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Building better balance

Balance is what makes it possible to stand, walk and move without falling. It’s essential for mobility and for fall prevention, and is a key element of fitness.

“Balance depends on the complex interplay of vision, the vestibular system – that’s your inner ear – and the joints, muscles and ligaments that make up the movement system,” says Tania Obljubek, a physiotherapist at Women’s College Hospital. “Those three elements work together to always let us know where we are in space.”

Vision, as well as the strength and flexibility of the movement system, can change with age or with health conditions. So for many people, balance requires maintenance. Loss of balance can be frustrating and can lead to a loss of strength and mobility.

External factors – such as an electrical cord you might trip over or an icy sidewalk – can obviously affect balance, and it’s important to make your home and environment as fall-safe as possible. However, intrinsic factors are also crucial for balance.

“Intrinsic factors are elements that are within yourself,” Obljubek explains. “Things like vision, strength or weakness, or problems with movement control.”

These affect both static balance, which is balance while standing still or sitting still, and also dynamic balance, which is balance while moving or walking. Exercise is a key strategy for improving both types of balance.

Challenging balance

A good way to start improving your static balance is to sit on a fitness ball or place a half-ball balance trainer on a chair.

“That makes you unstable, so your core has to work harder,” Obljubek says. “I’m a big proponent of core stabilization.”

Obljubek also recommends working on the floor, as long as it’s done safely. Many older adults are wary of getting on the floor because they fear they won’t be able to get up.

“The thing is, if you fall, you need to be able to get up. So unless you do exercises that work that specific area, you’re always going to be afraid you won’t be able to get up. For example, get on all fours and try to bring one leg up, just like you would in a fall,” she explains. “Of course you need to do this safely, in the presence of a rehab professional or a caregiver.”

To help improve dynamic balance, Obljubek often sets up an obstacle course and has patients do the course while holding a cup of coffee.

“They have to hold a cup of coffee because that is when we fall: when our attention is on something else,” she explains.

“This is not something you do once a month. If you’re going to choose to challenge your balance, you need to do it at least a few times a week,” Obljubek says. “The other thing is you need to keep challenging yourself to continue improving.”

Individual starting points

As with any type of exercise, everyone will have her own starting point, based on her individual abilities and fitness level. This includes people who have a health condition or a disability, or who are recovering from an injury.

“Start from your own place when you’re choosing your exercises,” Obljubek says. “You need to make sure you’re safe, but you’re challenging yourself.”

You may need to begin by using a support, such as a kitchen counter or a sturdy chair, and simple exercises like leg lifts. Move away from the support as strength and balance increase. Many people are afraid of using canes and walkers but mobility aides can actually increase your mobility and balance and allow you to walk longer and exercise more.

She stresses the importance of movement, even when it may be uncomfortable.

“Motion is lotion,” Obljubek says. “Unless you have an acute injury such as a fracture that needs to be medically addressed then you should move a joint even when sore. When you move it, it gets lubricated and it will start to feel better.”

There is good evidence to support overall community exercise classes.  They are fun, socially engaging and train balance.  Look to your local library, senior center, community center for classes.  Classes like tai chi, dance and the fall prevention classes offered through the Ontario government are also good choices. 

Overall, seeing a physiotherapist can also be helpful if you are really concerned, and good footwear is especially important when exercising.

This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: June 2019.

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