Balance, which is often overlooked and undertrained, is necessary for all functional movements and essential for the prevention of falls and fall-related injuries. Balance generally declines with age, with nearly one in five older adults reporting issues with dizziness or balance, including problems such as unsteadiness and difficulty walking on uneven surfaces and climbing stairs. In addition, these balance problems can negatively affect older adults’ ability to perform activities of daily living as well as participate in exercise, social events, driving and work responsibilities (Lin and Bhattacharyya, 2012).

Balance training, which consists of activities that challenge an individual’s ability to maintain posture and stability over a base of support, is essential for maintaining and improving balance. These balance improvements can ultimately help your older clients improve physical function, maintain independence and increase overall quality of life. Although balance training can be beneficial, it can often be challenging to fit additional balance exercises into the allotted time for your personal-training sessions or group fitness classes. Here are a few ways to incorporate balance training throughout your workout sessions or classes without adding additional exercises or extending the training session duration:

• Perform functional movements. Functional movements inherently train balance as they incorporate multijoint movements that challenge the center of gravity to mimic activities of daily living. Functional exercises such as lunges, squats and deadlifts specifically train dynamic balance, which is the ability to maintain stability while actively changing body position over a base of support. Additional progressions to further train balance and stability include incorporating multiplanar, plyometric and sport-specific exercises.
• Add a balance component to an exercise. Take your functional movement a step further and add an additional balance component to the exercise. For example, add an arm lift and rotation following a push-up or add a slow knee lift as you come out of a squat or lunge.
• Narrow the base of support. Narrow the base of support while performing standing exercises such as biceps curls or shoulder raises to incorporate a balance challenge into any exercise. This type of balance training can help improve static balance, which is the ability to maintain posture over a base of support. This can include bringing the feet together, performing a tandem stand with one foot directly in front of the other, or balancing on one leg.
• Decrease surface stability. Incorporate a variety of props including balance pads or discs, BOSU® Balance Trainer, balance boards or stability balls to decrease the surface stability on which your clients or participants are standing or sitting. Dynamic or static exercises can be performed with these props.
• Disrupt the client’s center of gravity. Disrupt your client’s center of gravity by pushing or pulling him or her off balance while he or she is performing an exercise. For example, gently push on your client’s shoulder while he or she is performing a lunge or push on the side of a medicine ball your client is holding while performing a squat. All clients should perform this type of activity first while holding onto a stable support such as a wall or fixed bar. Note: disrupting center of gravity should be avoided in clients who are at a high risk for falling (e.g., those who are known fallers, are on medications that cause dizziness, or for whom falling could be catastrophic such as those with osteoporosis).
• Incorporate sensory-specific balance challenges. There are three main sensory systems that the body uses to maintain balance: the visual, vestibular and proprioceptive systems. These sensory systems send information to the brain about where the body is in space. The visual system provides information about where your body is in relation to what you see in the environment; the vestibular system provides information about the position and movement of your head; and the proprioceptive system provides information about where the body is in space based on muscle and joint activity. Incorporate balance training in your sessions and classes by creating sensory-specific balance challenges. For example, closing the eyes during an exercise reduces visual input, moving the head while performing an exercise challenges the vestibular system, and standing on an unstable surface challenges the proprioceptive system.
• Add balance exercises in between sets. If your workout includes a rest period between sets, turn it into an active balance period by having your client or participants balance on one foot or stand on an unstable surface between sets.

Safety Considerations

Before incorporating balance training into your workouts, it is important to consider the following:

• Make sure participants can perform each strength or functional movement before adding additional balance or stability challenges to the exercise.
• Start out with a balance challenge that is appropriate for the individual’s fitness level and gradually progress from there.
• Perform balance exercises near a stable structure such as a wall or bench.
• Clear the floor of any obstacles not required for the balance exercise.
• Monitor intensity and always gain feedback from you client and participants.

Reference

Lin, H.W. and Bhattacharyya, N. (2012). Balance disorders in the elderly: Epidemiology and functional impact. Laryngoscope, 122(8), 1858–1861.