Whole-body and energy

Later on: balance is trainable

The WHO recommends that older adults do multicomponent activity emphasising functional balance and strength on three or more days a week, specifically to prevent falls.

What it is

Ageing brings a gradual loss of muscle mass and power, and a decline in balance, unless something is done about it. The loss of power, meaning the ability to produce force quickly, tends to matter more than raw strength for the things that go wrong: catching yourself when you stumble, getting out of a low chair, managing a kerb. The important part is that none of this is fixed. Balance and strength respond to training at every age, and the response is often larger later in life rather than smaller.

How it behaves day to day

Usually noticed as tasks rather than symptoms: getting up from a chair without hands, carrying shopping up stairs, feeling steady in the dark or on uneven ground. Confidence often falls faster than capacity does, and reducing activity because of a near-miss is the most common route to actually becoming less steady.

What tends to feed it

• ·Long periods of sitting, which cost muscle quickly
• ·Avoiding balance-challenging situations after a stumble
• ·A period in hospital or a long illness, after which condition drops fast
• ·Doing only walking, which is good and does not train balance or strength

What the research recommends

The WHO's 2020 guidelines on physical activity and sedentary behaviour are explicit for this group. As part of their weekly activity, older adults should do varied multicomponent physical activity that emphasises functional balance and strength training at moderate or greater intensity, on three or more days a week, to enhance functional capacity and to prevent falls. Moderate-certainty evidence indicates that fall-related injury risk may be reduced with multicomponent activity, meaning combinations of balance, strength, endurance, gait and physical function training. The systematic review by Sherrington and colleagues that informed those guidelines is the underlying evidence on falls prevention. The word multicomponent is the important one: walking alone does not deliver this, because it does not train balance or strength.

Sources

1. 1
   WHO 2020 guidelines on physical activity and sedentary behaviour

   Older adults should do varied multicomponent activity emphasising functional balance and strength training at moderate or greater intensity on three or more days a week, to enhance functional capacity and prevent falls.

2. 2
   Sherrington et al., evidence on physical activity and falls prevention for people aged 65+, systematic review informing the WHO guidelines (IJBNPA 2020)

   Reviews the exercise evidence for falls prevention that underpins the WHO recommendation on multicomponent activity.

Where Vinys is different

• ·Balance work is included as training rather than removed as risk. Taking balance out of a session for an older adult removes the thing the guideline specifically asks for.
• ·The balance work is supported, so there is always something to hold. That is what makes it safe to do genuinely challenging balance work at home rather than only in a class.
• ·Sessions are multicomponent by construction, mixing balance, strength and mobility, which is the exact word the WHO recommendation uses.
• ·Sit-to-stand work is included, because getting out of a chair is both a strength test and the thing people actually want back.
• ·Where yoga meets physiotherapy: standing balance is native to one and prescribed by the other, in a session that lasts fifteen to thirty minutes at home.

A short session to try

1. 1

   Sit to stand · 8 to 10 reps

   The single most functional strength movement there is, and it maps directly onto getting out of a chair.

2. 2

   Tree pose, lift and lower · 5 each side, near a wall

   Functional balance training with support to hand, which is the recommendation delivered safely.

3. 3

   Heel raise · 10 to 12 reps

   Calf strength, which is what recovers a stumble, and it trains ankle stability at the same time.

4. 4

   Bird-Dog · 5 each side

   Trunk and hip control, the steadiness underneath everything else.

5. 5

   Cobra, minimal lift · Hold 3 to 5 seconds, 5 times

   Back strengthening and extension, which supports posture and the spine.

Movements often used for this

Sessions for this lean on the balance, stability / core and transitional families in the library. These are the ones most likely to appear, not a prescription: your own session is built from your answers on the day.

Common questions

Speak to your doctor before starting if you have had a fall recently, get dizzy on standing, have had a fragility fracture, or have a heart or lung condition. Falls with a loss of consciousness need medical assessment.

Also called exercise for seniors, falls prevention, balance for older adults, staying mobile. Movements are drawn from the clinically authored Vinys library, and the guidance above is sourced to the publications listed. This page is general movement information, not medical advice, and it is not a diagnosis. How the method works.

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