Balance -Fundamental part of functional mobility -Always balancing (except sleeping) -Independent movement without fear of falling -Lower extremity strength essential - Core stability -Balance exercises performed daily Balls, Bands & Balance
Stability and Balance Stability – postural control –Maintained by adjusting the body position to accommodate for movement Base of Support (BOS) – area surrounding the body parts contacting the supporting surface Centre of Mass – an imaginary point around which an object’s mass is equally distributed Balance – ability to maintain the centre of mass over the base of support –A person becomes unbalanced when their centre of mass moves outside the base of support Gait – repetitive loss and recovery of balance allowing us to walk Balls, Bands & Balance
Factors Affecting Balance 1.Size of BOS 2.Movement of centre of mass outside of BOS 3.Altered sensory input 4.Changes to the nervous system 5.Certain diseases (i.e. Parkinsons) 6.Reduced muscle strength (especially muscles of the lower body) Balls, Bands & Balance
Flexibility -Range of motion around a joint -Required for independent living -put on a sweater, reach top shelf -Flexible spine indicates good posture -reduces risk of spinal fracture -Static stretching and/or range of motion activities Balls, Bands & Balance
Flexibility -Stiff muscles and joints in seniors is common -Decreased synovial fluid in joints due to normal aging process -Exercise promotes lubrication and keeps joints supple -Perform daily Balls, Bands & Balance
Muscular Strength & Endurance -Strength - Amount of force a muscle can produce in one maximal contraction -ADL’s: Lift heavy pot, get up from bathtub, lift grandchild -Endurance – number of times muscle can repeatedly contract -Required for housework, standing for long periods etc Balls, Bands & Balance
Muscular Strength -Atrophy critical problem for older adults -10% loss of mass up to age 50 -After 60-65, accelerated loss -By age there is 25-50% loss of muscle mass -¼ men and 2/3 women aged 74, unable to lift 10 lbs -Perform 2-4 times per week Balls, Bands & Balance
Keys to Effective Training Core Stabilization: ability to recruit stabilizers to support spine in it’s ideal alignment Spinal alignment: natural curve of the spine in it’s neutral position Balls, Bands & Balance Cervical spine – slight inward curve Thoracic spine – slight outward (kyphotic) curve Lumbar spine – slight inward (lorded) curve Cervical Lengthening – slight chin tuck and lengthening through the back of the neck extending out the top of the head
Keys to Effective Training..cont’d Balls, Bands & Balance Range of Motion – total range of angle which a joint or series of joints is able to move Control – control the movement by going slowly and paying attention to what you are doing; keep in mind each exercise has a specific function Concentration – focus on the muscle that you want to work and you will see that you work harder just by concentrating on that focus point Breathe – Generally, Inhalation = opening/extending; Exhalation = closing or contracting - For beginning use a breathing technique that’s most comfortable for you
Balance Training -Important contributor to falls prevention -Majority of falls occur in walking, turning, climbing stairs or changing positions -Effective interventions include practicing these activities -Strengthen muscles around the hips, knees and ankles Balls, Bands & Balance
Stand with feet shoulder width apart, with ball in hands in front of body. Shift weight onto right leg, and slowly lift left fot to mid-calf level; hold. To challenge balance further, slowly vary position of arms by bringing balls forward, back, to sides, and above head, etc. Unipedal Stance
Balls, Bands & Balance Feet together, ball in one hand, arms stretched out to either side Walk forward, heel to toe, 10 steps Turn around, and return to start position. To challenge balance, raise arms laterally above head and pass ball from one hand to other. Advanced option: If you are comfortable and steady; moving forward, try walking backward rather than turning around. Tandem Walking
Balls, Bands & Balance Functional Reaching Stand with feet shoulder width apart or wider Begin with ball in right hand, reach ball forward keeping feet planted Repeat reaching to either side without moving feet, and then with other arm To further challenge : reach as far as possible while holding ball in both hands and narrow your base of support
Balls, Bands & Balance Stand with feet shoulder width apart, hold ball in front with both hands Move hips around in circles, making circles larger as you progress. Pass ball around waist as you circle hips After circles switch direction and repeat Advanced Option: do same exercise with feet closer together giving you a more narrow base of support Hip Circles
Balls, Bands & Balance Over the Moon: Basic Stretch, Rock Forward & Sit up Sit tall at edge of chair, knees slightly apart, shoulders back and down. Place both hands on ball. Take a deep breath. Exhale fully leaning forward at hips while reaching over the ball Inhale as you roll back to sitting tall Repeat 8-12 times.
Balls, Bands & Balance Progression: Heavy Hands – Sitting or Standing Sit/Stand tall with shoulders back and down Hold light hand weights in each hand, bend both elbows 90 degrees. Begin to swing your arms at a slow and steady pace. Repeat 8-12 times. Sitting Standing Walking * Try to increase length of strides as you walk
Balls, Bands & Balance Kayaking Sit tall with feet flat on floor Both hands on pole, shoulder width, palms down & lift pole to shoulder height Dip pole low on left side and pull back Return to center, Repeat on right side. Return to centre Link strokes to develop rhythm. Repeat 8-12 times.
Balls, Bands & Balance Chair Stands Sit tall in chair, engage abs and back. Breathe in and lean forward from the hips (not waist) Stand up as you breathe out Slowly sit down on the chair while keeping back, head and neck aligned Repeat 8-12 times
Balls, Bands & Balance Stand tall, use a chair/wall as support if needed Mark a line 12-18in ahead with tape, chalk etc. Tap right foot on line. Bring it back and repeat times. Tap left foot on line. Bring it back and repeat times. Alternate right and left taps. Repeat alternate sequence 8-12 times. Step and Stop
Balls, Bands & Balance Stand tall, feet shoulder-width apart, one foot forward and one back Shift weight from rear foot to forward foot, keeping hips and shoulders square and feet on ground With ball between palms, move hands in big “wheel” motion (extend arms in front at hip level, back towards body at shoulder height, then back down to hips) Do 8-12 wheels then switch feet placement & repeat Tai Chi – Prayer Wheel
Balls, Bands & Balance Standing Weight Shifts Stand tall; feet hip-width apart Shift weight to right foot, back to center then to left foot, back to center Repeat alternating sequence 8-12 times. Progress by widening stance & add knee bends to leg receiving body weight Progress further by lifting leg that is not supporting weight Use chair for stability if needed
Balls, Bands & Balance Opposing Circles Divide participants to two groups. Form an outer circle & inner circle. One circle walks counterclockwise while the other walks clockwise. Slow down, then change directions Switch inner participants to outer circle and outer circle participants to inner circle. Repeat coordinated walking
Balls, Bands & Balance KEEPING YOU ON YOUR TOES (Plantar Flexion) Stand tall. Place hands on chair for support Keeping heels on floor, shift weight to toes Lift heels (standing on tip toe) & find balance over balls of feet Hold 3 seconds & lower heels back down Repeat 8-12 times.
Balls, Bands & Balance Stand tall with right foot slightly in front and toe dorsi-flexed up (chair for support) Rock forward and lift rear knee up and in front Hold. Bring rear leg back down, shifting weight back & lifting front toe off the ground Repeat 8-12 times, then switch legs.. Rock Forward, Knee Lift
Balls, Bands & Balance Stand tall feet shoulder-width, one forward & one back Rock weight onto back leg, while lifting front knee; Balance on back leg With lifted-leg, touch heel down first,& roll forward onto toes, coming up to balance on toes Shift weight back, and repeat 8-12x Switch legs and repeat. Heel-Touch and Roll-Up
Balls, Bands & Balance Pendulum Legs Stand tall behind chair. Place one hand on chair for support. Shift weight to right leg & lift left leg slightly in front Swing left leg from side to side by abducting and adducting the hip of the left leg Repeat 8-12 times Switch legs and repeat.
Balls, Bands & Balance Come up with 2 additional exercises you could do to promote Balance
Training with Small exercise Balls - Incorporate small balls into functional mobility programs - Learn stabilizing techniques to improve strength, balance and flexibility of older adults - Balls can be used to encourage fluidity and rhythm and to help modify exercises and postures that may be too easy/hard for older adult participants Balls, Bands & Balance
Benefits of Using Balls Improves core stabilization Improves balance, posture, body awareness and coordination Can progressively increase or decrease the intensity of each exercise by making slight adjustments in body position Provide dynamic resistance Help to reduce stress on joints Can enhance the “fun” of exercise Balls, Bands & Balance
Sit tall with thighs together Place the ball in lap; With both hands roll the ball toward your knees and back again for range of motion To add an upper back stretch, pause at the end of the roll when the ball is closest to your knees. Hold for seconds. RANGE OF MOTION – BACK STRETCH
Balls, Bands & Balance UPPER BODY COORDINATION AND RANGE OF MOTION Hold ball in hand at shoulder Stretch one arm out away from your body, then back to your shoulder Repeat reaching over head with ball Repeat with other arm
Balls, Bands & Balance UPPER BODY RANGE OF MOTION & COORDINATION Seated at a table, hold one small ball in each hand and touch it to the same shoulder. Extend your elbow so that the back of your hand touches table, then back up to your shoulder. Repeat with the opposite hand.
Balls, Bands & Balance RANGE OF MOTION – SHOULDER Hold the ball in your hand with your arm extended straight out in front of you Raise your arms above your head keeping elbows straight Repeat 8-12x then switch arms
Balls, Bands & Balance RANGE OF MOTION – HIPS Seated in chair, place one foot on ball With opposite foot, step to the side then return to start position Repeat with the other foot. For added challenge place ball under moving leg and roll ball under the foot while abducting hip
Balls, Bands & Balance SEATED REACH – ABOVE & SIDEWAYS Seated with a wall in front of you, place the ball against the wall at eye level. With both hands roll the ball up the wall and back down Repeat reaching motion to the left and right sides.
Balls, Bands & Balance UPPER BODY RANGE OF MOTION Seated at a table, roll the ball to the left using both hands, back to the centre, then to the right. Repeat motion rolling the ball under the palms, forward and backward
Balls, Bands & Balance UPPER BODY RANGE OF MOTION While seated in a chair, reach the ball to the floor beside your chair while maintaining core integrity Repeat using the other arm
Range of Motion & Coordination Hold one ball in each hand. With your left arm, touch the ball to the top of your head while reaching across your body with your right arm. Repeat the same using the opposite arms ….. Simon Says?!
RANGE OF MOTION – NECK Hold ball in left hand with arms extended to sides at shoulder height Slowly rotate your head to the left, looking over your left shoulder, hold for 6-8sec Bring ball and head to centre, switch hands and repeat to the right Strength is added by keeping arms up at shoulder level*
ROTATION OF WRISTS Hold the ball at chest level with both hands. Rotate ball in your hands so that it rotates away from you Repeat rotating the ball toward you.
BALL EXERCISES – UPPER BODY STRENGTH
MODIFIED SEATED PUSH-UPS Seated tall, in front of a wall, place ball against wall just below eye level; both hands on ball Lean forward at the hips, flexing the elbows, then exhale, pressing hands through the ball and extending the arms until you return to start position
SITTING LEG POSTURE & STRENGTHENING Sit tall in chair. Place ball between your ankles and palms on insides of either knee Squeeze legs together at ankles and knees as you press outward with the hands creating resistance on the adductor muscles Hold for 8-12 sec then release; repeat 2-3x
CHEST PRESS Hold the ball between your palms at chest level with your elbows pointing outwards. Press palms together through the ball, while contracting the pectoral muscles Repeat 8-12x
BICEP STRENGTHENING Place the ball on your shoulder. With the same hand, use your palm and press down on the ball, then release. Repeat using the opposite side.
DELTOID AND PECTORAL STRENGTH With arm extended straight, place ball underneath the arm Adduct the arm while squeezing through the ball to create resistance, then release Repeat 8-12x then switch arms
FOREARM GRIP STRENGTH - PRONATION AND SUPINATION Hold ball in one hand with palm facing up Squeeze ball while rotating arm so that palm faces down; then release Squeeze ball again and rotate back to palm-up position Repeat sequence 8-12 times, then switch arms
FOREARM GRIP STRENGTH - FLEXION AND EXTENSION OF THE WRISTS Hold ball in hand with arm straight out and palm facing up Keep elbow straight and squeeze ball while flexing wrist up Release squeeze as you extend your wrist back to start position Do 8-12 reps, then repeat with other hand
FINGER STRENGTH Hold ball in hand(s) and squeeze the ball with your fingers Imagine you are touching each finger to your thumb through ball Repeat several times
ISOMETRIC ABDOMINAL STRENGTH Sitting tall, place ball on one knee & both hands on top of one another on ball Press hands down through the ball by contracting the abdominal muscles Do 8-12 reps, then repeat with ball on other knee *note* The movement is coming entirely from the core – Keep arms stable!
SITTING POSTURE WITH BICEPS STRENGTHENING While sitting in a chair place ball behind back for lumbar support Hold a weight in your hand and flex the elbow bringing weight to the shoulder Do 8-12 reps, then repeat with the other arm
STRENGTHENING - BICEPS While seated tall in a chair, hold the ball between both hands, & rest hands on thighs Keeping elbows tucked in at the waist, squeeze hands together through the ball while raising the ball up to your chest Release squeeze and return ball to start position Repeat 8-12 times
STRENGTHENING – TRICEPS Sit tall in a chair & hold ball with both hands, arms straight above your head Flex elbows, bringing the ball back behind your head Squeeze palms together through the ball as you extend elbows back to starting position Repeat 8-12x
BALL EXERCISES – LOWER BODY
SQUATS Stand behind a chair with ball between your thighs & feet hip width apart Bend knees and squat down as far as you can but keep your knees behind your toes Repeat 8-12 times
CALF STRENGTHENING – HEEL RAISES Hold onto the back of a chair with a ball between your legs Lift yourself up onto your toes, hold, and return heels back to the floor Repeat 8-12 times Seated Alternative: Place ball between knees & hands on top of knees Lift heels off the ground as you press down through the knees to increase resistance; hold, then return to start
INNER THIGH STRENGTHENING Sit tall in a chair. Place ball between your knees (and one behind your back if possible) Squeeze your knees together, pressing through the ball; hold, then release. Repeat 8-12 times
BUTTOCKS AND HAMSTRING STRENGTH Sit tall in a chair Place the ball underneath the arch of your foot. Press straight down through the ball with your foot, hold, then release Repeat 8-12 times then switch to the other foot
PROPELLING WITH LEGS Place one ball under each foot (or do one at a time) Extend one leg out, by rolling foot over the ball, and hold for 8 seconds before returning to start position Repeat extension with the opposite leg With 2 balls, develop a rhythm by alternating leg flexion & extensions …as if you were foot propelling a wheelchair
Balls, Bands & Balance Come up with 2 additional Exercises that you can do with the Balls….
STRENGTH & RESISTANCE BAND EXERCISES Balls, Bands & Balance Strength and Resistance Band Exercise
Training with Resistance Bands In older adults, Resistance band training has been shown to: Balls, Bands & Balance o increase strength of knees, ankles, shoulders etc. o increase gait stability and velocity o increase balance (in healthy and stroke patients) o improve overall functioning and functional scores o decrease disability o decrease shoulder and back pain o increase grip strength o decrease fall risk
Balls, Bands & Balance Benefits of Using Resistance Bands Convenient to use at home or gym Light weight = easy to travel with Many different lengths and resistances Changing hand placement can change resistance More safe than free weights if dropped requires muscle activation throughout ROM because you cannot “cheat” & use momentum gravity does not affect bands like it does weights, allowing more flexibility in the movements performed (ie. Diagonal)
Chest Press Target Muscles: Pectoralis Major Stand tall (or sit with feet flat on floor) Wrap band around shoulder blades and under arms Grasp band at shoulder level with both arms at 90 degrees, palms down Extend arms forward, hold & return slowly Repeat 8-12 times
Chest Pull Target Muscles: Triceps, Rear deltoid & Trapezius* Stand tall (or sit tall with feet flat on floor) Grasp band in both hands (palms down) in front at chest level (shoulder width) with elbows pointed out to sides Exhale and extend arms out to sides Hold and return slowly to start position Repeat 8-12 times *Note* by alternating start position to shoulders rotated up and palms facing forward you work the trapezius more
Elbow Extension Target Muscles: Triceps Sit tall with feet flat on floor Hold band with both hands below chest level, keeping elbows in at the waist Keep left arm stable while extending right elbow down and back (keep both elbows tight to waist at all times) Hold and slowly return arm to start position Repeat 8-12 times; Then switch arms
Shoulder Flexion Target Muscles: Anterior deltoid Sit tall with feet flat on floor &shoulders back Step on one end with right foot & hold other end in right hand with palm down Keeping arm straight, flex the shoulder forward until arm is parallel with the floor Slowly release to start position Repeat 8-12 times then switch arms
Arm Raise Target Muscles: Deltoids Sit tall with feet flat on the floor & shoulder blades down Step on one end of the band with right foot & grasp the other with the right hand, palm facing inward Laterally raise arm, keeping elbow straight, until arm is parallel with floor; hold, then slowly release arm back down to side Do 8-12 reps then repeat on left side
Elbow Flexion Target Muscles: Biceps Sit tall on chair with feet flat Place band under right foot & grasp band with right hand (palm facing up) Flex elbow, bringing palm to shoulder Hold, then slowly release the arm Repeat 8-12 times then switch to left arm.
Hip Abduction Target Muscles: Abductors Stand tall (or sit with feet flat on floor) Loop band around right ankle and step on loose ends with left foot Abduct right leg to the side, hold, and return leg slowly Do 8-12 reps, then switch band to left leg for 8-12 reps
Hip Extension Target Muscles: Gluteus Maximus & Hamstrings Stand tall behind chair (or wall) Loop band firmly around right ankle & step on ends with left foot Extend the right hip back keeping the knee straight and back upright (do not arch or flex spine) Hold and slowly return hip to neutral position Repeat 8-12 times, then switch to other leg
Hip Flexion Target Muscles: Hip Flexors Stand tall behind chair. Have band looped around right foot and step on ends with left Keeping posture tall, slowly flex the hip bringing the knee toward the chest Hold, then return leg slowly to neutral position Do 8-12 reps, then switch legs
Knee Flexion Target Muscles: Hamstrings Stand tall behind chair Loop band around right foot & step on ends with left foot Slowly flex the right knee up behind you as far as possible (90 degrees) Hold, then slowly release to start position Do 8-12 reps then switch to left leg & repeat
Leg Press Target Muscle: Quadriceps Sit tall in chair & hold band ends in either hand Flex right leg up, wrapping band around the sole of the foot Keep elbows tight at the waist while slowly extending right leg forward; hold, then slowly return to starting position Repeat 8-12 times, then switch to the left leg
Come up with 2 additional exercises that can be done with the bands
MULTIJOINT DYNAMIC EXERCISES
Dynamic Multi-joint Exercise Training -multi-joint exercises involve movement of two or more joints -For ADL’s, you rarely use a single joint to do the movements -Multi-joint exercises can mimic everyday dynamic tasks -Supports the exercise training principle of generality - several aspects can be trained in one exercise -In daily life muscular strength exists in general, not specific, terms Balls, Bands & Balance
Benefits of Dynamic Multi-Joint Training -Efficient – spend less time doing exercise when you work more than one area with a single exercise -Promotes balance – isolating individual muscles could lead to strengthening that muscle, but surrounding muscles may become weaker in comparison; leading to imbalances - Increases intensity – by working more muscles and joints simultaneously, heart rate will increase which, in turn, will raise the overall intensity of the session -Fun – by combining various exercises in different ways you can promote variety in your classes and prevent boredom
Chest Pull with Heel Raise Target Muscles: Gastrocnemius, Triceps & Deltoid Band at chest level; both hands Extend right arm laterally then slowly Return to centre; repeat with left arm Lift heels rising up onto toes and slowly lower (x2) Repeat sequence 8-12 times
Triceps Kick with Toe Tap Target Muscles: Tibilais Anterior & Triceps Band below chest level; both hands; elbows tucked at side Slowly extend right arm down and back for 8 counts, keeping elbows in place Release slowly while tapping toes 8 times Repeat sequence 8-12 times, then switch to use the left arm
Shoulder Shrug with Arm Abduction Target Muscles: Trapezius & Deltoid Grab band at either end and step on middle with one foot Shrug shoulders 4 times (2 counts/shrug) Simultaneously abduct both arms until parallel with floor (4 counts up & 4 down) Repeat sequence 8-12 times
Lat Pull Down/ Leg Abduction Target Muscles: Latissimus Dorsi & Leg Abductors Band above head; hands near middle Keep left arm stable and pull down right arm contracting Lats Simultaneously abduct the same leg Repeat with other side; 8-12 times per side *Note* if simultaneous arm and leg movement is too difficult, alternate between leg and arm movements
Back Extension & Squat with Functional Pulls Target Muscles: Erector Spinae, Quads & Triceps Feet apart; band below chest level; both hands & elbows tucked in at sides Squat down and hold; complete 4 functional pulls Come up; keep left arm in place; extend right arm, flexing shoulder above head, while extending the left hip back Repeat sequence with left arm & right leg Complete 4-6 reps for each side
Lunge and Upward Row Target Muscles: Quadriceps & Trapezius Lunge stance with right leg in front; band under front foot and ends in each hand Press down into lunge (4 counts) come up (4 counts) Complete one upward row (4 counts up & 4 down); repeat sequence 8-12x Switch leg positioning and repeat
Squat with Shoulder Flexion Target Muscles: Quadriceps & Anterior Deltoid Wide stance, band under right foot and end in right hand Squat down (4 counts) and hold Flex right shoulder forward & release slowly, then come up to standing Repeat 8-12x Switch band to left side & repeat
Lunge with Forward Punch Target Muscles: Quadriceps, Triceps & Wrist Stabilizers Lunge stance with right foot in front; band below chest level in both hands, elbows tucked in at sides Lunge forward & punch with right arm keeping left elbow in place; repeat 8-12x Switch band to left side & repeat
Hip Extension and Hamstring Curl Target Muscles: Gluteus Maximus & Hamstrings Stand tall, loop band around right heel & step on both ends with left foot Extend the hip back as far as possible & hold Flex the knee, contracting the hamstring and hold Slowly release to hip extension, then to start position; repeat 8-12x Switch band to other leg and repeat sequence
Squat March with Leg Abduction Target Muscles: Quadriceps, Hip Flexors & Leg Abductors Feet wider than shoulder width, squat down and march for 10 steps before coming up Stand tall and abduct/adduct the right leg Repeat sequence alternating right and left legs Complete 4-6 lifts per side
Leg Press with Bicep Curl Target Muscles: Quadriceps & Biceps Sit in chair with ball as lumbar support; right knee up and flexed with band around right foot; hold either end of band Keep elbows tucked in at sides & extend right leg straight out in front; return slowly Pause and complete one tandem bicep curl, before repeating the sequence 8-12 times Switch band to left foot & repeat
Abdominal Crunch with Seated Row Target Muscles: Rectus Abdominus, Trapezius & Rhomboids Sit at edge of chair with feet straight out front & band looped around feet; ends in either hand Keep hands on thighs & slowly lean toward the back of the chair without touching it; pause and return to upright Retract shoulders in a rowing motion; feel a squeeze between shoulder blades & release Repeat sequence 8-12 times
Abdominal Crunch with Shoulder Abduction (elbows flexed at 90 degrees) Target Muscles: Rectus Abdominus & Posterior Deltoid Sit at edge of chair with feet straight out front & band looped around Keep elbows at sides & slowly lean toward the back of the chair; pause & return to upright With elbows at 90 degrees, abduct arms until parallel with ground, pause and return elbows to side Repeat sequence 8-12 times
Oblique Crunch with Adductor Squeeze Target Muscles: External Obliques & Leg Abductors Sit tall at edge of chair with ball between thighs Lean back to the right slowly, then slowly return to upright; repeat to the left Sitting upright squeeze ball between thighs and hold for 8 counts Repeat sequence 8-12 times
Around the World Squat with Abs Target Muscles: Quadriceps & Abdominals Stand with feet wider than shoulder width and ball in hands above head Keep arms straight while squatting down & simultaneously moving arms in large circles to the right Complete 8-12 circles, then switch to the left for 8-12 circles
Come up with 2 additional Multi-Joint Exercises that you could do with your senior participants
Questions? Nazia Bhatti Canadian Centre for Activity and Aging
Balls, Bands & Balance References The Scientific and Clinical Application of Elastic Resistance. Page, P. & Ellenbecker, T. Human Kinetics, Champaign, Illinois Hughes, C.J., P. Page & D. Maurice “Elastic Exercise Training.” Orthopaedic Physical Therapy Clinics of North America 9(4): Tudor-Locke, C., Ecclestone, N. A., Paterson, D. & Cunningham, D. A. (1997). Seniors Fitness Instructors Course (SFIC): Resource Manual. London, ON: Canadian Centre for Activity and Aging.