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Fitness Strategies to Minimize Fall Risk


Hey Hey readers! Welcome! Many of you know this, but for anyone who does not, I am also a speech therapist. I currently work in assisted living facilities, providing respiratory, postural, language, speech, cognitive, and swallowing therapy for older adults with a myriad of diseases, pathologies, and issues. In my years of working with older adults, I have come to learn that falls are sadly very common in this population, often resulting in significant injuries, such as broken legs, hips, or even head injuries. Falling is a very big issue for older adults, and falls can lead to some pretty devastating physical, emotional, and mental consequences. However, there are some solid evidence-based fitness strategies that you can begin to incorporate NOW into your movement diet in order to prevent, or minimize, the risk of falling. Thus, in this month's blog post, I go over some statistics, risk factors, and consequences of falling, as well as some legit tips and tricks to help reduce the chances of falling. While this post may seem like it is geared more towards the older population, this information is actually relevant and important for individuals of any age. Implementing these strategies now, regardless of your age, will help set you up for more success in your daily activities as you move through life, reducing the chances of falling and all the consequences therein.


Statistics of Falls in Older Adults

Falls are one of the leading causes of injury in adults over 65 years of age. It is estimated that 1 in 3 community-dwelling adults over 65 years of age will have fallen at least once per year. Yikes! Read that again. That means over 30% of older adults living outside of assisted living facilities, hospitals, or rehabilitation centers will fall at a minimum of one time per year. And, what is more worrisome is that the greatest risk factor of suffering a fall-related injury is having a history of previous falls. That means if you fall once, you are more likely to fall again AND injure yourself.


There is also an economic impact from falling. The CDC estimated that in 2015 the direct medical costs for falls in older adults (i.e. those over 65 years of age) equates to nearly $650 billion for fatal injuries, and $32 billion for nonfatal injuries. Thus, falls are not only common, but they result in some pretty hefty medical expenses.


Risk Factors for Falling

The most common factors that put one at a higher risk for falling include:

  • History of falls - if you fall once, you are more likely to fall again, and again

  • Balance deficits - difficulty balancing makes it hard to re-right yourself with gravity or to maintain your own center of gravity while stationary or in motion

  • Diabetes - to be honest, I am not entirely sure why diabetes puts one at a higher risk for falling, but I did see this documented in the literature as a risk factor for falling

  • Taking greater than 4 medications - the increased fall risk is likely due side effects, and/or interactions from the medicines

  • Taking a benzodiazepine - this is a category of medicines commonly known as tranquilizers, such as Valium; the tranquilizing effect of these meds makes it harder for your mind to be alert and focused on your body and environment

  • Gait deficit (i.e. difficulty walking) - this is pretty self-explanatory; if you have trouble with walking for whatever reason (e.g. post-surgery or injury), it increases your chance of falling

  • Muscle weakness - this is also pretty self-explanatory; if your muscles are weak, they simply won't be able to generate enough force to withstand the various loads and movements required to do daily tasks, increasing your chance for falling

  • Visual impairment - if you don't see as well, you will be less likely to see obstacles or hazards in your environment; also, FYI - it appears that bifocals might actually increase your risk for falling

  • Orthostatic hypotension - aka low blood pressure (BP) when moving from sitting to standing; if your BP drops too much too fast, it can cause fainting, weakness, or dizziness, increasing your risk of falling

  • Arthritis - inflammation in the joints negatively impacts your body's sense and range of motion at the joints, resulting in faulty movement and increased risk of falling

  • Cognitive impairment - if you have issues with attention, memory, or executive functioning skills, you are definitely at higher risk for falling since your mind and cognitive control of the body are altered

If any of the above-mentioned risk factors apply to you, I would definitely recommend you begin engaging in a fall prevention training program with the help of a certified personal trainer, physical therapist, or senior fitness specialist. Trust me, falling is very very common as we get older, and the consequences of falling are vast and significant. Continue to reading on to learn more about some of negative effects from falling.


Consequences of Falling

Oh, boy, where to start?! The effects from falling are numerous, especially if an injury is sustained. The following list shows the common injuries, conditions, and consequences from falling:


Injuries. Falling often results in some type of injury, with the most common being broken bones (legs, arms, ribs), soft tissue tears, joint injuries, and head injuries. Also, a history of falling significantly increases one's chance of sustaining an injury from a subsequent fall. Many of these injuries require surgery, immobilization, restrictions on weight-bearing status, and/or rehabilitative therapy (physical, occupational, speech therapy). This can all add up to some hefty medical bills.


Deconditioning. This refers to generalized muscle weakness that can be the result of immobilization or lack of movement after an injury. Your body gets weaker and fatigues faster with simple tasks.


Pain. An injury can of course cause pain in and of itself, but sometimes a fall can also impact peripheral nerve function, changing pain signaling and perception.


Altered balance. The inability to maintain balance after a fall-related injury is pretty common because the proprioception of the injured joint and tissues is negatively impacted. Proprioception is like your body's GPS, telling your brain where your body is in space. When proprioception is altered, balance ability suffers since your brain is not getting an accurate picture of where, and how, your body is moving through space. This puts you at a higher risk for repeated falls. Indeed, one of the largest risk factors for falling is having a history of falls.


Systemic diseases and infections. If an injury is sustained after fall, a person will likely spend a period of time being immobile, which can lead to circulatory and/or respiratory issues. Circulation problems can cause additional issues, and respiratory problems could cause pneumonia. If a head injury occurs from a fall, then there could be additional cognitive or motor control issues.


Psychological consequences. One of the largest psychological effects from falling is developing a Fear of Falling (FoF). This FoF leads to altered movement and neuromuscular control, putting you at a higher risk for repeated falling. Plus, FoF can be debilitating in the sense that it might make you less willing to move and engage in physical activity, further worsening your physical function and increasing your risk for falling even more. Another psychological consequence of falling is kinesiophobia, which is a fear of movement. This is especially true if an injury is sustained. Kinesiophobia can result in a lack of movement, which again, further weakens the body, putting you at a higher risk for falling again. Other psychological consequences include depression, anxiety, and social isolation, all of which can result from a fall-related injury itself or from the effects of FoF and/or kinesiophobia.



Ways to Prevent Falling

So, how can one minimize their risk of falling? Well, there are seven general areas that you should include into your regular movement diet in order to set your body up for success in your daily activities - cardiorespiratory training, resistance training, core training, balance training, plyometric training, speed/agility/quickness training, and training of basic movement patterns. The specific variables for each of these training regimens (e.g. sets, reps, rest periods, exercise selections, etc.) will vary based on your current physical capabilities and wellness goals. Please refer to a certified personal trainer for specific information for YOUR body. Read on below to find out more about each one of these training programs! Please note, though, that I'm only giving a brief summary for each of these areas. For more detailed information, feel free to search up any of these forms of training on the internet or send me an email, and I can point you in the direction of some resources.


Cardiorespiratory training. Aka, aerobic exercise or "cardio" - this type of training helps strengthen the heart and respiratory system, which can better support all types of movement. It's recommended to get 150 minutes per week of moderate intensity exercise, but this number can definitely be worked up to, if needed. Walking, treadmills, bikes, hiking, etc are some ways in which to train the cardiorespiratory system. Cardio exercise helps reduce the risk of falling since the heart, blood, and lungs can better support the working muscles (e.g. supplying oxygen to working tissues, removing waste from working cells, etc.). The muscular system doesn't fatigue as easy or quickly if you train the heart and lungs regularly. Thus, you are less likely to fall since your heart/lungs can better support your daily movements.



Resistance training. Performing movements in which the body is challenged mechanically by different types of loads or resistance keeps muscles and surrounding connective tissues strong, resilient, and stable. Resistance training, aka strength training or weightlifting, also challenges the skeletal system by imposing different loads for the bone tissue to deal with. There are also a lot of metabolic benefits from lifting and moving weighted objects. For more information on the benefits of strength training, check out my earlier blog post on this very topic (click here). Resistance workouts also help combat age-related muscle loss, known as sarcopenia. Sarcopenia simply refers to a loss of muscle mass, and this becomes more prevalent the older we get. It is recommended for adults to get 2-3 (or more, if appropriate) resistance training sessions in per week to maintain and enhance the muscular system's strength. Strength training significantly reduces the chances of falling since your muscles are better able to generate force to overcome the loads of daily life. Dumbbells, kettlebells, barbells, tubing, resistance/therabands, and even your own body weight can be a form of resistance.




Core training. Core training involves strengthening, stabilizing, and enhancing the mobility of the deeper (so-called "local core musculature") and the more superficial (so-called "global core musculature"). The deeper core muscles (tranverse abdominis, multifidus, diaphgram, rotatores, quadratus lemborum, pelvic floor) are generally more involved with stabilizing the spine, hips, and shoulders, limiting unwanted, unsafe, or unstable movements. These muscles are incredibly important for keeping your body upright, but they are also largely responsible for transferring forces between the lower and the upper body. Core training exercises for the deeper core muscles can include things like plank, dead bug extensions, and bird dog. The more superficial muscles of the core (rectus abdominis, obliques, hip flexors, glute max, erector spinae) are generally more involved with bigger movements and ranges of motion in the trunk, such as rotational and bending movements (think "6 moves of the spine" - for more details on this, click here to read an earlier blog of mine on this). Core training exercises for the superficial core include things like an abdominal crunch, loaded rotations (i.e. rotational movements with a weighted object, like a cable, resistance band, or medicine ball), loaded lifts, loaded chops, and back extensions.



Balance training. Balance training improves one's ability to maintain their center of gravity within a base of support while stationary or in motion. Balance training includes things like single-leg standing poses that may or may not involve movement of the stance leg - for example, tree pose in yoga or a single-leg squat. Training for balance also helps exercise the visual, vestibular (i.e. inner ear balance system), and somatosensory (i.e. bodily sensations) systems, improving function therein. Completing balance training exercises can reduce the risk of falling quite a lot. Challenging your body's limits of stability, and practicing the neuromuscular movements needed when there is a perturbation to adjust joint position, makes it more likely that you would not fall in the first place, but, if you did accidentally trip or stumble, your neuromuscular system will know how, when, and which muscles to activate to keep you from falling. I would argue that this form of training might be the most important for preventing falls, but that is just my personal opinion.




Plyometric training. I really like plyometric training. Plyometric training, aka plyo or reactive training, uses exercises that require explosive movements, like bounding, jumping, or forceful upper body movements. Please note, though, that this form of training is a little more advanced for the neuromuscular system, so definitely consult your doctor or a personal trainer before trying plyometric exercises to be sure it is safe for your body. Plyometrics train the body how to efficiently react, respond, and move to stimuli in the external environment, and it is really helpful in reducing fall risk. Example plyometric exercises include things like squat jumps and medicine ball passes and throws.


Speed/agility/quickness training. aka "SAQ" training - it is similar to plyometric training in that it improves reaction speed, response time, and efficiency of the neuromuscular system to better activate the right muscles, at the right time, in the right sequence, with appropriate force. Combine all that together and you get another form of training that is highly protective against falling. SAQs usually involve agility ladders or cones. I also really like SAQ drills. They are really fun and have a element of playfulness to them. SAQ drills are also really good for your cardiorespiratory system, so these exercises can sometimes substitute for more traditional versions of aerobic exercise.


Training of basic movement patterns. Another fabulous strategy for minimizing fall risk and maintaining quality of life and enjoyment in your own body is to train foundational movement patterns. These foundational patterns underlie all the movement in our body and include - squatting, hip hinging, pulling motions, pushing motions, vertical pressing motions, and lunging/split-stance motions. Training these foundational patterns through targeted exercise reduces your fall risk because the body is better able to execute the right motor plan for these movements in daily tasks. But training these patterns doesn't only reduce fall risk, it also makes movement more efficient and enjoyable in your body. Again, I would definitely recommend you consult with a certified personal trainer about how to incorporate training for these foundational motor patterns.




Summary

Phew! That was a lot of information. Thank you for sticking with me until the end. As this post explains, falling becomes much more commonplace the older we get, and these falls often result in some pretty debilitating injuries and symptoms. There are a variety of risk factors that can increase one's chance of sustaining a fall, including muscle weakness, balance issues, history of a previous fall, certain medications, and more. The consequences from falling include psychological issues, such as an increased fear of falling or fear of movement, and also deconditioning in immobilized or unused muscles, pain, balance issues, and systemic diseases/infections. There are, however, many fitness and wellness training strategies that can significantly reduce one's risk of falling and suffering the consequences therein. These exercise training schemes include - cardiorespiratory exercise, resistance training, balance training, plyometric training, SAQ training, core training, and training fundamental movement patterns. Using an integrated approach where all of the aforementioned exercises are included in some combination in your movement diet will offer you the greatest protection against falling. If you are brand new to exercise, that's okay! The data suggests that it is never too late to begin, and real changes can be made with consistent, integrated training. This might seem like a lot of work to do, but the alternative is to fall and potentially break bones, tear soft tissues, and/or injure your head. Not only will these training plans reduce your risk of falling, but you will feel better in your body everyday by doing these exercises. You will sleep better, have more energy, and simply feel more at ease in your body. I would definitely consider working with a personal trainer or a personal training/strength training gym to help you create a plan specific for your body. Feel free to email me if you are interested in my personal training, corrective exercise, or private yoga services. I would be honored to work with you.


As always, the information presented in this blog post is derived from my own study of human movement and yoga. If you have questions about minimizing fall risk for your body, please follow up with your physician, physical therapist, personal trainer, or yoga teacher. If you are interested in private yoga and/or personal training sessions with me, Jackie, email me at info@lotusyogisbyjackie.com for more information about my services. Also, please subscribe to my website so you can receive my monthly newsletters (scroll to the bottom of the page where you can submit your email address). This will help keep you "in-the-know" about my latest blog releases and other helpful yoga and wellness information. Thanks for reading!

~Namaste, Jackie Allen, M.S., M.Ed., CCC-SLP, RYT-200, RCYT, NASM-CPT, NASM-CES, NASM-SFC

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