Life in the Balance
Wouldn't it be great if we knew when we -- or our parents, or grandparents - were more likely to fall to the ground so we could take steps to prevent these falls before they forever change our lives -- or worse, end them?
Researchers like David Koceja, a professor in Indiana University Bloomington's School of Health, Physical Education and Recreation (HPER), and David Pisoni, professor in IUB's Department of Psychological and Brain Sciences, are hot on the trail of discovering a way to predict when older people are more likely to fall. Residents of Bloomington's Meadowood retirement community are willing subjects of Koceja's research -- getting shocked, prodded and stronger as they contribute to science and improve their balance in eight short weeks.
"I thought I had pretty good balance, and now I know I need to work on some things," said Jack Jones, 96, after he sashayed through and over an obstacle course set up in HPER gym 163 on a recent Saturday.
Jones said he has always golfed and been active. Around two months ago, however, a dear friend died as a result of blood clots that developed after he fell. Jones had heard good things about the spring balance training class that was part of this same research project. He decided to check it out.
"It's been really wonderful," Jones said. "I think about the principles throughout the day, concentrating on keeping my center of gravity vertical, not forward. I've noticed a difference in just four weeks."
Koceja has spent his academic career studying the body's central nervous system as it relates to balance and aging. As we age, he says, our muscles and nerves change and adapt. The central nervous system can change very quickly, he says, for better or for worse.
"You spend 30 years doing very little, you lose a lot," Koceja says. "In three weeks of training, you can gain a lot. There's a remarkable adaptability of the system."
Not your typical group exercise class
The Meadowood residents in Tammy Nichols' balance training class wear khaki pants, button-down shirts, pretty blouses, sandals and dress shoes (few sneakers) -- dressed more for lunch than a workout. They face her, doing many of their exercises seated in folding chairs.
"Now, stand up without using hands," she says, demonstrating for the class, and then the class moves through a series of strengthening exercises using resistance bands fastened to their ankles.
Nichols, a graduate student in the Department of Kinesiology, created a similar and popular balance training class at the Monroe County YMCA. A handful of college students helped with the Saturday class at HPER. The additional help is critical in classes such as this because of the real risk for falls as participants strengthen and train their muscles to help prevent future falls. At one point, for example, participants stood on foam cushions and closed their eyes. Some people visibly swayed as students stood behind them with raised hands, ready to offer support if necessary.
"I have a great respect for balance ever since I had vertigo this time last year," said Norma Beversdorf, who was taking the balance training class for the second time. "At first, I wouldn't even try to use the stairs. Now, I use them whenever I want."
Beversdorf has always been active, as well, performing a form of "quasi yoga" and using an exercise bike. She likes the functional aspect of balance training classes because they put a magnifying glass to how her body moves throughout the day, helping her tweak and strengthen where necessary.
"This is a better focus on daily movement," she said, after her turn through the obstacle course, which had classmates stepping over obstacles, weaving around them, reaching for objects and climbing steps.
Mind over matter
Falls that involves a broken bone can be devastating for an older person -- not to mention deadly -- because they often result in a dramatic decline in mobility, health, independence and quality of life as the person changes her lifestyle to avoid more falls.
Creating some sort of balance screening, similar to blood pressure and other health screenings, is gaining urgency as the population ages. Fatal falls involving men have increased by 32 percent in 10 years, Koceja said, with women seeing a similar increase.
Koceja's research has focused on how the sensory fibers and motor fibers in muscles communicate -- how the body lets muscles know they need to restore balance during a fall. If he can isolate the synapse responsible for producing the muscle reaction that is necessary after a fall, this could potentially improve balance and perhaps lead to pharmacological solutions.
Some of his recent research with his HPER colleagues has examined exercises people can do at home to improve their balance (see: http://newsinfo.iu.edu/news/page/normal/2817.html). They also use "wobble boards" to help people retrain their nerves and muscles, with the aid of electrical stimulation, to improve their balance.
While Koceja and his colleagues continue to make headway in understanding the neural mechanisms (how we know we're falling), he is particularly excited by a new element of their balance research -- examining how cognitive ability affects balance. They have found that a psychological inventory that probes such things as planning strategies and short-term memory is surprisingly effective in predicting balance ability. Coupled with a procedure developed by Koceja that uses electricity to stimulate a particular nerve to measure the body's reflexes, these measurements show promise in providing an accurate balance screening that could become part of a person's regular medical check ups.
"It's embarrassing to think we didn't think of this years ago," Koceja said. "I was always interested in the physical angle, the muscle strength, but there's a whole cognitive element, and we are now just beginning to understand the interaction between the cognitive and the physical."
If his research bears out the reliability of these tests, Koceja foresees a time when balance training can be tailored to the individual test scores. People who score high on the psychological tests but poorly on the neural tests could benefit from one particular type of training, for example, while people who score well on the neural aspect but poorly on the psychological tests would use different training.
The American College of Sports Medicine and the American Heart Association issued new exercise guidelines this summer encouraging people older than 65 to consider balance training to help prevent falls. Koceja suspects balance centers will someday be as common as strength training facilities.
How is your balance?
Balance is a complicated puzzle involving a variety of physiological "systems," such as vision, inner ear fluid, touch and reflexes. Age has little to do with predicting balance abilities because things such as medications, medical conditions such as diabetes, and cognitive abilities influence balance, as well.
Here are some signs that your balance might need some attention:
- You have difficulty walking and carrying on a conversation
- You avoid or lack confidence doing activities you previously enjoyed, such as walking the dog
- You have to devote a considerable amount of attention when performing simple movements
- You take four or more medications
- You notice that you sway considerably when you walk
Nichols likes to use a balance test called the Fullerton Advanced Balance Scale, which she says can be administered in roughly 10 minutes by personal trainers and other fitness experts. The scale examines various ranges of motion and offers training tips to improve weaknesses.