Andrews, MA, CSCS · 2019. 5. 7. · Always have support available. 3) Level Changes Sit to Stand...

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Walking Tall:Vertical Fall Prevention Drills

Guy Andrews, MA, CSCS• Master’s Degree, Education

• 35 year fitness industry veteran

• Certified Strength & Conditioning Specialist (NSCA), Performance Enhancement Specialist (NASM), Certified Personal Traner (ACE)

• Senior Fitness Specialist, City of Wilton Manors, FL

Balance, Falls & FracturesIn 2017, >27,000 seniors died as a result of a fallSource: CDC, 2018

• 95% of hip fractures are caused by falls

• Other common injuries after a fall:• Concussion• Rotator cuff / labrum tear• Wrist fracture• Low back fracture• Coccyx bruise/fracture• Hip labrum tear• Ankle sprain


Remaining Life Expectancy at Age 65, 2017Source: CDC, 2018

2017

Male 18.0

Female 20.5

For the first time in decades American life expectancy is declining. This is mainly due to obesity and related diseases: heart disease, cancer, stroke, etc.

Fall Risk & Longevity

• Thirty to 60 percent of community‐dwelling elderly individuals fall each year, with many experiencing multiple falls per year.

•Because falls are the leading cause of injury‐related deaths in older adults and a significant cause of disability in this population, prevention of falls and subsequent injuries is a worthwhile endeavor.•National Safety Council, 2014

Risk Factors for Falls

• Taking foolish risks•Unsafe home environment

•Poor lighting• Failing eyesight• Inappropriate shoes•Alcohol abuse•Dehydration•Medication


Common Medications That Impair Balance AARP, 2017

• Antidepressants• Anti‐anxiety drugs• Antihistamines prescribed to relieve allergy symptoms

• Blood pressure and other heart medications

• Narcotic pain relievers• Sleep aids (Prescription & OTC)

Alcohol Consumption & Fall Risk• As we age, our tolerance for alcohol decreases.

• Alcohol slows down basic motor skills, reaction times and overall stability, increasing fall risk dramatically.

• Stability for older adults declined rapidly when Blood Alcohol Content (BAC) surpassed 0.06%. Alcohol leaves the system at a rate of 0.01% every 40 minutes.

• Department of Clinical Studies, Lund University, 2018

• Legal Intoxication = BAC of 0.08%• 100 lbs = 2 drinks in under 1 hour

• 120 lbs = 3 drinks in under 2 hours

• 200 lbs = 4 drinks in under 2 hours

• National Highway Traffic Safety Administration, 2017

Research Review

•Harvard University Health Blog (10‐15)•Balance training seems to prevent falls, injuries in seniors.

• NIH, (10‐18)• A balance training program strengthens self‐efficacy in balance control leading to improved fall‐related self‐efficacy, reduced fear of falling, increased walking speed, and improved physical function.


Balance Training after Joint Replacement?

• Balance training is an often overlooked component of post‐surgical training.

• Adding balance training to the post surgical exercise program reduces fall risk and improves ambulation.

• Gait & Posture, • Volume 62, May 2018

More Research• US Physical Activity Guideline (11‐18)

• As part of their weekly physical activity, older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle strengthening activities.

• Journal of the ACSM (2‐19)•Balance classes resulted in significant reduction in fall risk as well as improved confidence.

•After a cumulative 50 hours of training benefits really began to snowball.

Recommendations for Balance Training:At Least 3 Times/Week; Daily is Better!


How Strong Muscles Prevent Falling

When we lose our balance:

• Toes grip the floor, muscles of the calf decelerate the ankle.

• Strong core muscles stabilize the spine.

• Quadriceps lock and stabilize the knee.

• Glutes and hamstrings decelerate the hip.

• Abductors stabilize pelvis.

.

Sample Fall Prevention Strength Program

GOAL ExerciseStrengthen core Resisted squeezes

Resisted pulls

Strengthen toes Toe scrunches

Strengthen calf muscles Standing heel lifts

Strengthen glutes & hamstrings Deadlifts

Strengthen quads Chair squatsLunges

Assessing Balance: One Leg Stand

• To perform the test, the client stands on one leg without support of the upper extremities or bracing of one leg on the other.

• The number of seconds that the client is able to maintain this position is recorded. Test ends when the foot touches the floor, or the arms touch something for support.

• Always have support nearby for this test.

• Seniors double their chances of falling and sustaining an injury if they are unable to perform a One‐Legged Stance Test for five seconds.

• Multiple balance measures (Tinetti Assessment, Berg Balance Scale and others) have reached the same conclusion.


“Vertical “ Balance Training?• The goal of any balance and fall prevention program should be to get the participant out of their chair and on their feet.

• If independent living and a high level of function are the goals the client must walk, carry things, weight shift, react, respond, slow down and stop, all while staying upright!

Balance Progressions1. Seated

2. Seated on unstable surface

3. Standing

4. Standing on unstable surface

5. Walking

6. Walking on unstable surface

Specific Goals of Vertical Balance Training

1. Maintaining neutral

2. Single leg balance

3. Level changes

4. Weight shifting

5. Walking & carrying drills

6. Reaction time


Please note•Provide support as needed for balance drills:•Wall• Table•Chair•Barre•Any stable object

1) Maintaining Neutral

Try it seated, standing, walking

Maintaining Neutral with Resistance


2) Single Leg Balance DrillsAdd challenges: Stand on an unstable object.

When stable, bat a balloon, play catch, move head up & down or side to side.

Always have support available.

3) Level ChangesSit to Stand Relay

• Participants sit alongside each other & pass the ball to the left or right.

• When they get the ball they stand, hand the ball to their neighbor and sit back down.

• When the ball gets to the end, the last person fast walks it to the end of the line and everyone moves down one spot.

The Wave


Stacking Drills

4) Weight Shifting DrillsBackward Pass Relay

• Participants line up and pass a ball overhead to the person behind them.

• When the ball gets to the back of the line the last person walks to the front and start over again.

• When the participants see the last person walk by they each take a step back.

• Repeat!

• You can also use several balls!

Sit to Stand Relay

• Participants sit alongside each other.

• They pass the ball to the left or right.

• When they get the ball they stand, hand the ball to their neighbor and sit back down.

• When the ball gets to the end, the last person fast walks it to the end of the line and everyone moves down one spot.


Group Level Change Drill:The “Bridge”

• Set‐up:• Participants form two lines making an arch with their hands

• The rest of the group walks or crouches under the arch

• The “bridge” moves backward as people walk forward

5) Walking Drills

• Walk … and Walk Fast

• “The Grim Reaper Study” correlated walking speed to longevity.

• The faster older adults can walk, the lower their mortality rate.

• Goal: Try to walk 4.5 feet per second (3 mph pace)

• This equates to 135 feet in 30 secs.

The Grim Reaper’s maximal walking speed

is just under 3 mph.(British Medical

Journal, December, 2011.)

Multi‐directional Walking Drill

• 2 cones, 10 or 20 feet apart:

• Fast walk A to B

• Pivot and fast walk B to A

• Side shuffle A to B

• Side shuffle B to A

• Repeat


Speed Walk Drills

Lines are 18’ apart. Goal is to cover the 18’ in 4 seconds or less. (3 mph)

Up & Go Deceleration Drill

• From a seated position, participants stand up, walk to a specified end point, pivot and return to seat.

“Sidewalks of New York” Agility Drill


Carrying Drills: Bucket Brigade”

6) Reaction Time:Glider Kicks

Glider Shuffleboard

Court size: Six feet wide at base tapering to a point 126” away from back line.


“Burst the Bubble” Drill

Standing Balloon Taps

Integrated Core Conditioning:Stability Ball Bounce

• Pair people up & have them roll, or bounce the ball to each other.

• Put participants in a circle and have them roll or bounce (but not throw) the ball to each other.

• They can call out a name or roll/bounce the ball randomly.


Stability Ball Rolls

“Beat the Passer” Drill

• 1 person (“the Passer”) stands in the middle of a circle and slowly rotates.

• At random the Passer tosses the ball to someone in the circle.

• The person who catches the ball goes to the center; the Passer joins the circle.

• Can also be done with 2 Passers, back to back!

Noodle Softball


“En Garde!”

Balance Homework for Seniors

Staying Vertical: The BasicsSTAND• Stand each leg for at least 5 seconds

• Do this multiple times per day

• Try not to hold on but have support available

• Inability to stand on each leg for at least 5 seconds is associated with a greater fall risk


Staying Vertical: The BasicsSQUAT

• Sit down and stand up multiple times every day

• Put a dining room chair against a wall for support

• Try to maintain a “crouch” positon for 5‐ 10 seconds

• Squatting is associated with increase in independent living

Staying Vertical: The BasicsWALK

• Walk every day

• Walk fast

• Optimal speed is 3 mph (4.5 feet per second)

• Try for 135 feet in 30 seconds

• Fast walking speed is associated with increased longevity

Andrews, MA, CSCS · 2019. 5. 7. · Always have support available. 3) Level Changes Sit to Stand...

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