Fall Prevention

Risk Falling Fall prevention Slip and fall Wet floor sign, Lorm Ipsum ...

September is Fall Prevention Awareness month. It is estimated that one in four Americans over the age of 65 will fall every year. Falls not only can be life threatening, but they are associated with poor health outcomes and a sense of fear that can hinder independence, activity and strength in older adults. Therefore preventing falls in the first place is important. The Mayo Clinic offers the following tips for preventing falls:

  • Review your medications with your doctor. Some drug interactions may increase your risk of falling.
  • Exercise to improve strength, balance, coordination and flexibility.
  • Wear sensible shoes. Shoes like high heels and floppy slippers can contribute to a fall.
  • Remove tripping hazards from walkways in your home.
  • Secure loose rugs with double-sided tape or remove loose rugs entirely..
  • Clean up spills immediately.
  • Make sure there is adequate light in your living spaces so you can see where you are going.
  • Turn on the lights before going downstairs.

In addition to these tips for the home, aquatic fitness instructors can help with fall prevention by including some of the following exercises in their classes:

  • Gait training. People who are afraid of falling, perhaps because of a previous fall, tend to shorten their stride and look down at the floor. The hydrostatic pressure of the water supports the body and reduces the fear of falling, so a water exercise class is the perfect place for gait training. Walking is a good warm up at the beginning of class, or cool down at the end of class. Walk forward, backward and sideways. Include starts and stops. Try slow motion walking, or walk without moving the head or torso. Try walking with hands on hips to remove stabilizing arm movements. Change the tempo by walking slow for a few steps, then fast for a few steps, and slow again. Walk with quick changes of direction.
  • Strength training. Include exercises to strengthen the muscles of the back to improve posture. Examples include shoulder blade squeeze; standing rows with webbed gloves, drag bells, paddles or kickboards; bowstring pull with drag bells or resistance tubing; lat pull-down with webbed gloves, drag bells, paddles, resistance tubing or dumbbells; and chin tucks. Leg exercises against the resistance of the water will strengthen the quadriceps, hamstrings, gluteus maximus, gluteus medius and adductors.
  • Flexibility. Movements through their full range of motion promote flexibility. A form of exercise that uses full range of motion is Ai Chi created by Jun Kono of Japan and brought to the United States by Ruth Sova. Follow the link for a YouTube video of June Kono performing Ai Chi. It is also important to stretch at the end of class, while the muscles are still warm. Stretches can be static or dynamic. Examples of static stretches are clasping hands behind the back to stretch the chest, and lifting the heel in back with a pelvic tilt to stretch the quadriceps and hip flexors. Examples of dynamic stretches are swinging one leg forward and back through a full range of motion, and lifting one leg to the side, crossing the midline in front of the body, lifting it to the side again, and crossing the midline behind the body.
  • Ankle flexibility. Weak ankles or reduced range of motion in the ankles contribute to reduced stability. Some exercises to improve ankle flexibility are walking on toes or on heels – both forward and backward, rolling from heels to toes and back to heels, ankle circles, sitting on a noodle and writing your name with your foot, and squats keeping the heels on the floor. Squat with the feet in various positions, such as a narrow stance, a wide stance, toes pointing in, toes pointing out, or a tandem stance with one foot directly in front of the other.
  • Balance challenges. Asymmetrical movements require more core stabilization. Try walking, jogging, cross-country ski or jumping jacks with one hand on the hips or behind the back, or with each arm performing a different movement. Another challenge is to jog, ski or do jumping jacks with just one leg, keeping the other foot grounded. Stand and reach one arm as far forward as possible until you start to lose your balance. Reach your arm to the side and to the back until you start to lose your balance as well. Walk with one foot directly in front of the other or do a crossover step. Stand on one foot with and perform asymmetrical arm movements, or turn your head from side to side, or keep your head still and look from side to side, or close your eyes.
  • Unpredictable command. Improve your participants’ reaction time with the unpredictable command technique. Direct the class to perform unexpected movements. For example, walk diagonal, forward, backward, or sideways. Walk faster, knees higher, on toes or heels, with toes curled up or down or one of each. Look over your shoulder, tuck your chin, lower your shoulder blades, or touch your shoulder. Lift one arm to the side, front or back, lift both arms and let your fingers walk on the water. For more on the unpredictable command technique, see a previous blog post “Improve Reaction Time.”

Deep water exercise requires a lot of core stabilization, often leading to improved posture. My book, Water Fitness Progressions, includes 3 lesson plans, one for functional core strength, one for balance training, and one a Pilates fusion class for deep water. There are also variations of the same 3 lesson plans for shallow water. Now is a good time to start working on fall prevention.

See you in the pool!

Author/Instructor Photo
Chris Alexander

Ai Chi for Deep Water

Ai Chi (“energy of love”) is a water exercise and relaxation program that combines deep breathing and slow, large movements, performed in continuous, flowing patterns. It was created by Mr. Jun Konno of Japan and further developed my Ms. Ruth Sova in the United States. The YouTube video above shows Mr. Konno demonstrating Ai Chi.

Ai Chi, performed in shallow water, is so wonderfully relaxing that I wanted to try it with my deep water classes. This required modification, since weight shifting is not possible while suspended in deep water. I will present my modifications on Ai Chi Day, on Sunday July 25, 2021. The Zoom conference lasts from 8:00 AM – 12:00 noon EDT (7:00 AM – 11:00 AM CDT). There will be 18 presenters, including Jun Konno and Ruth Sova; my presentation is 10:10 – 10:19 AM EDT (9:10 – 9:19 AM CDT). If you are interested in attending, you can contact Ruth Sova at ruthsova@ruthsova.com for more information.

I am excited about presenting. Here is a preview of Ai Chi in deep water:

Contemplating
Floating
Enclosing

The first stage of Ai Chi is called Contemplating and it is a preparation for the moves to come. your body is in an upright posture with the spine in neutral and the legs apart. The arms are out to the sides near the surface of the water. Focus on your breathing. Inhale through the nose and exhale through the nose and mouth. Become aware of how your body rises and falls in the water. Then begin the first sequence, a series of four moves called Floating, Uplifting, Enclosing and Folding, which focus on breathing. They feature a series of arm moves. Most of the upper body moves work well in deep water, but upward movement, such as the front shoulder raise in Floating, tends to make the body sink. You can avoid sinking by turning the thumbs up and slicing through the water.

Gathering
Accepting

The second Ai Chi sequence focuses on healing, and includes exercises for the upper body and trunk stability. You will need to brace your core to stabilize in deep water. Webbed gloves can also help with stability if necessary. The movements in this sequence are called Soothing, Gathering and Accepting. The moves begin with a turn to the side. In deep water you will use a scull to assist in turning. The legs stay apart in a suspended lunge position while the arms sweep and flow. After you perform several repetitions of a move on one side, you turn to the other side and repeat the repetitions.

Balancing Begin
Balancing
Balancing

The third Ai Chi sequence is called healing and it focuses on the lower body. The moves are called Accepting with Grace, Rounding and Balancing. To get into position you turn to the side using a scull which puts the legs in a suspended lunge position. From there you need to drop the legs into neutral or the lower body movement tends to become a slow cross-country ski. Instead, brace the core and move one leg to the back, or to the front, or swing it front to back as in Balancing (in the photos above) while the arms sweep and flow. After performing several repetitions of each move on one side, turn to the other side and repeat the repetitions.

There is no right or wrong way to perform Ai Chi. Whatever adaptions you make, including deep water adaptations, will make it right for you. See you in the pool!

Author/Instructor Photo
Chris Alexander

Maintain Your Flexibility

Some of my water fitness class participants enjoy stretching at the end of class and a few leave the pool before we get to the stretches. Are they missing anything important?

The American College of Sports Medicine recommends incorporating stretching exercises into your workouts 2-3 days a week but notes that daily stretching is most effective. They recommend that stretches be held for 10-30 seconds. Stretches that are held for 10-30 seconds are called static stretches. Stretching can also be dynamic. This means that you move a joint slowly through its full range of motion.

Stretching is a way to improve flexibility. Loss of flexibility results in a slower walking speed, smaller steps while walking, back pain and increased risk of falls. Improving flexibility reduces your risk of getting injured during physical activity. Muscles that are less tense are likely to have fewer aches and pains. You are less likely to have muscle cramps. Increasing your range of motion helps with balance. Flexibility and strength are two sides of the same coin. Stretching lengthens the muscles while strength training contracts the muscles. Performing both types of exercises makes you more physically fit.

There is a type of dynamic flexibility training that involves both stretching and contracting the muscle group being targeted. It is called Proprioceptive Neuromuscular Facilitation or PNF for short. In PNF an arm or a leg moves in a diagonal pattern. In the first illustration above, the right arm starts at the upper left front corner (left shoulder) and moves to the lower right rear corner. In the second illustration, the right leg starts at the upper left front corner and moves to the lower right rear corner. The opposite motion from the lower left front corner to the upper right rear corner is also performed. PNF stretching improves range of motion and muscular strength at the same time.

Ai Chi is another form of dynamic stretching. It was developed in Japan in 1993 by Jun Konno and introduced to the United States by Ruth Sova. Typically performed in shoulder depth water, Ai Chi moves arms and legs through a full range of motion while focusing on breathing patterns. You can find a video of Jun Konno performing Ai Chi on YouTube. A number of variations of Ai Chi have been developed. I find Ai Chi wonderfully relaxing and created a variation to use with my deep water classes. Ruth Sova is compiling the variations, including mine for deep water, which she will publish later in 2020.

Static stretching, dynamic stretching, PNF and Ai Chi can all be performed in a water fitness class to meet the American College of Sports Medicine’s recommendations on flexibility exercises. If you would like some ideas for stretches for various muscle groups to get you started, see pages 18-19 for shallow water and pages 175-176 for deep water in my book Water Fitness Progressions.

See you in the pool!

Chris Alexander