Fear of Falling

Yesterday’s New York Times had a story about the far-reaching effects of falling.

The article notes that while young children fall more than any other age group, the consequences are usually just minor cuts and bruises. However, among the elderly, the consequences of a fall can be devastating.

Data shows that about 40 percent of those aged 65 and older fall at least once a year; one in 40 of them ends up in the hospital, after which only half are still alive a year later. Put another way, out of 200 people over the age of 65, 80 of those individuals will fall at least once per year. Out of those 80, 2 of them will be hospitalized, and only one of them will still be alive a year later.

Our family has had personal experiences with the negative impact of falling. My mom fell down the last few steps in her house about 11 years ago. She was 78 years old at the time, but in reasonably good health. However, after that fall she was never quite the same. She has been using a walker since, her energy level has dropped, she isn’t able to get out as much as she used to, and she has had a couple of falls. While her advanced age certainly plays a role, she has a good deal of difficulty completing what is often referred to as ADL, or activities of daily living. To me, much of her decline can be traced to that tumble down the steps several years ago.

In addition to her decreased physical abilities, she has also developed a strong fear of falling. This is not surprising, and in the New York Times article it is noted that such a fear can become a self-fulfilling prophecy. Reducing one’s activity level because of a fear of falling may lead to a loss of muscle tone, balance and bone density, leading to a greater chance of falling.

And then just two weeks ago my Aunt slipped on some ice and ended up breaking her hip. She’s 79 years old and looking at a long recovery.

The New York Times article also brought back  memories of a paper I had written almost 10 years ago on the dangers of falling, the fear of falling, and how to prevent such problems among the elderly. The paper was for a course in the Design of Exercise Programs for Special Populations, with the elderly as one of the special populations.

We were required to develop a sample class for our targeted population, and I thought I would share it here, as a public service message, to get the word out about the importance of balance training for the elderly. I’ve added some updates to what I would do now with such a program, based on a few more years of knowledge and experience. The updates are in bold.

First, a couple of notes to give some clarity to the exercise program described below. The course was part of an Associates Degree program in Health and Fitness Promotion at the local community college. I wrote in the beginning of the paper that my wife and I planned to retire to Hilton Head in a few years, and I was interested in starting a business related to fitness. I came up with what I thought was a clever name for the business: SURFing at the Beach: Stopping Unnecessary Risks of Falling.

Balance Training Program for the Elderly

Warm-up (5 minutes) Given that the beaches in Hilton Head offer the ability ride a bike, class would begin with a slow, gentle ride on incumbent bikes (3-wheeled) down the beach for about ¼ mile, and then a turnaround and return to the starting point. Instructors would ride along with the participants for companionship, safety, and information gathering (how are they feeling that day, observations of their performance, etc.). Riding on the beach should offer a pleasant start to the class.

Resistance training (10 minutes) The resistance part of the program would use exercise bands. Such bands allow for full range of motion while performing the exercises, resistance levels that everyone in the class can accommodate (as well as the ability to increase the level as the participants become stronger), and can be used in any environment. There would be six “workstations” available, which would consist of the following: a beach chair, a tent pole, and a set of exercise bands. The chairs and the poles would all be securely anchored in the sand. There will be approximately 8-10 exercises completed in this phase, with a  primary focus on the core and lower body. The exercises would be performed in one set of 10-15 repetitions. The exercises would be designed so that there is little transition time from one exercise to another. Thus, I would estimate that each exercise would take about 40 seconds, with 20 seconds for transition. (Note: I have never actually used exercise bands, but I have been reading quite extensively on their benefits recently, and they seem ideal, not only in this situation, but for older adults in general. I have asked for a complete set of bands for Christmas, so at that point I can begin to gain some hands on experience and would have a better feel for the specific set of exercises and how hard it will be to transition from one exercise to another. I can’t wait until Christmas morning!) I did get exercise bands for Christmas, and I am a big fan of them, particularly for rehab type work.

Balance exercises (10 minutes). This would consist of a series of exercises performed on an exercise ball. While there is some risk of falling off an exercise ball, I believe that the beach offers some advantages over a typical classroom environment. First, if a participant does fall, the sand offers a relatively soft cushion, particularly when the fall would only be from the height of an exercise ball. In addition, for those who have problem maintaining their balance on the ball, the ball could be anchored somewhat in the sand to prevent from rolling too much in any direction. This should offer some level of comfort for anyone who has a fear of falling off of the ball. For those who are reluctant to use the ball, a modified set of exercises will be designed to be completed using the beach chair. (As with the exercise bands, I have limited experience with an exercise ball, but from I have been reading, they are quite useful for developing a person’s balance and stability. At some point, I do plan to gain some hands-on experience with the use of exercise balls.) I have gotten some experience with using an exercise ball since then, and this suggestion is just crazy! There are much better devices for working on balance without the risk that would accompany a medicine ball. Can you imagine a 70 year old trying to stand on an exercise ball, on the beach??!! Ah, the naivete of the young (I was 48 years old…)

Aerobic/endurance training (15 minutes) This portion of the class will consist of about a 2-mile bike ride on the beach (I could be way off in my estimate of the distance, but I assumed about an 8-minutes per mile pace. The distance is not as relevant as the time. In addition, participants will be able to monitor their improvements each class by how far they travel within the 15 minute time period.) To break up the possible monotony, cones will be placed on the beach at various intervals to give the ride more of a slalom-type feel, as well as help the participants to use their judgment to weave through the cones.

Balance exercises (10 minutes) This set of balance exercises would once again take advantage of the unique environment in which this class is offered. This part of the program would consist of balance exercises performed while standing in the sand (standing on one foot, walking heel-to-heel, etc.) Since the sand offers varying levels of gradation, this would offer the ability to easily modify the level of difficulty of the exercises. As the participants become more adept at the exercises, they could move to where the sand is more uneven (not as tightly packed), and perhaps even to the edge of the water, where the movement of the waves in and out would also add a level of difficulty to the exercises. In addition, some of the exercises could be performed with the eyes closed, to work on the vestibular systems of the participants. I got excited when I saw mention in the New York Times article about doing some balance training with your eyes closed. Also, how impressive-sounding is the word “vestibular”!

Stretching exercise (5 minutes) This portion of the program will consist of some gentle stretches, now that everyone’s muscles and joints are sufficiently warm. The stretches will be done on an exercise mat (provided), standing, and in the beach chair. Once again, the focus will be on the core and lower body, since the overall purpose is to help improve the stability of the participants.

Cool down (5 minutes) Class would end with a slow, gentle ride on incumbent bikes (3-wheeled) down the beach for about ¼ mile, and then a turnaround and return to the starting point. Instructors would ride along with the participants for companionship, safety, and information gathering (how they are feeling after the class, observations of their performance, what they liked and did not like about class, reminders about the next class, etc.). Riding on the beach should offer a pleasant way to end the class.

So there you have it, SURFing at the beach. And for anyone who has read this far, I’ll offer you a free week of SURFing if you sign up for the class. You’re just going to have to wait about eight years to redeem that offer, and instead of Hilton Head, we’re now considering Sarasota, FL. But who knows, the idea could take off and we’ll have locations at beaches up and down the coast.

I’ll just have to weigh my desire for an enjoyable retirement against a desire to provide a useful service to as many people as I can.

As with SURFing at the beach, it will come down to finding the right balance.