Fall Prevention: Strength Training with your Physical Therapist

More than one out of four adults, 65 and older, fall each year.  Falling once doubles your chances of falling again.  One out of five falls causes a serious injury such as a broken bone or head injury.  More than 95% of hip fractures are caused by falling.  One in five hip fracture patients dies within a year of their injury.  Women fall more often than men and are more likely to break a bone.  Over the last 10 years, death from falls has increased by 30% in United States.  It is estimated by 2030, falls will result in one death every seven hours.  Clearly, fall prevention programs are needed.

Falls are associated with extrinsic and intrinsic factors.  The extrinsic causes are related to the home environment such as rugs, stairs, and poor lighting.  The intrinsic causes are related to problems with balance or gait, muscle weakness, poor vision, cognitive deficits, the presence of chronic disease, abnormal blood pressure or medications.  Research shows the most effective interventions for preventing falls are based on balance and strength training.

Fall Prevention: Lower Body Strength Training

Fall prevention exercise programs for older people not only reduce the rates of falls but also prevent injuries resulting from falls when they do occur.  Not only does strength training improve muscle size and strength but it also improves bone density.  Therefore, strength training improves an individual’s protective responses during a fall.  The result is a more resilient older adult who is less likely to sustain a debilitating hip fracture from a fall.

Older adults are advised to perform weight-bearing lower body strength training a minimum of 2 to 3 days per week.  Most research studies show that a minimum duration of 26 weeks is needed to achieve the best results.  Body weight exercises, such as squats, are often performed.  However, research shows better improvements in strength and balance when external resistance, such as weights, is used.  Substantial improvements in strength can be achieved with light, moderate, or heavy loads.  Multiple sets of each exercise produce greater improvements in strength compared to single set routines.  Performing 6 to 12 repetitions per set is a great way to achieve improvements in strength and muscle size.  Perhaps most importantly, all strength training exercises initially focus on proper form and then loads are progressively increased over time.

The most frequent exercise utilized in fall prevention exercise programs is the sit-to-stand exercise.  This exercise involves an activity which older adults perform frequently in their daily lives.  The ability to perform this activity without the assistance of the hands has been linked to fall risk in older adults.  It can be easily performed in the physical therapy clinic, any community exercise studio, or in the home.  The exercise is progressed by lowering the height of the chair or by holding weighted objects such as a medicine ball or kettle bell.  Other lower body exercises commonly prescribed include step-ups, hip, and ankle strengthening exercises.


Fall Prevention: Trunk Muscle Strengthening Exercise

Although an important component of any fall prevention program, performing lower body exercise does not guarantee reduced fall risk.  Improvements in lower body muscular strength may not transfer to improved balance if other factors are at play.  One such factor which can influence fall risk is core or trunk muscle strength.  The trunk muscles are composed of the abdominal, pelvic, hip and low back muscles.   These muscles are responsible for transferring forces from the lower to upper body during whole-body movements such as walking or climbing stairs.   The trunk muscles are highly active during a trip suffered while walking.  These muscles act in order to stabilize the trunk over the feet when loss of balance occurs.  The ability of the trunk muscles to react to unexpected disturbances (i.e., suddenly being thrown off balance) has been shown to be delayed in older adults.  Poor ability to activate the trunk muscles has also been linked to an inability to transfer from a chair to standing unassisted.

Trunk muscle exercise focusing on strength and the appropriate timing of contraction can significantly improve balance in older adults.  Trunk muscle strengthening programs can be individually prescribed and progressed by doctors of physical therapy.  Also, many personal trainers, strength coaches, and Pilates instructors are skilled at instructing older adults in these exercises. Exercise can be performed in various positions such as lying on the back, stomach, side, or in kneeling and standing positions.  Trunk strengthening exercises may also be performed using unstable training devices such as exercise balls or balance pads.  Often, resistance bands, light weights, and medicine balls are incorporated based on the individual’s goals.  The 90/90 leg lower and Pallof press are two examples of trunk strengthening exercises but there are many more.


Closing Thoughts

Research supports the benefits of both lower body and trunk strengthening exercise for reducing falls in older adults.  The importance of the trunk muscles for balance and mobility in older adults has been underestimated and often overlooked.   Fall prevention exercise programs are optimized by including individually prescribed lower body and trunk strengthening exercise.   If you are not sure about how to get started, give your physical therapist a call.

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