Balance training is one of the top ten worldwide trends in the fitness industry. Balance is the ability to distribute your weight in a way that enables you to hold a steady position or move at will without falling. Poor balance is a contributing factor to falls. According to the National Council on Aging (NOCA) falls represent the leading cause for fatal and non-fatal injuries in older Americans.

Here is a quick test to gauge your balance skill. Stand with your feet shoulder distance apart. Fold your arms over your chest. Raise one foot behind you and close your eyes. Have someone monitor the time until you uncross your arms, tilt sideways more than 45 degrees, move the standing leg or touch the other leg to the floor. People 20-49 years old are able to hold the position for 24-28 seconds on average. People 50-59 years old for 21 seconds; 60-69 years old for 10 seconds; and 70-79 years old for 4 seconds. People over 80 typically cannot maintain the position at all.

The good news is that balance can be improved and the pool is the perfect place to train. Because the water’s buoyancy and resistance helps support the body, exercises can be done without fear of falling. There are a variety of strategies used to improve balance including gait training, core strength training, deep-water exercise, unpredictable commands and balance challenges.

Gait training is walking practice. People who are afraid of falling may shorten their stride, keep their feet in contact with the floor (shuffle), reduce their arm movements, and bend forward to see where their feet are going. Ironically this increases their risk of falling. The goal of gait training is to lengthen the stride and improve confidence while walking. Some gait training exercises for the pool include:

• Walk forward
• Walk backward
• Walk sideways
• Walk in a diagonal pattern - face forward while walking toward the corner rather than turning toward the corner
• Walk in a square
• Walk in a bowtie pattern
• Walk in random patterns

Core strength training targets the postural muscles of the trunk. Reduced core strength affects posture, may cause difficulty with walking and, thus, may contribute to falls. Functional core strength exercises can be performed in a vertical position with the spine in neutral alignment. Try these aquatic movements that target core strength:

• Walk forward or backward with hands on hips

• Walk forward or backward with resisting arm patterns
• Walk forward, stepping with the same foot first
• Lift the knee, straighten the leg & power press down
• Side step with arms up at shoulder level
• Crossover walk
• Run in multiple directions
• Wide leg jog
• Jog with the toes in or out
• Rocking horse
• Cross-country ski
• Cross-country ski with feet wide
• Cross-country ski with rotation
• Cross-country ski, Level II
• Jumping jacks
• Jumping jacks with the toes in or out
• Crossover kick
• Crossover kick and sweep out
• Athletic stance, brace the core, create arm turbulence
• Spinal rotation
• Spinal rotation with resistor arms

Deep-water exercise is performed in water that allows the participant to remain vertical without the feet touching the pool floor, typically while wearing a flotation device. The deep end of the pool is ideal for targeting core strength, as the individual must continuously engage the stabilizing muscles of the core to maintain neutral spinal alignment. Regular participants in deep-water exercise classes often notice marked improvement in posture. Deep-water exercises that functionally train the core include:

• Knee-high jog in multiple directions
• Knee-high jog with hands on hips
• Knee-high jog with resisting arm patterns
• Flutter kick
• Bicycle
• Bicycle with one leg and breaststroke
• Reverse bicycle with one leg and reverse breaststroke
• Crossover walk
• Straddle jog
• Skateboard with thumbs up
• Cross-country ski
• Cross-country ski with rotation
• Jog, flutter kick, bicycle or cross-country ski with the body leaning to a side diagonal (note that the ears, shoulders, hips, knees and ankles are still vertically stacked)
• Crossover kick
• Crossover kick and sweep out
• Deep-water jacks
• Jack tucks
• Seated bent knee jacks
• Seated kick with unison shoulder press, travel forward
• Seated kick with unison shoulder scoop, travel backward
• Tuck and hold with breaststroke or reverse breaststroke
• Log jump side to side
• Log jump forward and back
• Abdominal pike and spine extension
• Brace the core, create arm turbulence
• Seated swirl

Unpredictable commands train the body to react to the unexpected, and offer a great option to target core muscles. One seldom anticipates a fall, so being able to react quickly when something unexpected happens can reduce the risk of falling, or minimize injury should a fall occur. Practice fall recovery in the pool. Start with buoyant equipment, such as a noodle or hand bars, in the hands. Let the body fall forward or sideways, then tuck the knees and feet under you and return to standing. After some experience, try this drill without equipment.

The Unpredictable Command Technique uses familiar and unfamiliar random patterns to improve awareness, balance, agility, coordination and reaction time (Ogden, 2001). Some unpredictable commands to try in the pool

• Walk with quick change of direction
• Walk, circle both thumbs clockwise
• Walk diagonal to a left corner, look over right shoulder (and opposite side)
• Walk forward with the right foot forward (or the left foot forward)
• Walk forward with the right foot forward, right hand on hip, bowstring pull with the left hand (or opposite side)
• Step sideways right 3X, step sideways left 1X
• Step sideways, one arm crosses in front & one crosses in back
• Step sideways, turn head sideways
• Knee-high jog with one foot forward
• Knee-high jog, circle clockwise, look over left shoulder
• Knee-high jog, circle counterclockwise, look over right shoulder
• Knee-high jog, one arm breaststroke, the other arm crawl stroke
• Cross-country ski with lat pull-down
• Cross-country ski with one arm behind the back
• Jumping jacks with arm swing
• Jumping jacks with one arm behind the back
• Inner thigh lift right, hopscotch left (and opposite side)

Balance challenges are exercises performed with a narrow base of support, such as feet together, one foot in front of the other, or standing on one foot. If necessary, the exercises can be done holding onto a wall. When that becomes easy, try holding onto a noodle instead of the wall. The goal is to be able to perform the exercises without holding onto anything. Slow movements are more challenging than faster ones. Adding equipment also increases the challenge. Be sure to cue participants to brace the core.

The following is a sampling of balance challenge exercises:

• Weight shift – with weight on right leg, lift left foot off the pool bottom; then put the left foot down, shift weight to the left leg & lift right foot off the pool bottom
• Walk on a balance beam (one foot in front of the other)
• Walk on toes
• Walk forward 3 steps, pause & lift the heel
• Walk forward 3 steps, stand on one foot with hands up and check posture
• Walk forward 3 steps & pause, sideways right 3 steps & pause, backward 3 steps & pause, sideways left 3 steps & pause
• Jog 3X and hold (knees high or heels high)
• Jog travel sideways 2 steps, stand on one foot with hands up and check posture
• Rocking horse 3 counts & pause
• Squat on one foot
• Stand on one foot, swing opposite knee forward and back
• Stand on one foot, swing opposite leg forward and back
• Stand on one foot, open and close opposite hip (knee bent)
• Stand on one foot, swing opposite leg to the side and then cross midline
• Stand on left foot, flex the left shoulder & right hip (or opposite side)
• Stand on left foot, abduct the left shoulder & right hip (or opposite side)
• Stand on left foot, flex the left elbow & right knee (or opposite side)
• Stand on one foot, arms sweep side to side
• Stand on one foot, arms sweep side to side, eyes closed
• Stand on one foot, turn head R and L
• Stand on one foot while a partner runs around you creating turbulence
• Exercises with equipment:
• Feet tandem (one in front of the other) or stand on one foot, sweep drag resistance side-to-side (both arms or one arm)
• Feet tandem or stand on one foot, lat pull-down with drag resistance or buoyant hand bars (both arms or one arm)
• Feet tandem or stand on one foot, triceps extension with drag resistance or buoyant hand bars (both arms or one arm)

There are so many options that it is easy to include exercises to improve balance during the cool down portion of your class, or make it the focus of an entire class. Improved balance benefits everyone.

RESOURCES

Adler, Donna. Integrated Balance. MAAP CET, September 27, 2014

Aquatic Exercise Association. 2010. Aquatic Fitness Professional Manual, Sixth Edition. Champaign, IL: Human Kinetics.

Heyward, Vivian, and Gibson, Ann. 2014. Advanced Fitness Assessment and Exercise Prescription – 7th Edition. Champaign, IL: Human Kinetics

Ivens, Pauline and Holder, Catherine. 2012 Do No Harm: Contraindications in Water Exercise. www.aquaaerobics.com

National Council on Aging. Falls Prevention Facts. Accessed June 10, 2016. www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/

Ogden, David. 2001. The Unpredictable Command Technique. DSL, Ltd.

Sova, Ruth. Designing a Balance and Mobility Program. AKWA, August/September 2015.

Author

Christine Alexander is the author of Water Fitness Lesson Plans and Choreography. She is an AEA CEC provider and a member of the board of the Metroplex Association of Aquatic Professionals in Dallas, Texas. She teaches water fitness classes for the City of Plano Parks and Recreation Department. She holds certifications through AEA, USWFA, YMCA, and the Arthritis Foundation. Christine can be reached through her webist at www.waterfitnesslessons.com