Balance and Strength Training to Reduce Fall Risk: A Community Health Perspective
According to the Centers for Disease Control (CDC, 2024), falls are the most common injury for adults over 65. Approximately 14 million people, or 1 in 4 adults, report falling yearly.
One in five adults that do fall experience broken bones or head trauma. Injuries, including fall-related hip fractures, lead to over 300,000 hospital admissions a year.
In 2021, falls resulted in over 38,000 deaths and accounted for 3 million emergency department visits. In 2020, the annual cost of treating fall-related injuries among older adults was $80 billion.
Common risk factors that increase a person’s chance of falling include muscle weakness, vision difficulties, an inactive lifestyle, diabetes, and pre-existing challenges with balance and walking. Physically inactive adults are 39% more likely to experience recurrent falls.
Exercise programs emphasizing muscle strength, flexibility, and balance training are key in reducing the risk of falls in adults over 65. Individual home safety assessments, fall risk screenings, and medication management also help decrease a person’s fall risk.
Understanding how the body coordinates a balance response when responding to the challenges of the outside environment is key when designing and participating in an exercise program.
The Visual, Proprioceptive, and Vestibular Systems: The Dynamic Trio Central to the Balance Response
Our nervous system coordinates information from our environment through our visual and proprioceptive pathways and our inner ear or vestibular system. Proprioception relates to the body’s awareness of its position and movement relative to its environment. This process enables our bodies (i.e., eyes, nervous system, muscles, and joints) to coordinate an appropriate response so we can respond to our external environment and not fall.
Maintaining balance during daily activities involves a complex interplay between various balance control subsystems. A person’s ability to steady themselves and not fall relies on their ability to maintain their center of gravity within their base of support. The body’s balance control systems involve automatic and anticipatory postural control movements, dynamic walking or gait, using body awareness to interpret our external environment (proprioception), and integrating these responses with a person’s fear of falling.
The Four Systems of Dynamic Balance Control
Balance Control Subsystems: These postural control, sensory orientation, and dynamic gait (walking) subsystems coordinate responses between the brain, spinal cord, and visual, vestibular, and motor (muscle) pathways.
Sensory Inputs: Vision, proprioception (body position sense), and vestibular senses are critical for balance. Proprioception plays the most significant role among these sensory inputs, directly affecting balance control.
Nervous System Involvement: The nervous system aims to achieve postural equilibrium and orientation. It involves brain networks, including the basal ganglia, a brain center that controls and refines voluntary movement.
Musculoskeletal System: This system provides the structural support necessary for maintaining balance involving antigravity postural tone.
The Four Key Automatic Postural Responses:
Ankle Strategy (AS): The body uses the AS to respond to small balance challenges. The muscles around the ankle work to maintain the center of gravity within the base of support (BOS). For example, if you are falling backward, the muscles on the front of the ankle/lower leg will work to bring you forward over your BOS.
Hip Strategy (HS): The body uses the HS for moderate-intensity balance challenges. It is initiated quickly and used when the center of gravity reaches the outer limits of a person’s BOS. For instance, if a person falls backward, their hips will extend, creating a backward bending movement, and their arms will move up and forward.
Stepping Strategy (SS): When significant balance disruptions occur, the body uses the SS to protect itself against falling. The person takes a step or two to establish a new BOS so they do not fall.
Reaching Strategy (RS): The RS is the last defense against falls. The goal is to reach for anything so the person does not fall. It is typically used when the ankle, hip, and stepping strategies fail to help the person recover their balance.
Recent research shows that anticipatory postural adjustments are most associated with a fear of falling, whereas reactive or automatic postural adjustments are least related to this fear. Balance control system attributes such as anticipatory and automatic postural control, dynamic walking or gait, and sensory orientation (i.e., body orientation relative to gravity) demonstrated an indirect relationship.
Sensory information from the visual, proprioceptive, and inner ear or vestibular pathways affect one another directly. The Proprioceptive System plays the most important role out of these three systems in maintaining balance.
The human balance system is a complex mechanism involving multiple subsystems working together to maintain postural equilibrium and orientation. This system is crucial for daily activities and involves sensory inputs, motor responses, and cognitive processes.
Your Journey to Better Balance Health and an Active Lifestyle Begins with Wahl Solutions
Wahl Solutions’ Proactive Balance Health Approach for an Active Lifestyle
Our four-step process:
Assessment: We offer a computerized motion analysis assessment that evaluates your joint flexibility and complex, functional movements such as squatting, lunging, jumping, and single-leg stance control.
Client Education: We interpret your results and educate you regarding your current “motion health,” including where you excel and need to improve based on your current joint mobility and movement pattern limitations.
Exercise Program Design: Based on your motion analysis results, we create an exercise program to enhance joint flexibility, muscle strength, and balance. You will perform this exercise program from the convenience of your own home through an interactive AI (artificial intelligence) exercise software platform. Your personalized program aims to help you maintain an active lifestyle and reduce your risk of falls.
Program Follow-Up: Once you perform your program 3 times a week for 12 weeks, our team will conduct a second motion analysis assessment to evaluate your progress.
Final Word
Fall risk increases with age due to decreased muscle strength, sensory function, and postural control. A proactive approach to balance training can significantly reduce the likelihood of falls and related injuries. Wahl Solutions’ unique four-step system assesses movement health, provides personalized exercise plans, and tracks progress to optimize balance and coordination. Through targeted strength and flexibility training, individuals can confidently improve their ability to navigate daily and sports-related activities, preventing falls and preserving long-term mobility.
Further Reading
Accidental falls in the older adult population: What academic research shows
The Body's 4 Natural Defenses to Fight Falls – ADL Balance
Falls Prevention Awareness Week 2023 | ACL Administration for Community Living
Get the Facts on Falls Prevention
Perturbation-based Balance Training in Practice
References
Wu, K., Zhang, J., Mohsen, A., Wang, Z., Jin, Y., Wang, W., Peng, X., Yao, D., Valdes-Sosa, P., & Ren, P. (2024). Analysis of the Relation Between Balance Control Subsystems: A Structural Equation Modeling Approach. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 32, 625-637. https://doi.org/10.1109/TNSRE.2024.3357613.