FALL PREVENTION THROUGH EXERCISE

My parents are 87 and 89 years old, and they will celebrate their 65th wedding anniversary this year. They live independently in their own home, largely because they are both healthy and active, particularly my mother. My parents go to a community based senior exercise class two times a week. This keeps my Dad active, and they have a large social network with the same group of people who have attended the classes for over 20 years. My mother has walked daily for the past 30 years in all types of weather. She tells me she usually walks three miles, but due to some of her walking partners inability to keep as brisk a pace as hers, they now walk for one hour versus a specific distance. My parents also maintain exceptional gardens throughout the summer, which further challenges their strength and balance. Thankfully, neither has either fallen or been injured in a fall. I am lucky to have parents who are able to continue living independently in their own home. Many other people are concerned about themselves perhaps, or their own parents. How can they continue to live safely on their own? Is there something that can help them maintain their independence? You bet! In one word, EXERCISE! Not just any exercise. Fall prevention exercises. Balance exercises. Falls and their resulting complications have a major impact on older adults. It is estimated that one-third of adults age 65 years and older living in a community suffer from a fall each year. As Physical Therapists, we often see patients for complications resulting from a fall, such as fractures, surgery related to a fracture, back pain or persisting dizziness or loss of balance. Physical Therapists also address some of the common medical conditions, which may be a part of the elements to a fall. These might include arthritis, joint replacement surgeries, osteoporosis or stroke. Other common non age-related issues such as Parkinsons disease, peripheral neuropathy and vestibular disorders also may contribute to falls. What affects my balance? Balance is affected by three primary systems. If any one of these systems is in any way altered or dysfunctional, balance will be altered. The three systems are visual, somatosensory and vestibular. Big words, but easy to explain. Most people rely heavily on their vision to help them balance. This can lead to difficulties when walking in the dark, wearing sunglasses, when moving from light to shadow or when vision is impaired. Reduced visual acuity (such as what occurs with macular degeneration) can affect the ability of the eyes to find a target or visual reference.

The somatosensory system comes from receptors in our skin, muscles and joints. These receptors, when working properly, help give feedback about the bodys position in space. When not working properly, (as with reduced or exaggerated sensation in the feet from peripheral neuropathy, following severe ankle sprains or joint replacement) you may have difficulties feeling the surfaces you are walking on. You may also have difficulty noticing a change in the contour of the surface you are walking on. The vestibular system is sometimes referred to as the inner ear. It works like a carpenters level to sense how level you are in space. This system is often underused in older adults and we may have difficulty balancing in reduced light or on changing surfaces such as stairs, gravel, stepping over a curb, etc.

What are fall prevention exercises? Fall prevention exercises or balance exercises will strengthen the use of each of the three systems that contribute to balance, thus improving balance. These classes will also enhance posture, improve lower body strength, increase confidence and maximize safety. For example: A forward flexed posture will change your center of gravity, making it difficult to recover in a fall. Muscles of the back are strengthened to counteract this tendency to be forward. Along with improper posture, an irregular or shuffling gait can create problems and lead to a fall. Gait exercises focus on walking in different ways to practice proper gait, as well as challenge balance by interrupting or altering walking patterns. Lower body strength is also very important in fall prevention. A fall is often the result of a weak lower body. If a person trips, is pushed or bumped or loses balance in some way, it takes lower body strength to step and recover. Fear of falling can reduce your confidence to be out in the world, away from your home. This results in a decrease in your activities and you may become more isolated. Practicing exercises in a safe, supportive setting increases confidence and you will be encouraged to try new and challenging activities! Safety and confidence go hand in hand. When you are challenged in a safe environment, your fear of truing new things may be reduced and you will be surprised at your new confidence and abilities!

NBalance NBalance is a program for fall prevention which was developed through the cooperative effort of many individuals and organizations in Colorado. Classes for older adults are implemented by persons who have completed the instructor training. Mountain View Physical Therapy is very fortunate to have two people who have completed their instructor training. Caryl Rutledge, Physical Therapy Assistant, and Lynette Appelhans, fitness instructor, offer up to six classes weekly, for varying levels of abilities from beginner to advanced. The beginner class includes a pre and post assessment of specific tests designed to provide information on the various components of wellness and balance. Every class is designed to address the individual problems of each participant. At the end of a typical 8-week session (twice weekly) all participants have seen measurable improvements in balance, strength and confidence.

Who is appropriate for this class? Anyone age 60+ who is concerned about their balance, or who has had a history of multiple falls. People with arthritis with restricted range of motion will benefit from the strengthening and flexibility exercises. Anyone with lower extremity weakness, Parkinsons disease or Peripheral Neuropathy will find improvement in his or her abilities and level of confidence. The requirement to participate in the NBalance class is that you must be able to stand for 30 seconds on a firm surface with your eyes open.

Tai Chi for Arthritis/Fall Prevention In addition to NBalance, Caryl is now offering Tai Chi for Arthritis/Fall Prevention. This class will begin on March 26th and will be offered on Mondays and Thursdays. The objective of tai chi is to achieve physical balance by strengthening muscles and improving coordination, while at the same time improving mental balance. With the modifications made for this class, the program is less complex and easier to learn, thus allowing a wider audience base with more positive results, specifically in the area of balance, improved flexibility and pain relief. These features include:

Agile steps, with many forward and backward movements. This improves flexibility. Powerful Qigong exercises to improve relaxation and facilitate healing. Higher stances, making it easier for beginners and older people to learn and practice. Because each class builds on learning new stances, drop ins are not allowed for this class and a commitment to attend the entire 12 class session is recommended. I am always encouraged by the progress and results achieved by those with balance issues and the older adults who attend our classes. Its exciting to see people gain confidence, improve gait, and generally just feel more in control of their bodies. We always have a good time in our classes too! If you or someone you know would benefit from a balance assessment, please talk to a Physical Therapist for additional information.

Valerie Gluth is a Physical Therapist and owner of Mountain View Physical Therapy & Pilates, which is located in the Bergen Village Shopping center on the lower west level. To learn more about NBalance classes and Tai Chi for Arthritis/Fall Prevention, call 303-674-7889, or visit www.mtnviewphysicaltherapy.com. Mountain View Physical Therapy offers a wide variety of fitness classes for many ability levels and strongly believes that transitioning patients from rehabilitation to fitness, along with education, will keep patients healthy and will help prevent future injuries.