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Protect against falls with progressive resistance training.

One out of three adults age 65 and older suffers a fall each year, and falls are the leading cause of both fatal and nonfatal injuries among seniors, according to the Centers for Disease Control and Prevention.

"A fracture resulting from a fall can lead to blood clots, respiratory complications, pressure ulcers, and muscle weakness, as well as exacerbation of pre-existing conditions due to inactivity, such as diabetes, heart disease, and arthritis," says Ellen Wilson, PT, Director of Therapy Services with UCLA Health.

"Even people who fall, but are not injured, develop a fear of falling. This may cause them to limit their activities, which leads to reduced mobility and fitness level, and ironically, increases their actual risk of falling."

Hip, knees, feet, and ankles

Balance exercises have been shown to help seniors reduce their risk of falls. Yet a new study has shed light on another means of protection: progressive resistance strength training.

These exercises target the joints and muscle groups that tend to weaken with age and are linked to most falls: the hip, knees, feet, and ankles.

Published in the Journal of Clinical and Diagnostic Research, the research involved subjects age 65 to 82. They performed a structured progressive resistance training program (PRT) for one hour, four times a week, for six months. The six-exercise PRT routine targeted muscle groups in the lower extremities: hip flexors, extensors, and abductors; knee flexors and extensors; ankle dorsiflexors; and plantar flexors.

"These muscle groups and regions are designed, in part, to maintain upright posture and are constantly activated to maintain balance," says Wilson. "If one loses their balance, these are the muscles and joints that will prevent the fall, so they need to be strong and flexible."

The amount of weight used in the exercises was based on each person's one-max rep (1 RM)--the maximum amount of weight needed to complete one repetition with good form.

Subjects performed three sets of 10-12 repetitions for each exercise, with a rest period of up to one minute between sets. For the first week, the exercise intensity was set at 45 to 55 percent of the individual's 1 RM, and was gradually increased every week until it reached 65 to 75 percent.

The researchers found that PRT increased subjects' strength by 22 percent and improved overall balance function and stability compared with a group who performed only balance exercises.

PRT specifically works to strengthen both fast-twitch and slow-twitch fibers in muscles, says Wilson. "The fast-twitch fibers are activated when a quick reaction is needed, such as preventing an active fall. Slow-twitch fibers are constantly activated to maintain upright posture and balance. Throughout the day, these fibers help to control movement and stabilize your upright posture."

The right combination

The researchers pointed out that PRT should not be regarded as superior to balance exercises, or as a substitute, but could be used to further increase one's stability and balance. "The ideal exercise regime is a combination of both strength training and balance/stability exercises," says Wilson.

You can perform these same types of PRT exercises at home using a resistance band and exercise ball to produce the necessary force.

In order to replicate the progressive resistance aspect without using weights, begin with smaller reps (about five) and gradually increase to 10. You can also increase the resistance by making the bands tighter, using heavier resistance bands (they come in different colors to indicate levels of resistance), or holding the poses longer before coming out.

The five exercises illustrated on pages 6-7 target the hip, knees, feet, and ankles: Resistance Band Clamshells (hip), Stability Ball Wall Squats (knees), Dorsiflexion and Plantar Flexion Resistance (feet), and Ankle Inversion/Eversion Resistance (ankles).

Add them to your regular workout routine and balance exercises and you can protect yourself from becoming a fall statistic.

RESISTANCE BAND CLAMSHELLS

Lie on your left side, right leg on top of the left, knees comfortably bent.

With a resistance band wrapped around your knees, rotate the right leg up until your leg makes a 90-degree angle to the floor.

Hold for 1-2 seconds and slowly return to the starting position.

Change positions and complete the same number of repetitions and sets with the opposite leg.

STABILITY BALL WALL SQUATS

In a standing position place a stability ball behind your back against a wall at waist level with your hands to your sides.

Slowly bend your knees into a semi-squat position, upper legs not quite parallel to the floor, allowing the ball to roll up your back.

Hold for 2-3 seconds, straighten your legs, and slowly return to the starting position.

Variation: Don't bend your knees or lower your body to the full semi-squat position.

PLANTAR FLEXION RESISTANCE

Sit on the floor or in a chair. Place a resistance band around the ball of your right foot, and hold the ends in your hands.

Push the band toward the floor until you feel your calf muscle contracting.

Hold for a second; then return to the starting position to complete one repetition. After finishing your reps, switch feet and repeat.

DORSIFLEXION RESISTANCE

Sit on the floor or in a chair. Secure one end of a resistance band to a table leg or sturdy object, and hook the other end around the top of your right foot.

Pull the band towards your body until you feel the stretch in the bottom of your foot.

Hold for a second; then return to the starting position to complete one repetition. After finishing your reps, switch feet and repeat.

ANKLE INVERSION/EVERSION

ANKLE INVERSION (right): Secure one end of a resistance band to a table leg or sturdy object, and hook the other end to the inside of your forefoot

Keep the heel still and move your forefoot inward, pulling against the band. Return to the starting position to complete one repetition. After finishing your reps, switch feet and repeat.

ANKLE EVERSION (right): Hook the band on the outside of your forefoot, and then move your foot to the outside against the band. Return to the starting position to complete one repetition. After finishing your reps, switch feet and repeat.

WHAT YOU SHOULD KNOW

Guidelines for performing at-home PRT:

* Do five reps at first, and gradually increase to 10 reps.

** Complete two to three sets.

* For added resistance hold the pose longer, and/or make the bands tighter, or use a heavier resistance band.
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Title Annotation:EXERCISE
Publication:Healthy Years
Date:Feb 1, 2015
Words:1066
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