No matter how fit and healthy your older clients are, there is one thing that can change their lives forever: a bad fall. Every year, almost 1/3 of older adults fall and many cause injuries that will affect them the rest of their lives.

As a fitness professional, you need to be well-prepared to deliver the most effective fall prevention exercise programming to your clients. You can find excellent guidance on assessment and program design at www.mobilitymatters.fit. But you also should be providing advice to your clients on how to reduce their fall risk in other ways.

Have them do these and keep them on their feet!

1. Many falls happen outside where there are lots of potential hazards. Advise your clients to avoid walking on loose gravel, metallic/painted surfaces and cracked sidewalks and avoid being outdoors in bad weather (e.g., rain, sleet, snow). Appointments can always be rescheduled, but a trip to the ER should never be the reason!

2. Indoors, advise your clients to make sure that their path from the bedroom to the bathroom is free from obstructions (e.g., pet toys, rumpled rugs) prior to going to bed at night – that way a trip to the bathroom will not include a trip and a fall!

3. Advise your older female clients to never wear high heeled shoes outdoors. Put their heels in a canvas tote bag and walk outside in sneakers or flats instead. Nobody looks good falling, no matter how stylish the shoes!

4. In the bathroom, advise your older clients to line the floor of their shower/tub with textured adhesive strips. These are less likely to cause a slip or a trip than a rubber bath mat that might slip or bunch up. They also give a nice pedicure!

Christian Thompson, PhD is an Associate Professor in the Department of Kinesiology at the University of San Francisco and founder of Mobility Matters, an exercise assessment and program design platform designed to help fitness professionals and clinicians work with older adults. Christian has published scientific articles on exercise programming for older adults in peer-reviewed journals such as Medicine and Science in Sports and Exercise, Journal of Aging and Physical Activity, and Journal of Applied Research.

Specialized Education for Fit Pros

Falls can happen in an instant. They are one of the top fears for older adults. The statistics are frightening. Between the years 2000-2016 the rate of mortality from falls for those over age 75 more than doubled.⁽¹⁾
Weakness when standing, insecure balance, and falling are leading cause of fatal and non-fatal injuries for older Americans.⁽²⁾ Standing and walking balance is taken for granted for a large portion of our lives. When adults start talking about balance, it is usually when they begin to notice their balance declining. By then, they may have already reduced activity, and may have even resigned themselves to being forever unbalanced and at a risk of a fall. Most older adults know that if they fall and become injured, the outcome could have dire circumstances. Who wants to live like that?

With all the negative information out there, no wonder there is so much fear around loss of balance and falling. National surveys show that only 1 in 3 people get advice on physical fitness or exercise from their medical doctor. Racial, ethnic minorities and the elderly get this advice even less. Most advice surrounding exercise given by doctors has historically been centered around cardiovascular health and aerobic exercise. “Get out and walk!” they are told. Not always is this a practical solution for those who are unsteady and feel fearful being out of the home at risk of a fall. The risk outweighs the reward.

Physicians and physical therapists need more resources and avenues for senior adults to access when they need to improve their balance and reduce their fall risk. Evidence-based fall prevention programs are fortunately on the rise in retirement communities, senior centers, and general recreation and fitness facilities. These programs are valuable but do not begin to serve the needs of the expanding geriatric demographic. More qualified fitness professionals as well as more accessible and affordable programs are needed to help serve this growing need to keep our aging seniors upright and steady on their feet! Fall resistance and resilience training will change these statistics.

It is safe and realistic to say that there are 2 categories of older human beings in relation to balance: the “fallen” and the “not-yet fallen”

Often a trainer will acquire a client that has already fallen and is fearful. The client must first work to overcome this intense fear and the hesitancy of movement that this fear creates. The importance of using E3 (Educate, encourage, and empower) cannot be underestimated here. It is important that geriatric fitness trainers have a deep understanding of the basic principles surrounding the science of balance as well as training methods that are best for reducing fall risk for both categories. Getting the “already fallen” to rise up and move with confidence again will require systematic and progressive programming combined with patient and compassionate instruction.

Fall Resiliency for the “Already Fallen”

Each year millions of older adults suffer falls. Many of these result in serious physical injuries that can reduce their mobility and functioning, cause pain and discomfort, and even increase the likelihood of death in the near future. It is not only the physical effects of the fall that you should consider. Once the injuries have healed and general function is restored, they may be experiencing serious emotional consequences in the form of fearfulness which can diminish their quality of life as they age in place. Helping them to handle this type of impact can help them to move forward after their fall and preserve their lifestyle.

A 2012 university study found that loss of mobility might be due, in part, to “balance confidence”, an issue closely related to a fear of falling. The study concluded that among people who have had a fall-related hip fracture, an independent relationship exists between balance confidence and mobility and balance performance – as well as perceived mobility function.

The study tracked 130 adults over the age of 60 who had suffered hip fractures between six weeks and 7.4 years prior to observation. To test balance confidence, researchers used a simple but comprehensive measure called the Activities-specific Balance Confidence Scale (ABC Scale).(4) The ABC scale can be self-administered, and is comprised of a series of questions that gauge an adult’s confidence in various walking scenarios, such as walking up steps or on an icy path. Adults who rated a higher balance confidence tended to do better in balance and mobility tests.

Use these tips to help someone recover from the emotional impact of a fall:

Acknowledge it. An older adult may feel as though their emotional response to their fall is overly dramatic or not a big deal, and cause them to not discuss it, which can worsen the negative impact. Acknowledge that they have gone through something frightening and humbling. Show them that you can offer support and encouragement as they overcome the fear and movement hesitancy the often comes after a fall.

Recognize the risk. Suffering from one fall does increase the chances that your senior will suffer from another fall. Recognizing this risk and acknowledging this fact is important because it both validates the fear they may now have, and it may foster difficult decisions surrounding their safety in the future. Keeping open communication surrounding this serious issue will allow for prudent decisions regarding their living situation.

Encourage them. The emotional impact of falling can range from simple embarrassment to worry and distress about the changes in their physical functioning, which creates the fear that they will fall again. It does not mean that they should just stop engaging in activity which could actually further diminish their quality of life and increase the possibility of another fall. Introducing movement and exercise in incremental steps and stages will rebuild their confidence, but must be done at their pace. Praise all progress.

Imbalance is not entirely a result of muscle weakness. Strengthening muscles alone will not improve balance. Balance will improve when it is practiced in everyday activities and keen body awareness. Imbalance begets inactivity and inactivity accelerates the aging process.

Balance cannot be willed by the mind. We are not born with balance. We learn balance developmentally as we grow from babies to adults. The body learns how to stay erect in the face of gravity and the forces that are put upon it. It retains balance by staying active. Inactivity erodes balance which in turn inhibits people from being active. A vicious cycle that needs intervention and solutions.

Retraining balance and fall resistance requires knowledge of the anatomy and physiology involved in balance. The muscle systems of the body belong to one of two categories. The Phasic muscles are the mobilizing and movement/action muscles. The mind tells these the body to move in a certain way and the joints move from the contracting and elongation of these mostly fast-twitch muscles. The second type are the Postural or balance muscles and are not subject to conscious direction. These are slow-twitch stabilizing muscles and they engage automatically to hold a person erect against gravity’s pull. They do not shorten or lengthen, but supply isometric tension. With underuse, these postural muscles can “forget” how to maintain balance even on steady and level surfaces. Falling and hesitant walking is the sign that a lifetime of balance muscle memory is declining or lost. Without retraining our postural muscles, imbalance will take over. The solution is to re-educate and activate these essential postural/balance muscles in concert with the Phasic (movement/action) muscles (3) Trainers must encourage daily balance practices and educate their clients on how to manage their posture and center of gravity through drills and skills that align with their functional and independence needs.

Fit Pros: Work with Older Clients on Fall Prevention (and MORE!) as a Geriatric Fitness and Lifestyle Specialist

Millions of people over age 65 looking for guidance from fitness professionals who are knowledgeable in exercise, nutrition and lifestyle principles that can help them improve functional mobility, while also preventing and managing chronic conditions to live their highest quality of life. The Geriatric Fitness and Lifestyle Specialist online certificate course will give you insights, strategies and tools to be a successful professional in this rapidly growing market. Learn how to be a valued part of clients’ continuum of care, working with the medical team to improve functional outcomes and positively impact people’s lives.

Holly H. Benson, BS, is a veteran in the Recreation and Fitness industries with over 35 years of administrative and technical experience. She holds two bachelor’s degrees, Corporate & Community Fitness and Recreation Administration, and numerous fitness certifications. She has developed thriving fitness programs for special populations and has passionately focused her career on the much older adult.  She currently owns and operates Moving Strong Medical Exercise, LLC in Lakewood, Colorado and provides in-home and virtual fitness training to older adults and persons with chronic medical and orthopedic conditions.

References

1. https://nytimes.com/2019/06/04/health/falls-elderly-prevention-deaths.html?searchresultposition=1
2. https://www.cdc.gov/falls/data/
3. Vladimir Janda. http://www.jandaapproach.com/the-janda-approach/philosophy/
4. https://www.activesolutionspt.com/files/pdf/abc.pdf

“Core strength” is a popular fitness buzz term, but what’s the big deal all about? Core strength is essential for all our movements. The core is a collection of muscles that stabilizes the central muscles in our torso and spine. As our body’s center, our core has the big task of holding us upright. A strong core makes everyday activities easier to do.

You might think core training is all about lying on a yoga mat doing interminable “crunches.” But there’s way more to core training than aiming for a flat tummy or a “six-pack.”.

Importantly, you use your core when you put on shoes and when turning to look behind you. Likewise, reaching that box on your top kitchen shelf, or sitting in a chair are activities rely on a strong core. In fact, you might not notice a weak core until these activities become difficult or painful. Significantly, a strong core is also how you avoid back pain as you get older.

Breathing Helps Build Core Strength

The key to building core strength is by employing stomach-based, diaphragmatic breaths, so that our torso and ribcage expand forward, back, and to the sides. Breathing in is bodyweight exercise that lengthens the transverse abdominis muscles and obliques, which helps build core strength. Breathing correctly can increase flexibility and lower the risk of exercise-related injury. Also, a strong core helps with things like balance, and, oh yeah… it makes you look thinner.

4 Common Breathing Problems

1.Your neck, chest, and shoulder muscles feel tight. If you carry a lot of tension in the muscles around and under your neck, those muscles may feel painful or tender. Poor diaphragmatic control can cause neck and shoulder muscles to become short and tight. Slouching means you’re not activating your diaphragm when you breathe.

2. You sigh, or yawn frequently. If you must take a deep breath, sigh, or yawn every few minutes, it’s a sign that your body isn’t getting enough oxygen when you breathe.

3. You breathe with your mouth open. Unless you have a sinus infection or congestion that prevents you from breathing through your nose, your mouth should be closed as you breathe.

4. Your resting breath rate is too fast. A normal, resting breath rate should be about 12-20 breaths per minute. If the number of times you breathe each minute is too fast, your breathing is probably shallow. A normal respiratory rate keeps the balance of oxygen and carbon dioxide even in the body.

4 Ways to Practice Correct Breathing

1. Keep your shoulders still. Sit in a chair that has arms on the side. Support your arms and elbows by the arms of the chair. As you inhale through your nose, push down onto the arms of the chair. Exhale while you purse your lips and release any pressure on the arms of the chair. The purpose of this exercise is to keep you from elevating your shoulders as you inhale, which can cause upper chest breathing.

2. Slow your breath. Pursing your lips forces you breathe more slowly. Start by creating as small an opening as possible in your mouth when you breathe. Imagining you’re blowing through a straw or blowing at a candle only hard enough for it to flicker, but not blow it out. Breathe in through your nose for 2-4 seconds, then breathe out for 4-8 seconds, keeping your lips pursed. Repeat this for about 3-5 minutes.

3. Use upper chest resistance. Lie on your back, place a hand on your upper chest, apply slight downward pressure to the hard bone (your sternum) in the middle of your chest and maintain that pressure while you inhale and exhale. This will force you to “bypass” your chest while breathing and start to breathe from deep within your belly.

4. Blow up a balloon. When you blow up a balloon, you activate your abdominal muscles, align your spine and pelvis, and contract your diaphragm. Blowing up a balloon works your deep core muscles. It also requires all your mid-section muscles to work together. Sit on a chair with a straight back, or the floor against a wall, with your knees bent and your feet flat on the ground without leaning against the chair back or wall. Inhale deeply from your nose with your mouth closed, pushing your belly out. Then exhale by blowing slowly into the balloon, exhaling as much air as you can. Your deep abdominal muscles activate as you blow into the balloon.

Jacqueline Gikow, whose holistic, health and wellness practice centers on pain relief through better movement, is the owner of Audacious Living NYC™. She is certified through the National Association of Sports Medicine (NASM), the National Board of Medical Examiners (NBCHWC), the Functional Aging Institute (FAI), Medfit (MFN), and the Arthritis Foundation (AFAP/AFEP). Her fitness practice includes in-home and remote, one-on-one fitness training and coaching in New York City. Visit Jacqueline’s website at audaciouslivingnyc.com, or on Facebook.

References

• https://www.healthstatus.com/health_blog/health-fitness/six-signs-that-indicate-you-have-a-weak-core/#ixzz4Z8o0iXmk
• http://www.quickanddirtytips.com/health-fitness/exercise/how-to-breathe-the-right-way

Falling is an issue for almost every chronic condition discussed in this text, from peripheral neuropathy to CVA’s, as well as sarcopenia that leads to fragility. Things like poor hearing, dizziness, joint stiffness or even wearing glasses can also disrupt a person’s balance. Some medications such as blood pressure, sleep medications and antidepressants may influence balance. A bad fall can make a chronic condition even more disabling. The consequences of a fall include serious injury, limited activity and significant medical costs. Many older people never fully recover from a fall. 

Guarding Against Falls 

If they are going to fall, most people (particularly stroke victims) will fall toward their weak side. They can also fall forward or backward. They fall primarily because their muscles are weak and their legs crumple under them or because their balance is poor. The American Geriatrics Society suggests fall screening be done at each annual doctor’s visit. Tell your client to mention to the doctor if they are having a balance problem or have fallen within past 12 months. 

Safety Tip 

If the person’s left side is weaker, stand at the person’s left side and just a little behind. Put your right hand on their belt or transfer / gait training belt and your left hand on the front of their shoulder. In this position you can push back on their shoulder and push forward on their hips to straighten them up, or you can pull them against yourself. In case you cannot hold the person up, you are in a good position to ease them gently to the floor if they should start to fall. Remember to use good body mechanics. If a person is falling, you can do more harm to your back and to them by straining to hold them up than if you ease them to the floor. You should never hold a person only by the arm or let them hold onto you, because if they suddenly start to fall, you will both fall over. 

Tip: Transfer belts are available at most drug stores. 

Preventing Falls

Keeping the walkways well lite is a good precaution. Nightlights on. To make house safer consider the following top 10 safety checklist items:

1. Don’t let person rush to phone or door.
2. Discourage them from wearing long bathrobes or slippers that can be a tripping hazardous.
3. Teach person to get up slowly from sitting or lying, to avoid postural hypotension, (Low Blood Pressure).
4. Teach them to transfer safely from place to place.
5. Make sure person knows how to use cane or walker properly
6. Remove all tripping hazards, extension cords, books, throw rugs. If the people have pets make sure toys are out of way and cats should wear a bell.
7. Keep things within reach, to avoid step stool use.
8. Have grab bars installed where needed.
9. Use non-slip mats where needed.
10. Teach them to be alert to outside hazards, wet sidewalks etc. 

Reprinted with permission from Karl Knopf

Karl Knopf, Ed.D, served as 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.

References

• Focus on Healthy Aging publication, 2016
• ISSA Fitness Therapy Course, 2019
• WebMD – focus on falls, March, 2019
• IDEA Journal, Effective Posture, February 2015
• American College of Sports Medicine, “physical activity falls and physical function, ,July, 2019
• Weights for 50 plus, Knopf Ulysses Press, 2006
• Resistance Band Workbook, Knopf, Ulysses Press, 2013
• Stability workouts on a Balance Board, Knopf, Ulysses Press, 2017 Core Strength for 50 plus, Knopf, Ulysses Press, 2012