Balance Exercises to Build Stability with Katie Lawton, MEd

Podcast Transcript

John Horton:

Hello and welcome to another Health Essentials Podcast. I'm John Horton, your host.

More than 3 million older Americans land in emergency rooms every year because of a fall, making it the leading cause of injury for the 65-plus crowd. Staying off that statistical list starts with maintaining strength and balance throughout life. So today, we're going to learn a few simple exercises to help you stay steady and on your feet, particularly as you age.

Our trainer in this effort to stay vertical will be exercise physiologist Katie Lawton. She's one of the many experts at Cleveland Clinic who join us weekly on the podcast to offer tips for healthier living. So with that, let's find out how a few minutes of daily exercise may be all that it takes to stay upright.

Katie, so great to see you again. We always appreciate return guests.

Katie Lawton:

Thanks for having me back.

John Horton:

Well, like I said, you are one of our favorites. Don't tell everybody else.

So before we get into talking about ways and how we can improve our balance, let's talk a little bit about why our balance fades over time. I feel like I'm in pretty decent shape, and I got to admit, I don't feel nearly as sure-footed as I used to be, and that's painfully obvious to me whenever I'm out hiking with my sons and they're mountain-goating over everything and I am just waiting to fall on my butt. So why is this?

Katie Lawton:

There could be multiple changes that are happening. Some of it can be just from your eyes themselves, from your vestibular system kind of within that inner ear a little bit. Some of it is some strength. There is also some things that can happen in the neurological system as well within all the little intricate nerves within your feet or within your legs, and things along those lines that don't allow your body to actually be able to just do as well.

John Horton:

Yeah. And I just feel like, I just react slower now. And man, it's so frustrating, but it just happens that way.

Katie Lawton:

It is. It's really frustrating, and I do see it a lot. I feel like for some people, it just happens all of a sudden and they don't feel as secure as what they once were when doing those types of activities. And we'll talk about the training part, I'm sure, but that is one thing that you can almost need to throw into your training program.

John Horton:

Well, we're definitely going to work on that. I know we've made aging sound very glorious here with this last answer, but the key to keeping your balance is working on it, which is what we're going to do.

Katie Lawton:

Yep.

John Horton:

When you talk to patients, you have people come in, what's their biggest worry when it comes to their balance? What are their fears with it?

Katie Lawton:

Falls. I mean, I think that's the biggest thing, right? Because with any type of major fall, it can create a domino effect to your health — surgeries, broken bones, being sanitary — and that's scary for most part for all of us. And, yeah, I think that's the major one for sure.

John Horton:

Yeah. Well, yeah, you start to feel like it affects what you can do in life.

Katie Lawton:

The quality of life.

John Horton:

What you can go out and do, yeah.

Katie Lawton:

Yeah. I mean, being able to do things like hiking and being able to climb nearly as well as you used to and trying to keep up with people — sometimes, even just walking — some people find that they're shuffling when they are walking — they can't keep up nearly as quickly as once they used to. They feel like they're holding people back when they go out in a group and they try and go do these types of activities. And so it's hard for some people.

John Horton:

And even simpler than that, just what you're doing around the house, everyday tasks, getting in out of a tub can all of a sudden become way tougher.

Katie Lawton:

Yeah. Stairs also become a huge issue for most people. They have to hold onto the railing when they're also climbing the stairs. The dog would sometimes get in the way or the corner of the rug, we trip on that, we didn't use to have to worry about before. Other things.

One of the big things is actually urinary incontinence. People having to rush to get to the bathroom is one of the other things that most people also have higher risk for falls because you have to hurry up to get to the bathroom real quick. That is another thing that most people are usually concerned about as well and have to prepare for it.

John Horton:

Well, which is why, as we're going to talk about now, it's so important to do some exercises and activities that kind of help you maintain that balance as you get older, at least as much as possible. Now, I know we all know Father Time is undefeated, but are there things that we can do to prevent or limit some of the natural deterioration that leads to all this unsteadiness?

Katie Lawton:

My number one thing is actually just staying active. Generally, we become more sedentary for longer periods of time. That's when we see a little bit more deterioration between the neurological system and the muscles themselves. So again, if you don't use it, you lose it. So that's my number one thing is just to keep moving.

And then there are other balance-type exercises that you can do within an exercise program or outside of an exercise program that can help at least maintain it, if not make it better for that matter. But I think everyone just has different reasons as to why their balances decrease. So depending on that will depend on how easily you can make those changes to your balance.

John Horton:

And when you're talking about staying active, I know, obviously, your balance can kind of deteriorate over time and sometimes, you do feel more unsteady and less like you want to do some of these things that suddenly feel risky — things you used to do and didn't even think about. Is it good to go out and keep pushing yourself a little bit and just take a little extra time when you're doing these things, just to make sure you don't slip and fall or just to kind of offer a little protection?

Katie Lawton:

Yeah. That one is a hard one. I think that just depends on the person and what their severity of what their balance is like. If you have really poor balance, I'm not going to tell you to go on a hike by any means, but if it's moderate then ... not moderate, but if it's decent, like you said for yourself, yeah, I think you're OK to continue to hike. But, yeah, there might be some other things in your training outside of just the hiking itself that's really important for you also to consider doing outside of it to making sure that the next time you go, you feel a little bit better about when you're hiking as well.

John Horton:

So when you're doing these exercises or these workouts, I take it, there's some muscle groups that you really want to target when it comes to retaining balance. So what are those?

Katie Lawton:

The intricate ones are kind of within the feet and the calf and the front of the shin. And then if you want to go into some of the bigger muscle groups, it's the core, it's the glutes, the hamstrings, the quads, those are the other primary movers as well.

John Horton:

Yeah, it sounds like from the core down are kind of where you just want to stabilize everything.

Katie Lawton:

Yep.

John Horton:

What happens? If you do have a solid core in that, what does that do to help you just stay steady on your feet?

Katie Lawton:

The biggest piece of it is it actually helps keep your pelvis level. And once we see your pelvis kind of shifting, that's also going to make things not act as quite as well it's supposed to. So in your center of gravity, if it's within your core and in your abdomen, so if that's not straight, that's where everything kind of tends to tilt. It makes it a little bit harder for yourself as well.

John Horton:

Yeah. And it's always hard. Nobody likes doing core exercises. They're so important, but I think they're everybody's least favorite.

Katie Lawton:

I wouldn't say everybody. There are some people that's all they primarily do, but yeah, anyways.

John Horton:

Well, maybe I'm talking for myself, which is why I don't have a six-pack of abs going right now.

Katie Lawton:

But, yeah, the goal is to not do more of the planking, bracing. You don't have to have your core activated all the time, but just that strong enough to support your spine and your hips in a level position.

John Horton:

All right. Well, let's break down some of these kinds of balanced exercises that people can do. And if you could walk us through a few of them, that would be fabulous.

Katie Lawton:

Again, it all depends on where you're kind of starting from, but if I generally start people kind of in what's called a tandem stance balance … so you're placing one foot in front of the other, heel to toe, and that's where you're going to start and you're going to switch ways after however you hold it for. I usually will start having a goal of 20 to 30 seconds on each side. But that's where I generally like to start and then kind of progressing from there. Sometimes I'll-

John Horton:

…so just walking the line for the classic police thing, right?

Katie Lawton:

…yeah, sort of.

Now, that's another step to making it harder is kind of walking on a balance beam is another variation to it as well, which is another step harder than just standing there with your feet in that tandem stance.

John Horton:

What does that do? Because it seems so simple, just the idea of putting one foot in front of the other and just taking those little steps. How does that help with your balance? Is it just engaging certain muscles?

Katie Lawton:

Certain muscles within the feet and the ankles, but it's also, again, the reaction that you have to have to be able to hold steady. The whole point of when we are trying to balance is to make sure that we're not wobbling as you're doing it. We really want to try and stay as steady as you possibly can. If you're having way too much movement as you're balancing, you still need to work on being able to try and keep as steady as you possibly can in those positions.

John Horton:

OK, all right, so heel-toe walk, one big one to go do.

What else can people do to try to just keep things balanced and steady?

Katie Lawton:

Single-leg balance. Just standing on one leg and sometimes, that's just hard for some people as well. So that is, again, where you're just going to shift your weight all to one leg and you're going to lift the other leg up and try and hold that position. Again, I like to go for at least 20 to 30 seconds where we're not kind of faltering before you can move into another more challenging position.

John Horton:

Is it OK — and a lot of times, people will do that and you put your arms out, you airplane for a little balance — is that OK to do, or is that something you should strive not to need?

Katie Lawton:

I think that should be something you strive not to do, but I think when you're starting out to learning it a little bit, I don't think that's a bad thing to also kind of do as a counterbalance to begin with, and then slowly lowering your arms down as you get better at it.

John Horton:

And I thought I saw with that, too, you can do it where you just lift your leg up, kind of bend your knee and do it like that, but then there's some modifications you can do with that same one-leg stand, too, right?

Katie Lawton:

Yep. So you can kick your leg out in front of you or you can kind of kick your leg out to the side and you can kind of do it in a repetition phase. And that's actually going to be really hard because that movement is going to make things so much more challenging. Or you can hold that leg out in front of you or hold your leg out to the side for 10 seconds at a time.

John Horton:

All right, so kind of increase the degree of difficulty on that.

Katie Lawton:

Always. If it's easy, we should be trying to make it harder as much as we possibly can because, yeah, once things get easier, our body is going to get used to it, so we always want to try and make sure we're challenging it any further.

John Horton:

Now, if you're going to try something like that, and you haven't done it in a while, should you make sure that you have something nearby that you can hold onto, whether it's a wall or a chair or just something in case you start to lose your balance or you can catch yourself?

Katie Lawton:

Yeah, I really actually like to use the countertop, is actually a pretty good height as well for most of us, and it's extremely sturdy. Plus, there's usually some type of timer that's also within the kitchen, whether it's an Alexa or whether it's the microwave timer that you can also use. A wall is also a really good option. A sturdy chair, making sure that's a folding chair, and you can also have somebody there that's close by that's also going to stand behind you as well. That's also probably not a bad idea either.

John Horton:

Probably not one of those office chairs with wheels, too.

Katie Lawton:

No.

John Horton:

That could cause some problems.

What other kinds of exercises or stands could people try?

Katie Lawton:

The BOSU™ ball, I don't know if you've ever heard of that.

John Horton:

A BOSU ball?

Katie Lawton:

BOSU. It's the half ball, it's a blue half ball with a slat on the bottom.

John Horton:

OK.

Katie Lawton:

And you can actually flip it over and use both sides of it, but the top blue part is another challenging variation. Again, that's probably more for your advanced people, like yourself, just need more steadiness when we're going for our hikes or skiing. That's another one that we would generally use that for as well.

John Horton:

Yeah, those balls, they kind of look like Saturn, right? With the rings around it and just-

Katie Lawton:

…yep, exactly. Yep.

A foam pad, if you've got a foam pad, would make it a little bit more challenging. Sometimes, I'll tell people to use a pillow or a folded-up beach towel at home to also try and stand on those to make things a little bit more challenging at home, too.

John Horton:

So what does that do if you have a folded towel? Is it just that it makes it that much more irregular what you're standing on that it kind of engages more muscles?

Katie Lawton:

A softer surface, yes, and that just makes us have to work a little bit harder to try and reposition our feet, and our nerves have to act a little bit.

John Horton:

Now, if you're going to do some of these exercises or some of these moves or stands, can you do them regularly? I mean, should you do them like once a day? Can you do them just whenever you're just kind of standing around, you're in line waiting, you can just pop up and stand on one leg for a little bit?

Katie Lawton:

Yeah, I think it just depends on where you're starting. Again, if your balance is pretty good, I think four days a week should be ... or depending on what your goal is with the balance, I think four days a week should be really good. If your balance isn't very good, then I would say probably the frequency would have to go out to seven days a week, if not twice a day at some times as well. But I also think it depends on what you're doing during the day and the other activities you're doing as well.

Yeah, I mean, it doesn't hurt to do it more frequently. Now, I will say things like lack of sleep, dehydration. What else is there? Nutrition, some types of medications, those types of things will make the balance a lot harder and you'll notice some shifts or changes. One day, it'll be really good and one day, it won't be as good as the other day. So if it's not feeling as good that day, there probably is another reason potentially. If you did it the day before, it was really good; today, we're going to go ahead and do it and it isn't as good as it was yesterday. There are some other factors that might also take into effect in some of that, too.

John Horton:

Yeah. And how long should you spend on these? I know we kind of talked them through, but is it just 10 ... oh, you said 10, 20 seconds for each one?

Katie Lawton:

I do two or three sets generally, just to get a little bit more practice. Sometimes, that first set is a warmup and generally not as good for some people, so the second and third set is a little bit better. So it's better to do them a couple times as well.

John Horton:

So really, you're just looking at a few minutes if you did that heel-toe walk and standing on one leg and just those two, it sounds like you can get a pretty good balance workout in and really, it's a couple minutes of time.

Katie Lawton:

Correct.

John Horton:

All right. Now, we've kind of focused on how this is so important for those of us with more candles on our birthday cakes, but are balance exercises something that you would recommend people try at any age?

Katie Lawton:

Absolutely. And actually, the sooner you do it in life, the better it is as you do get older as well. I mean, we do expect some deterioration as you get older, but if you think about setting your standards up higher at a younger part of your life and trying to maintain that, you're going to be much better as you get older as well.

John Horton:

Well, I got to say, I'm feeling better about my odds of staying upright after this chat, Katie, and I'll have to do a couple of those just to make sure the next time I go out hiking with my sons, I'm not that wobbly on some of the rocks. But if someone was listening to this, what's the one thing you want to make sure that they take from this podcast?

Katie Lawton:

Obviously, I think it can be done every single day. It doesn't have to be done to that extreme for necessarily everybody, but I think it depends on where you're starting from. No matter what disease you might have. Some of it may not get any better, but I still recommend practicing it just because we don't want it to get worse. And your body will generally tend to make the adjustments coming from other systems and other muscles to kind of help you keep that balance. So you kind of still have to practice it a little bit, and so that your body can get used to being in those positions.

Increased risk for falls goes up as our balance. So I would like to think that, that's one thing that people can try and do to prevent, as they do get older, is to do some of those balance exercises. And it actually has a correlation between your independence of living as you do get older as well. So if you don't have good balance, you're going to lose some of your independence as you get older as well.

John Horton:

That's great advice, and I think that we all want to make sure we stay on our feet, and you give us a lot of help to do that. So Katie, once again, thank you so much for coming in. You always give such great advice and guidance and hopefully, it'll help a lot of people.

Katie Lawton:

It was nice talking to you, John.

John Horton:

Balance issues that lead to falls often can be traced to lower-body muscle weakness. Your chances of staying upright improve the more you work and use those muscles, so don't ignore them.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

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