shown that without the intervention of progressive resistance training, lean muscle tissue loss can begin as early as the age of 30.(1,3,5) These small changes go unnoticed or are even accepted as part of normal aging until a person finds difficulty in completing simple tasks. While the outward circumference of a limb may remain the same, the interior integrity of the muscle mass is decreasing. We can visualize the muscle loss as analogous to a lean steak’s transformation to one with marbled fat. So it is with humans: A muscle biopsy shows intermuscular fat within the muscle.

Why is less muscle detrimental? One reason is that muscle tissue is the furnace that revs the metabolism, thus assisting an individual to better control body weight, which in many cases decreases the risk of type 2 diabetes, hypertension, and other metabolic diseases. An increase of only 7.7% in resting metabolic rate derived from strength training would result in an increase of 50,000 extra calories expended in one year, which could result in a loss of 14 lbs of fat (in a 180-lb person).(1,5,7)

Strong leg muscles lead to improved balance.1 Strong functional muscles enable a more active and independent lifestyle. Being involved in a sensible strength conditioning program can foster improved bone density. Wolf’s Law says the strength of the bones is in direct proportion to the forces applied to them. If a person sits during most of the day, then he or she will have bones made for that kind of lifestyle. “Use it or lose it” applies to muscle strength as well as bone strength.

The hallmark study done by Maria Fiatarone, MD, a researcher at Harvard Medical School, placed 100 frail nursing home residents aged 72 to 98 into several experimental groups.(1,3,5-7) Her research found that those participating in progressive resistance exercises improved their strength significantly vs. those who were given nutritional supplements. The strength-training group increased their overall strength by 113%; gait velocity improved significantly as well stair-climbing ability over the nonexercising groups.

The take-home message was that resistance training is superior to nutritional supplementation and is far more cost-effective.

Exercise Benefits

A review of the literature appears to prove that proper physical activity has broad and positive influences over many of the characteristics associated with normal aging. It could be said that everything that physically declines with age can be positively influenced with proper exercise.(4,8,9)

We’re all familiar with normal aging, but healthful aging often is determined by the activity or lack of activity that precedes old age. An inexpensive strategy to improve the prospects of living long and well includes a regular dose of sensible physical activity. Some commonly acknowledged benefits of a well-rounded exercise program include improved self-efficacy, metabolism, sleep patterns, cardiovascular capacity, balance, muscular strength, endurance, and movement along with reduced fatigue, depression, anxiety, and arthritic and low back pain.(1,8,9)

Designing a Fitness Program

While it’s never too late to feel great, it’s best to start early. While this article attempts to show ways to intervene with a patient experiencing some level of frailty, the best solution is to encourage patients to engage in activities that help prevent it. It’s better to do a little bit of anything than a lot of nothing. Remind patients to start slow and progress cautiously. All of the exercises suggested below can be done simply with a chair. It’s even possible to perform some of the exercises in bed.(4,8,9)

Providing motivation to embark on an exercise regimen and stick with it presents a challenge, though. Suggesting participation in activities patients don’t want to do requires patience and skill. Focus on ways to make the activities appealing while preventing injury. Matching the exercise routine to a person’s personality and physical abilities often is more of an art than a science. A good coach/teacher can motivate a patient to do something he or she doesn’t want to do—and thank the coach for it later.(4,8,9)

It’s wise for health care professionals to provide patients with guidelines of indications and contraindications related to exercise. If possible, try to match patients with suitable options within the community that match their physical abilities, personalities, and social and economic issues. Some long term care facilities offer in-house and/or programs available to local older adults.(4,6,7)

An exercise program for patients at risk of becoming frail should aim to improve functional activities of daily living. An assessment by an occupational therapist, physical therapist, or nurse should provide some direction on the major areas to be addressed. While the aim of the intervention is to improve function, make sure the person leading the session keeps some fun in functional. This may require some socializing and interacting with patients. If patients are unmotivated to perform activities or exercise, even the best program will have low compliance rates and not produce the desired outcomes. All programs should follow some type of evidence-based guidelines.(8,9)

Improving muscular strength and endurance helps enhance patients’ functional muscular endurance and strength to perform daily activities without becoming fatigued. The basic concept of progressive resistance training, commonly called strength training, weight training, or weight lifting, is to begin with a resistance that can be comfortably performed six to eight times and then continue increasing the number of times (reps) until he or she can perform the movement easily between 10 and 15 times.(6)

Once that level is attained, patients can add small amounts of resistance to again challenge the muscles. As an individual advances, another set (a grouping of reps) can be added. The number of reps and sets varies depending on the objective. Matching activities to the functional tasks a person needs to perform can involve lifting a milk jug, opening jars, getting up from the toilet, or walking outside to get the mail, for example. The goal should be to build up a reserve of strength so patients can engage in any necessary activities.(4)

Strength training can include the use of resistance bands that come in varying levels of resistance. Light water bottles, hand weights, or attachable wrist/ankle weights work well. For patients who are particularly weak, simply using the weight of their limbs is a fine starting point.(4)

Cardiovascular Fitness

Aerobic simply means with oxygen. Most exercise physiologists use the example of anything you could do while holding your breath as anaerobic while the opposite characterizes aerobic exercise. Running a 100-yard dash could be called anaerobic and walking a mile aerobic. The goal of aerobic exercise is to improve the ability to move freely without becoming winded or to execute activities that facilitate locomotion, whether it’s propelling a wheelchair farther or safely walking unassisted to the dining room. This addresses breathing function as well as aerobic exercise to assist in reducing cardiovascular diseases and burning calories. Seated aerobics, peddling a stationary bike, and even walking exercise can be suitable options.

Balance and posture exercises should aim to improve the muscles that influence posture, such as the core muscles and muscles that retract the scapula as well as muscles that promote proper neck alignment. There is evidence that improved posture translates into standing erect and improved balance.

Balance activities should include both static and dynamic movements. Physical therapists can offer recommendations on exercises to enhance balance. Experts suggest patients can begin balance work in a chair, similar to activities for spinal cord-injured and post-stroke patients, as a safe exercise method.

Comprehensive Program Design

Attempting to include all of the aspects listed above would be ideal; no one element supersedes another. However, it’s often advisable to establish a baseline of patient stamina. A comprehensive exercise class can easily include each element. An example of such a class could include five to 10 minutes of warm-up moves, five to 10 minutes of upper and lower body strength training, and five to 15 minutes of light aerobic exercise followed by some light flexibility moves. All of these can be done safely if the activities match a patient’s ability. Individualization is the key even for a group exercise class.(4)

Ideally, providers can perform individual patient assessment. Utilizing a group assessment method such as the Senior Fitness Test also can provide information on fitness levels and achievable goals.

The bottom line is that exercises and activities should be adapted to a patient’s abilities and should never exacerbate an existing condition, as patient safety is more important than any exercise. If an instructor cannot appropriately adapt the movements, then he or she is not qualified to be teaching this segment of the population.

Basic Activities

A sample exercise program to prevent and improve the status of frailty should include the following:

• Range of motion/flexibility: Motion is lotion to stiff joints. A warm-up that addresses the major joints and helps prepare the body for physical activity should last between five and 15 minutes. Include gentle range-of-motion/flexibility activities that foster functional movements, such as putting on socks and shoes or getting dressed. In the early stages, this may be the limit of a patient’s capability, so stopping here is fine.

• Muscular strength and endurance: The focus is to improve functional muscular endurance and strength to enable a patient to perform daily activities without becoming fatigued. The activities should be matched to the tasks an individual needs to perform, such as lifting, dressing, and walking.

Plan of Action

There are not enough physical and occupational therapists nor insurance dollars available to provide all the functional fitness needs of this burgeoning group of older adults. We need to have a stable of well-trained fitness professionals prepared to serve the fitness requirements of today’s elders. The medical community needs to have confidence that when they refer someone to a fitness class, the instructor will do no harm. The fitness trainers of the future should understand the diversity within this group and understand how to assess and train older adults with varying degrees of ability and fitness. It’s essential to adapt fitness methods to a patient’s abilities and conditions and focus goals on improving functional wellness.

Ideally, this article will serve as a wake-up call, not only to the fitness industry but also to health care professionals to work toward establishing national standards for trainers who work with older adults. A great opportunity will be lost if there are not enough trained fitness professionals available to serve this burgeoning demographic.

The field of gerontology promotes aging in place as a viable option. If early and comprehensive frailty prevention programs can be conducted in senior centers, hospital settings, or assisted-living communities, it could possibly delay the onset of frailty along with the associated costs.

In Conclusion

The evidence is convincing that elders’ chronic illness is a powerful driver of medical costs. Research shows that a proactive lifestyle can lessen the challenges often seen in old age. Think of prevention as wholesale and treatment as retail in helping patients understand physical maintenance of their bodies. The goal is to inspire patients to be internally motivated to take positive steps toward becoming the best they can be, no matter what their age or disability.

Originally published in Today’s Geriatric Medicine. Reprinted with permission from Karl Knopf.

Karl Knopf, Ed.D, was the Director of The Fitness Therapy Program at Foothill College for almost 40 years. He has worked in almost every aspect of the industry from personal trainer and therapist to consultant to major Universities such as Stanford, Univ. of North Carolina, and the Univ. of California well as the State of California and numerous professional organizations. Dr. Knopf was the President and Founder of Fitness Educators Of Older Adults for 15 years. Currently, he is the director of ISSA’s Fitness Therapy and Senior Fitness Programs and writer. Dr. Knopf has authored numerous articles, and written more than 17 books including topics on Water Exercise, Weights for 50 Plus to Fitness Therapy.



1. Rose DJ. Fallproof! A Comprehensive Balance and Mobility Training Program. 1st ed. Champaign, IL: Human Kinetics; 2003.

2. Durstine JL, Moore G, Painter P, Roberts S. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities. 3rd ed. Champaign, IL: Human Kinetics; 2009.

3. National Institute on Aging. Exercise & Physical Activity. Bethesda, MD: National Institutes of Health; 2009. NIH Publication No. 09-4258.

4. Knopf K. Total Sports Conditioning for Athletes 50+: Workouts for Staying at the Top of Your Game. Berkeley, CA: Ulysses Press; 2008.

5. National Institute on Aging. In Search of the Secrets of Aging. 2nd ed. Bethesda, MD: National Institutes of Health; 1996. NIH Publication No. 93-2756.

6. Brody LT, Hall CM. Therapeutic Exercise: Moving Toward Function. 3rd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2010:1-49.

7. Ehrman JK, Gordon PM, Visich PS, Keteyian SJ. Clinical Exercise Physiology. 2nd ed. Champaign, IL: Human Kinetics; 2009:135-146.

8. Knopf K. Creating wellness. Paper presented at: Wellness Conference at the Palo Alto Medical Foundation Annual Meeting; October 2012; Palo Alto, CA.

9. Knopf K. Grow well, not old. Paper presented at: El Camino Hospital Aging In-Service; May 2013; Mountain View, CA.


Step up to Better Balance

When we are young we take our balance and coordination for granted. Yet as we progress through the years sometimes our muscles get weaker and joints get tighter and our posture changes all contributing to decreases in balance skills.

Everybody knows to stay fit a person needs to engage in cardiovascular exercise, stretch what is tight and strengthening what is lax. But too often people miss an important aspect that is critical for functional fitness, which functional balance. The ability to maintain balance is a very complex skill that requires a vast array of systems to interact simultaneously.  Even the basic activity of walking involves a complex sequence of neurological and muscular interactions.

Functional Balance is critical for everyone from the world-class skier to the wounded warrior trying to regain his or her ability to walk again.  Functional balance is a combination of both static and dynamic balance.  These two parts of balance are critical for maintaining an independent and fully functional life!  It is easy to see how the loss of functional balance can inhibit even the simplest activities of daily living, to a person’s involvement in recreational sports.

Many common chronic conditions from arthritis to neurological issues can influence a person’s ability to maintain proper balance.  Some research published in the Archives of Physical Medicine and Rehabilitation 2015 discussed that person’s with Osteoarthritis and Rheumatoid had better mobility, and more stability after participation in a balance training program. Person’s with Ankylosing Spondylitis had improved quality of life after a seven months of balance training. Another study found that individuals with Fibromyalgia had less falls after 6 weeks of balance training.

What is balance? 

Balance is defined as “the ability to maintain the center of a mass over the base of support”.  This is evident even when you see rocks strategically placed on top of each other to produce sculptures.

Types of Balance

Static balance means remaining stationary in one place for a period of time. A common balance assessment to measure static balance is to stand on one foot for a period of time. A functional example of static balance is standing on your tiptoes while reaching for something without losing one’s balance

Dynamic balance is when the body is able to maintain in a state of balance while in motion or transition. Functional examples are being able to move effortlessly and gracefully from one place to the next at any given speed, or to be able to change direction quickly while still maintaining balance. Dynamic balance is critical for performance in most sports but is underappreciated until deficits set in sometimes seen in aging or in chronic health condition.

Extrinsic & Intrinsic Factors that Influence Balance

The occurrences of Chronic Conditions are often classified as “intrinsic” factors influencing the likely hood of diminished balance.  Many common chronic conditions from arthritis to neurological issues to sensory losses can impair balance.

Extrinsic Factors come in all shapes and sizes. Many extrinsic factors that contribute to falls are preventable. The following is a list of things that are commonly listed reasons people fall and visit the ER.  These can occur no matter what your age or fitness level.

Home Hazards

Loose carpets, slippery rugs, ill-fitted slippers, things left on the floor, clutter, reaching for objects, poor lighting, bathroom showers and tubs.

Outdoor Hazards

Wet/icy surfaces, uneven surfaces, hurrying, climbing ladders and wearing inappropriate shoes.

Effects of Medication

Many medications/drugs interfere with balance. Whether the medication is prescribed or is an over-the-counter medication it can still have a deleterious effect upon a person’s balance and coordination. Taking more than four medications increases a person’s risk of falling.  Also, it has been found that older clients (65yrs and over) cannot tolerate medications the same way a younger person can. It also goes without saying that alcohol; marijuana and other recreational drugs can impair balance and coordination.

Other Factors that Influence Stability

COG = center of gravity

Base of Support = the wider the base of support the better the stability of the person.

Friction = often called the glue/traction between the surface and the supporting platform.

Supporting systems = having enough strength to support the person. Thus the use of a cane, crutches and walkers are examples of aides to improve the supporting system.

More and more research supports the incorporation of balance training in a comprehensive fitness program.

Six Steps to Better Balance

  1. Avoid Disuse, which will cause atrophy. Use it or lose it! If flexibility and muscle development are not done on an on-going basis, the strength and flexibility will be lost! Maintain adequate strength and flexibility in joints and muscles.
  2. Keep core muscles firm.
  3. Maintain good lower leg and ankle strength and flexibility.
  4. Practice proper posture and head placement.
  5. If you suspect a deficient in the sensory, visual or neurological systems seek medical attention. No amount of balance training will help if a dysfunction exists.
  6. What you do today determines your tomorrows. Practice balance work daily. Some people practice while brushing their teeth or walking to work.

Balance Assessment

  • Stork Stand. Can the client stand on 1 leg for 30-60 seconds without wobbling all around?
  • Can the client get up and down from a chair in 30 seconds?
    • If under 40 years of age, over 15-20 times = good
    • If over 60 years of age, over 10-12 times = good
  • Sit to stand and walk 10 feet and turn around and return to your seat.


One thing is for sure when it comes to balance, change will occur! Diminishes in balance range from a simple embarrassing slip to a major fall leading hospitalization. It is up to the person whether the change is positive or negative.  The good news is balance can be maintained and often improved at any age or condition.  It is never too late to make positive contributions to better balance.

For more specific information and exercise protocols from Dr. Knopf, check out his book, Stability Workouts on the Balance Board

You can also read some of our other articles on the topic,  4 Exercises to Increase Balance for Seniors and Strategies to Improve Your Balance and Stability

Karl Knopf, Ed.D, was the Director of The Fitness Therapy Program at Foothill College for almost 40 years. He has worked in almost every aspect of the industry from personal trainer and therapist to consultant to major Universities such as Stanford, Univ. of North Carolina, and the Univ. of California well as the State of California and numerous professional organizations. Dr. Knopf was the President and Founder of Fitness Educators Of Older Adults for 15 years. Currently, he is the director of ISSA’s Fitness Therapy and Senior Fitness Programs and writer. Dr. Knopf has authored numerous articles, and written more than 17 books including topics on Water Exercise, Weights for 50 Plus to Fitness Therapy.