The act of balancing

Maintaining proper balance as you age requires attention, strength, and flexibility.

One skill that can sharply decline with age, and often with little warning, is your sense of balance.

"As people age, changes in flexibility, muscle strength and power, body sensation, reflexes, and even mental function all contribute to declining balance," says Dr. Brad Manor, associate director of the Mobility and Falls Translational Research Center with Harvard-affiliated Hebrew SeniorLife. "You need to work on all these factors to maintain a strong sense of balance."

Your sense of balance is what enables you to maintain your center of mass when you stand, walk, jump, run, bend, twist, or make any other type of active movement. We take our ability to balance for granted, but it actually involves a complex system.

Whenever you move, your eyes and brain process information about your surroundings. Your feet detect changes in the terrain. Your arms swing to keep you stable, and your lower-body muscles and joints generate rapid power so you can move forward, stop, and change directions.

Get moving with tai chi

The mind-body exercise of tai chi is another way to improve balance. In tai chi, you work on transferring weight from one side to the other while you move your legs, arms, and upper body. The slow, flowing sequence of movements also forces you to pay attention in order to perform the action accurately and remember what comes next. Tai chi is ideal for people who struggle with balance or have recovered from surgery or an injury that may affect stability. Poses also can be modified and done from a chair. You can find tai chi classes at many community and senior centers. You can learn more from the Harvard Special Health Report An Introduction to Tai Chi (www.health.harvard.edu/tai).

System breakdown

Unfortunately, this system works less effectively over time. The sensation of our bodies moving through space is not as crisp, and information travels more slowly between the body and brain. Muscles become weaker, and joints lose flexibility.

"Our sense of balance also is dependent on attention to detail and short-term memory," says Dr. Manor. "This helps block distractions, so you can make quick decisions, like when to move faster or slower or how to navigate across a busy street or uneven pavement."

Any breakdown in your balance system increases your risk of falls, which can cause hip fractures, broken bones, and head injuries. In fact, more than one out of four adults ages 65 and older fall each year, according to the CDC.

Taking steps

"Doing more balance exercises and activities can keep your sense of balance in good shape, but you also want to focus on multifaceted movements that work on all the elements of your balance system," says Dr. Manor.

There are many kinds of balance exercises. Science has not tapped any specific ones as the best; however, some have stood out in many balance-related studies.

For example, a 2016 study in the journal Gerontology and Geriatric Medicine found that a specific Balance-Enhancing Exercise Program (BEEP) improved balance skills among adults ages 60 to 80. Study participants did better on both solid and uneven surfaces and increased their walking speed and overall confidence.

The BEEP program focused on three exercises: squats, heel and calf raises, and one-legged standing. "These types of exercises increase both the physical and cognition skills needed for better balance," says Dr. Manor. "Plus, they mimic movements of everyday life."

He recommends adding these to your regular workouts, or even doing them daily on their own. "Balance is definitely a use-it-or-lose-it skill," says Dr. Manor. "But if you work on your balance continuously, you are almost guaranteed to see improvements."

Squats. Stand with your feet shoulder-width apart. Bend your knees and imagine you are sitting down on a stool. Lower down until your thighs are parallel to the ground, or as far as is comfortable.

Keep your weight on your heels. Extend your arms forward or place your hands on a chair, counter, or table for stability. Pause for a second or two, then rise back to the starting position. Do this up to 10 times.

Heel and calf raises. Stand with your arms crossed over your chest and raise your heels so you rise up on your toes. Hold this position for up to 10 seconds, or as long as possible, and then lower your heels. Do this five to 10 times. If you need support, hold on to a door frame, a table, or another sturdy object. You also can place your hands flat on a wall.

One-legged standing. Stand tall and place your hands on your hips or hold on to a table or chair for stability. Then raise one leg so your foot is about six to 12 inches above the floor. Keep your gaze straight ahead. Hold for 20 to 30 seconds. Repeat on the other leg. Switch back and forth three to five times.

Hop to it

Older adults often fall when they stumble and cannot quickly regain their balance. "This is usually because of slower reaction time," says Dr. Brad Manor, with Harvard-affiliated Hebrew SeniorLife. You can improve this skill with bunny hops. Place a strip of tape on the floor and jump back and forth over it up to 10 times. For a challenge, make a cross with the tape and jump from corner to corner.

Dual tasking

You also can perform these exercises with your eyes closed to work on coordination and concentration.

Another option is to "distract" yourself by doing unrelated cognitive tasks; for example, count backward, name words that begin with the same letter, or make a mental grocery list.

"This kind of dual-task training can strengthen the connection between your brain and your body, so you think and move at the same time," says Dr. Manor. "This can help prevent distractions and mental lapses that may contribute to a fall."

Image: Nastasic/Getty Images

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