Balance. How Is It Changing With Age?

Standing, walking, or other activities require good balance performance. Aging affects our balance control, muscle strength, and coordination, and reduces proprioception. How can physical characteristics be maintained? Answer: - Healthy aging without physical activity cannot be imagined.

Key takeaways:
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    Maintaining standing, sitting, or other positions needs integration of all systems: central nervous, sensory, and musculoskeletal.
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    Postural control is maintaining, achieving, or restoring balance during any posture.
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    About one-third of people with age more than 65 years old have at least one episode of fall each year.
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    Aging decreases muscle strength, and coordination of the lower extremities, and reduces proprioception and balance control.
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    Higher physical activity can reduce the risk of falling between 30% to 50%.

Basic understanding of balance

Maintaining the body position in standing, sitting, or other activities requires integration of the central nervous system (CNS), sensory, and musculoskeletal system. The cerebellum which is the part of the CNS controls our vestibular, postural, and distal muscle functions. If there is dysfunction of the cerebellum, balance, posture, or other motor skills could be affected.

Some receptors are located in muscles, tendons, and joints and mostly it is called proprioceptors which are responsible for the understanding of touch, position, movement of the body parts, and balance maintenance. These receptors are part of the somatosensory system which sends signals to the CNS and controls our body movement and balance.

Proprioceptors give us information about the force, position, or movement of the body, as well as balance. Proprioception is combined with vestibular and visual systems. The clinical test which is mostly given for patients to understand proprioception is Romberg’s test where a patient needs to keep their balance with feet together and eyes closed. This test shows that all components work properly.

Balance is associated with stability and postural control. Our balance is related to the area of the base of support and the position of humans in the center of mass. During an upright position, the person has a high center of mass which is near the sacrum, and a small base of support, because we have only two feet.

Our body in a standing position always moves, but the movement is very small and not always visible. To make sure that our body sways the computerized posturography test is performed.

Postural control is maintaining, achieving, or restoring balance during any posture. There are also strategies of postural control: reactive and predictive or a combination of them. The predictive control strategy can be predicted with voluntary movement and increased muscle activity, while the reactive strategy acts under unpredicted disturbance.

Moreover, to maintain postural control there are a few strategies that can be described as the ankle, hip, and stepping strategies.

The swaying from the ankle joints is mostly used when balance disturbance is not very challenging, mostly we use this strategy when standing in the metro. It is tightly related to muscle activity, when we sway back, the front muscles of the shin try to back the body to the neutral position.

The swaying from hip joints is mostly used when the balance is medium challenging. During this strategy we involve arms and if we forward flex the hips then the arms go back and vice versa, that is how we avoid falls.

Stepping strategy or grasping appears when the balance is very challenging and we feel that we will fall. But stepping forwards or backward can help to prevent the risk of falling when the balance is disturbed.

These strategies help us to avoid falling if any disturbance appears. In some cases, if we have lower back pain, reduced ankle amplitude of movement, or other issues, these strategies do not work properly because our proprioception is damaged. And there is a high possibility to lose balance and falling.

Older people: how balance is changing with age and why

The risk of falls increases due to an increase in average life expectancy. About one-third of people with age more than 65 years old have at least one episode of fall each year. About 60% of falls happen at home because seniors spend a lot of time in it.

Moreover, the risk of falls increases with age due to degeneration processes in organisms and reduced physical and cognitive functions. What happens in the body when we are getting older? The strength of the muscle decreases as well as the coordination of the lower extremities, furthermore, reducing proprioception and balance control.

One fall increases the risk of other falls. After one fall, seniors fear the recurrence and feel post-fall anxiety syndrome, mainly described as reduced activity, movements, and daily activities. These fears and anxiety syndrome reduce self-esteem, muscle strength, and balance, and promote abnormal walking.

So, inactivity is one of the factors which decreases body functions. However, physical activity can counteract inactivity consequences. As written in the article “How to manage the dangers of sitting”, higher physical activity can reduce morbidity and mortality, and also, it can reduce the risk of falling between 30% to 50%.

What exercises can reduce the risk of falling in the elderly?

According to World Health Organization guidelines, seniors should do multicomponent physical activity three or more times a week at a moderate or greater intensity to increase functional capacity and prevent falls.

It is very important to strengthen the human body, however, seniors, who want to avoid the risk of falling must do these exercises daily:

  • Leg strength training
  • Balance exercises (single leg stance, unstable platforms, etc.)
  • Resistance exercises
  • Aerobic exercises (walking, bicycling, swimming, dancing, etc.)
  • Tai Chi
  • Pilates

All these exercises increase proprioception of the ankle, knee, and hip joint, and due to this reason increase the ability to balance. Moreover, balancing on an unstable surface increases proprioception and brain activity in the supplementary motor area which is responsible for the control of movement.

Physical activity is an essential criterion to avoid the risk of falling in the seniors' population.