Fall Prevention: Balance & Functional Training - How To Do It
- Daniela Radoman
- 2 days ago
- 9 min read
Falls are one of the leading causes of injury, hospitalization, and even death among older adults.1 In fact, 1 in 3 adults aged 65 and older will experience a fall at least once per year.
A fall in older adults can often mark the beginning of a decline in health, mobility, and independence. For those living with osteoporosis or osteopenia, where the bones are weakened and makes them more susceptible to fractures and breaking, a fall can have especially devastating consequences.
Yet, many falls are preventable - with the right approach.
The good news? Among the most effective strategies for reducing fall risk is regular, structured exercise. Focusing on strength, balance, coordination, reaction time, mobility, and functional movements all play a key role in helping people stay on their feet - literally.
The 9 Best Practice Recommendations for Fall Prevention2:
Exercise programs for fall prevention should provide a challenge to balance, while safely progressing to more and more difficult variations.
At least 3 hours of exercise should be done each week.
Consistent, ongoing exercise is necessary, or else the benefits can be lost
Fall prevention exercises should be directed to the general public and to those who are at high risk of falls.
Fall prevention exercise can be done at home or in a group based setting.
Walking training can be included in balance training, but those at high risk should not be prescribed brisk walking.
Strength training may be included in addition to balance exercises.
Exercise providers should refer out for other risk factors to be addressed.
Exercise as a single intervention may prevent falls in people with Parkinson’s Disease or cognitive impairment. There is currently no evidence that exercise as a single intervention prevents falls in stroke survivors or people recently discharged from the hospital. Exercise should be delivered to these groups by providers with particular expertise.
Which Types of Balance and Functional Training are most effective at reducing falls?
Anticipatory Control & Dynamic Stability: Movements that train the body’s ability to prepare for voluntary movement or external stimuli by activating muscles and adjusting posture in advance of the event. Dynamic stability refers to the body's ability to maintain equilibrium during movement, particularly in the face of unexpected changes or perturbations by keeping the centre of mass within the base of support.
This includes gait retraining, walking on toes or heels, toe taps on a step, agility ladder drills, Clock Yourself app exercises
Reactive Control: Similar to above, reactive control refers to the automatic, rapid adjustments the body makes after unexpected shifts in balance or external forces to prevent a fall or to maintain stability.
Moving and balancing while standing on an unstable surface, catching and throwing a ball, external push/pull on part of the body while doing an activity.
Functional Stability Limits: The ability to voluntarily shift your weight within your base of support before needing to take a compensatory step.
Reaching or weight shifting in all directions standing or on one foot, one or two legged hinge/Romanian deadlift.
Functional Training: Resistance training or other training targeting goals or impairments.
This can look more like your traditional gym routine including squats, deadlifts, pushups, band pull aparts, calf raises, and posture training.
Balance Training
Balance is particularly critical when looking to prevent a fall. Impaired balance, which often declines as we age, increases the risk of falls and often without warning.
You can get creative with balance training. From balancing on one foot to swaying side to side. Here are some progression ideas you can use when looking to make your balance training a little more challenging.
From using more support to less support
E.g. holding onto a chair to not holding onto anything
From a wide base of support to a narrow base of support
E.g. Double leg to tandem (one foot directly in front of the other) or single leg
From stable to unstable surfaces
E.g. from standing on a flat floor to a foam pad/pillow/soft mat
Introduce less sensory feedback
E.g. Eyes open to eye(s) closed
Introduce unexpected aspects
E.g. perturbations or managing multiple tasks at once
Introduce dynamic or functional aspects
E.g. Carrying objects, responding to signals or tasks, different directions or diagonals for balance tasks.
Postural Training
Posture is a key piece to the puzzle when it comes to maintaining balance and preventing a fall. Changes in posture that are common as we age, such as a forward head posture, or a rounded back and shoulders, can shift the body’s centre of gravity more forward which can make it harder to stay upright and recover from a stumble. Poor posture can also put additional strain on the bones in the upper back, which compounds the risk of a cervical vertebrae fracture in those with osteoporosis.
The goals of posture training: Increase the endurance in the back extensor and abdominal muscles, and increase shoulder stabilization.
Examples of back extensor and abdominal exercises include a supine head press into the floor, prone head lift, supine toe taps.
When it comes to endurance, you want to try to build up to being able to perform a higher number of reps and sets, and/or longer holds.
This can look like starting out at 5 reps, then progressing to 8, or holding a position for 10s, then building up to 15s.
For shoulder stabilizations, we want to work on strengthening the muscles all around the shoulder, which can include back muscles, chest muscles, and even neck and arm muscles.
This can include banded or weights presses, pushes, and pulls as part of a strength program. It can also include exercises that work on increasing the range of motion around the joint as well.
There are some considerations to keep in mind when you start implementing exercise into your routine if you have some of the posture traits noted above (forward head posture, rounding of the back and shoulders). Note that sometimes it’s best to get a more detailed assessment and/or exercise program from someone who is specialized and has clinical experience in this realm. Take a look at some of the considerations below.
Hyperkyphosis, which is extra forward curvature in the spine
Some hyperkyphosis is fixed, meaning that it may be due to a condition or a previous fracture and that there isn’t much that can be done to change it. Other forms of hyperkyphosis are flexible, meaning they can be changed and are sometimes due to muscle imbalances, for example. It’s important to know whether it is fixed or flexible in order to determine if an exercise intervention can make a difference and to also manage expectations.
Screen for fractures. Cervical spine fractures may be present or someone may be at a higher risk of a cervical fracture with this posture presentation. Acute management is best addressed under clinical supervision.
Adapt positions for exercise as needed! Can’t lie down comfortably on your back without your neck or head being angled funny? Try adding a pillow for some additional support. The forward posture already shifts your weight forward? Try avoiding keeping weights in front of you and instead practice holding them to your sides or use other modalities instead of weights to introduce resistance.
Shoulder rounding, which is often shoulder internal rotation
Either avoid or modify overhead arm positions. This can look like using arm lengtheners, prone extensions, or using a landmine instead of dumbbells for pressing motions.
Prone positions (lying on your stomach) with overhead arm movements may be difficult or uncomfortable. Instead, modify and try these exercises on your back or standing.
Forward head posture
It may be helpful to determine if this is due to, or related to, other imbalances or conditions (hyperkyphosis or muscular imbalances).
Targeting the cervical portions of the erector spinae/deep back extensor muscles may be helpful.
Strength Training
Just as important is strength training. Stronger muscles, especially in the big muscle groups like the legs, hips, and core, can make everyday tasks like walking, going up and down the stairs, carrying groceries in, and even catching yourself from a stumble much, much easier.
Strength training helps strengthen muscles, helps grow or maintain muscle mass, stabilises joints, improves reaction time, and can help improve balance and posture as well. For those with osteoporosis, it can also help slow bone loss, and even help maintain or possibly even improve bone density.
As a side note, the posture training from above can also fall under strength training.
We have multiple blog posts already on factors to consider when strength training You can check them out HERE, HERE, and HERE!
We’ll still do a little re-hash on these principles below.
Exercise Selection
You want to include exercises that target the major muscle groups. This would include:
Push: Chest, shoulders, arms
Pull: Back and arms
Squat: Legs (quads) and hips
Hinge: Legs (hamstrings), hips and lower back
Press or Reach: Shoulders and arms
Carry: Whole body including core (abdominals, back extensors), forearms
Here are some example exercises from each of these movement categories at different difficulty levels.
Movement | Beginner | Intermediate | Advanced |
Push | Wall Push Up | Counter Push Up | Push Up off the Floor |
Pull | Resistance Band Row | DB Row, Cable Row | Pull Up, Chin Up, TRX Row |
Squat | Sit-to-Stand from Chair | Body Weight Squat | Goblet Squat, Barbell Back Squat |
Hinge | Bridge | Banded/Weighted Hip Hinge | Barbell Deadlift, Hip Thrust |
Press/Reach | Overhead Reach | Resistance Band Overhead Press | DB Incline Press, DB/OH Shoulder Press, Pike Push Ups |
Carry | Farmer’s Carry | Suitcase Carry | Bottom’s Up Carry |
When it comes to the amount of weight you should be lifting, there really isn’t a set guideline on exactly how much that should be. It’s relative to you.
To figure out a baseline, it may take some trial and error experimenting with different weights or modalities.
You want to aim to be able to do 10 repetitions of an exercise before your form starts to degrade. 10 reps is about 80% of a 1 rep max, or the max amount of weight you can lift for only 1 rep. Why do I mention this? Take a look at dot jot numero uno in the guidelines below.
General Strength Training Guidelines
Lifting 60% of your 1 rep max is the minimum load necessary for muscle adaptation in untrained individuals.
This is equal to being able to do about 15 reps before form starts to deteriorate.
There are greater strength effects with lifts at 80% of 1 rep max.
Sets: Complete at least 1 set of each exercise, but more sets (2-4) may be better. Look to progress to more sets down the road.
Reps: This will depend on your desired intensity, but aiming for anywhere between 6-12 reps with good form and effort is a good target.
Frequency: 2-3 exercise sessions a week with at least 24-48 hours rest between sessions of the same muscle group.
Duration: You want to aim to stay consistent on a training program for at least 12-16 weeks in order to reap the benefits.
Progression: Choose really any variable to increase the difficulty! This can look like increasing the weight used, the reps completed, adding an additional set, or doing multiple exercises for the same muscle group.
As a good rule of thumb, if doing 12-15 reps can be done easily and/or you finish a set and it feels like you could do 3+ reps still, then consider increasing the load by 2-10%, or 2.5-10lbs depending on the exercise and muscle groups being targeted.
Power Training
Power is another aspect of our physical health that decreases as we age. It’s an often overlooked aspect in training as well!
Power training is actually very important in our everyday lives. From getting out of a chair quickly, crossing the street before the light changes, and climbing up a set of stairs.
As a good rule of thumb, if you can complete 2 sets of an exercise at a normal pace with good form and no pain, then power training can be incorporated.
As a start, you can do the same exercises that you’re already doing, but just try to make the lifting portion of the exercise faster! For example, if you’re doing a squat, try to stand back up as fast as you can (1-2 count), then go at a normal, slower pace on the way down (3 count).
There has been some evidence to suggest that power/impact training can have benefits on bone mineral density, but more research is needed at this point.
If you have moderate to high risk osteoporosis, arthritis, balance impairment, you want to make sure you progress carefully and safely. This can look like starting with lower impact exercises, having some support, and incorporating more power without impact or landing.
An example progression is given below.
Beginner | Intermediate | Advanced |
| Jump, low drop jump (soft landing) to jump squats, side hops, bunny hops, skipping | Higher drop jumps (soft knees), depth jump |
Conclusion
Working with a professional can be a vital aspect in increasing your strength and improving your balance to help prevent falls - especially if you have other conditions such as osteoporosis!
Having a consistent and progressive strength training program that also incorporates balance, posture, and even power training, can make a huge difference in your level of functioning and everyday life.
If you don’t know where to start, or are having trouble staying consistent, get in touch with us today.
Our goal at Delta Kinesiology is to help women reach their health and fitness goals regardless of age, ability, or experience level. We tailor each session using evidence-based principles and methods to help you reach your goals. Whether that be going about your day pain-free, building muscle, improving stamina, or feeling better about yourself, we are here to help.
Get in touch with us today to schedule a free consult by clicking the link below.
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References
Alamgir, H., Muazzam, S., & Nasrullah, M. (2012). Unintentional falls mortality among elderly in the United States: time for action. Injury, 43(12), 2065–2071. https://doi.org/10.1016/j.injury.2011.12.001
Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., Cumming, R. G., Herbert, R. D., Close, J. C. T., & Lord, S. R. (2017). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British journal of sports medicine, 51(24), 1750–1758. https://doi.org/10.1136/bjsports-2016-096547
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