Balance Training

Original Editor - Lucinda hampton

Top Contributors - Ahmet Begde, Lucinda hampton, Anthonia Abraham, Kim Jackson, Oyemi Sillo, Carina Therese Magtibay, Candace Goh, Aminat Abolade, Nupur Smit Shah and Angeliki Chorti  

Introduction

Balance is defined as an individual's ability to control their centre of gravity within the limit of Base of Support (BOS). Body balance control is a complex body function that involves regulating posture and movement via the cerebellum by processing sensory inputs from the vestibular visual and proprioceptive systems in the cerebral cortex . Ageing, neurovascular problems, weak muscle strength, limited range of motion, and cognitive decline could adversely affect the static and dynamic balance control ability, which increases the risk of falling and negatively affects the performance of activities of daily living(ADLs).

Multicomponent training combining balance exercises with strength , aerobic and flexibility exercises improve overall health and physical activity.

Indications

Balance training is undertaken in order to:

• Prevent falls/injury

• Improve posture
• Improve strength
• Improve standing balance and locomotor performance in older adults
• Improves dynamic trunk control, sitting & standing balance, mobility in person's post stroke
• Strengthen self-efficacy in balance control leading to improved fall-related self-efficacy, reduced fear of falling, increased walking speed, and improved physical function
• Improve quality of life

For Whom

Having good balance is important for many activities people do every day e.g walking, putting clothes on the line, reaching up or down into cupboards, going up and down the stairs.

Exercises that improve balance can help prevent falls, a common problem in many populations:

• Older adults
• Neuromuscular conditions (multiple sclerosis, Parkinson's, stroke)
• Dementia
• Cancer Rehabilitation
• Amputees
• Those who are obese since weight is not always carried or distributed evenly throughout the body.
• Back pain (balance training is one of the best ways to strengthen your core and prevent back pain).

Clinical Presentation

Decreased balance is attributable to an age-related decline in multiple physiological systems that contributes to :

• Decreased muscle flexibility and strength,
• Reduced central processing of sensory information
• Slowed motor responses.

Exercises and Implementation

A comprehensive balance assessment should be done prior to commencing a balance exercise programme to provide best available evidence-based and person-centered exercises.  There are several clinic tests and laboratory-based procedures to assess body balance control.

Clinic tests:

• 4 Stage Balance Test
• Berg Balance Scale
• Falls risk assessment tool
• Timed Up and Go Test
• The Balance Outcome Measure for Elder Rehabilitation
• Functional Reach
• Short Physical Performance Battery (SPPB)
• Performance Oriented Mobility Assessment
• Balance Evaluation Systems Test

Laboratory-based balance measures:

• Force Plate
• Motion capture analysis
• Wearable inertial sensors

Introduce the exercises gradually, allowing for the proper adjustment of the clients while ensuring their safety. Allow for gradual and safe exposure to new equipment or a new exercise

Preferably, older adults and those at risk of falls should do balance training 3 or more days a week for at least 45 minutes to reduce falls.. Common duration of exercise programmes are usually 12 weeks. It is suggested that lifelong regular physical activity, including balance exercises, maximise physical functioning in older age.

The programme should incorporate exercises that include:

• Static vs. dynamic stability postures
• Changes in the base of support
• Variations in the height of the centre of gravity
• Different standing surfaces

Additionally, it should progressively reach higher levels of challenges in the form of more complex exercises involving both motor and cognitive tasks (dual- and multi-task activities).

Examples of balance exercises include:

• Standing feet together
• Tandem stance
• Single leg standing
• Sit to stand without using hands
• Walking while alternating knee lifts with each step
• Tai chi
• Yoga
• Using equipment (balance board) for added challenge
• The Otago Exercise Program
• Perturbation-based balance training - involves repeated postural perturbations aiming to improve control of rapid balance reactions. This training has been proven to improve reactive balance control in post-stroke individuals during the sub-acute phase.

Progressions:

• Closing eyes
• Increasing duration of holding a position
• Adding movements eg. neck rotations
• Letting go of the support

Resource

• NICE Guideline (Strength and balance training)
• NHS inform (Balance Exercises)
• American Heart Association (Balance exercise)