For many years, falls prevention has relied primarily on improving balance. Today, says exercise physiologist Cate Reade, there is a more refined understanding of balance – and it’s a game changer for falls prevention in senior living facilities.
Balance is driven, Reade says, by a complex system involving the joints, nerves and muscles. As people walk, nerves in the feet and ankles constantly collect information about the environment. The nerves share this information with the brain, which instantly analyzes it, instructing the rest of the body to make subtle adjustments. That process, called the proprioception, is how people stay upright and balanced.
Reade, who also is a registered dietitian, has been teaching, writing and prescribing healthy eating and exercise programs for over 35 years. In the most recent 10 years of this work, she has studied balance improvement in older adults, documenting her findings in a series of studies.
Reade’s research reveals, among other things, how seniors can train their proprioceptive system to work better and faster. She has helped seniors in assisted living facilities, recreation centers and other settings strengthen the body-brain connection – and the muscles used to make corrections and prevent falls.
Seniors have made “significant improvements in a very short period of time relative to their ankle flexibility, to their balance, to their leg strength, and their functional independence. Even those individuals in wheelchairs were able to improve their functional capacities,” she reports.
The Internal Gyroscope
Many adults are living with a reduced ability to steady themselves when they lose their balance. As early as in our 30s and 40s, people begin to lose range of motion in joints, such as the ankles, that play an important role in balance. “We’re not activating those sensory nerves, or proprioceptors, and that significantly contributes to a lost sense of body awareness,” explains Reade.
Proprioceptors are like an internal gyroscope. These sensory nerves keep tabs on the body’s position and movement, but they don’t work as well when the joints, muscles and tendons they get cues from stiffen.
“If we don’t have that sense, it doesn’t matter how strong your muscles are, because your brain can’t register correctly where you are in time and space,” adds Reade. “You can’t, for instance, plant your foot effectively or place your trunk over your foot.”
Moreover, when joints can’t move through an appropriate range of motion, the muscles around them can’t be activated. “If you’re training older adults without improving their joint range of motion first, you’re missing the boat from just a structural, biomechanical perspective,” says Reade. “If you can’t move the joint, the muscles that move the joint can’t move either. Just increasing the proprioceptive capabilities of older adults will accelerate whatever exercise program you’re promoting for balance and fall prevention.”
Fear of Falling
Reade says it’s important to address deficits in range of motion given the risks that falls pose. “Falls are one of the leading causes of injury, disability and death in the older adult population,” reminds Reade. “Hundreds of thousands of people every year are experiencing disability and death from the result of a fall. Hip fracture is one of the biggest fears that I hear, and understandably so.”
When seniors break a hip, only one in three is able to return to functional independence. Another one in three enters a nursing home. Sadly, the remaining third die within one year of a hip fracture.
“No one wants to be afraid of falling, because it just limits your engagement in the community. Your world shrinks when you’re so afraid of falling. You don’t want to see anyone living in fear because that’s no way to live, and it increases your fall risk in and of itself.”
Reade says flexibility and mobility exercise improves residents’ mental abilities and social well-being and spurs confidence. “As you are able to engage more with your community and family and friends, that’s the social well-being aspect.” Reade asserts.
“You’ve got to feel confident in your body’s ability to sense a loss of balance and then recover it as fast as possible,” says Reade. “That’s the way you can really make an impact on reducing falls.”
Move More
The insights from Reade’s research can easily be applied in senior living facilities. “You’ve got to get those joints moving through a more comfortable, pain-free range of motion,” she says. “And you can do that. It just takes consistent practice over time, and it’s not hard.”
She recommends three specific exercises – up to 10 repetitions each, one to three times per day – to improve range of motion, and joint mobility and, ultimately, balance in senior living residents:
- Toe Lifts – Lift and lower toes.
- Heel Lifts – Lift and lower heels.
- Toe Circles – Lift toes, make circles. Repeat in the opposite direction.
Importantly, Reade says senior care residents should be encouraged to “focus on the movement, not just the momentum.” In some cases, that may mean encouraging residents who are not able to lift their toes or heels to picture doing so in their mind’s eye. “Have them visualize that toe moving up towards the shin, because the research shows that you’re going to be strengthening those connections just by thinking about it.”
These exercises are a great place to start for improved joint health, improved range of motion, increased strength and stronger body-brain connection. For those who want a deeper dive, Reade offers extensive resources, many of them free, on her website, https://www.movemor.com/.
