Keep Your Balance

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The components of physical fitness are cardio-respiratory endurance, muscular strength and endurance, flexibility and body composition. The skill related components of fitness are balance, agility, coordination, and power. Balance is the ability to maintain equilibrium both while standing and while moving. Balance is important for athletes in gymnastics, football, baseball and other sports, but it is also important for older adults who worry about injuries they may sustain from falling.

Fall risk is the result of deconditioning, not age. To assess your fall risk, stand on one leg without the support of the upper extremities and without bracing one leg on the other. Count the number of seconds you can maintain this position. Time is up when the foot touches the floor or an arm touches something for support. Your chance of falling and sustaining an injury is double if you are unable to perform the one legged stance for 5 seconds. According to the American College of Sports Medicine, balance training may reduce the risk of falling and fear of falling and probably reduces the number of falls. It is recommended that balance training be performed at least 3 times a week, and daily is better. Balance training can be performed either on land or in the pool.

A sample fall prevention strength program on land might include the following exercises: (1) Resisted row with a band, focusing on squeezing the shoulder blades together, to strengthen the upper back and core. (2) Toe scrunches to strengthen the toes. (3) Standing heel lifts to strengthen the calf muscles. (4) Deadlifts, focusing on avoiding bending the trunk, to strengthen the glutes and hamstrings. (5) Chair squats, that is sitting in a chair and standing back up again, and lunges, to strengthen the quads. Also work on walking fast. since the faster older adults can walk, the lower their mortality rate.

Ruth Sova wrote an article for Akwa magazine that described multiple exercises for improving balance in the pool. Here are a few examples: (1) Sit on a noodle like a swing with the feet on the pool floor; turn eyes to the right and hold 10 seconds, and then left. No head movement, only eyes. (2) Sit on a noodle like a swing with the feet on the pool floor and bend to the right further than is comfortable and recover. Notice what is used to recover (legs, head, jerking movement?) and try to use only the core muscles. (3) Sit on a noodle like a horse with the feet on the pool floor and walk forward with feet rolling heel to toe, and nothing moving but the legs. Stop and restart. Stop and walk backwards. (4) Squat with the feet together, with the feet apart, with one foot directly in front of the other, or in a lunge position. Add various arm movements using both arms or one arm. (5) Stand and lift your toes off the floor then roll up on your toes as the chin lowers. (6) Stand with your right heel on the floor and roll the outside edge of the foot to the tips of the toes while turning your head slowly to the left. Repeat with the left foot. (7) Weight shift from side to side and from front to back. (8) Walk on tiptoes, or on heels, or with toes out or toes in. (9) Use unpredictable commands, such as marching in place on tiptoes while circling the right arm. (10) Cross-country ski with the hands on the hips and travel sideways. If you are an AEA member, you can check out the article for more exercises.

The goal is not to be able to perform on a balance beam like Simone Biles. The goal is to avoid becoming one of the 2.8 million seniors who visit the emergency room each year because of a fall. And beyond that, balance training is good for the brain. Memory, language skills, problem solving and decision making are coordinated by the cerebrum. Balance, posture and fine motor skills are coordinated by the cerebellum. The cerebrum and cerebellum are connected by a direct neural link. When an older adult trains for strength and balance, cognition improves.

My resources for this article are Ruth Sova’s article “Seated and Standing, Static and Dynamic Balance” in the October/November 2019 issue of Akwa magazine and Exercise Etc. Inc.’s 2019 webinar “Balance & Fall Prevention.”

See you in the pool!

Chris Alexander

Why Exercise?

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

How to Fall Safely

More than one out of every four people 65 or older falls each year. One out of five falls causes a serious injury such as broken bones or a head injury. Over 800,000 patients a year are hospitalized because of a fall injury. Each year at least 300,000 older people are hospitalized for hip fractures. These statistics from the Centers for Disease Control and Prevention are a concern for many of my water exercise class participants and for me. When I came across some articles on How to Fall Safely, I decided the information was worth passing on.

I found articles from several sources, including AARP, physical therapist blogs and wikiHow. The pictures in this Blog post come from wikiHow. The co-author of the post was Chris M. Matsko, MD.

Protect your head. Head injuries can be very serious. Make sure you prioritize protecting your head. Tuck your chin down to lower your head. If falling face first turn your head to the side. Use your arms for additional protection. Put them in front of your head if falling forwards or behind your head if falling backwards.

Turn as you fall. If you are falling either straight forward or straight backwards, try to turn your body so you land on your side. This reduces the risk of injuring your head, face, arms or back.

Keep arms and legs bent. It may be tempting to try and catch yourself with your arms. However, landing with your arms straight out can break your wrists and/or your arms.

Stay loose. Tensing up increases the chance of sustaining an injury. The tense parts of the body are more likely to break. Try breathing out as you fall to help keep your body relaxed.

Spread out the force of the fall. A big part of falling safely is to spread out the force of the impact over a large area of your body. This reduces the risk of a serious injury to a single part of the body.

Another suggestion is to roll out of the fall. This is difficult to do unless you have practiced beforehand. If you wish to learn the technique, you can ask a physical therapist to show you how, or practice falling and rolling in a gym with padded and cushioned floors.

Just as important as knowing how to fall is taking steps to prevent falls in the first place. Wear shoes with slip resistant soles. Pay attention when you walk. Be aware of uneven areas on the ground, curbs and stairs. Hold the hand rail when taking stairs. In the home, close drawers after you are done with them. Don’t leave cords in walkways. Keep the area well lit. Use non-slip bath mats. Remove small throw rugs.

Another way to reduce your risk of falling is to improve your strength and balance with exercise. The pool is the perfect place to work on both strength and balance. Because the water’s buoyancy and resistance helps support the body, exercises can be done without fear of falling. Options include the following:

Gait training. Gait training is walking practice. The goal is to lengthen the stride and improve confidence while walking.


Core Strength Training. Core strength training is training for the postural muscles of the trunk. This includes the Trapezius and Rhomboids, the Latissimus dorsi and the Erector spinae. Exercises to try are rowing, bowstring pull, and lat pull-down using the water’s resistance or drag equipment. Walking backward strengthens the Erector spinae.

Deep-Water Exercise. Deep-water exercise is performed, while wearing a flotation device, in water in which a person can remain vertical without the feet touching the floor. Exercisers must aggressively engage the stabilizing muscles of the core to remain upright.

Balance Challenges. Balance challenges are exercises performed with a narrow base of support, such as the feet together, one foot in front of the other, or standing on one foot. Slow movements are more challenging than fast ones.

Falling is scary, but learning how to fall and taking steps to prevent falls in the first place are things we can all do now to reduce the risk.

See you in the pool!

Chris Alexander

Exercises for Balance

Every 14 seconds an older adult is treated in the emergency room for a fall. Every 29 minutes an older adult dies from a fall related injury. Fear of falling often causes an individual to shorten his/her stride, shuffle the feet, and bend forward to see where the feet are. Ironically, this increases the risk of falling.

It is important to know how to recover from a fall. First, ease yourself up onto your elbows. Move onto your hands and knees. Then hold onto a firm surface, such as a chair, to support yourself. Facing the chair ease yourself to a standing position. Turn yourself around and sit on the chair.

Balance is the ability to distribute your weight in a way that enables you to hold a steady position or move at will without falling. It is possible to improve balance with exercise, and in fact, balance training is one of the top 10 worldwide trends in the fitness industry. The pool is the perfect place to work on balance. Because the water’s buoyancy and resistance helps support the body, exercises can be done without fear of falling.

There are a number of strategies for improving balance. Some of them are:

  1. Gait Training. Gait training is walking practice with the goal of lengthening the stride and improving confidence while walking.
  2. Core Strength Training. The goal of core strength training is to improve the strength of the postural muscles of the trunk.
  3. Deep-Water Exercise. Deep water exercise is performed, while wearing a flotation device, in water in which a person can remain vertical without the feet touching the floor. Exercisers must aggressively engage the stabilizing muscles of the core to remain upright.
  4. Unpredictable Commands. Unpredictable commands train the body, and in particular the core muscles, to react to the unexpected.
  5. Balance Challenges. Balance challenges are performed with a narrow base of support, such as the feet together, one foot in front of the other or standing on one foot.

For specific exercises using each of these 5 strategies, you are invited to attend my lecture, Exercises for Balance, at the Bone Buddies osteoporosis support group on Saturday, May 14 at 9:45 AM. The meeting is free and open to the public. The location is the Methodist Richardson Medical Center, 2821 George Bush Hwy. Suite 200, Richardson, TX 75082.

Whether you wish to work on improving your own balance or you are an instructor interested in adding balance training to your water fitness class, there lots of exercises to choose from. I hope you’ll join us.

See you in the pool!

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