The Netherlands Institute for Sports and Physical Activity (NISB) has developed five short course modules as part of the “Exercise and Health” project aimed at preventing or reducing ageing problems. The modules have been developed for people who have gotten out of the habit of exercising and are designed to get them back to a daily exercise routine that meets the Dutch standard for healthy exercise (30 minutes of moderately intensive physical activity on at least 5 days per week).
This article discusses one of the five modules: In Balance. In Balance is a sporting and educational program aimed at preventing falls.
Falls: Figures and Consequences
Falls are a major - though often underestimated - social problem across the globe. About one-third of all over-65s fall once a year, and 15% fall twice or more .
According to the knowledge network for fall prevention in older adults, about 88,000 seniors in the Netherlands are treated in emergency rooms of hospitals for fall-related injuries each year. Just over half of these elderly patients sustain a fracture, 11% of which concern hip fractures, often with dramatic consequences .
More than one-quarter of people who fall die within one year of sustaining the fall, half of them never regain full mobility, and one-quarter make a full recovery. It should be noted that these serious consequences are not always the direct result of the fall. The period of inactivity following the fall may also have disastrous consequences for organs, limbs, and muscles.
However, falls without serious injuries have consequences as well. Recurrent fallers develop a fear of falling and tend to become less physically active. This is unfortunate, as exercise is a particularly strong factor in preventing a range of ageing symptoms.
Fall Prevention and Motor Skills Training
Recurrent falling is caused by a combination of extrinsic (home environment safety) and intrinsic factors (physical and mental condition). Everyday home situations can cause falls to occur. Falls are often the result of tripping, slipping, and stumbles from fixed stairs.
In the 1990s, efforts were primarily directed at eliminating extrinsic factors, but research has demonstrated the important role of intrinsic factors. Today, it is clear that intrinsic factors make the difference.
The main intrinsic risk factors are confusion, use of psychopharmaca, and cardiovascular problems. At the top of the list for community-living elderly people are mobility disorders . Decreased motor skills form a major approach to fall prevention, especially as practically every elderly person will be affected .
All residents of long-term care facilities have an increased fall risk. As people’s capacities to literally stand on their feet decrease, environmental factors and interventions (e.g., passive protection measures such as hip protectors) become more important. For elderly people living in the community, this is different. Motor problems adversely affecting mobility usually manifest themselves by the age of 75. It is therefore advisable to start prevention programs around this age. This applies even more for seniors who have experienced more than one fall per year.
Therefore, a range of studies as well as a guideline from the Dutch Institute for Healthcare Improvement (CBO) call for targeted training programs within a multidisciplinary context. General training alone is not enough. Specific training designed to reduce the number of fall incidents must contain elements of balance, strength, and coordination.
One effective fall prevention program is In Balance, developed by the Netherlands Institute for Sports and Physical Activity (NISB). A recent study by the Amsterdam VU University found that the program can reduce falls by up to 61%. (Just ten years ago, physical training programs were able to achieve reductions of 20%.)
Launched in 2000, In Balance combines Eastern and Western approaches and includes information aimed at increasing participants’ personal knowledge and enhancing their motivation. The program is designed with a low psychological threshold because many seniors with a fall risk are inactive, and its components allow for the activities to be incorporated into daily life. The program is also suitable for a group format.
In Balance consists of a theoretical part (three sessions) and a practical training (ten sessions). The training part includes the following:
- Strengthening and flexibility exercises for feet, ankles, legs (work on the base)
- Strengthening and flexibility exercises for the pelvic area (work on the middle)
- Balance enhancement exercises (simple movements, performed according to tai chi principles). The exercises under 1 and 2 serve to support these balance exercises.
- Balance dance, a short sequence of movements derived from tai chi-related Chinese exercises (moving qigong). (Everything that has been learned comes together in this dance-like sequence of movements.)
- Functional training of walking, standing, sitting, standing up from a chair or from the floor, all on the basis of the skills and awareness already practiced.
Over the years, program designers have made improvements based on experience gained in practice. One of the elements that has been added is a series of simple tests, so that both individual progress and group progress can be monitored. The result of all this is that In Balance has now become a fully-fledged information and training program, targeted at elderly adults who exhibit the first signs of fall problems or general motor impairments.
Results of In Balance
In 2003, three years after the launch of In Balance, a small effect study was carried out by the Netherlands Organisation for Applied Scientific Research TNO. The study found that In Balance had a positive effect on the outcome of balance tests and some other mobility-related tests .
The percentage of participants who could stand in a tandem position for 10 seconds increased from 66% before program participation to 88% after participating (p <0.05). The time needed to perform the timed up and go test averaged 11.2 seconds before program participation; that time was reduced by an average of 1.1 seconds (p = 0.03) after program participation.