Shareable Resource: Ten Exercise Ideas for Better Balance

STATIC WITHOUT THE CLING. Static activities are a category of exercises that challenge one’s center of mass while the feet remain fixed in one place. For example, if an individual’s hypothetical baseline balanced position was a wide double-leg stance, progressions could include taking a more narrowed stance, adopting a series of staggered or tandem stances, and culminating in single-leg stances. For example, the tandem stand is performed with one foot directly in front of the other, the toes of one foot touching the heel of the other. Stand as tall and still for a set duration as you are able to and repeat by switching the position of the feet. See Video 1, Supplemental Digital Content, https://links.lww.com/fit/A433, for a demonstration. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_yysjym1c"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} A DYNAMIC SITUATION. Dynamic activities are another category of exercises that challenge the center of mass, but in contrast to static activities, dynamic activities put the feet in motion. Examples of dynamic activities could be any combination of weight shifting (e.g., front to back and side to side). Here is a fun dynamic challenge. Start with a staggered stance position with the left foot forward and the right foot back. Rock forward onto your left foot while simultaneously reaching forward with your left arm and reaching back with your right arm; then rock back while reaching forward with your right arm and reaching back with your left. Switch up your stance leg and repeat. See Video 2, Supplemental Digital Content, https://links.lww.com/fit/A434, for a demonstration. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 2.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_57rbp8fx"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} THE GAIT KEEPER. Dynamic gait training attempts to enhance stability during locomotion, focusing on exercises that force the body to rapidly adjust and stabilize to better prepare for real-life challenges found in walking and daily movement tasks. Examples of dynamic gait training exercises include boxing classes, dance steps, walking in circles or figure 8s, changing directions when given a command, and completing an obstacle course. An agility ladder can be implemented to create a series of dynamic gait challenges by starting with the basics, stepping each foot forward into the square before moving on. To progress, introduce a lateral movement, moving in and out of the squares of the ladder to the right and then to the left. See Video 3, Supplemental Digital Content, https://links.lww.com/fit/A435, for a demonstration. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 3.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_chyeawlj"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} YOU CAN’T GO WRONG WITH GETTING STRONG. The incorporation of resistance training is a very effective strategy to improve balance. Resistance training exercises have been shown to improve the muscles that aid in stability and, subsequently, balance. An initial exercise prescription consistent with ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition of at least 2 days a week with at least one set of 8–12 repetitions is an excellent starting point. One such exercise to consider is the step-up. To begin, stand in front of a stable step and place your entire right foot firmly on the step. Press through your right heel, lifting your body until your right leg is straight, bringing your left foot up onto the step. Slowly step back down with your right foot, then your left. Complete your target repetitions and switch lead legs. Remember, if you are using a staircase to do this, use the last step at the bottom and the handrail for assistance, if needed. See Video 4, Supplemental Digital Content, https://links.lww.com/fit/A436, for a demonstration. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 4.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_c6w6ttyo"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} MORE POWER TO YOU. Once a solid foundation of muscular strength has been developed, the incorporation of power training is the next logical step to improve balance. It is well documented that in older adults, the decline in muscular power happens sooner and drops more precipitously than strength and muscle hypertrophy. A wide range of exercises can be selected for the purposes of training power if they are performed with the concentric muscle action occurring as fast as possible. One such simple beginner exercise is the bodyweight chair squat. To begin, sit on the front half of a sturdy chair, feet flat on the floor, about shoulder width apart. As you are able, rise up into a full standing position as quickly as possible. Sit back down and reposition yourself to perform the next repetition, making sure each repetition is performed with maximal intent. Simple progressions include picking up the tempo or holding an appropriate weight while performing the movement. See Video 5, Supplemental Digital Content, https://links.lww.com/fit/A437, for a demonstration. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 5.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_2cl18nq0"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} TWO FOR THE PRICE OF ONE. Dual-task training involves doing a primary task, such as balance or motor task, while simultaneously performing a secondary task, typically a cognitive task that is somewhat mentally challenging. Through the concurrent integration of cognitive and motor functions, dual-task challenges are believed to be effective by strengthening executive functions and making the balance/motor task more automatic. Here are two examples of dual-task challenges to try at home. Motor-motor task (two separate motor tasks) includes standing upright and marching in place. Simultaneously, have a partner toss a ball and attempt to catch while continuing to march in place. Motor-cognitive task (motor task paired with a cognitive challenge) can be performed by walking in a straight line, heel-to-toe, while naming vegetables that are green. See Video 6, Supplemental Digital Content, https://links.lww.com/fit/A438, for a demonstration. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 6.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_x1fwqvzn"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} AM I SENSING SOMETHING HERE? In order to maintain balance, the body needs to integrate sensory information from the visual, vestibular, and somatosensory systems. Therefore, exercises that challenge one of these systems will force the other systems to work harder to maintain balance. Here are three examples that challenge each of the systems using the example of being in a single-leg stance. For a visual challenge, assume the single-leg stance and then close your eyes and attempt to maintain your balance. To perform a vestibular challenge, assume the position and start moving your head from side to side or up and down, picking up the pace of the head movements to increase the challenge. This activity may not be appropriate for those with vestibulocochlear dysfunction, such as vertigo, and without supervision of a qualified healthcare professional. Somatosensory challenges can be implemented by standing on a soft, uneven, or unstable surface such as a foam pad or pillow, and assume the stance position and try to maintain your balance. See Videos 7A–C, Supplemental Digital Content, https://links.lww.com/fit/A439, https://links.lww.com/fit/A440, https://links.lww.com/fit/A441, for demonstrations. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 7.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_7smnbi5c"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} DON’T GET PERTURBED. Anyone who has ever slipped on some ice but managed to regain their balance to keep from falling has effectively had their balance “perturbed.” This rapid reflexive response can be trained in laboratory settings with a device such as a perturbation treadmill in which the individual will wear a safety harness to prevent actually falling and will begin to walk on a treadmill in which the belt will purposely slip, forcing the individual to regain their balance. A much more accessible attempt at perturbation training could use a stability ball with a partner in the following manner. Start by assuming a narrow stance while holding a stability ball in your arms. Have a partner begin striking the ball on all sides while you try and maintain balance. See Video 8, Supplemental Digital Content, https://links.lww.com/fit/A442, for a demonstration. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 8.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_iz5qwn9s"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} GET IN THE GAME. Active computer gaming (AKA: active video games or exergaming) has the potential to provide a significant benefit to efforts to improve postural stability. These games are unique in that they combine elements of both physical and cognitive training, but in a fun and engaging format. Many of the exergames contain elements of dual-task training in which they may be required to perform a series of movements that challenge balance while concurrently having to process information and make quick decisions to solve a puzzle or hit a target using systems such as the Nintendo Wii or Xbox Kinect. An additional unique benefit that has been observed with the use of exergames is that older adults feel more connected with their family members, especially when playing with their grandchildren. A GOOD WAY TO MULTITASK. Multicomponent/multitask physical activities are those that systematically combine multiple types of training, typically muscle strengthening, balance, flexibility, and aerobic endurance training components. Furthermore, many of these multitask activities not only have physical demands such (e.g., speed, coordination, and balance) but also incorporate mental demands (e.g., remembering sequences or quickly strategizing), and social demands (e.g., coordinating with a partner or following group cues) highlighted in specific multitask activities such as ballroom dancing, pickleball, Nordic walking, Tai Chi, and yoga.