It’s no secret that balance tends to decline with age. Your clients may notice they are swaying a bit more while standing and walking, or feeling weaker or less steady. We all want it, but what is balance? We need to understand what it is in order to restore what was lost, safely, effectively and efficiently. 

Balance is the ability to maintain the body’s center of mass over its base of support. Your center of mass is a few inches below your belly button or can be thought of as your trunk. Your feet are your base of support (unless you are performing a handstand!) 

Balance is the ability to stay upright when standing (static balance) or when moving and performing activities like walking or climbing stairs (dynamic balance). The most common question I hear from older adult clients is, “Why am I losing balance?”  Let’s find out why. 

What is Balance?

Balance is a sense that lives in the brain. Balance relies on information constantly flowing into the brain from three main sensory systems including our visual, vestibular and proprioceptive systems. Moving properly depends on the ability of the brain to gather and interpret the sensory information provided by eyes, ears and joints.  This is essential because the brain then tells the body how to respond to stay upright and balanced.

The quality of the sensory input gathered directly impacts the quality of movement. The stronger the sensory signals sent to the brain, the more accurate the instructions sent to the body will be. On the flip side, as sensory signals become impaired, movement quality dwindles, as reaction time becomes slower. 

Making Sense of Balance: The 3 Systems

Let’s explore the sensory systems that make up balance.

Visual System: Your eyes tell your brain about where your body is relative to the environment, whether you are walking inside your home, in a busy airport, or strolling on the beach. With aging eyes, a great many people don eyeglasses to function day to day, and as our eyesight weakens, so too does the quality of the sensory input.

Vestibular System: The ears relay information to the brain about the motion and position of the head to adjust posture to maintain balance. Semicircular canals in the inner ears  contain fluid and tiny hair cells. As the head nods up and down, moves left to right, or tilts to the side, the fluid in the inner ear moves and the tiny hair cells sense the speed and direction the head is moving in. 

By age 70, it’s typical to have lost 40% of those sensory-detecting hair cells (Zalewski 2015).  

Proprioceptive System: Proprioception, literally meaning “sense of self”, is your sense of body awareness and is a prerequisite for balance. It’s how you understand the parts that make up your body, where they are located, how they feel and even what they can do. It’s the way your body communicates with itself so you can walk without looking at your feet. 

Proprioceptors are sensory nerves that live in and around joints, in ligaments, joint capsules, tendons, muscles and connective tissues. They sense and send signals to the brain about joint position and motion, as well as the muscle force involved in movement.  

As we age, our sense of body awareness is impaired leading to poor joint function, body alignment, control and coordination. The result: poor balance and higher risk of falling. 

Losing and Restoring Balance

As our eyes, ears and joints lose their sensory capabilities, this is why balance is gradually lost. 

To regain what was lost, we apply the SAID principle (Specific Adaptations to Imposed Demands) to improve function with targeted training. Up to 70% of the sensory input for balance comes from your joints (Peterka 2002), so improving joint function can be a highly efficient way to improve proprioception at any age so clients can enjoy better balance and more confidence to prevent falls. 

Most Efficient Balance Training

I start each balance training session using the MoveMor® Mobility Trainer to warm up clients’ lower body, restore ankle mobility and foot stability while increasing proprioception. Clients are thrilled to experience improved functional abilities so they can save themselves in time to prevent falls.  

With 12-points of resistance, MoveMor® makes it simple to restore joint flexibility and strength in less time than any other tool, all from a safely seated position! This wakes up proprioceptive sensory nerves essential for balance while stimulating motor nerves for quicker reflexes. 

You can get started with training clients on their journey to feeling steadier, stronger and more confident by visiting MoveMor.com/exercise-programs. There are 7 exercise programs to choose from that vary in length from 5-30 minutes. Our Take 10 to MoveMor exercise program is proven to improve balance, ankle flexibility, strength and more in just 10 minutes! An exercise guide makes it simple to identify weaknesses and tailor exercises. 

MoveMor® seamlessly integrates into your balance and fall prevention training to accelerate functional outcomes and satisfaction so your clients can enjoy better balance and an extra spring in their step today!

Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.

With the right training, you can help older adults retain or regain balance and reduce fall risk. Losing balance as we age is not inevitable. However, your older clients may express increasing concerns about falling. Those concerns may be well founded, especially if their senses are diminishing with each passing year. Certainly lack of movement also contributes to balance challenges.

We rely on information from our body in space and the environment to stay upright. Both internal and external factors affect this ability (over 200 factors. Wow!). For instance, we notice where we are in relation to the terrain and anticipate and adjust accordingly. But if the information coming in is compromised – due to weakening vision or hearing loss, for example – balance is compromised. Certainly if your clients have lost muscle mass over the years, their fall risk rises as well.

Fortunately, whether you work one-on-one or with a group, you can design effective, science-based, cutting edge balance workouts. The “old school” approach of offering static balance moves to reduce the risk of falling by standing on one leg is not backed by research. Instead, offer dynamic, integrated, functional tasks and movement challenges.

Three Systems Affecting Balance

Before addressing training protocols, let’s review the three internal systems that affect balance. Let’s call these three systems “Feel Me, Hear Me, See Me.” (Any of you just get “Tommy, the Who” playing in your head?) When any system is not functioning correctly, a person can feel off-balance.

Visual – See Me: (the most heavily used system) The visual system works with the vestibular system (defined below) by sending signals from the eye muscles to the balance organs in the inner ear. For instance, when you turn your head, your eyes go in the opposite direction. If eyesight degenerates, balance becomes more challenging.

Vestibular – Hear Me: This inner ear system lets us know that even when our bodies move through space, the world is not suddenly shifting. Our legs, ankles, knees, and neck muscles also send signals that help us keep our balance.

Somatosensory – Feel Me: A complex system of sensory neurons and pathways that responds to changes at the surface or inside the body, the somatosensory system is also involved in maintaining postural balance. Proprioceptors within the joints, muscles, and inner ear give us info about our body’s movement relative to its base of support and the various body parts. Relaying information about body position to the brain allows it to activate the appropriate motor response or movement.

If any of these three systems give faulty or reduced data to the Central Nervous System, the response will be also reduced. Bad data in; bad data out. So if your clients have inner ear issues, sarcopenia or stiff feet, for instance, balance will be negatively affected.

Four Integrated Factors to Address: Balance: Posture, Strength, Cognition

In addition to taking into account the three internal systems defined above, Balance, Posture, Strength (including speed and power), and Cognition are also critical and integrated factors. If you affect one, you affect the others.

A well-designed and effective balance program will offer tasks that recognize the integrated aspect of balance, posture, speed, power, and coordination (aka cognition). Look for dynamic exercises that enhance the above.

Walking: The Ultimate Dynamic, Functional Balance Activity

The prime example is gait. Walking is our number one functional balance activity. Every leg swing through requires balance on one leg. Therefore a balance program for older adults needs to offer some form of gait training: walking slowly, walking quickly, walking with stops and starts, walking up and down steps, walking backwards, walking with frequent turns, walking around obstacles. You get the idea.

In order to accomplish these gait tasks, clients will simultaneously improve their posture and/or strength as they strive to follow your cues. For an additional posture challenge, they can put glider discs, foam yoga blocks, or small, deflated balls on their head while walking (forwards and backwards). You can cue random squats or hops or small jumps as they walk with the glider or ball staying in place.

They may also improve their cognition if they are walking while citing their childhood phone number or counting backwards by threes or naming animals in alphabetical order. To challenge their senses, you can dim the lights or play music or cue them to walk in ever-decreasing space without running into each other or anything in the room. Of course, safety is always the first consideration, so choose your variations according to your client’s or group’s abilities.

Can your clients walk and talk at the same time? We take this ability for granted, however older adults may start to walk in stops and starts if the cognitive load increases. Challenge them to maintain a constant speed while thinking through a conversation, math problem, recall task, or verbal pattern (such as naming their teachers from kindergarten through sixth grade).

To challenge their somatosensory, vestibular, and visual senses, ask them to toss a tissue or balloon or scarf in the air as they walk. Right hand toss and catch only; then left; then two-handed. Then have them toss the item back and forth with you or other group members. Do you see where you are also addressing at least two of the four integrated factors with these challenges?

Walking examples are just a fraction of the tasks, games, and exercises you can use to help your clients with their balance. For more ideas and exercises that out the above factors into action, view the related webinar, “Help Your Boomers Achieve Better Balance.”

Older adults want to ford streams when hiking, climb stairs abroad where no railings exist, recover when they do fall. In short, they want the freedom to move, walk, and balance with confidence and a spring in their (upright) step.  If you apply the concepts of function, dynamic movement, and an integrated approach, you will offer them an effective (and dare I say, “fun”) balance program.

Webinar: Help Your Boomers Achieve Better Balance

Whether you work one-on-one or with a group, you can design effective, science-based, cutting edge balance workouts. Join Kymberly Williams-Evans for this webinar to learn more!

Kymberly Williams-Evans PhD (ABD) has taught fitness to more than 40,000 participants on 4 continents in 4 languages. Her teaching career spans land, sea, and airwaves and started in the first aerobics studio in Europe. Former faculty at University of California Santa Barbara in both the Dept of Exercise and Sports Studies and English, she specializes in baby boomer and older adult group exercise. Her newly released online Better Balance course offers more than 120 videos and concise manual for both pros and consumers.

Balance is a critical component to human movement and independence. It is essential to strength train and practice balance exercises on a regular basis. We always talk about age related balance issues but stress is rarely ever mentioned as a risk factor when it comes to balance. It is imperative to visually and physically assess all clients who come to you with acute, severe, or chronic stress. In this article we would talk about age related balance issues and Psychogenic Gait Disorder which is a balance disorder caused by stress and trauma.

How do you assess your clients’ balance? How can you adapt your training plan to deal with natural fluctuations in their balance?

Physical balance is complex and can change daily. Many clients will refer to how long they can stand on one leg when asked about balance issues, but how useful is this as a measure of their postural control or their risk of falling?

Many people who’ve had any kind of formal balance assessment have only done so after having a fall. New statistics show that falls are the leading cause of trauma room visits, across all age groups, and in the case of those over 65, 1 in 4 falls each year. Indeed, the number of deaths by falling is increasing, and yet there are many proven interventions to improve balance and avoid falls.

Many older adults are reluctant to discuss falls or balance issues with their doctors, some wrongly believing that falling is an inevitable part of aging and marks the beginning of the end for them.

Fitness trainers have a significant opportunity to help educate their clients in both the measurement and management of balance and balance issues.

Good balance is the result of the somatosensory, proprioceptive and neuromuscular systems working together. Each system is complex and can be affected by factors such as stress, quality of sleep, medications and exercise habits so understanding where your client is on any given day is helpful for optimizing their health goals.

Regular balance measurement can also be a powerful motivational tool, especially for older adults who want to remain independent and age on their own terms.

Dr. Katharine Forth is an expert in motor control, and conducted post-doctoral research at NASA, where she became the co-founder of Zibrio technology. The Zibrio SmartScale is a bathroom scale that uses artificial intelligence to measure balance and fall risk in a simple 60-second test. The product won an innovation award from the Consumer Technology Association in 2020, and was named by AARP as the winning technology to help ‘older adults stay in the game’ at their pitch competition at CES 2020, judged by Joe Montana. More information can be found at www.zibrio.com