Category: Fall Prevention

The Benefits of Ai Chi

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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 by Ms. Ruth Sova in the United States. In spite of the similarities in names, Ai Chi is not a variation of Tai Chi. It has 20 movements: Contemplating, Floating, Uplifting, Enclosing, Folding, Soothing, Gathering, Freeing, Shifting, Accepting, Accepting with Grace, Rounding, Balancing, Encircling with a Shift, Encircling, Surrounding, Nurturing, Flowing, Reflecting and Suspending. For a demonstration and a description of Ai Chi, download Ms. Sova’s video, Ai Chi Quick and Easy from her DSL LTD store. Scroll down to the Techniques: Ai Chi – Video section, to the fifth row, and place your order. It’s free.

There is a focus on breath during Ai Chi. Take slow deep diaphragmatic breaths that expand the ribcage. Inhale with arm movements toward the surface of the water or away from the midline of the body, with the palms facing up. Exhale with arm movements toward the pool floor or toward the midline of the body, with the palms facing down. Do not worry about inhaling or exhaling at the wrong time. With practice, matching the breaths to the movements becomes natural. However it turns out is how it was meant to be for that session.

Ai Chi is used by aquatic therapists and rehab specialists for a variety of outcomes. For example, Ai Chi improves balance and reduces the risk of falling. Shifting, Accepting, Rounding, Balancing, Encircling with a Shift, and Nurturing are all movements that involve shifting the torso away from and back toward neutral, which is a skill necessary for recovering balance. Gathering, Freeing, Accepting, Encircling, Surrounding, and Nurturing are performed with a narrow base of support, which challenges balance. Lateral stepping becomes more difficult with age; Flowing involves steps to the side. Being able to reach over a certain distance is a predictor for fall risk; Gathering, Freeing, Accepting, Rounding, Balancing, Encircling, and Nurturing all involve reaching in various directions. Gait variability decreases with age because of decreased rotation in the spinal joints; Gathering, Freeing, Reflecting and Suspending all involve turning. In addition, having the eyes follow the hands during upper body movements increases cervical spine rotation. (Ruth Sova MS ATRIC, “Ai Chi and Fall Prevention” 3-11-2022)

  • Spiraling Ai Chi, in which the upper body movements are lead with the back of the hand, is used to enhance and create movement in areas where the neuromuscular movement has been compromised. Spiraling Ai Chi is designed to be multi-planar and multi positional. Diagonal patterns are used to increase coordination and promote joint stability. (Spiraling Ai Chi Course description)
  • Psychotherapists have used Ai Chi to treat patients with heightened anxiety or depression. People with heightened anxiety are “over the top” and people with depression are “under the bottom.” Ai Chi helps calm the nervous system so that the patient becomes more in touch with his/her body, reducing physical and emotional pain. Ai Chi movements are mindful, which is defined as present-centered awareness with the mindset of nonjudgment, openness and acceptance. Patients have been able to experience a sense of inner calm. (Patricia Henry-Schneider MS, LPC, “Ai Chi as a Model of Calm” 5-6-2022)
  • Ai Chi’s slow movements in water have been used to help wounded warriors who have lost a limb, learn to balance without being able to feel their prosthetic limb on the pool floor. (Ai Chi Day, 7-25-2021)
  • Women with multiple sclerosis who practiced Ai Chi showed notable improvements in muscle strength, functional mobility and fatigue. (Rena Goldman “Health Spotlight: Ai Chi” 5-2-2018))
  • Ai Chi was found to be effective for improving function, mobility and balance in patients with mild to moderate Parkinson’s. (Goldman)
  • After 10 Ai Chi sessions, women with fibromyalgia experienced improvements in pain levels, mental health and quality of life. (Goldman)

I am a water fitness instructor, not an aquatic therapist. I use periodization with my classes, which means that I progress my classes by increasing intensity over a period of time until participants reach peak fitness. I love using Ai Chi as the cool down at the end of a high intensity interval class. And a long session of Ai Chi works great for the active recovery season that follows peak fitness to allow the muscles to rest, heal any microtears that may have occurred, and replenish their energy reserves. (For more about periodization see my book Water Fitness Progressions.) I created a modification of Ai Chi for my deep-water classes that Ms. Sova is going to include in a book on Ai Chi variations. Watch for it to show up in her DSL LTD store.

NOTE: The photo above is from a recording of Ai Chi Day 2020 which can be purchased in the DSL LTD store.

See you in the pool!

Author/Instructor Photo
Chris Alexander

Ai Chi / Fall Prevention

Fall Prevention

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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.
  • Webbed gloves
  • Drag bells
  • Paddles
  • Resistance tubing
  • Foam dumbbells
  • Kickboards
  • 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 / Balance exercises / Fall Prevention / Strength training

Squats

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An important exercise to add to your fitness routine is the squat. A squat is a functional movement because you use it whenever you sit in a chair, get into the car, use the toilet, or pick up a basket of laundry. Practicing the squat will enable you to continue to perform these activities of daily living much longer. Squatting uses your hips, knees, ankles, glutes, quads and core. Strengthening these muscles in your lower body will also make you more stable and help prevent falls.

Sit down and stand up

So how to get started? Begin by sitting in a chair and standing up. If this is difficult, then hold on to a table or counter while performing the move. Progress to sitting down and standing up without holding on. When you are comfortable with this, see how many times you can sit down and stand up in 30 seconds. The goal is 12 repetitions.

Incorrect Squat
Correct Squat

The next progression is to squat without a chair. How deeply you squat is not important, but make sure your knees are not projecting forward over your toes, as in the first picture. Instead, bend forward from your hips while keeping your knees aligned over the toes, and your weight on your heels, as in the second picture. You will feel it mostly in your quads and glutes. There are several ways to vary the squat. Try squatting with the feet close together or wide apart. You can also try the squat with one foot in front of the other. A lunge is essentially a one-legged squat, with the weight on the front leg and the back leg assisting with balance. Another progression is to hold weights while squatting. If you have a bar you can hold onto, you can take your squats deeper. To see a video with additional information about squats, check out the Being Balanced website at https://www.beingbalancedmethod.com/fitness-videos

Feet Close Together
Feet Wide Apart
One Foot in Front
Lunge

Squat on Step
Squat One Foot on Step
Lunge on Step

Take Your Squats to the Pool. When you squat on land, gravity assists as you lower your body, and the quads and glutes do the work as you rise. The dynamic is different in the water. There buoyancy assists you to rise, and the hamstrings do the work to lower your body toward the floor. This is not necessarily a bad thing. You can increase the work for the hamstrings by holding buoyant equipment, such as foam dumbbells, down by your sides as you squat. One way to work the glutes and quads in the pool is to do squats and lunges on an aquatic step. In this way, more of your body is out of the water and therefore gravity comes more into play. Another way to work the glutes and quads is to perform rebounding moves in which you push off from the floor with both feet. Examples are cross-country ski, jumping jacks and various kinds of jumps, as in the pictures below.

Tuck Jump
Split Jump
Skateboard Jump

Squats and jumps are not options in deep water, but there are other exercises that can be used to work the glutes and quads. One option is to focus on pressing the heels toward the pool floor during a knee-high jog. You can perform a seated leg press, an action similar to using a leg press machine, or rock climb, leaning forward and moving the arms and legs as if climbing a rock wall. Glutes can be worked individually with a cross-country ski or skate kick; and quads can be worked individually with a seated kick. All the underwater photos are from my book Water Fitness Lesson Plans and Choreography.

Seated Leg Press
Rock Climb
Cross-Country Ski

Recommendation: To be able to continue to do important activities of daily living such as sitting in a chair and standing up, driving your car and using the toilet, be sure to include squats in your fitness routine or work your glutes and quads in the pool or do both!

Author/Instructor Photo

Chris Alexander

deep water / Fall Prevention / shallow water / Squats / Strength training / water fitness

Balance Training at Home

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14 Exercises for Seniors to Improve Strength and Balance | Philips Lifeline

Although the pool is a great place to do balance training, with COVID-19 cases on the rise in many states, we are still being encouraged to shelter in place as much as possible. It is important to stay active during this time, and it’s a good idea to include balance training among your activities. It is especially important if you are older than 60 since balance training reduces your risk of falling.

Exercise Etc. Inc. offered a Balance & Fall Prevention webinar in 2019 describing a variety of balance exercises you can do at home. Some recommended strength training exercises include the following:

  1. Resisted rows for the upper back. If you don’t have a band, do a standing row. From a lunge position, with the R leg forward, pull a dumbbell (or water bottle) in your R hand from your knee up towards your hip, squeezing your shoulder blades. Then repeat on the L side.
  2. Toe scrunches to strengthen the toes.
  3. Standing heel lifts to strengthen the calf muscles.
  4. Deadlifts to strengthen the glutes and hamstrings. Keep your back straight. If you don’t have dumbbells, use water bottles.
  5. Chair squats to strengthen the quads.

In addition to strengthening the muscles that are important for balance, there are some specific balance training exercises you can do. First find your neutral alignment. Sit in a chair up against a wall and put a balloon behind your head. When you are able to maintain that position, try standing up against the wall with the balloon behind your head. Progress from there to walking with a book on your head.

The following exercises are done sitting in a chair:

  1. “The airplane” – Extend the arms to the side and lean slowly side to side.
  2. Alternating heel/toe lift – Lift your heels one at a time while pumping your arms with the elbows bent
  3. Seated crawling – Lift your knees one at a time while lifting the opposite hand as if you were crawling up a wall.

A one legged stand is another recommended exercise. There are a variety of ways you can practice it. At first you may need to hold on to a chair or the wall for support. Next try standing on one leg without holding on for a minimum of 5 seconds, or as long as possible. Always have support available in case you start to lose your balance. Progress to standing on one leg with one arm up. Next stand on an unstable surface, such as a one-inch thick piece of wood about the size of your shoe. You could also stand on a brick or a book. Finally try batting a balloon while you are standing on one foot on your unstable surface.

Besides strength training, practicing neutral alignment, chair exercises and one legged stands, it is important to practice walking fast. The faster you can walk, the lower your mortality rate. Shift your weight from your heel to the ball of your foot to the toes. Keep your spine in neutral and your head level. Your toes point forward and your feet are 3-5 inches apart. Your elbows are bent 90 degrees, your arms are close to your body and they pump for momentum and balance. Don’t forget to breathe! The following are some exercises you can do to improve your gait:

  1. Tap one heel at a time on the floor in front of you. Then tap the toes in front of you. This improves ankle strength and ankle range of motion.
  2. Walk with long steps to improve stride.
  3. Lift knees with arm pumps to improve your arm swing efficiency.
  4. Lift your heels up behind you towards your buttocks to improve hamstring strength.
  5. Walk with one foot in front of the other to improve stability.
  6. March to reduce shuffling.
  7. Walk with head rotations to improve balance.
  8. Walk with U-turns to strengthen hip rotators.
  9. Walk backward.
  10. Place 2 cones (or water bottles) 10-20 feet apart. Walk fast from A to B, pivot and walk fast back to A.
  11. Step sideways from A to B and back to A.
  12. Place a chair 10 feet from your cone (or water bottle); from a seated position stand up, walk to the cone, pivot and return to the chair.

All of this can be done in your living room. Pick several exercises to do at least 3 times a week, or even daily. You can also do some fast walking outside in your neighborhood. If you live in Texas, like I do, you will want to do this early in the morning since it gets too hot in our summer afternoons and evenings. Keep moving!

Chris Alexander

Chris Alexander

Balance exercises / benefits of exercise / Fall Prevention  

Why Exercise?

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I have been teaching water fitness for 26 years. Clearly I enjoy exercising. But I know there are a lot of people out there who do not exercise. The excuses include not being motivated, not having enough time, being too tired, exercise is not fun, being too out of shape and not liking to sweat.

Motivation. Everyone wants to look younger and live longer. The secret to longer life is not a magic pill but exercise. Scientists can predict how long someone will live by how well they perform 5 simple tasks. How many times can you stand up from a chair and sit back down in 60 seconds? How long can you balance on one leg? How long is your stride length? How is your grip strength? How good is your posture? A good reason to exercise is to make improvements in these areas to improve your longevity and make the activities of everyday life easier.

Not Enough Time. Instead of trying to find time, try to make time. Some activity is better than none. Find a time during your day when you are free of commitments and schedule some exercise during that time. It doesn’t have to be a lot of time. Start with 10 minutes and increase it by a minute a week. Soon it will become part of your routine.

The remaining excuses. Once your fitness starts to improve, you will find you have increased energy. If one type of exercise is not fun, try something active that you do enjoy. Here’s where I put in a plug for water exercise. Hanging out in the pool when we were children was so much fun that many of us find getting in the water to exercise is really enjoyable. The buoyancy of the water supports your weight so that it seems easier to exercise even if you are out of shape. And the water cools your body so that you are not aware that you are sweating.

Many of the simple tasks that predict longevity can be worked on in the pool. Squats can improve your ability to stand up from a chair and sit back down. The pool is the perfect place to work on balance because the water supports the body and reduces the fear of falling while at the same time water movement makes balancing more challenging. You can work on increasing stride length by water walking. Hand grip exercisers are best for improving grip strength, but gripping pool equipment helps some. You can also concentrate on exercising with good posture in the water to help improve posture on land.

Exercising regularly makes the activities of daily life such as climbing stairs, playing with grandchildren and carrying groceries easier. It also improves blood flow to the brain which decreases the risk of cognitive decline. We cannot stop from aging, but we can work to maintain our functional fitness well into our retirement years.

See you in the pool!

Chris Alexander

balance exercises / Benefits of water fitness / Fall Prevention / Good Posture / shallow water / water fitness