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Your Daily Walk May Not be Preventing Falls!

Walking is an excellent exercise. Elders who walk on a regular basis have a lower chance of developing obesity, arthritis, heart disease, diabetes, and many other chronic health conditions.  Walking helps to maintain muscle strength, mobility, and agility. Walking is one of the most popular forms of exercise for many elders (70% of physically active elders report walking as their main form of exercise) and is often prescribed by doctors and other health professionals as a way to reduce the risk of falling.

So it came as a surprise, when I recently read a report in which walking programs designed for sedentary elders had no real impact on avoiding falls. One reason for this is that while walking improved mobility, it didn’t improve balance.

In order to improve balance, walking needs to be brisk. Walking at a leisurely pace helps to maintain one’s mobility, but is insufficient to improve balance. Elders who walk vigorously (at least four times per week) are at much lower risk of falling than elders who walk less often, more slowly, or not at all.

The sense of balance and walking speed (how fast a person walks) worsens with age. As the years pass, elders often start walking more slowly and with greater difficulty, fatiguing more easily. When required to walk quickly, individuals may not be able to increase their speed and stride length at the same time. This is because elders tend to be more cautious and opt out for greater stability. Individuals with a fear of falling, in particular, walk very slowly and exhibit great caution with each step.

Walking ability can be further compromised by:
  • Health conditions (such as arthritis, diabetes, heart disease, Parkinson’s, etc.)
  • Medication side effects causing fatigue, light-headedness, etc.
  • Visual problems (cataracts, glaucoma, macular degeneration) and an inability to see environmental obstacles/hazards.
  • Hearing loss. This may result in not hearing warning sounds when walking, such as oncoming traffic and/or people. 
  • Lack of muscle strength and flexibility.
  • Foot and ankle problems (bunions, hammertoes, etc.).
  • Improper/poorly fitted footwear.
  • Hazardous environmental conditions Trip/slip hazards include sidewalks with cracks, hard to visualize curbs/curb cuts, unsafe surfaces (wet leaves, mud, gravel, ice/snow, etc.), items in the walk path, etc. 

Health Visits

If elders have any problems with walking, they should schedule a visit with their doctor. He or she will do a complete evaluation of the elder’s health (including a review of all drugs) to see if there are underlying health conditions that might be interfering with their walking ability. Elders should also have their eyes and ears tested annually to keep them sharp.

Footwear 

Choose the right footwear:
  • Make sure that shoes fit properly.
  • All footwear should be sturdy and well-fitting.
  • Choose flats or shoes with low heels. Avoid high heels or thick soles (>½ inch thick).
  • When choosing walking shoes, look for something lightweight with a midsole not too flexible.
  • Avoid slick-soled or shoes that are too ‘grippy.’

The Walking Environment

Pay attention to where you walk:
  • Pathways should be wide enough to navigate easily.
  • Sidewalks should be in good condition (free of cracks or potholes that can create an unexpected trip hazard).
  • Surfaces should be free from gravel, rocks, and mud.
  • Sidewalks that have depressions in the walking surface can trap water and mud and create a slip hazard. These should be repaired.
  • Items placed in the path of travel, such as trash cans and garden planters should be removed.
  • Landscaping that is planted too close to sidewalks should be kept pruned If unchecked, the vegetation can overtake the sidewalk creating trip and fall hazards.
  • Tree roots can cause sidewalks to heave and buckle causing serious trip and fall hazards. These areas should be identified and corrected.
  • In winter weather, make sure steps and walkways are cleared of snow and ice. Use snowmelt, rock salt or even cat litter in areas where water may accumulate and re-freeze.

Walking Exercises

There are several ways to vary a walking routine that helps to improve balance:

Take Long Strides

When walking, pick your feet up, landing with a heel hitting the ground and taking long strides. Additionally, it is important to swing the arm that is opposite to the foot being stepped on up to shoulder height. This will help to provide momentum and improve balance. At first it may be necessary to think about every step taken, but with practice it will become more natural to land on the heel first and swing the opposite arm.

Tandem Walking

To do the tandem walk, stand straight and step your right foot forward so that your right heel lands touching the front of your left toes. Then place your right toes down so both feet are flat. Next, step your left foot forward so your left heel touches your right toes and then lower your left toes. Continue walking forward, touching your heel to your toes. For those with balance problems, start out using the hallway for support and safety (select a hallway that is narrow enough that your fingertips can touch the walls when your arms are stretched out to the side).

Tai Chi Walk

Tai Chi is a slow and graceful form of exercise. To perform a Tai Chi walk, stand straight with the feet together. Bend the right knee and lift the right foot off the floor. Step forward placing the right heel down first. Then roll through the right foot until both feet are flat and the legs are in a lunge position. Do the same motion with the left foot and continue walking forward. The focus is on moving slowly, with control and rolling through the foot when pushing off and landing. The larger the step that is taken, the harder it is to balance, so take small steps at first.

Water Walking

For those individuals with painful joints or severely compromised balance, walking in the water is an option. The buoyancy of the water eases pressure on painful joints, and you can walk along the side of the pool and hold on to prevent a fall. Walking in the water uses all the major muscle groups if you focus on pushing your body through the water to walk.

Guest post by Dr. Rein, this post originally appeared in E-CareDiary.com

Rein Tideiksaar Ph.D., PA-C is the president of FallPrevent, LLC, Blackwood, NJ, a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr Tideiksaar is a gerontologist (health care professional who specializes in working with elderly patients) and a geriatric physician's assistant. He has been active in the area of fall prevention for over 30 years, and has directed numerous research projects on falls and has developed fall prevention programs in the community, assisted living, home care, acute care hospital, and nursing facility setting.

Dr. Rein has written several online continuing education course on falls: 

Caring for People With Fall Risks
Facts About Falls
Managing Falls In the Nursing Home: Who, Why and What Next?
Managing Falls IN the Nursing Home for Administrators
Preventing Falls
The Fall Prevention Care Process


Dr. Lisa Goins has written a fall prevention course:

Vitamin D Prevent Falls in Older Adults 


Posted: 3/2/2015 1:52:01 AM
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