Balance Training

Original Editor - Lucinda hampton

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

Introduction

Balance exercise is one of the four types of exercise along with strength, aerobic and flexibility exercises.

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 persons 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.

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.

In addition to an increased risk of falls, diminished balance and mobility may limit

• Activities of daily living
• Participation in leisure-time activities.

Accordingly, it is essential that balance exercises be incorporated into the physical activity programs of older adults.

Aims

Balance training programs aim to:

• Strengthen balance control in everyday activities leading to improved fall-related self-efficacy, reduced fear of falling and increased walking speed
• Improve 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 e.g

• Older adults
• Neuromuscular conditions (multiple sclerosis, parkinsonism, stroke),
• 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).

Preferably, older adults and those at risk of falls should do balance training 3 or more days a week and do standardized exercises from a program demonstrated to reduce falls.

It’s not known whether different combinations of type, amount, or frequency of activity can reduce falls to a greater degree.

Tai chi exercises also may help prevent falls. Balance, strength and flexibility exercises can be combined.

Exercises and Implementation

A client must have a balance assessment prior to commencing a balance program.  

• With now an emphasis in therapy towards evidenced-based practice to demonstrate the effectiveness of certain intervention special balance tests have evolved. Many exist (see outcome measures below), choose appropriately. These tests are used to assess patient’s abilities pre and post interventions.

Based on the literature

• Older adults be exposed to a program that includes flexibility and balance exercises for 2–3 sessions each week, for periods of at least 8 weeks, as a tool for quality of life improvement.
• 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

The program 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, weight on one leg and raising the other leg to the side or behind.
• Putting heel right in front of your toe ie tandem stance
• Standing up and sitting down from a chair without using hands
• Walking while alternating knee lifts with each step
• Doing tai chi or yoga. Tai chi is a time-honored martial art that involves slow, rhythmic movements, including rotation of the trunk, shifting weight, coordination, and a gradual progression to narrowing the lower extremity stance. It has gained recognition as a good exercise choice for the elderly. Studies have shown tai chi improves postural stability more so than other exercises. It also offers multiple musculoskeletal and cardiopulmonary benefits.
• Using equipment, like a Bosu, (or other balance board) which has an inflatable dome on top of a circular platform, which challenges balance
• The Otago Exercise Program
• Perturbation-based balance training (an intervention involving 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 sub-acute phase.

Over time, you can make these exercises harder by:

• Holding the position for a longer amount of time
• Walking tandem stance with support then without (see Otago)
• Closing eyes
• Letting go of chair or other support

Outcome Measures

Many exists some are listed below

• 4 Stage Balance Test
• Berg Balance Scale to evaluate static and dynamic balance, the
• Falls risk assessment tool
• Timed Up and Go Test to assess a patient's mobility
• The Balance Outcome Measure for Elder Rehabilitation
• Functional Reach