Author name here for Edited books chapter Assessing Balance and Designing Balance Programs chapter

Objectives Differentiate between static and dynamic balance Identify factors influencing balance Understand general guidelines for balance testing Identify exercises to improve balance Understand guidelines for designing balance programs

Principles of Balance Balance is gaining recognition as a key component of functional fitness. Balance training is emerging as one of the top 10 exercise trends. For seniors, balance is extremely important to maintenance of independent living status and successful completion of ADLs. Balance training helps prevent falls.

Definitions and Nature of Balance Balance is the ability to keep the body’s center of gravity (COG) within the base of support when maintaining a static position, performing voluntary movements, or reacting to external disturbances. –Static –Dynamic –Functional

Static, Dynamic, and Functional Balance Static balance is the ability to maintain COG within the supporting base while standing or sitting. Dynamic balance is maintaining an upright position while COG and base of support are moving and the COG is moving outside of the supporting base. Functional balance is the ability to perform daily movement tasks requiring balance.

Factors Affecting Balance and Risk of Falling The further the COG from the base of support, the lower the stability. The broader the base of support, the higher the stability. Resistance training and stretching programs may be useful for maintaining and improving balance. Exercising on unstable surfaces can challenge balance response and provide variety. (continued)

Factors Affecting Balance and Risk of Falling (continued) Balance, resistance, and flexibility training programs are more effective than endurance training for reducing risk of falling. No optimal fall prevention program has been identified yet.

Assessment of Balance Most balance test batteries are comprehensive and include multiple test items to assess both static and dynamic balance. Direct measures of balance may be obtained using computerized force plate devices.

Assessing Static Balance Using Indirect Measures Romberg tests: measure static balance while standing with eyes open and eyes closed Unipedal stance test: timed one-leg stance test that provides simple measure of static balance; two conditions: eyes open, eyes closed Clinical test of sensory integration of balance: evaluates the contributions of the visual, proprioception, and vestibular sensory systems to balance

Assessing Dynamic Balance With Indirect Measures Functional reach tests: measure maximum distance one can reach beyond an arm’s length without losing balance or moving the feet Timed up and go tests: assess dynamic balance and agility of older adults Star excursion balance test: provides a significant challenge to athletes and physically active individuals

Figure 12.1

Figure 12.2

Figure 12.3a

Figure 12.3b

Assessing Dynamic Balance Using Test Batteries Tinetti performance-oriented assessment of mobility test (POMA): assesses balance and gait of older adults; contains 14 performance-based items Berg balance scale: evaluates balance performance of nursing home and community-dwelling older adults; contains 14 functional mobility items Dynamic gait index: composite measure of ability to adapt gait during movement-related tasks

Assessing Static and Dynamic Balance With Direct Measures Uses expensive, computerized force plate with at least three force transducers that quantify vertical pressures applied to the support platform. System derives coordinates of center of pressure. Computerized systems provide data about postural sway and steadiness. Force platform balance tests provide valid information about postural control that can be used to predict risk of falling among older clients. (continued)

Assessing Static and Dynamic Balance With Direct Measures (continued) Computerized dynamic posturography assesses the individual and composite functioning of sensory, motor, and biomechanical components of balance. Can examine ability to maintain an upright posture when visual and proprioceptive sensory information is modified mechanically. Can be used to assess functional tasks such as walking, turning, and changing posture. (continued)

Assessing Static and Dynamic Balance With Direct Measures (continued) Limits of stability test measures maximum excursion of COG and assesses degree to which one is able to lean in several directions while maintaining balance over a fixed supporting base. Limits of stability test provides reliable scores and is predictive of risk of falling. Biodex Stability System can evaluate and train neuromuscular control by quantifying ability to maintain dynamic postural stability on both stable and unstable surfaces.

Designing Balance Training Programs 2008 Physical Activity Guidelines for Americans suggests balance training at least 3 days a week for inactive and active older adults (≥65 years). ACSM stated that balance, agility, and proprioceptive training is effective for preventing falls. Balance training exercises are effective for reducing the risk of ankle sprains and recurrent sprains in athletes. (continued)

Designing Balance Training Programs (continued) General guidelines: –Engage in balance activities 2 or 3 days a week. –Progressively increase difficulty of the balance exercises by using a narrower base of support. –Include dynamic movements that challenge the COG. –Use exercises that stress postural muscles.

Balance Training Exercise Prescription Resistance training, stretching programs, and numerous other forms of exercise may help maintain and improve balance. Uneven surfaces and computerized balance training systems may add variety and challenge to balance training programs. (continued)

Balance Training Exercise Prescription (continued) Exercises specifically designed to improve functional ability of lower extremities may help improve balance and prevent falls in older adults. They complement flexibility and resistance training routines. Square-stepping exercise is better than regular walking in reducing risk factors associated with falling. (continued)

Balance Training Exercise Prescription (continued) Resistance training as an isolated intervention is not shown to consistently improve balance of older adults. Therefore, strength alone is not the major underlying mechanism for poor balance. Muscle power (force x velocity) may be a limiting factor in balance control. High-intensity strength training targeting key lower- extremity muscle groups can improve postural control in balance-impaired older adults. (continued)

Balance Training Exercise Prescription (continued) Research on balance training is scarce. Therefore, there are no existing guidelines for balance program design other than to individualize the program. Tai chi is a popular method of exercise with numerous benefits; it has received substantial amount of research interest. Yoga is not as well researched in terms of balance programming.