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128: Does “Balance Training” Prevent Falls, or Just Improve Balance?
390 Plays4 hours ago
In this episode, we break down what drives fall risk, and why the common advice to “just work on your balance” falls short. We explore how falls are measured, what balance tests really tell us (and what they don’t), and why improving a test score doesn’t automatically mean you’re less likely to fall in real life.
We dig into the evidence on exercise and fall prevention, and explain why simpler, consistent exercise programs often outperform more complex approaches. We also look at surprising findings, like a randomized trial where a yoga group fell more than the control group, and what that reveals about confidence vs actual capacity.
From there, we focus on what matters most: power, reaction time, and the ability to recover from instability. Most falls aren’t failures of static balance; they’re failures to respond quickly when something goes wrong.
Finally, we cover what almost no one talks about: what happens after you fall. We discuss “long lies,” why getting up off the floor is a critical independence skill, and how a small amount of targeted practice can make a meaningful difference.
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RESOURCES
- CDC data on falls in older adults
- 2024 Korean study on fear of falling
- 2024 JAMA / USPSTF systematic review
- 2025 SAGE RCT, Iyengar yoga and falls
- 2020 Sherrington et al. Cochrane Review
- 2017 Sherrington et al. Cochrane Review
- 2022 Simpkins et al. power vs strength
- 2025 Zhu et al. power and fall prediction
- 2021 Okubo et al. stepping impairments and fall risk
- 2022 Devasahayam et al. reactive balance training
- Sheffield Long Lies Study
- Floor Rise Training Trial
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Transcript
NFL's Snack Choice: Uncrustables
00:00:00
Speaker
The NFL consumes copious amounts of Uncrustables. It's the official food? is It's like the official snack of the NFL. Yeah. I find that as someone who runs a lot, it that an Uncrustable is a pretty unbeatable snack. I mean, it's low fiber.
00:00:17
Speaker
So that's good because then you don't have to spend energy digesting and feeling really gassy while you run. It has good carbs, including... a mixture of glucose and fructose. Liver glycogen depletion likes fructose.
00:00:32
Speaker
And then glucose is what your muscles like. And then it's got a little bit of fat and a little bit of protein from the peanut butter. And it just, it goes down easy. So I can totally understand why nfl football players consume like hundreds of thousands. I had no idea. Every season. Yeah. Yeah.
Introducing Laurel and Sarah: Challenging Fitness Norms
00:00:51
Speaker
I'm Laurel Biebersdorf, strength and conditioning coach. And I'm Dr. Sarah Court, physical therapist. With over 30 years of combined experience in fitness, movement, and physical therapy, we believe in strong opinions loosely held. Which means we're not here to hype outdated movement concepts. or to gatekeep or fearmonger strength training for women. For too long, women have been sidelined in strength training. Oh, you mean handed pink dumbbells and told to sculpt?
00:01:16
Speaker
Whatever that means. We're here to change that with tools, evidence, and ideas that center women's needs and voices. Let's dive in.
Power Play Course: Importance and Content
00:01:38
Speaker
Let's talk about power play. This course, I'm super proud of it. Me too. We tend to think of power exercise. The first thing in my head is plyometrics. And then the next thing is box jumps.
00:01:51
Speaker
like Right. Olympic barbell lifts. Right, exactly. If that's what I think power is, then I have to figure that's what a lot of people think power is. Really hard movements they can no longer do. Power plays a much bigger role in our lives. We need to move against resistance quickly. Even just something super basic like getting out of a chair air has a power component to it. I don't think we realize how often we use it and then how quickly we lose it. Yeah, absolutely. i think a lot of people don't realize that it's a capacity that they need to work on. Let's say your
00:02:26
Speaker
in your 40s or 50s and you've been working on your strength training, but all of a sudden you're supposed to do faster movement and you're suddenly discovering that, oh wow, that's actually weirdly hard. That doesn't feel as automatically accessible as it used to when I was younger. We stop doing that type of stuff as we age. We lose this athletic way of moving as we get older, which is really about producing force quickly. And that's what our course is all about. It's about moving your body weight, moving objects through space quickly and explosively. The other thing that I really like about this course is that we have these exercise demonstration videos that show each of the movements that we're teaching and how to take it from pretty basic to much more challenging. But then we also have these three to five minute workouts.
00:03:09
Speaker
And by the way, adding power is literally three to five minutes. It's actually these very short yeah little bites of exercise. And it lands best when it's short like that. Yeah, we've actually made workouts for people so that you can mix and match how hard you need it to be, how much time you have, what you're working on, and select a workout that works for you. And then also progress that workout once it gets easy.
00:03:29
Speaker
I think we do a really good job of showing them how to progress safely. Definitely. In addition to plyometric exercises involving impact, we also have medicine ball exercises where you can literally take out all of your aggression on the wall or the floor with a ball. We also have weight-based power exercises like the clean, the push press, where we're using a kettlebell or a dumbbell. Also training power for your upper body, right? So it's not just about hopping and skipping and jumping, but actually explosively move through the upper body. Another thing I think that people don't realize about power is that the amount of weight you're going to be lifting should be something that feels actually quite light because now we're going to ask you to shove it, throw it, slam it around, and we need you to be able to move quickly with that load. It definitely is a course that is going to bring you back to some of the more athletic movements that you did when you were younger. i think people are going to dig skipping and bounding and throwing balls against walls and coordinating somewhat sophisticated movement in the air. Expressions that are just inherently joyful.
00:04:40
Speaker
And we're going to reclaim our ability to move with jubilance. It goes on sale on May 22nd, $99. That price will go up after this sale period.
00:04:51
Speaker
And then the cart closes May 31st. We just got this little window to grab it. If this sounds interesting to you, if you want to hear more about it, then you're going to head on over to the page on our website. The link for that is in the show notes. All
Falls Risk: Assessment and Real-World Impacts
00:05:02
Speaker
right. So today,
00:05:04
Speaker
We are talking about falls risk and falling. Now, falling and balance is a really big topic. So we are going to be talking about it over several episodes, and each episode is going to focus on different aspects.
00:05:17
Speaker
Today's episode, we're going to zone in on the fall part of falls risk and its relationship to balance, because as it turns out, it's not quite as straightforward as you might think, especially when it comes time to try and create research around falling.
00:05:31
Speaker
So we're going to talk about what puts someone at an increased risk of falling, how that falls risk is measured using evidence-based tools, since we don't generally just shove people and see if they fall over for research, although that seems to be changing. and No, it does. And what being at a falls risk translates to in terms of real-life outcomes like fractures, hospitalization, and mortality.
00:05:57
Speaker
We're also gonna look at what are and what aren't good predictors of falls. What are evidence-based ways to reduce falls? Whether quote unquote improving balance actually leads to a reduction in falling and what can reduce harm if and when a fall happens anyway.
00:06:16
Speaker
Before we get into it, thanks before we get into it I want to make the point that one of the risk factors of falling is vestibular issues like BPPV, which is vertigo, vestibular neuritis, vestibular labyrinthitis, which are both types of inflammation of the inner ear. These are special conditions that require treatment by a physical therapist or another kind of vestibular disorder specialist.
00:06:40
Speaker
That is something that might come up in a falls risk assessment for an individual, but But broadly, it's not what we're going to be talking about today. We're also not... I started to, but we're also not going to get deep in the weeds of other special populations because if we do, this episode is going to be three days long.
00:06:58
Speaker
ah So this is a topic that I'm especially interested in because I work with a number of older folks who themselves actually vary widely in their fall riskiness.
00:07:09
Speaker
Not really a spoiler alert, but spoiler alert, it has a lot to do with their overall physical fitness. And there are a lot of older folks who are worried about falls generally, but they don't really know what to do about it, or they think there isn't anything they can do about it, or they have sort of a vague sense that they should practice standing on one leg.
00:07:29
Speaker
All of these things happen to me. Oh, yeah, me too. Yeah, I'm sure, I'm sure. Or they'll demonstrate to me how hard it is to stand on one leg, because that's what they think of when they think about balance. But as we're going to see in this episode, it's not quite so straightforward.
00:07:41
Speaker
I have a question. Sure. When's the last time you fell? Oh, I can tell you exactly. Okay. Well, but this goes in an asterisk because at the moment I don't walk very well because I'm dealing with some pain in my hip to help with walking, to help with my pelvis. I have this thing on one of my shoes underneath the shoe ah to to make that leg a little bit longer, yeah but my brain doesn't totally know that that thing is there all the time. Yeah. Sometimes I actually catch it slightly, but I'll tell you the exact last time I fell, I was trying to figure out if I could still do a trap bar deadlift and I was at the gym. So this was last week I was at the gym and on their own, they actually weigh a fair amount, like 20 or 30 pounds. They're not light to the trap bar. And so someone had left it on the ground and I went to pick it up, which is not a great move for me generally. And I picked it up and I carried it over to the lifting platform
00:08:38
Speaker
And then when I put it down, it was hurting my hip as I put it down. So then I just kind of like tripped and fell over it. Oh, no. But it wasn't hard fail. Did you all the way down on the ground? Yeah, yeah. I was kind of halfway down and I knew I was going anyway. And I put my hands down and I was like, well, that wasn't successful. It was sort of a slow motion fall. But I haven't fallen. Like I missed a step and wasn't able to recover from it. Like I haven't not been able to catch myself and fall in.
00:09:04
Speaker
I mean, in a while, definitely. Yeah. Yeah. one of our most memorable falls was in the nude Olympics, which my college does. By the way, the voice note that I left you, did you get to listen to it ever? Not yet. I'm sorry. No, no, no. Because the point of it is the story about my friend who ran the marathon the day after yeah doing mushrooms. Oh, yes. I saw you left me at an addendum.
00:09:27
Speaker
Yeah. So the addendum to that story, and then I'll tell you about the nude Olympics, but the addendum to that story is that I had lunch with a college friend and I mentioned that you and I had been talking about it and she went, Sarah, not only did she take mushrooms the day before, she didn't train for the marathon at all.
00:09:44
Speaker
She just decided that the day after doing mushrooms, she thought she would run the Paris marathon. And so that might be why she was on crutches for so long afterwards. Yeah. Yeah. The common denominator here is poor judgment. And so I'm not surprised. I'm not And the kind of like, you can get away with anything attitude of someone in their early 20s. Poor judgment. Poor judgment. The front of your brain is not fully formed until you're 25. You know, it's yeah not their fault. No. And speaking of doing dumb things, so the nude Olympics was every winter, the sophomore class in college, the first snowfall.
00:10:18
Speaker
And they stopped doing this maybe a few years after I was there. There was the nude Olympics, which was at midnight, in one of the courtyards, everyone gathered around to watch the sophomores run around naked.
00:10:30
Speaker
I mean, written and that was literally it. We were very drunk and there's a bunch of people wearing woolly hats and scarves and gloves and boots and that was it. And so I hit a patch of ice and I did a full on banana peel slip fell on my butt. So that was weird that was one of my most memorable falls.
00:10:46
Speaker
This is the point in our entire podcasting career where I need to out you. oh no. as having gone to Princeton. Indeed I did.
00:10:57
Speaker
And I want to say something about this. In all the years we've been podcasting, you have never once name dropped Princeton. And I've just been waiting. I've been just hoping you would because listen, it's fucking impressive, but you refuse, you refuse to walk around and tell people you went to Princeton. Right.
00:11:18
Speaker
Which I have to say, Sarah, I fucking admire. Thank admire it about you. But I think it's now the time for people wondering why it was snowy and where she might have gone to college and what kind of people run around naked. Drunken lunatics. Our girl went to Princeton, y'all.
00:11:36
Speaker
Thank you. It is something i will say, and maybe this is why I do it. Of the like big three, Harvard, Princeton, Yale. Mm-hmm. Princetonians, it's a weird point of pride for us that we don't mention that we went to Princeton.
00:11:52
Speaker
Oh. Whereas people from Harvard, in our opinion, in our racist opinion about people from Harvard. They let you know. They let you know. like within the first five sentences. yeah Whereas people for Princeton, if someone says, where do you go to school?
00:12:06
Speaker
Nine times out of 10, this is true. We'll say, I went to school in New Jersey and leave it at that. No, true. The school of New Jersey? No, I went to school in New Jersey. The school of New Jersey.
00:12:17
Speaker
Yeah. but like New Jersey as like a place to get education. It's a good state. I mean, I say it with love. I've spent a lot of time in New Jersey. Yeah. So so it may not be the kind of pride that you were expecting me to have where I announced that I went to Princeton, but it's a different kind of pride where we're, in some ways we consider ourselves better than people who went to Harvard and Yale because we don't bring it up at every possibility. It's a humble brag. It's a humble pride.
00:12:44
Speaker
It's not even a brag. It's just like a humble because then it's more impressive when you find out that's where went. we're trying to really just push up the wow factor. Right. Addition by subtraction. That's right. That's right. All right. Well, now everybody we got that out of the way. Me too. It's been weighing on me. The anticipation of when will she actually name drop Princeton. Too years have gone by, so I had to do it. Thank you.
00:13:09
Speaker
So the CDC says that falls are the leading cause of injury for adults 65 and older, and that over 14 million or one in four older adults report falling every year.
00:13:25
Speaker
Now, being at an increased falls risk is associated with obviously a higher likelihood of injury, but also fractures, which lead to hospitalization, which lead to long-term disability, and death. I heard a phrase used on barbell medicine called catabolic crisis, right? So when you go into the hospital and you haven't stocked up on your muscle mostly, right? And fitness, you can enter into a state of catabolic crisis where the little that you did have starts to go away because use it or lose it.
00:14:03
Speaker
And then it makes coming out of that hospital extremely difficult. This obviously leads to major reductions in independence, mental health, quality of life, and higher health care costs. And all of this can begin with a fall. The CDC also says that 37% those who fall report an injury that either required medical treatment or a restricted activity for at least a day.
00:14:30
Speaker
This is great because it means that the other 63% didn't get injured. I think that's a positive note to remember. yeah But 37% of them do report an injury. Now, something to clean up that gets misquoted often, I think mostly as marketing tactic to scaremonger people, is this, in-hospital death,
00:14:53
Speaker
after a hip fracture is actually much lower than people think. So it's only around 5%, which is not nothing. But what we have to be concerned about is what happens after these people are discharged from the hospital.
00:15:06
Speaker
This is what leads to the higher mortality rate of around 15% to 35% in the following year. So we can't maybe directly trace it back to the fall, but the fall precipitates a lot of other downturns in health, fitness, and then longevity.
00:15:27
Speaker
The fracture itself, right, starts this series of events. Decreased independence leads to increased frailty because if we're not as independent, we're not moving around and doing the things in our life, we're less active, increased frailty, increased susceptibility to diseases like pneumonia, infections, and cardiovascular events. And I'm wondering, Sarah, why do you think decreased independence leading to increased frailty would lead to susceptibility to these diseases and infections and events?
00:15:58
Speaker
Well, the people for whom this is happening, right? It's not everybody, right? It's a large number. It's this like 15 to 35%, but it's not everybody. So some people break a hip, get discharged from the hospital, turns out they're okay. Like it maybe it takes longer for them to recover and they don't maybe get all the way back to their prior level of function, but they're basically okay. But the people who are in real trouble like you said, are dealing with this catabolic crisis, meaning let's say they were in the hospital and they stayed in the hospital for a
Exercise as a Lifelong Preparation
00:16:28
Speaker
couple of days. If they were already deconditioned or had several co-conditions or were somewhat frail, the statistics around spending even just a couple of days in bed
00:16:41
Speaker
And how much that tanks your body's capabilities is wild. You do not have to be bedbound for many days for it to have a really deleterious effect on your health. So let's say you're in the hospital for a few days, you basically laid around, then you get discharged, you go home.
00:16:58
Speaker
Unless you've got somebody on you who is then working on getting you back up and moving and working on all of these other health effects, like are you getting enough food? Are your other health issues getting managed properly? And potentially in a lot of scenarios, those things aren't being taken care of. yeah And so it becomes this boulder gathering speed downhill where it's just everything multiplies onto everything else.
00:17:23
Speaker
Yeah. I mean, i recently lost my father. Yeah. And he has been experiencing this decline in independence, increased frailty for several years.
00:17:33
Speaker
He had a number of chronic diseases, but he then got pneumonia. And that's where this catabolic crisis, this precipitous decline really happened where he was in the hospital with pneumonia.
00:17:49
Speaker
He then had to go to a rehab center to just be able to live at home. He got back some of his physical capacities to be able to go home, but the home had to be completely redone so that he could shower and go to the toilet and get up out of a special chair that would actually like help him stand up and use a walker and things like that.
00:18:11
Speaker
And. He's been athletic his whole life, but not especially active. So golf is a somewhat sedentary sport because he would ride the freaking cart. But he was still modestly active, I would say. yeah i wouldn't say that he was extremely sedentary. But at any rate, I think...
00:18:31
Speaker
even though he did fall a few times and actually didn't incur serious injury, his falls were obviously due to this physical decline that he underwent. Ultimately, what took him out was the chronic disease. He had a stroke. But it's really that pneumonia event that yeah really was a turning point that I'm not sure he would have had the stroke on the same date had he not had this big downturn with pneumonia. And the pneumonia, we don't know how he got it, where he got it from, but that really was ah a deciding turn of events there that he just couldn't, he could not come back from the amount of muscle, the amount of movement capacity, the amount of strength that he had before he was in that hospital bed.
00:19:24
Speaker
I wouldn't say he regained even like 20% of the amount that he lost, even through rehab. Thankfully, andm very grateful he regained enough to be able to live out the rest of his days at home.
00:19:36
Speaker
But he was not able to come back from that. Me and my brothers watched this happen, and it just starts to really sink in that like right now, when we're in our 40s and 50s, we better get busy. yeah you know It's starting to really kind of hit home that like this is the time where you actually start to prepare for things like pneumonia.
00:20:01
Speaker
Yeah. Where you're going to have enough to get you through and you want to be exercising for joy and and happiness and health and being around people and in nature and things that you don't want to be thinking about your future in a hospital bed. But that should somehow, I think, be in people's minds as well, that like you're doing this because movement is good for you in the moment, but you're also doing this because this shit adds up over time.
00:20:32
Speaker
yeah The more you can be active, the better you'll fare when health and stuff in your life takes a turn for the worse. You're going to have the capacities, the movement skill, the nervous system preparedness to be able to come out of that a lot better.
00:20:53
Speaker
Yeah. Oh, for sure. So, okay. Back to falls. If 37% of falls result in injury, as I said, this also means 63% of them don't, which is great.
00:21:06
Speaker
And this is important because here's what happens. If you talk to any senior who's concerned about falls, they all obviously don't wanna hurt themselves. They don't want to end up in the hospital. They don't wanna break a hip and they don't wanna die, right? So it's not that we want to downplay the importance of being able to catch yourself and not fall when you lose your balance.
00:21:33
Speaker
But if you work with an older population, it's also really important to help boost their confidence around movement in general and to help them understand that like the bright side of that statistic is that even if you do fall, there's a higher chance that you won't get injured.
00:21:51
Speaker
There are also small differences in fall reporting and fall fatality in men and women, not huge ones, But our point here is that when it comes to fear of falling, this actually plays a really big role in how people behave, right? And what they choose to do and choose not to do which in turn comes around to an influence their preparedness to handle balance challenges and fall recovery.
00:22:22
Speaker
So let's talk about fear of falling and what we'll call the shrinking world loop. Okay, there are several studies that look at the psychological and physical impact of fear of falling, including a 2024 longitudinal study from Korea that looked at around 10,000 people aged 65 and older.
00:22:43
Speaker
It found that prior falls and fear of falling, which comes from the prior falls, right? Possibly, right? Are likely to end up restricting people's daily activities.
00:22:56
Speaker
And then this physical inactivity in turn reduces their muscle mass. It reduces their strength. It probably reduces their power, their endurance, and all of this can accelerate the progression of physical frailty over time.
00:23:11
Speaker
So fear of falling is not just in your head. It's not just a mental tick that you have. It's going to influence your behavior.
00:23:24
Speaker
And it can be a very rational response to risk. and we're going to talk a little bit more about that in future when we look at an interesting study. But it can also have a negative side, which is it can become part of this mental mechanism that increases your future vulnerability to actually fall and not recover well because you've been inactive due to your fear of falling.
00:23:52
Speaker
We can think of it like the Ouroboros, the snake eating its own tail, that shrinking world loop. Someone has a fear of falling, so they reduce the types of activities that they believe will increase their risk, like leaving their house. This in turn decreases their physical function and possibly their mental health, and it can also increase their frailty, and this in turn increases their risk of falling.
00:24:19
Speaker
There is evidence to suggest that fear of falling is more common among women and older subjects and that it is associated with impaired functional capacity, decreased cognitive capacity and depression.
00:24:33
Speaker
Now, association does not mean cause. And we don't have clear data in terms of which comes first, right? The chicken or the egg. As in, was it the impaired function that caused the fall?
00:24:46
Speaker
Or did the fear of falling result in the impaired function? But it would be easy to see how any of these impairments could either result from or be the reason for an increased fear of falling.
Fear of Falling: Psychological and Physical Impacts
00:25:00
Speaker
Now, it makes sense that women have a greater fear of falling, to me at least, as women also have a greater incidence of frailty than men as they age.
00:25:12
Speaker
And so what can become a somewhat realistic appraisal of their physical ability then becomes a fear that is part rational, but then also part destructive.
00:25:24
Speaker
And the onset of frailty also occurs sooner in life for women than it does for men. But This is interesting. The evidence shows that men actually have a higher incidence of death at each frailty level than women do. So while women have higher levels of frailty, they tend to be able to survive them better than men. This is interesting, and this is just me opining about why I think this is the case. But I think that we have this generation of older women right now who were not encouraged to participate in exercise for the development of their physical capabilities if they exercised
00:26:00
Speaker
lot of why was for appearance, not for everyone, but for a lot of women. They exercise to lose weight and to look a certain way. And I think this might explain the higher and earlier frailty levels. I also think that the way that gender roles work in the home and at work, like men are typically the people called upon to lift the heavy things. to go out and do the yard work, to do the more physical, demanding jobs. And women stay in the home. They take care of the children, which is physically demanding. Don't get me wrong. They take care of the house cleaning and things like that that are maybe a little bit less demanding.
00:26:40
Speaker
Now, why men die younger than women is a large can of worms, and it's not going to be the topic we get into in this episode, but it's worth noting.
00:26:51
Speaker
So we know from evidence that the fear of falling actually narrows life two times. First, psychologically, I'm afraid of these other environments out there, these other challenges out there that will cause me to fall.
00:27:07
Speaker
which in turn makes it so that you don't go to participate in the challenges of those environments and the challenges of those activities, which causes narrowing of your physical ability to handle those challenges. So the world gets smaller and then the body gets smaller, both physically, bone mass, muscle mass shrink,
00:27:28
Speaker
But also it gets smaller in its abilities. And now this fear becomes even more justified, right? I've lost so much strength. I can't handle that. I've lost so much of my ability to do these things. Therefore, I now really can't do them.
00:27:43
Speaker
Yeah. And I mean, i've seen this I've seen this with a lot of different older women that I've worked with. So if we're talking about a falls risk, oh, you guys, Laurel's eating her Uncrustable.
00:27:53
Speaker
And i really delicious I really wish I was there. My mouth is an explosion of raspberry and peanut flavor right now. I might have to go buy some Uncrustables after this. The texture of the highly processed white bread is delightful. It's really good.
00:28:07
Speaker
All right. So if we talk about how falls risk is measured using evidence-based tools, We need to know if these are actually good fall predictors. So we can test static balance, right? Standing still and balancing. Gait speed, how fast you walk. Chair rise time, how long it takes you to get up out of a chair.
00:28:28
Speaker
Single leg stance, it's like same thing as static balance. And just general movement confidence. And we can get outcomes on balance using these tests. So for example, you could set up a study that's what's called a pre-post test. So you give the person the balance test. How long does it take you get out of the chair? And then we provide an intervention of choice. And then we test again afterwards to see if in fact the balance has improved.
00:28:57
Speaker
But the outcome we care about is whether someone actually falls in their day-to-day life. And here's what I think is really interesting. Improvement in balance using these tests versus any change in your actual fall risk are not interchangeable outcomes, as it turns out.
00:29:17
Speaker
So I asked ConsenSys, which is the research AI tool that we use, what are the most commonly used balanced tests in research? And so we're going to talk about those now and what they each measure.
00:29:28
Speaker
Some of them have multiple components, and therefore they measure more than one outcome. and I also asked consensus if for each of these tests, was there a direct correlation between the outcome of the test and a person's false risk? and so We'll see what came out of that.
00:29:46
Speaker
so A super well-known one in the rehab world is the TUG test. TUG stands for timed up and go. and It involves standing up from a chair, walking three meters away, turning around, walking back to the chair and sitting down. And so it's time.
00:29:59
Speaker
And so this measures what in the clinical rehab world we would call functional mobility, which has nothing to do with either functional training or mobility training. Like, like you see on social media, it means, can you get through your life? This is a very basic life test, standing up from a chair, walking, turning around, going back.
00:30:18
Speaker
It's like, can you cross the room to grab the remote so that you can sit down and keep watching TV? Right. So functional mobility, dynamic balance, and gait speed. Another one that's very common is the Berg balance scale. And this is at an actual 14-part assessment for a static and dynamic balance. So it looks at things like reaching, turning, standing, a whole bunch of different tests.
00:30:38
Speaker
the six minute walk test, which measures really more specifically your functional aerobic capacity, your cardiovascular endurance, and your endurance for gait for a period of time. So it doesn't measure balance directly, but there is a balance component in walking, especially if you're doing it unassisted.
00:30:56
Speaker
And if you're using an assisted device like a walker or you're walking at a but much slower pace, that gives us general indications around your dynamic balance while you're walking. But as a predictor for falls risk, it's actually more useful for specific populations like post-stroke or other neurologic conditions like multiple sclerosis or Parkinson's disease.
00:31:16
Speaker
And then there's the famous single leg stance, famous to me maybe, which measures your ability to stand on one leg, right? It measures static postural co control and stability.
00:31:27
Speaker
Now, people don't fall because they habitually stand around for long periods of time on one leg. So this to me... is a real head-scratcher as to why it's... Wait, can I just clarify?
00:31:38
Speaker
Just because a person stands around long periods of time on one leg doesn't mean their fall risk is lower? Or people don't fall by standing on one leg for long periods of time, meaning standing on one leg for long periods of time is not going to cause you... A common activity? It's not going cause you to fall?
00:31:58
Speaker
People can be decent at standing on one leg and still trip and be able not to catch themselves and fall. I think that's the sentence. But also. i got it. Also. I get it now. People don't just spend days standing around on one leg waiting to fall. So it's not like a skill we need to train, right? I mean, unless someone only has one leg.
00:32:18
Speaker
That's true. But even then, they might be using a prosthetic. That's true. And that's a real niche special population that I think we're not addressing today. It's even smaller than the vestibular population. There are people who can do Olympic barbell cleans one leg.
00:32:32
Speaker
It's amazing. People who are missing limbs very often can do things that I can't physically do. Yeah. I saw a guy in a wheelchair once. They strapped the wheelchair to his body and then he climbed a rope.
00:32:46
Speaker
Like not only upper body strength to carry his own body, but also a wheelchair attached to him. Exactly. i just want to just point out something like this use it or lose it. We often take the lose it side of it and we go, oh my God, I got to get up and do something. I'm losing it. But actually use it, right? Let's focus on that. People have trained themselves to be able to write beautifully with their feet. People can climb ropes with a wheelchair strapped to their butt. People can do the most incredible human physical feats
00:33:19
Speaker
of just sheer strength and skill and power and speed and endurance because they used it. You I'm saying? Use it. So what you're saying is if you have all four limbs, you don't have an excuse.
00:33:33
Speaker
I mean, what I'm trying to say is... Focus on the using it and what you can do using it with the using it. The usey doozies, and not the losey. Poozies. Poozies. I think that's a good place. 63% of people don't hurt themselves when they fall.
00:33:53
Speaker
Yeah. And usey doozies. That's right. Okay. Other commonly used tests, something called the functional reach test, which measures the limit of your postural stability. And in this test, you stand and then you reach forward and they measure how far can you reach forward while standing still, while you're not moving your feet.
00:34:12
Speaker
There's also what's called a chair stand, or I learned it as the five times sit to stand, which is just how fast can you stand up from a chair five times. time We timed ourselves doing that in one of the power episodes. We did. And unsurprisingly, Laurel treated it like a race. Yeah.
00:34:26
Speaker
And I treated it like someone who just was standing up five times. That tells you a lot about each of our personalities. Yeah, it really does. Yeah. So the five times sit to stand assesses lower body strength, but really much more specifically, this power aspect of standing up from a chair and that functional capacity. Is standing up from a chair a one rep max activity, or can you actually do it multiple times in a row?
00:34:48
Speaker
And then tandem gait or tandem stance. So tandem in the rehab world means one foot in front of the other with your back toes touching your front heel, like you're standing on a tightrope. So that's often a test of just static control. Can you hold that position and, or can you walk? I don't typically, I've never really used it as a test, but sometimes I've used it in treatment where it's like, if you can do this much harder thing,
00:35:13
Speaker
like walking a tight rope and not lose your balance, then regular walking will be easy. So sometimes I use that as like an overtrain kind of a thing. So while each of these tests is validated,
00:35:26
Speaker
which means we have evidence that it measures what it claims to measure. Whether the result actually relates to something we care about is a different question because a test can be valid for measuring a particular kind of balance or capacity and still not tell us very much about who is going to fall.
00:35:44
Speaker
So there's also, God, these words make me nauseous, the relative specificity and sensitivity of these tests. Now, Laurel understands it. So I'm going to let her explain it. Because even when she tried to explain it to me, I i have such like a visceral reaction to it because I hated it so much in PT school. And we had to memorize a lot of specificity and sensitivity, which was a total waste of freaking time. So Laurel, can you tell the good people what these two things mean?
00:36:10
Speaker
Listen, i am a so I'm still learning this too. So hopefully I don't butcher this. But You're taking these tests to figure out what your fall risk is. and You want a negative, right? You want to be a negative for fall risk.
00:36:24
Speaker
So that's the ideal scores. I passed these tests. My fall risk is low. Now, if the test is sensitive, it's very unlikely that it will produce a result that is a false negative.
00:36:41
Speaker
In other words, it's not going to say, the wrong outcome, which is that even though you tested well, meaning you have a low fall risk, in actuality, your fall risk is high because the test lacked sensitivity, right?
00:36:58
Speaker
Now, specificity, what that would look like is If the test lacks specificity, it's possible that you do poorly on these tests, right?
00:37:13
Speaker
So you are a positive for fall risk, but because the test lacks specificity, you could have false positives as a result, which means that even though it says that you're at a high fall risk, you're actually not.
00:37:27
Speaker
Yes, this is very confusing. Just know that tests typically lean one way or the other. for the most part. Fall risk tests are screening tools.
00:37:40
Speaker
So what this means is that they generally are more sensitive than specific. This means that if someone passes these tests,
00:37:52
Speaker
It's unlikely that they are truly at a high risk of falling because false negatives are unlikely, right?
00:38:03
Speaker
There are so many other factors that contribute to whether or not someone falls that these tests do not specifically capture. And these can be things like your eyesight. You could perform well on these tests with poor eyesight.
00:38:19
Speaker
But poor eyesight is going to hurt you in your home for falling. What is your home environment like? Is everything built to code slash? Do you have railing slash? Do you have slippery surfaces? is there stuff all over the floor constantly?
00:38:34
Speaker
Do you live? In a wintry area where half the year the roads are slick, there's so many things in addition to the medications you're taking. Urinary incontinence, maybe Sarah, you can speak to that, has some effect on people's fall rate. There's so many other factors that these tests simply do not capture, therefore they lack specificity, but they are quite sensitive, right?
00:38:58
Speaker
If you do well on these tests, you're probably not at a high fall risk. This is what I understand. Did what I say make sense? Yes. So for all of these tests, according to my search on consensus, there are varying levels of how well the tests predict or correlate to future falls.
00:39:17
Speaker
None of them on their own are better than moderately correlated, and most of them are poor predictors of falls risks. So what this has led to is that clinically the tests are often used in groups. Let's say somebody comes in for PT because they've already fallen, they're concerned about falling again. The PT is going to perform several of these tests together to get a sense of their balance capability broadly across different contexts of movement and also then to maybe get a sense of what needs to be worked on.
00:39:47
Speaker
especially in like acute settings, hospital settings. Balance tests are also typically used alongside certain assessment tools to come up with a better picture of an individual's fall risk. So these are tools like the Morse fall scale, the Hendrick II fall risk model, the Downton fall risk. I always want to say downtown fall risk in index.
00:40:08
Speaker
Downton Abbey fall risk index. Some of them include questions about the patient's fall history, like have you already fallen? Because if you have already fallen, that's a pretty big risk factor for falling again.
00:40:20
Speaker
In fact, it's a very powerful predictor. And yeah i've I've read that it's one of the most powerful predictors of fall risk is fall history. Right. It's similar to cancer. One of the highest risk factors for cancer is having already had cancer. Yeah. And injury. Yeah. Best way to predict what your next injury is going to be is what your past injuries were. So these assessment tools measure other aspects of the individual's health, not just their ability to balance, like use of medication, sensory deficits, memory, or other mental health deficits like depression, other co-conditions, things like that. The one that Laurel brought up about urinary incontinence, the reason it relates to falls is quite often
00:41:03
Speaker
if someone has what's called urge incontinence, which means you feel the sense that you need to pee, but you don't have the ability to hold it long enough to get to the toilet. And so you end up being incontinent.
00:41:16
Speaker
Very often in that instance, someone will be like in a hurry to try to get to the bathroom and they might start to move in ways that they're not actually able to do safely more quickly. And then they fall. A lot of people fall on their way to the bathroom, sometimes in the middle of the night, especially because the lights are off.
00:41:33
Speaker
So there's no singular way to predict someone's falls risk, but we can look at a series of these balance tests as well as other biological, psychological elements, historical elements of the person's health to then best assess their specific fall risk. But the big takeaway is that the tests for balance do not in and of themselves predict a risk of falls.
00:41:57
Speaker
So now we've got two new questions. If we can't specifically test for falls risk, how do we then provide interventions for falls risk?
00:42:08
Speaker
And since we can test balance and we can improve balance, can we say definitively that balance improvements actually lead to a reduction in falls risk?
00:42:19
Speaker
So let's look into those questions. Cool. And we're going to do a whole episode about balance too. Nice. Yeah. We're going to start by looking at what are the best evidence-based interventions currently measured in research for reducing falls before we try to look at individual differences in these types of exercises or exercise interventions.
00:42:42
Speaker
Now, we have a systematic review and meta-analysis from 2024 that synthesizes the evidence around effective ways to reduce falls. This paper is from JAMA.
00:42:53
Speaker
the Journal of the American Medical Association, and the USPSTF. And now I can't read what's coming after that because Sarah blacked it out. It's redacted. And then she wrote in a little comment over here.
00:43:06
Speaker
Laurel, guess what this stands for before we reveal it. I immediately go to USPS as United States Postal Service, but that's definitely not what it is. USPS, United States Postal Service Trips and Falls.
00:43:25
Speaker
That's right. thank its um all service truth ofs I think because this is a research paper, we have ultra serious people, which are definitely scientists are ultra serious people, right? Ultra serious people studying tripping and
Government Review: Effective Fall Prevention Strategies
00:43:38
Speaker
falling.
00:43:38
Speaker
It's an excellent guess. Do you want to tell the people what it actually is? United States, we had the first two words right. Preventative Services Task Force. Wow. Task Force. yes It is ultra serious. Oh, yeah.
00:43:52
Speaker
It sounds like a branch of the military. know. United States Preventative Services Task Force. Task Force. It's the words task and force. Roar. Task Force. We are not ultra serious people, folks. Nor are task force. Nor are we a task force. So all of this context combined tells us that this is probably pretty good evidence.
00:44:14
Speaker
Now, with that said, while it is a review of 83 randomized controlled trials and roughly 48,000 people, the randomized controlled trials themselves are only fair to good quality.
00:44:32
Speaker
But we got a lot of them, so that kind of makes up for it. Now, since this is a government-associated review, we do have to then assume that the level of evidence that exists for evidence-based ways to reduce falls is only fair to good.
00:44:47
Speaker
That is worth noting. Is it fair to good because it hasn't been looked at enough? Or is it fair to good because it's extremely hard to measure? This review paper explicitly evaluated interventions for community-dwelling adults aged 65 and older who were at an increased risk of falls. Community-dwelling just means they're not in hospital, right? They're not tested living under some kind of institutionalized care. yeah Yeah. Okay. So they're living independently.
00:45:16
Speaker
It focused on two groups of interventions, multifactorial and exercise only. Let's talk about what these mean. So multifactorial interventions included exercise alongside psychological interventions, nutrition therapy, education, medication management, urinary incontinence management, and environment assessment or modification. So all of those things together Whereas the exercise only interventions were a variety of types of exercise and they included walking, exercising with a physical therapist and group exercise activities.
00:45:58
Speaker
The review paper found that exercise interventions, that group were associated with statistically significant reductions in total falls, the risk of having one or more falls and injurious falls.
00:46:15
Speaker
They also estimated that Based on national rates per 1,000 people treated, this exercise-only intervention could prevent, of those 1,000 people treated, 107 falls, 22 people experiencing a fall at all. So by the way, 107 falls does not necessarily mean 107 people fell, right? People can fall multiple times.
00:46:39
Speaker
22 unique people experiencing a fall and 27 injurious falls. So multifactorial interventions, on the other hand, so this is in contrast with exercise interventions, this is now multifactorial interventions, which includes exercise, but all this other stuff, was found to reduce the number of total falls, but it did not show clear or consistent reductions in injuries,
00:47:04
Speaker
or the proportion of people who fall, right? Those unique individuals who fall. So it's not that they don't work, obviously, but it's that the results are actually less consistent across all of these outcomes of interest, which is that we want to reduce total falls, we want to reduce the number of people uniquely who fall, and we want to reduce the number of injurious falls. The multifactorial interventions were less consistent than the exercise-only interventions. That is a very counterintuitive yeah
00:47:34
Speaker
result. Because you would think that more is better, right? right So exercise demonstrated the most consistent statistically significant benefits across multiple fall-related outcomes. Now, if you're thinking like I am, why the heck didn't multifactorial work better?
00:47:55
Speaker
This is where things can get a little messy. Because these multifactorial interventions are complex, right? There's lots of different things we're trying to change and there's all these different probably steps and referrals and behaviors we're trying to change. And what was implied or suggested in the research is that this led to adherence tending to drop off at each of these stages. So the complexity hurt the adherence.
00:48:26
Speaker
So even though they included exercise, The overall dose of what people actually ended up doing to make these changes to reduce their fall risk ended up being inconsistent.
00:48:39
Speaker
And the exercise only interventions were perhaps simpler. Now we're just going to focus on one thing. You show up, you do the work, and you get that stimulus. Maybe because it's simpler, it's this more consistent thing to have to focus on.
00:48:55
Speaker
This is not saying that exercise is better than multifactorial interventions. It just means that in the data, exercise shows up more clearly and reliably as effective.
00:49:12
Speaker
okay And while exercise reduced the rate of injurious falls, it did not show a statistically significant reduction in the individual risk of having an injurious fall.
00:49:24
Speaker
and it did not show a clear reduction in fall-related fractures. And if you just went, what the F does that mean? Here's what that means.
00:49:37
Speaker
So if we take 100 people, and before doing exercise, 30 of them fall, but 60 total falls are reported because some of them fall more than once,
00:49:49
Speaker
And then after exercise, 30 people still fall at least once, but only 45 total falls occur. This tells us that the total rate of falls went down from 60 to 45, but the individual risk did not change as it was still 30 people falling.
00:50:11
Speaker
So the people who are at risk of falling are not necessarily less likely to have one fall, but they may be less likely to have repeated falls. And then when it comes to fractures, there are a few reasons why we don't see a clear reduction.
00:50:29
Speaker
Now, first of all, fractures are much less common than falls, which makes them harder to study. And overall, the evidence here is just less clear. So what we are seeing is that no single exercise or physical therapy program appears as the best model.
00:50:46
Speaker
And this is likely because even when we remove confounders like vestibular disorders or dementia, There are still a variety of factors that go into why any one individual person is falling.
00:51:01
Speaker
And instead of the usual hunt for a singular magic modality or system, we may need to more clearly assess the person's movement limitations or deficits and then and environment, I would say, and then match the training choice to the actual problem. This just goes straight back to this idea that You can make broad recommendations to large groups of people and they should be broad, but when it comes to actually helping individuals, you have to look at them as unique individuals. And if someone has deficits in multiple areas, let's say for example, they have significantly reduced range of motion in their ankles, as well as reduced coordination for walking, as well as reduced speed when changing directions,
00:51:48
Speaker
we can understand that there's probably not going to be one single modality that is going to fix everything. So if we have a situation where someone is claiming X intervention can improve your balance, that's probably true
Yoga and Balance: Misconceptions and Real-Life Risks
00:52:04
Speaker
enough. But if they are claiming X intervention is the best way to reduce your risk of falls, we don't actually have evidence for that.
00:52:13
Speaker
And this is where yoga is a perfect example. ah Because one of the main ways some yoga programs are marketed is as a way to improve balance, which in turn will reduce your likelihood of falls.
00:52:30
Speaker
However, yeah now we have a very interesting study from 2025, the SAGE randomized trial, S-A-G-E, in the Lancet Healthy Longevity, right? Which is a very well-respected gold standard type journal.
00:52:46
Speaker
And they compared a group practicing Iyengar yoga with a control group that were sitting and relaxing. Okay, so doing nothing. And contrary to expectations, there was a higher fall rate in the intervention group than in the control group with 33% more falls in the Iyengar group than in the seated relaxation control group, even though there was no increase in falls resulting in injury, which is good. But 33% more of them fell.
00:53:20
Speaker
That's what I like to call a womp womp. ah Yeah. The authors of the paper, I looked at this paper for my lit review on falls and exercise for fall prevention, and it's pretty jaw-dropping. It's jaw-dropping because it's not surprising when you see that the exercise group didn't improve much beyond the control group. That happens all the time in research. A lot of times it's because of the research design or the amount of time people were exposed to the exercise intervention. Wasn't enough time to make a change. But in this case, the exercise group fell 33% more. They were way worse off.
00:53:57
Speaker
Okay. So that's crazy. It's pretty nutty. The authors of the paper suspect one reason they gave was that these practitioners who did this Iyengar program became overconfident. They had an overinflated sense of their ability to balance based on their experience in the poses so that they went out into their lives and they took risks that were probably not smart, okay?
00:54:27
Speaker
and They were not in line with their capacity. They did not properly appraise their ability to handle those risks. And this suggests to me That a healthy fear of falling is not all that bad, folks. Can I also? Yes, go ahead.
00:54:41
Speaker
I wonder if part of why they were taking more risks is because they had been led to believe that doing yoga was going to decrease their fall risk incorrectly.
00:54:52
Speaker
You would hope that wouldn't happen in a research setting, right? But maybe just things they had heard about yoga in general. Well, this is the problem with exercise research, which is that you can't blind it, right? People know they're doing this activity right that is supposed to help them with their balance, which in turn, the logical conclusion is this will prevent me from falling. exactly And then they have some success and they're like, oh, look at me holding this pose. Look at me able to do these things Therefore, I can definitely jump across this puddle. Or therefore, I can step up onto this stool in my home or whatever. Yeah. So a healthy fear of falling is not all that bad, okay? Especially if capacity is realistically not on par with the balance challenges you are about to subject yourself to.
00:55:34
Speaker
The authors imply that the yoga practices these folks were doing did impose balance challenge in the context of the yoga practice, but that the exercise itself did not create in these peoples, in these peoples, in these people, the capacities or abilities to handle the balance challenges of real life.
00:55:56
Speaker
It also suggests that a realistic appraisal of your ability to handle balanced challenges in real life can be protective, right? Fear is not all bad. That's right. So that you don't put yourself in situations that you actually aren't reasonably able to handle, right? So improving balance qualities in yoga poses, which tends to be that static balance, does not automatically result in fewer falls. In fact, it resulted in many more.
00:56:23
Speaker
and Probably because yoga is not ecologically similar, can I say that, to the type of balance challenges that you face in your life. Oh, and I want to say, this is the big takeaway, okay?
00:56:38
Speaker
We have to be careful not to confuse improving on a test. or the ability to perform a yoga pose, or frankly, the ability to do any single task anywhere with improving a complex outcome of interest, which is your ability, in this case, to not fall in your life, right? We can't say, oh, because I can do a single leg RDL with 45 pounds for 10 reps,
00:57:08
Speaker
that I've reduced my fall risk. We still can't say that, right? So I think that that's just important to remember. Yeah, definitely. So this kind of segues really nicely into what people think balance training is, and if something that calls itself quote-unquote balance training can actually lead to a reduction in falls. Right.
00:57:30
Speaker
So when people say balance training in the wild, or if somebody says something like, I need to work on my balance, they're not referring to a group of clearly defined evidence-based interventions.
00:57:42
Speaker
They're referring to the kind of things that we could categorize as exercises or positions where you try not to fall while staying mostly in place. So it includes things like the classic, that old chestnut, standing on one leg,
00:57:59
Speaker
or doing a yoga pose like tree pose or eagle or other standing balancing poses. Sometimes it involves special equipment like standing on a wobble board, a foam pad or a BOSU ball, or maybe doing any of these and then closing your eyes, right?
00:58:16
Speaker
We've all been in that yoga class where you're in tree pose and the teacher says, now gently close your eyes and you immediately just like tip over. So the underlying goal of these types of exercises is to maintain equilibrium without moving your base of support very much. it means while you're standing here, don't fall over.
00:58:37
Speaker
And so then this version, this type of balance training then assumes that falls happen because you can't control your center of mass and that the solution is to improve this kind of static or near static control.
00:58:54
Speaker
And if you can hold these positions better, you're gonna fall less. So in other words, this kind of quote unquote balance training, it trains the ability to stay stable.
00:59:05
Speaker
It doesn't train the ability to recover from instability. Recovering from instability is the hallmark of a trip but not fall situation, right? It's not just, can I hold myself still? It's when things, when I'm pushed off balance, can I recover from it?
00:59:30
Speaker
Yeah, well, static balance does involve recovering from instability, but through like postural control and your ability to not move your base of support, but to get your center of mass over top that base of support.
00:59:42
Speaker
Yes. Which is a way of recovering instability, but it's not a dynamic way of doing it. And it's not a way that people typically- The way we're mostly doing it. Yeah. It's not a way that people typically fall. They don't slightly shift their weight and fall over for the most part. That's how it can start though, right? It's like you are standing statically and then because of poor postural control, you then end up coming out of that static state into a dynamic one and then you're ill-prepared to react. Yeah. Yes.
01:00:12
Speaker
Unless you are very specifically either frail or have some sort of neurologic or vestibular issue, simply standing still is not how most people fall over. Yeah. And even minor challenges to standing still, yes, can make someone fall or lose their balance, but then recover it. But it's not how it's happening in real life. Yeah.
01:00:37
Speaker
Right? So that's what the point that I want to make is if we're thinking about this kind of static or near static balance, this postural control, that in and of itself does not have a huge carryover to that not falling in real
Dynamic Balance Training: Real-World Applications
01:00:51
Speaker
life. It does not. It does not. In fact, tests that look at static balance are poor predictors.
01:00:56
Speaker
Yeah. Poorer predictors, I should say, of fall risk as compared to more dynamic tests. Yeah. And I talk about this all the time with the older people that I work with because Like we're saying, real life balance requires a lot of elements. It's not just this static control. We need things like what's called reactive stepping, which is what you do when you are have already lost your balance and it's go time for your feet. Can you get your foot out fast enough? Hey, feet, go time. It's that kind of quick response time, right? Not just how fast can you move your foot? Maybe your best option is how fast can you reach your hand out to grab a railing or a piece of furniture?
01:01:37
Speaker
Both require a type of ah force production under time pressure, which is what we call power. There's also often these specific contexts that we are not prepared for that show up. Unexpected challenges like you go to take a step and you misjudge it or you miss it completely or you're walking along, someone bumps into you, right? There's all these real world contexts that we can't really understand.
01:02:00
Speaker
test. Actually, they are starting to test for, and you can kind of train for it now, but also other things like other real world contexts, like you're walking, you're carrying something, you're turning while you're looking at your phone, all of these things at the same time, right? We don't see stuff like that in a workshop on balance, right? They're not like, okay, everybody stand up. I'm going to walk down this line and shove you and let's see what happens, right? That's not that's not what happens in those kinds of classes. So typically when someone says they do balance training,
01:02:28
Speaker
It means they practice not moving. But falls in real life and recovery in real life are really about what happens when you have to move quickly, unexpectedly, and imperfectly.
01:02:39
Speaker
Yeah. And when the risks are probably a little bit higher than they are in like a yoga class too, right? Which is one of the kind of conundrums that we face when we're trying to improve our balance, which is that we actually have to step and into a little bit of risk because we need to have to react. We need to be perturbed. We also need to have to solve problems.
01:02:56
Speaker
challenging puzzles, right? So I wanted to say this because I wanted to say this at the beginning after you talked about the last time you fell and then we just moved on the conversation. The last time I fell was in a trail was going to ask you. Yeah, yeah, yeah. i fell in a trail race. It was a flat, like unusually flat part of the race. It's very hilly around here. And yeah, I just, my foot caught a root or a rock. And what happens Typically, when this happens, when I'm trail running, is that I suddenly have to sprint, like my legs have to get in front of me really, really fast to catch myself from falling down, right? And a lot of times when I successfully catch myself, i end up kind of hurting my hamstrings. Because the force on the hamstrings to get my thighs in front of me at the hip, are so it's such a high force because the speed is so high that and my hamstrings aren't necessarily like ready for it. And I'll often be like, oh, shit, I hope I didn't tear my hamstrings. And then thankfully, I haven't yet. But one one race, I actually went and actually ended up winning this race. At age 44 or 45, I can't remember how I was first female overall.
01:04:00
Speaker
was super excited about that. Partly because I'm fucking insane on the downhills. I just fucking barrel downhill. I'm like, fuck it. Let's go. Better for worse. Right. But this is what I'm talking about. Like trail running is exceptional at improving your ability to navigate challenging terrain and not fall. But the risk of falling is so fucking high. In this case, I fell. I kind of slid across the leaves on my belly And one of the most annoying injuries I've ever sustained from a run, an acute injury, is an injury to my fucking thumb because my hand ran into a rock and I was unable to like grip with my thumb for a very long time. And I was like, is this sucker going to heal? like Do I need to go to a hand doctor? But yeah, like falling and getting better at not falling, getting better at catching yourself and then also possibly getting better at falling involves putting yourself in situations where there is at least some risk.
01:04:51
Speaker
Right? Yeah. That's what a lot of, there's a lot of newer testing and training is actually highlighting that, which is cool. Okay. So for going back to talking about, what are we talking about? What is balanced training?
01:05:04
Speaker
What leads to actually reducing the number of falls that happen? So there's a Cochrane review by Sherrington et al. from 2020 that that looks at different groups of exercise interventions. And it found that exercise in general reduces the rate of falls by 23%. Great, that makes sense.
01:05:23
Speaker
great that makes sense More specifically, it found that balance and functional training, and we're going to talk about what this means in context in a moment because it for sure doesn't mean what someone on social media is showing you, that that reduced falls by about 24% with high certainty, otherwise known as good evidence.
01:05:42
Speaker
So this included standing balance challenges, things like stepping, doing sit to stand, and other controlled movement tasks. Even more effective than just balance and functional training, although the evidence was more moderate, were multi-component programs that also included resistance training.
01:06:03
Speaker
Along with balance and functional training, they reduced falls by about 34%. Now, in this review, they found that there was unclear or insufficient evidence around just doing resistance training by itself and doesn't mean it doesn't help, but they just didn't have enough evidence to show it as as significant if you only do resistance Yeah, just standalone. As a standalone. yeah as a standalone Or same goes for walking programs, same goes for dance, and there was low quality evidence around Tai Chi as an intervention.
01:06:35
Speaker
So let's just talk for a second about what counts as functional in research, because it's sure as hell not crawling around on the ground like an animal. Or using a cable machine and doing these bizarre connections with different movements together. Yeah, right?
01:06:50
Speaker
So in trials, functional training typically includes the aforementioned sit-to-stand, stepping in different directions, turning, different walking tasks. So sometimes that means like walking and turning your head while you're walking, climbing stairs, reaching while you're standing or walking and getting up from the floor. And these are sometimes combined into short sequences or circuits. The common thread is that these are related to tasks that people need to perform in order to stay independent and to avoid falls. So functional training in a clinical setting is not about a single capacity. It's about
01:07:27
Speaker
coordinating multiple capacities of strength, balance, timing, speed, and coordination all at once power so that you can do the thing you're trying to do. Whereas in fitness marketing, functional training often means unstable surfaces, special tools, complicated movements. I just always think of people crawling around on the ground like an animal.
01:07:49
Speaker
Never, ever anteriorly tilting your pelvis. Yeah. Never. which is And that's all basically the exact opposite of what functional training means in research. So when the review says that balance and functional training reduces falls, what they actually mean is dynamic balance, movement-based tasks, real-world actions reduce falls, not just standing on one leg.
01:08:12
Speaker
and training them systematically in an exercise format, not just try to be more active in your house, but rather, no do things. sets of these exercises repeatedly over time, progress them.
01:08:26
Speaker
Yeah. And an earlier meta-analysis by the same group from 2017 also adds some important detail. These programs worked better when they challenged balance meaningfully.
01:08:38
Speaker
So things like single leg tandem standing, reaching, weight shifting, stepping up, not using your arms to help yourself, And when they were done for more than three hours per week, which a lot. Yeah, that's a lot. lot And also when they included progressive difficulty or progressive overload in the exercise. So when all of those elements were present, fall reduction then reached around 39%. Yeah.
01:09:05
Speaker
yeah Yeah. And it sounds like a strength training workout. Yeah. go right It sounds like, and and frankly, if you were someone who was working on your balance, some of the things that you'll be doing will look like strength training, like stepping up onto a step and getting back down and stepping back up on, you know, that kind of stuff. Sit to stands or squats.
01:09:22
Speaker
Yeah. So as far as what matters and what doesn't for reducing falls and falls risk, here's what we know so far. Balance training alone is insufficient. Resistance training alone does not have enough evidence to come to any conclusions.
01:09:39
Speaker
No one single method is best. And improving performance on balance tests does not automatically lead to fewer falls. So instead, what we're learning is that the best programs are multi-component.
01:09:54
Speaker
They involve a lot of different aspects of ways that our balance is challenged in real life. The most consistent ingredients are challenging your balance and functional movements, which themselves all require components of strength and power and coordination and speed, right? So you're actually working on these capacities.
01:10:16
Speaker
Even then, outcomes will vary depending on how much people participate, whether it's progressed whether it covers all the different categories of ways that we lose balance, things like that.
01:10:31
Speaker
Yeah. And a big one too is how long were they exposed to the intervention? Right. And how often during the week were they exposed to it? Lots of research I looked at for my lit review was just so short. It was like four to six weeks and they were meeting like twice a week. Right.
01:10:46
Speaker
That doesn't cut it according to this Sherrington analysis. Yeah. Three hours, three hours a week. That's three one hour sessions. That's a lot. Yeah. Not all just pure strength training, obviously, but you're up and you're doing structured exercise three hours a week. That's more than most people are doing of structured exercise. Oh, absolutely.
01:11:07
Speaker
Regardless of whether they're training for balance not. People aren't even getting close to that. Yeah. And these are people in their 30s and 40s. It's just going to probably get worse, right? Yeah. That's what we see. People become less, not more active as they age unless they make a decision consciously to become more active, which you can do at any time. Right. You certainly can. let's Let's talk about what capacities we need to catch ourselves from falling, okay?
01:11:29
Speaker
Because that's relevant. The relevant capacity we need to stop a fall when we are in the middle of it is actually not balance as we typically think of it, right? Which is keeping our center of mass over our base of support.
01:11:42
Speaker
It is actually the ability to produce enough force fast enough in the right direction at the right time to get our base of support under our center of mass, right? Right? And all those capacities are things like power, rapid force production, strength, and reaction time, right? that This is not static balance, obviously. So let's look at a couple of studies that dig into more nuance about the capacities we need. So there's a study by Simpkins et al. from 2022 that looked at whether it was working on power or strength
01:12:16
Speaker
that led to better outcomes for preventing falls. And they used the five times sit to stand test to measure power and then isometric strength in the lower limbs to measure strength.
01:12:29
Speaker
They found that sit-to-stand leg muscle power was more protective against everyday living falls than strength alone in community-dwelling older adults. This was a good study because it looked at falls, actually.
01:12:44
Speaker
There's also a systematic review and meta-analysis by Zhu et al from 2025 that found that lower average leg press power and lower peak sit-to-stand power could predict prospective falls in older adults, especially injurious or recurrent ones.
01:13:04
Speaker
So we know that power is force times velocity or strength generating at speed, but the speed component by itself is not enough.
01:13:18
Speaker
If we think about something like getting your foot forward quickly enough to prevent you from falling, it's not just a question of getting your foot in place. You're actually trying to change the trajectory of your entire body's direction in which it is going, which weighs something, right? It has mass. So you have to stop your body weight from going down and get it to go back up.
01:13:40
Speaker
You have to be able to generate enough force with that speed to counteract the pull gravity on your body weight and to make that direction change happen. And you might be able to get your foot out quickly, but end up taking a weak or an effective step, or maybe your ankles buckles underneath you, and this doesn't actually stop you from falling.
01:13:59
Speaker
And the same thing goes if you are trying to stop your fall with reaching. Your arm may be able to move out in front of you fast enough to touch the railing or a piece of furniture, but it then also has to be able to generate enough force at the same time to actually stop your movement, whether that's grip strength on a railing or pushing strength, right?
01:14:20
Speaker
And so this is a big piece of why static balance training is just not a sufficient way to reduce fall risk. Okay? A lot of falls are not failures of quiet standing.
01:14:34
Speaker
I think that's a great sentence. They are failures of recovery after a trip, after a slip, after a destabilizing event. So The training question is not, can you stand on one leg? But what happens when you start to lose your balance, right? What can you do?
01:14:52
Speaker
Okubo et al. did a systematic review and meta-analysis in 2021 that concluded that both volitional and reactive stepping impairments are significant fall risk factors among older adults. So volitional stepping being something that you're choosing to do consciously, like walking,
01:15:15
Speaker
stepping in particular directions, maybe around cones, up onto boxes, right targeting your foot placement in specific ways by your own volition. Whereas reactive stepping is going to happen way faster than your ability to choose to sit your body, putting your foot where it needs to be reactively. almost It's almost like a reflex, right? The type of movement you do kind of reflexively, you don't consciously think about it ahead of time. It's too fast.
01:15:41
Speaker
And you do it to avoid falling. when you start to lose your balance. So a new direction in testing and training balance that we're seeing is something called reactive balance training that has increased in popularity in the past few years.
01:15:55
Speaker
Deva Sahayim, I might have totally butchered that, et al. from 2022 asks the question, does reactive balance training, RBT, outperform traditional balance or exercise programs in reducing fall risk?
01:16:10
Speaker
Now, reactive balance training is a newer approach to assessing fall risk that is much closer to real life situations. It therefore might be something that we can say with greater clarity improves fall risk as opposed to other tests and techniques that we can only say improve or test balance.
01:16:32
Speaker
Now, part of why it might be better is that historically we don't like to just take people who are at a risk of falling and push them over and see what happens or expose them to very unstable, slick surfaces, things like that. but That's how people fall, right? That's how they really fall. So we have to figure out how can we test this? How can we train it, but also prevent people from actually hurting themselves?
01:16:58
Speaker
I just want to interject quickly, sorry, that I remember before PT school, when I was volunteering in a clinic, I remember talking to the clinic owner and she was telling me about some studies that they do on people with impaired balance where they put the person on a plate yeah and then with no warning, they just shake the plate and see what happens. And I'm like, that sounds awful. like Why would you do that to someone who's already at a risk of falling? Right. But you know, sometimes that, that is what they do. Right.
01:17:26
Speaker
Yeah. yeah In this review paper, they define reactive balance training as the following. People are exposed to unexpected balance disturbances, like slipping on a treadmill, being pushed or pulled by someone else, or lean and release setups, like you're leaning into someone and then they just move out of your way and then whoop.
01:17:45
Speaker
you know And then, you know obviously, you've got respond because they're not supporting you anymore. People are then forced to execute these real balance reactions like stepping, grabbing, recovering from this loss of balance, all of which require speed, strength, power, coordination. The paper concluded that reactive balance training reduced the likelihood of falls in daily life for older adults and others with balance impairments.
01:18:11
Speaker
Although adverse events were reported more often than in control, the risk went up with that type of training. yeah That is useful because it it suggests that training balance reactions may matter more than static balance challenges, though it does pose more potential injury risk.
01:18:32
Speaker
Yeah. I mean, I've seen a lot of social media posts more recently where it's like a class on balance training and they'll have a whole bunch of people lying on their belly And they'll push themselves up like they're going into like an upward facing dog.
01:18:44
Speaker
And then they quickly take their hands away and have to get their hands back in place again so that they don't hit the floor with their faces. Right. So that's a very sort of like, can you get your hands out fast enough yeah move when you're falling? There was another one that I saw where had a person standing in their kitchen and they were holding the handle of their Swiffer and they were letting the handle go. the handle would start to fall away from them and then they had to reach and grab it. Oh, wow.
01:19:08
Speaker
So from ah from a clinical perspective, I really like these because that's more typically what happens when people fall. So let's train the ability to react to that. And I remember there was a comment on the Swiffer video where someone just wrote, this is nice, but there is a fall risk.
01:19:26
Speaker
And so I responded, life is a fall risk. If you don't practice things quickly, you're going to be up the creek without a paddle when it happens, yeah right? So to your point about there's they found more injuries in this training, yes, because you have to take higher risks to actually get better at having reactive time. You've got to try to do things more quickly with more power. The question is what's an an acceptable amount of risk? Right. And that's going to vary person. Depending on the person, yeah.
01:19:53
Speaker
I mean, right now where I am, I don't know anything about my bone mineral density, but my guess is that it's pretty damn good. i am quite strong and quite agile.
01:20:04
Speaker
And i definitely take risks every time I go trail running, especially running downhill, right? Like those are real risks where I could take a very bad fall.
01:20:15
Speaker
And I feel like that's an acceptable risk given how frequently I have fallen in the past, which is very infrequently actually. and pretty sure-footed. And then what I notice about my ability to handle terrain with practice, it just there is a real skill involved in trail running where you are constantly processing information as it comes quickly depending on how fast you're running. choosing every single placement of your foot. The trails around here are not only hilly, but very rough. There's roots, there's rocks.
01:20:43
Speaker
There's a lot of times there's leaves covering obstacles. You can't actually tell what's under the leaves. And so as I practice trail running more and more, I find myself getting better at it and sometimes a little too confident, right? I'll take some risks that I'm like, oh, fuck, I just rolled my ankle because I was so sure that I could go down that hill that quickly. But, you know, it's always about risk assessment and balancing risk and reward. But it's very difficult to get big rewards without any risk.
01:21:15
Speaker
You got to risk it if you want the biscuit. Yeah. And there's also psychological components to all of this, which we've mentioned fear of falling. And like in these research settings, they'll have people on a treadmill and they'll be like strapped to a harness.
01:21:26
Speaker
And they'll do funky fucked up shit with the treadmill to make these people fall and see if they can recover balance. These people know that they're being held by a harness. They know they're not actually going to fall. And so all of that mental challenge has been removed, which immediately reduces the amount of challenge they feel that they're facing, which is going to change how they respond. Right. So like it's just so interesting.
01:21:51
Speaker
With that said, though, I would say this for my person that I currently am working a lot on various balance challenges with, if we're working on something like going up the stairs, I'm standing pretty close behind her so that if she happens to lose her balance and starts to tip backwards, she's not going to fall. I'm not standing in front of her. So if she trips, she's going to go down on her own. So I think in practice, there's always this kind of balance that you're trying to strike of not making this actually something where someone could hurt themselves real badly, like taking a tumble backwards down the stairs yes would have a lot of bad effects. But
01:22:26
Speaker
replicating enough of the real life risk so that they're willing to take some amount of risk and they're willing to mentally process that and be able to do that. Right. And I think that's always the sort of the fine line that you're trying to walk. Absolutely. That's why my daughter was wears a helmet when she ice skates.
01:22:41
Speaker
Right. Quick question for you. Have you ever stepped on a pile of leaves and gone plummeting into a hole? Not yet. That somebody dug. to try to trap you and then, I don't know, something that happens the movie. I don't think home would be there nefariously, but that is a real possibility as well. And it's always on my mind. See, that's what I'm talking about, the mental load of facing the real risks of falling, which is like a real part of it. It's a real part of the practice of it. Like you have to be willing to face it physically, but also the possibility you could hurt yourself too is a part of the exercise. Sometimes I'll see videos of people working on trying to do a box jump and you see it's not that they physically cannot bend both knees, spring up and land on the box. You can actually watch the mental block happening in real time where it stops them from like...
01:23:34
Speaker
coordinating their legs to work together or like they'll do like a weird little hop or they put their knee on them. Sometimes it is like a physical demand, but very often it's, you see it's that mental block of taking the risk, right? Of being like, I might smack my shins real hard on this box, but I need to take that risk. Yeah.
01:23:50
Speaker
It's a big part of it and it's not all bad, right? Fear of falling, as we've discussed, it has its upsides and its downsides. Mm-hmm.
Strength vs. Power: Key to Fall Prevention
01:23:59
Speaker
All right, so is it possible to determine whether power or strength matters more to prevent falls?
01:24:05
Speaker
I think this is a very good question and it's the one that I did my lit review around to try to solve. So for strength training, the fairest statement is that it is commonly part of effective fall prevention programs and almost certainly important, right? So strength training is often a part of these programs, but the best evidence is stronger for strength plus something else or multi-component exercise.
01:24:32
Speaker
than it is for strength only protocols. The JAMA review, the Cochrane review both point in that direction. There is also direct literature on strength training alone.
01:24:44
Speaker
A 2021 review on strength training to prevent falls reported beneficial effects on reducing fall rate. But again, this body of evidence is not as decisive or as consistent as the multi-component exercise literature.
01:25:02
Speaker
for power training. The literature is very interesting, but also a little less definitive. If your endpoint is actually false, which it should be, that is the outcome of interest. That is what you should be measuring. It's just difficult to measure. It's easier to measure someone's performance in a test, right?
01:25:19
Speaker
So a systematic review and meta-analysis from 2023 concluded that power training increases functional capacity related to fall risk, aka it improved people's test scores on these on power type exercises. Power types mobility or functional capacity tests, sit to stands, walk gait speed, things like that, that power training increased functional capacity as measured by these tests that do predict fall risk more so than other types of exercise in older adults, for example, strength training.
01:25:53
Speaker
Their highlights explicitly say power training improves performance in these tests while also noting that future studies should follow subjects' actual fall history So strength matters. Power may matter even more for that fast corrective action.
01:26:10
Speaker
But the best current falls prevention evidence still favors multi-component programming rather than trying to anoint one isolated variable as the whole answer.
Post-Fall Strategies: Reducing Harm and Improving Recovery
01:26:21
Speaker
Okay.
01:26:22
Speaker
So this next thing that we're going to talk about is something that I have found historically, certainly in the movement world, people aren't really talking about, and maybe it's because it comes more in the rehab setting that you think about things like this, but what are we going to do for someone when they fall anyway?
01:26:42
Speaker
How are we going to reduce the farm? The farm? Laurel, it's time to reduce the farm. We need to cut back on the pigs and the chickens and the corn. Too many goats. Too much to take care of.
01:26:54
Speaker
Yeah. Okay. So how do we reduce the harm that a fall might create, right? So clinically I've worked with a few different people who are worried about and at a risk for falls. And one of the things that I work on with this population, separate from trying to reduce their risk of falls or the number of falls that they have is what to do if and when they do fall. Because no matter, and this is true for everybody, no matter how much you train and no matter what kind of training you take part in, there are some falls or let's call them losses of balance
01:27:29
Speaker
that just can't be avoided. It's the middle of the night, you get up to go to the bathroom with the lights off, you trip over something that you forgot was there. If you're a healthy adult, chances are you're gonna be able to get your other foot out and catch yourself while swearing.
01:27:45
Speaker
But for other people, that trip means you're gonna hit the ground. So there you are on the ground and maybe you gave yourself a few bruises, but you're basically okay. Now, how are you gonna get back up off of the ground?
01:27:59
Speaker
And for people who are more frail or deconditioned, this can actually turn into a real problem that's called a long lie. Now, a long lie is not just about telling a fib that goes on and on and on.
01:28:12
Speaker
Is that like some some people's whole life? Yes, one long lie. or is it a nap? going to go take a long lie. gosh. That actually, in that context, I love it. And maybe we'll start calling naps long lies. I'm just going to go take a long lie.
01:28:27
Speaker
ah All right. So a long lie is not about telling a fib. That's right. It's not about napping. It's about the effect of being stuck lying on the floor because you lack the ability to get back up and what health issues can actually arise because of it.
01:28:43
Speaker
So there's something currently going on called the Sheffield Long Lies Study. Hmm. And they're defining a long lie as being unable to get up off the floor for at least an hour after a fall.
01:28:55
Speaker
And that happens to about one in five falls for adults over 65. And here's a quote from the study design. People who have a long lie may suffer a number of complications, including dehydration, pressure injuries, muscle and tissue damage, and psychological harm. Mm-hmm.
01:29:15
Speaker
Longer ambulance response times due to growing pressure on ambulance services means that people are being left on the floor for increasing periods of time. The problem of long lives may therefore be leading to worse health outcomes for an increasing number of people.
01:29:31
Speaker
Whilst there has been a lot of research to understand how to prevent people from falling, there is currently little information about how to manage people once they have fallen. I have another story about my dad.
01:29:43
Speaker
Please. He had to wake up frequently in the middle of the night to use the bathroom. and one of those nights, his wife was sleeping in the basement, probably because she was very sleep deprived as his primary caretaker and was like hoping to get a little bit more sleep that night.
01:29:57
Speaker
And he ended up falling. And he could not get up. But thankfully, he happened to have his cell phone in his pants pocket and he called the police.
01:30:08
Speaker
And a police officer arrived in the middle of the night and helped my dad up off of the floor. And had he not had his cell phone, I think this would have been a situation where yeah he would have been very cold and because his wife couldn't hear him. so right Right. He would have been there longer. He would have been there a lot longer. yeah Potentially all night.
01:30:29
Speaker
Yeah. So this study is currently ongoing. It hasn't yet produced any conclusions around what are the best interventions for people who are at risk for a long lie after a fall.
01:30:42
Speaker
But to me, it would make sense if you're doing work with someone who's worried about falling or who is legitimately at a risk of falling, it would make sense to include practicing getting up from the floor in whatever training you're doing with these people.
01:30:55
Speaker
So I have this woman in particular for whom working on getting up off the floor has proven to be a really big deal. She is someone who is an active fall risk basically all the time.
01:31:07
Speaker
She has falls less fortunately now, but she has had periods of time where she was falling a lot. And so when I was working with her, we had one day where for about an hour, we just pretended she had fallen and she was lying on her back on the ground.
01:31:23
Speaker
And then we just systematically identified each part of what she needed to do to get back up. So first rolling over onto her side. So we just worked on that for a bit and then getting onto hands and knees and then crawling over to a piece of furniture.
01:31:38
Speaker
and then using the piece of furniture to pull herself back up. And she, when I tell you that she was so irritated the entire, she was actively mad at me. She was giving me stink eye. Like she was not on board with this, but she did it.
01:31:53
Speaker
Since then, she has used this technique more than once when she was full. And she told me that even though it was deeply annoying at the time, she was ultimately grateful that we worked on it in this kind of stepwise approach to getting up off the ground.
01:32:08
Speaker
So if you're working with someone who is a falls risk, and if they're capable of doing this thing where you're like, well, let's pretend you're down on the ground. You can get them down to the ground. Get them down on the ground and work on these movements.
01:32:21
Speaker
I will say also, it takes some of the fear out of being on the floor for people who haven't gotten down and up from the floor in a long time. Like they start to get afraid of the floor. Mm-hmm. So by getting them down on the floor, even if it takes you 15 minutes to get them down on the floor, at least they're down there now. And they're like, okay, I've got options now that I'm down here. yeah And I would say as well, if you're working with someone who can still get up and down from the floor, but with effort, work on that capability so that they don't lose the ability to completely do it from not doing it regularly. You should put your social media post that you put up about this like
01:32:57
Speaker
deconstructing getting down and up off of the floor? Yeah, I was thinking about that. I will. so So there's not as much evidence for this exercise to get up off the floor then as much as there is for the exercise for fall prevention, but there is evidence and it's growing. There's a new, what they call floor rise training trial from age and aging in 2026. So the trial investigated whether floor rise training improves floor rise ability.
01:33:27
Speaker
So they had two groups. People either practice the floor rise training for 20 minutes, five times a week. The control group just watched a video of fall rise training without actually doing it. So what they were looking at is what's the specific value of physically doing it, not just learning about it.
01:33:43
Speaker
And they found that three to five sessions, so not much, of this training significantly improved older adults' floor rise ability and their perceived post-fall recovery efficacy. So in other words, these people now felt they were prepared to get up from the floor if they fell.
01:34:05
Speaker
Yeah. Right? Which is, you know, part of that fear of falling, right, that we were talking about. If you feel like you've got a little more capacity, if you do fall, that's definitely going to take some of the fear out of it. Yes.
01:34:15
Speaker
So post-intervention, 100% of the intervention participants could independently rise from lying down. but And there was zero change in the control group. So just learning about it was not enough to make a change in your ability to do it.
01:34:32
Speaker
But interestingly, because a lot of people think this kind of training, you have to do it forever and ever, they found that just three to five sessions of doing it actually immediately improved people's ability to do it. That's cool.
01:34:43
Speaker
And then something that I thought was interesting, and I think this probably relates as much to the general mobility of the person in question, they published their training protocol and they actually did it backwards. They called it backwards chaining protocol. So they taught them first bend over and hold onto a chair, then bend over, hold onto a chair and bend your knees and put one knee down on the ground. So they basically had them work on getting down to the ground and getting back up instead of just starting down.
01:35:13
Speaker
So getting up from the floor is not just a humiliating test item. It is a survival and independence skill. And in my opinion, fall prevention programming is incomplete if it never teaches floor transfers, floor recovery, or what to do after an actual fall.
01:35:32
Speaker
Right on.
Conclusion: Comprehensive Approach to Fall Prevention
01:35:34
Speaker
All right. So in conclusion of this whole discussion, we're What we've seen is that just improving your balance through static balance training does not translate to a decreased falls risk.
01:35:46
Speaker
And while the falls literature does support exercise, it doesn't support the overly simplistic story that falls are mainly a static balance problem and that the solution is generic balance training.
01:35:59
Speaker
The much better supported story is that falls are multifactorial events that involve strength, rapid force production, reactive stepping, exposure to variability, confidence, and what happens if you end up falling because you don't have the ability to recover before you fall.
01:36:15
Speaker
So the question is not just, can you stay upright? The question is, can you respond when you stop being upright? And this is where that reactive balance training, power training, and floor rise practice can finally start talking to each other and help you. Yeah. And another topic briefly is the ability to fall well.
01:36:36
Speaker
I have a personal training client who has a baby and she fell carrying her baby. And she remarked on the fact that she fell really well. It's just like all the strength training we've been doing. together really prepared me to be able to fall well. And I was like, i fucking love that because sometimes folks, you're going down. Yeah. You are going down. So how can you fall well? And I was thinking, well, what are the types of exercise modalities or activities that you could engage in that would potentially train you in all these multiple different ways of getting down onto the ground quickly
01:37:08
Speaker
without breaking something like controlled fall and or getting obviously back up quickly because that's going to train you in going down as well. And was like, well, burpees aren't looking so bad, right? Split squat jumps aren't looking so bad. But then also was like a lot of martial arts, a lot of modern dance type practices, potentially tumbling type gymnastics type work is probably pretty damn good practice.
01:37:34
Speaker
have slash preparation for falling well, right? yeah And when we talk about balance, we'll talk about how it's just every single response to a fall is unique, right? And so just having a lot of different exposure to different ways of getting down to the ground and back up in a multiple variety of different ways. How do you fall backwards? How do you fall the side? How do you fall the other side? How do you fall forward? How do you fall forward with and without your arms, right? Yeah.
01:38:03
Speaker
It's something to start thinking about if you don't currently have the capacity to tolerate this type of exercise. There are ways of regressing exercise down and up off of the ground. But if you do think about different types of, i mean, even yoga, which is a slower activity, is not a bad choice for all the level changing that we do in yoga. That's going to help to some extent, definitely with the mobility, partly with the strength of getting up and down off of the ground.
01:38:31
Speaker
like This is something that happens slowly or quickly, depending. And so we just want to be doing it. Get down on the floor, folks. And then get up again. Spend some time. And then do it again. Yeah. That's right.
01:38:43
Speaker
That's right. All right. Thank you so much for listening to this episode. We hope you enjoyed it. Please subscribe. Please rate and review and keep an eye out for our new course, Power Play, which is going to be available very, very soon. And we will see you in two weeks.