How steady you are on your feet can indicate how likely you are to live a longer, healthy life. Here are some tips
How do you tie your shoelaces? Do you sit down, crouch, or flashily stand on one leg? As with most things in life, it’s a question of balance. What can be a little shaky at the best of times becomes even harder as we get older. The first time you notice that you can’t right yourself after a fall can come as a shock. The cost of falls to the NHS and social care has been estimated at £2.3 billion per year. While a study published in the British Journal of Sports Medicine last year found that people who cannot stand on one leg for 10 seconds are almost twice as likely to die within 10 years.
Eighteen months ago, Dr Jeremy Welch set up the Stitch in Time initiative in the Gloucestershire town of Tewkesbury. Across five GP practices, 11,000 over-65s were contacted and offered weekly strength and balance classes working on functional mobility. Resistance-band workouts, lunges and squats were the main focus, in order to improve core strength. “It’s about deconditioning. We do less as we age, and before we know it, it’s caught up with us and you start going out less. It’s a slippery slope.”
While it’s too early to know statistically if the classes have led to a reduced number of fractures and broken hips, the practices have seen a drop in the number of patients in this cohort contacting their GP for other reasons. Dr Welch thinks that social prescribing is an important element. “If people were feeling low and depressed, a lot of those have been addressed by the physicality of the classes. Working on balance means you get more confident, get out more, get more exercise and feel more positive about life.”
What is balance?
The ability to remain upright and steady is something that we take for granted until something goes wrong. The balance system is made up of lots of different sensory components, explains Nicola Harris, a vestibular rehabilitation physiotherapist.
Good balance depends on correct sensory information from your eyes (visual system), muscles, tendons, joints (proprioceptive input), and the balance organs in the inner ear (vestibular system). The brain stem makes sense of all this sensory information in combination with other parts of the brain. “All these little bits of anatomy help to orient us in space and give us information about where our head and body is relative to gravity,” Harris says. Closing your eyes adds another challenge to balance because it removes the visual cues the brain relies on, so it has to work a bit harder.
Why is balance so important?
The most obvious benefit of good balance is that it helps prevent falls and therefore injuries, and simply makes daily activities easier and safer to perform. Not being afraid of falling means you are more likely to leave the house and socialise, which has a positive effect on mental health. However, having poor balance may also act as a marker for other health troubles. These include problems with memory and thinking skills and a greater risk of stroke.
What happens with age?
Unless you develop a balance disorder, the first time people become aware of balance issues is when they get older. Harris says that people with balance problems at her clinic often talk about the loss of the ability to look from side to side as they cross the road because they feel unsteady. “That is fundamental because the balance system as a whole starts to get worn,” says Harris.
Vestibular hair cells in the inner ear show a significant decline between the ages of 65 and 70, as does the righting reflex, which corrects the body’s orientation when it is taken out of its normal upright position. “So you lose that ability to move your head quickly in space and keep yourself steady,” says Harris. Arthritis and worsening vision will all be factors that contribute to the balance system not working. Still, you might not notice any changes immediately because, says Harris, “There’s a lot more capacity and more plasticity within your balance system, so it will learn to compensate.”
Can you improve balance?
“Oh, I have terrible balance.” These words may sound familiar, but with a balance programme, Harris says you can help your brain compensate for poor stability at any age.
“It doesn’t matter what age you are, you can do balance training from when you’re a child through to your 90s.” In her clinic, through a variety of exercises, Harris works with clients to introduce errors in the system that encourage the brain to learn to compensate. “When you do a controlled wobble, the brain will see this error and pick up the activity, and the brain will work to adjust accordingly.”
So, while a strong core and functional mobility aid balance, it’s also about challenging the brain and the balance system. “We’re not just talking about strength and postural control. We’re talking about the whole system together, the eyes, the joints, the feet, the balance organs, all to be working as a team. Obviously, the stronger you are, the more likely you are to have better balance.”
How good is my balance?
A very simple test to assess how good your balance is involves standing on the floor and closing your eyes. “For somebody whose balance system is compromised, they will wobble,” says Harris. From there, you can progress to doing one-legged balances. Use a chair if you’re unstable. And if you’re really good, you can close your eyes.
“Heel raises, walking on the spot, squats and lunges all help to build strength in the legs,” says Dr Welch. Attendees at the Tewkesbury classes build up from one-legged squats out of a chair to being able to do pistol squats without any support, which are extremely challenging.
Harris is mindful that some extreme balance exercises, or vestibular exercises – which involve eye, shoulder and head movements – won’t be appropriate for everyone, particularly the elderly: “If you’re younger, you can challenge yourself and push a bit harder, but with an elderly person, it’s important they have guided instruction with exercises.”
What activities are good for balance?
Pilates, dance and t’ai chi are all good exercises to maintain good balance. “Other things that work your balance slightly differently, but again are really good, are ball games. Anything involving hand-eye coordination, such as tennis or table tennis,” says Harris. “It’s good to do a mixture of static stuff with more dynamic work.” However, she warns against just doing strengthening exercises in the gym using machinery: “That’s not going to improve your balance.” Incorporating free weights and resistance bands into your workout will not only strengthen your bones and muscles but your balance, too.