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The vital role of balance and strength as we age


Our lives are a remarkable and unique journey for every one of us. As we age, our bodies change and don’t work quite how they used to - depending on what we choose to do with our lives. While some changes are gentle and unobtrusive, others carry substantial implications for our overall wellbeing. As we navigate the path of aging, there is one undeniable truth - maintaining our balance and strength is fundamentally crucial to being able to continue walking, moving, and doing the things that we love to do. In Australia, screening of strength and balance traditionally do not tend to happen until around the age of 60. Consequently, for many individuals, three decades or more may have elapsed before concerns receive due attention. Furthermore, the longer we allow problems to linger unattended, the more formidable they become to manage – increasing our risk of falls and losing confidence in our ability to complete tasks that we used to be able to.


This article will discuss the importance of maintaining balance as we age, the factors that make up balance, signs to keep an eye on, and some basic testing you can do it home to keep yourself informed over time.


There are several factors that work together to help keep us upright.


Balance refers to the body’s ability to maintain its centre of mass over its base of support. In practical terms, when standing, it is your ability not to fall over.


Muscle strength refers to a muscle’s ability to generate force. The stronger our muscles are, the more capability they have to maintain balance and prevent falls. The key muscles we are focused on are the bigger muscles in our legs – think quadriceps, gluteals, and calves.


Muscle power refers to force production from strength, with an additional speed component– so it is our ability to produce force over a short period of time. Studies (1) have shown that power testing can be more predictive of someone’s falls risk, than strength testing. The power component is often overlooked with testing. If we think about it, something like a fall happens very quickly, so reacting fast and with sufficient force to stabilise yourself is essential to preventing a fall – and these are the two factors that make up muscle power.


There are some other factors at play when it comes to balance, such as vision, the inner ear, suitable footwear, skin health, range of motion, and sensation, which are all very important as well.



The importance of maintaining our balance over time can really all be broken down in to two important aspects - quality of life and falls prevention.


Quality of life refers to your ability to continue to independently perform daily tasks, personal care, hobbies, leisure, and work. Things like getting up out of a chair, walking on uneven surfaces, going up and down stairs, running on the beach, or riding a bike - all rely on varying degrees of balance, and being able to continue performing these tasks enhances our quality and enjoyment of life.


Falls prevention is increasingly important as we age. There can be detrimental health outcomes when you experience a fall. For example, a 2023 study in Victoria, Australia (3) concluded that hip fractures are a major public health concern. The number of hip fractures cases has increased by 20% from 2012 to 2018. The chances of dying within a year of a hip fracture are higher if over 85 years old, in men, in those who are frail, and living in a non-metropolitan region.


The pivotal question is whether we can proactively identify these problems before they manifest as falls, mobility restrictions, or more severe health complications. The answer to is yes! And it might be easier to identify than you think.


While many strength/power assessments need specialised equipment and are less practical for in clinic or at home testing, accessible alternatives such as the following tests offer valuable insights when assessing our ability to balance.


Single leg stance test (SLST)

A simple test of standing on one leg with your hands on your hips, the aim is to time how long you can do it for until either your second foot touches the floor or your hands come off of your hips. Studies (2) have shown that the ability to balance for at least 10 seconds significantly reduces falls risk and has significant impact on longevity and overall health.


5 x sit to stand test (5xSST) This test is as simple as it sounds. It requires you to stand up and sit down five times in a chair as quickly as you can with your hands across your chest. It is timed and compared against normal values for your age.


These tests not only differentiate between fallers and non-fallers but also equip us with a straightforward, workable means of evaluating both muscle power and balance, and make it accessible to everyone. As clinicians, it is our job to then take these results and with further testing, use them to form the basis of exercise programs.


As we age, maintaining balance and strength becomes crucial for sustaining mobility and independence. Delayed screenings for these issues often leave them unaddressed for years, increasing the risk of falls and diminishing our confidence. This article emphasises the importance of muscle strength and power in preventing falls and enhancing quality of life.

Accessible tests, such as the SLST and the 5xSST, offer practical means of evaluating balance and power. By proactively addressing these concerns, we can lead fulfilling lives with confidence and independence as we embrace the journey of aging.



References:


(1) Simpkins C, Yang E (2022) Muscle power is more important than strength in preventing falls in community-dwelling older adults. Journal of biomechanics, 134.


(2) Araujo C, e Silva C, Laukkanen J, Singh M, Kunutsor S, Myers J, Franca J, Castro C (2022) Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. British Journal of Sports Medicine, 56(17). 975-80.


(3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10148778/


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