Tuesday, April 7, 2015

Do You Fear Falling....Thinking About Balance, Preventing Falls & Osteoporosis

May is National Osteoporosis Month…

I recently spent a 3 day weekend at a large fitness conference.  The founder of this conference, recently had a trip and fall accident, fracturing her jaw and losing teeth.  This is a superfit lady in her 50s, so what are the rest of us less fit maturing Baby Boomers to do?  Prevention needs to start early, so the following information really applies to anyone over the age of 30.

What is it?  Osteoporosis literally means “porous bones” and is diagnosed when too much bone structure is loss, or when you make too little bone.  This results in weaker, more brittle bone, which can result in fractures from minor falls, or even sneezing.

Risk Factors  Do you know the risk factors for osteoporosis?  Did you know that over 20 million broken bones occur each year in the US due to osteoporosis? Its not just elderly women who suffer from osteoporosis.  Female athletes who train so hard as to lose their monthly period, and older men are also at risk.  Often fractures will be treated and heal, but the patient does not get screened for osteoporosis.  The National Osteoporosis Foundation would like this to change.

The risk factors  that you cannot influence, according to the National Osteoporosis  Foundation are:
  • Being over age 50
  • Being female
  • Menopause
  • Family history of osteoporosis
  • Low body weight/being small & thin
  • Broken bones or height loss 

Controllable Factors    These you can influence by your lifestyle choices:
  • Not getting enough calcium & vitamin D
  • Not eating enough fruits & vegetables
  • Getting too much protein, sodium & caffeine
  • Having an inactive lifestyle
  • Smoking
  • Drinking too much alcohol
  • Losing weight
  • Medications & disease can also cause bone loss, increasing your risk levels. 

Economic Costs – Some Facts & Figures
With 70 million Baby Boomers turning age 65 by 2030, fitness & medical professionals are starting to wake up.   The 85 years & older segment is the fastest growing population segment.  The direct medical costs from older adult falls in 2013, was $34 billion.  One in three adults aged 65 and older fall each year with 20-30% suffering moderate to severe injuries.  Annually there are 2.5 million nonfatal fall injuries necessitating an ER visit.  These numbers are expected to increase as Baby Boomers age. 

Its Not Hopeless!!  While one cannot prevent aging or randomness from happening, there is quite a bit one can do to be proactive.  As always, in an evolving field, the research is incomplete.   A little background first….

Balance – Or equilibrioception  is defined by exercise physiologists as the physiologic ability to keep yourself upright when walking or standing still.  It’s not just one body system that can be labeled “balance”.  Many body systems work together to keep us vertical.

Balance – Or equilibrioception, which is defined by exercise physiologists as the physiologic ability to keep yourself upright when walking or standing still.
It’s not just one body system that can be labeled “balance”.  Many body systems work together to keep us vertical.

First there’s the eyes or visual system.  Then there are the ears or vestibular system.  These two work together to help us keep objects in focus when our head is moving.  If you’ve ever had a problem with your inner ears or vestibular system, you know that you may lose your balance easily. And if you’ve ever walked down a dark hallway, you may have also noticed that your body moves less surely when you aren’t sure what’s ahead.

There’s also proprioception, which is our body’s sense of where we are in space.  Nerve endings in our feet and skin send messages to the brain which work with our muscles and bones, to adjust body position to movement.  These tend to deteriorate as we age but practicing balance has been shown to help.   Brain surgery, Meniere’s disease, an ear infection, blows to the head or a bad head cold can also disrupt one’s sense of balance.  Dizziness, disorientation and nausea can follow, perhaps precipitating a fall.

Adapt a Healthy lifestyle Fall prevention starts with a healthy lifestyle.  Proper diet, avoiding smoking & too much alcohol, and improving muscle strength, endurance, as well as flexibility all can have beneficial effects.  Since fractures are an adverse outcome to falls, maintaining healthy bones and preventing osteoporosis should be a priority for older adults & professionals who work with them. 

Put It In The Bank  We have maximal bone density in our thirties.  After about age 35, we start to lose more bone than we can build.  We start drawing from our calcium bank, so to speak.    By age 60, if we do not exercise and eat calcium rich diets, we can lose up to 30% of our bone mass.  Attention to diet, calcium intake and exercise should start in the early decades.  Since osteoporosis is a silent condition until a fracture occurs, one needs to pay attention to maintaining a healthy lifestyle.

A Healthy Diet with adequate levels of calcium, Vitamin D, and other bone building nutrient is important.  Find out what those levels are here in this CDC fact sheet.   

Exercise – it is the pull of muscle against bones that keep the bones strong.  Use it or lose it definitely applies here.  The exercise should be weight bearing & muscle strengthening.  Resistance exercise of any kind – whether the resistance is provided by actual weights such as dumbbells, machines, elastic resistance such as tubing or bands or even body weight work the best to build muscle and therefore bone.  Although it may seem like it's impossible to stem the progress of osteoporosis, I have had clients maintain their bone densities and even improve them slightly with a regular resistance training program.

Weight bearing exercise also includes dancing, hiking, high impact aerobics, jogging, running, jump rope, stair climbing & tennis.  Lower impact exercise would be to use an elliptical trainer, perform low impact aerobics, or fast walking on a treadmill or outdoors.  Swimming & biking don’t quality, I’m afraid, as providing enough resistance.

How Much Exercise Do You Need?  In general, weight bearing exercise should be performed for 30 minutes most days of the week.  Muscle building exercise is recommended 2 or 3 times a week.  Balance, posture & functional exercise can be done every day.  Here are some exercise examples that can be done at home.
Many exercise physiologists are now providing Fall Prevention classes but a class that encompasses all the facets of balance are still difficult to find.   I have taught such a class at senior retirement facilities and locally at  Mission Hills Athletic Club .   My classes contain the following elements to provide a well rounded progressive program.

Posture & Flexibility Development – poor posture and limited range of motion can contribute to falls.  It has been found particularly that maintaining ankle flexibility & hip abductor/adductor is important.

Functional Exercises – help with how you move in every day living.  Can you still stand on one leg to put on your pants?  Can you get up out of chair or climb a set of stairs easily?  Can you lift your knee/leg high enough to avoid tripping?

Balance Exercises – help strengthen leg & core muscles.  These should be both stationary (one leg stances), and moving (we don’t usually fall when standing still).  I like to incorporate various balance challenges (balance pillows, balance beams, BOSU, half foam rollers) on varied equipment and situations (one leg, eyes closed, moving, darkened room, carrying large loads, and so forth).  Over the course of 6 or 8 weeks, I am able to progress the challenges, and the improvement is noticeable both to me & my clients.  Practice is necessary so there’s always “homework” which can be worked into your daily activities with a little planning.

Strength Training  - strong muscles make all of the above easier, and help maintain muscle & bone mass.  We start by following the BEST protocol developed by Arizona State University and which is customized for you.

This is just an overview of a complex topic - several blog posts could be written for more complete coverage.

Better Bones & Balance   For those of you in the Tri City area, a new class will start in May.  For a free consultation, more information, or questions & comments, please contact judy@fitness-spark.biz.  For details on the class, which is open to the community, please call Christina at Mission Hills Athletic Club, at 656-2250.

Statistics  - World Wide                     ©Fitness Spark Personal Training, March, 2015.

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