Balance Exercise Prescription
According to the National Institute of Health, balance is one of the four main types of exercises that is recommended to improve your health and physical activity. However, “balance exercise” is a general term when referring to a variety of exercises. The big question is: how often and how much of this do I actually need to do to make a difference? The frequency, type and intensity of exercise is important when making a difference to your health and lifestyle. In this blog post we are going to be talking about the recommendations on how to start working on your balance!
As described in our previous post HERE on balance, we know that balance is affected by many factors. Therefore there are many areas in regards to exercise that we can work on to improve our balance. The FITT Principles are designed and researched by the American College of Sports Medicine to give a guideline of Frequency, Intensity, Time and Type of exercise that is beneficial for improving safety, quality of life and overall health. When it comes to balance exercises, due to the complex nature of our balance systems, they give a more general guideline and recommendation for how to maintain and improve our balance as we age. They state that neuromotor exercise training should include a combination of balance, agility and proprioceptive training 2-3x/week, at a minimum. The recommendation for those with a balance impairment however would be slightly higher but is individual to each person. When designing a balance program, it is recommended to focus on 5 main areas to ensure that the entire balance system is challenged. This should initially be done with the supervision of a trained professional, such as a physical therapist, due to the increased risk of falling and the specialized nature of the exercises.
5 areas of focus for balance programs:
Static balance: increasingly progressive postures that narrow the base of support. For example, moving from standing on 2 legs, to one foot in front of the other to a single leg stance.
Dynamic movements: performing exercises that perturb the center of mass such as line walking or circle turns. This can be made even more challenging by adding external stimuli and working on complex whole body movements.
Postural muscles: performing movements or adding challenges that initiate the use of postural muscle activation such as heel/toe standing or forward reaching.
Proprioceptive Training: reducing sensory input. This can be in the form of changing the support surface to one that is more compliant or performing exercises with eyes closed to impede the visual system.
Tai Chi: this specific type of exercise is so important it has its own section. We will be doing a whole blog post in the future on the research behind Tai Chi but in general it works on slow and controlled movement, transitions from one leg to another, and challenging your base of support and ability to weight shift.
These 5 recommendations are areas that physical therapists focus on when designing a balance program for a client. Usually a balance program will include a combination of all of the above. Physical therapists are trained in the ability to assess balance and then appropriately regress or progress exercise to allow individuals to safely move to improve their quality of life. The types of exercises mentioned above are focused on working on balance doing strictly “balance exercises”. The research is strong in this area but additional research shows that there are many types of exercises that can improve your balance even if they are not considered balance exercises. We know that working on your strength, cardiovascular fitness, vestibular system and flexibility are just a few areas that can improve your balance indirectly. We will dive more into each of these topics individually in follow up posts.
Intensity and Time
Now that we have discussed the frequency and type of balance exercises, lets talk about intensity and time. The research is mixed on what is the ideal time is that an individual should work on their balance exercises. While some research articles state that 5-15 minutes is adequate to make a change in one’s balance, others state 60-90 minutes may be needed for specific balance exercises such as Tai Chi. The time a person works on their balance should be individualized to them and goes along with the intensity of an activity. The American College of Sports medicine does not have a prescribed intensity for balance exercises because this is also individualized to each person. What may be challenging for you may not be challenging for your friend or spouse. Therefore, each person who wants to work on their balance would benefit from an individualized assessment from a physical therapist to determine the appropriate intensity of their program. And, intensity really matters! We know that from the perspective of our brain, an activity needs to be challenging enough to make a difference both physiologically and anatomically within our nervous system. The tricky part is measuring how intense an exercise is and what qualifies a balance exercise to be appropriately intense for an individual? Unfortunately, this is where the research stops short.
A large review found that when determining how intense a balance exercise is, most measurements that are used look at the cardiovascular or respiratory system and apply it to a balance activity. When a physical therapist looks at balance clinically, we look at how successful an individual is at the balance task being asked of them. We then use analysis of the task and subjective information from the individual to progressively increase the difficulty of the task. When measuring intensity for any exercise we may use something called the Rate of Perceived Exertion scale (RPE). This scale is a subjective assessment of how challenging a client perceives a task to be. Ideally, we are exercising on the hard to very hard side of the scale to challenge our brain enough to make a change!
Some of the areas of exercise prescription for balance are unclear but here are the main take aways:
Balance exercises should be done a minimum of 2-3x/week.
Balance exercise programs should be designed to address all aspects of an individual's balance system.
Exercises need to be intense enough for an individual to make a physiological change. If you don’t feel like you are being challenged, make sure to let your trainer or physical therapist know!
Next week we will be starting our weekly balance classes Wednesday mornings at 9am. Sign up HERE! Each class will be focused on a different type of exercise that can be done to improve your balance. Join us to start working on your balance or check out our on demand section for more ways to exercise!
Lippincott Williams and Wilkins. ACSM’s guidelines for exercise testing and prescription. Ninth edition. Wolters Kluwer Health. 2014:209-211.
Four types of exercise can improve your health and physical ability. National Institute of Health. Jan 21, 2021. Accessed August 22, 2021.
Farlie M, Robins L, Keating J, et al. Intensity of challenge to the balance system is not reported in the prescription of balance exercises in randomised trials: a systematic review. 2013. Journal of Physiotherapy. 2013: Vol 59;227-235.