Balance Training: The Missing Piece?
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Here’s a simple task for you as you read this introduction. In your head, list the types of exercise training you either perform, or know you should perform….
You’ll be thinking of resistance training, cardiorespiratory training, and flexibility training, but how many of you can honestly say you immediately thought of specific balance training? We can all benefit from this type of exercise training; it is not just something we should turn our attention to after the age of 50. Read on if you wish to understand how it can improve athletic performance and quality of life, prevent deconditioning, and how best to implement this training.
How do we balance?
To understand how we can benefit from improving our balance, and actually how to improve it, we first need to understand the mechanisms involved which help us to stay vertical.
In our ear, we have our Vestibular System. This consists of 5 components:
Three semi-circular canals
Two ‘Otolith’ (Literally ‘ear stone’ from Greek and Latin) organs
The semi-circular canals are filled with fluid, and this fluid essentially turns these canals into an internal spirit level. If you tilt your head to one side, this fluid pushes against tiny hairs, which sends nerve signals to the brain to signify that the head is rotating, and in which direction. When your head stops moving, it takes some time for this fluid to lose ‘momentum’ and eventually push the hairs in the opposite direction. In a really clever system, each of the three canals is responsible for detecting movement in each of the three planes: One detects side-to-side movement, one detects upwards and downwards movement, and one detects tilting towards the shoulder.
The otolith organs also posses hairs, which detect changes in speed of movement. Examples may include accelerating in a car, or taking a lift/elevator. Just like with the semi-circular canals, each otolith organ has a specific role. One monitors for changes in speed moving sideways, forwards or backwards, whilst the other monitors for changes in speed either upwards or downwards.
Together with other sensory organs, such as the eyes, the vestibular system raises an awareness of changes in speed and movement which may otherwise disorientate us. In certain circumstances, generally when travelling, our body may become confused by contradictory messages from different organs. For example, when facing the ‘wrong way’ on a train and travelling backwards, or when on a ship which is ‘tilting’ according to your internal spirit level, but looks straight to your eyes looking only at the inside of the ship. This can be a cause for travel sickness in some individuals.
The Importance of Balance for Athletic Performance
As mentioned, balance plays a crucial role in sports performance. This is especially true of sports which are unpredictable in nature, multidirectional, and team-based. However, balance is also crucial to a number of skill and power-based sports, too. The obvious example here may be gymnastics, in an event like the beam where the body is required to maintain balance both when still and during movement. However, football, rugby, and basketball also require high levels of balance and control. Improved balance has been correlated with better performance on specific tasks for agility, vertical jump power development, and repeated sprints. It is suggested that performing balance-specific training, alongside resistance training, is optimal for sports performance.
Balance for fall prevention
Logically, good balance, alongside adequate lower limb strength, is associated with a lower risk of falling, which, especially for populations over the age of 65, in turn lowers the risk of other fall-related issues, such as fractures, deconditioning and a loss of independence. Recent statistics show that 30% of individuals over the age of 65 suffer at least one fall over the course of a year, which can cost the NHS over £2 billion annually. Clearly, there are many advantages of preventing falls.
Interestingly, many large studies, including meta-analyses and systematic reviews, suggest that cardiorespiratory training and resistance training may improve balance even though this might not be the primary goal of the training. This does make sense. For example, some lower limb exercises, such as lunges and marching, whilst primarily aiming to improve strength and cardiorespiratory function, do also expose the individual to spending time on one leg at a time, which in turn can improve balance. Furthermore, based on data collected from control groups, a lack of exercise may be the driving factor behind worsening balance with age. In short - some exercise of any type is likely to improve balance compared to doing no exercise at all.
Balance Training Protocols
So, we know that balance is vital for preventing falls and improving sports or athletic performance, but what specific protocols can we put in place? As mentioned, it appears as though almost any type of exercise will improve balance to some extent, but if we are looking to optimise balance, then we can take inspiration from the following.1
Exercises Whilst Sitting on a Swiss Ball
Simply balancing - lifting one or both feet off the floor at the same time.
Balancing and adding some additional tasks, such as throwing and catching a ball, raising a hand, reading, or counting. or closing eyes.
Balancing whilst throwing a ball to a partner and catching the return.
Exercises Whilst Walking
Slalom walking (forwards or backwards) around obstacles.
Heel-toe walking or crossover walking.
Walking in a ‘chaotic’ environment - essentially a sensible obstacle course.
Walking, but having to perform unilateral exercises, such as lunges, when requested.
Walking on an unstable surface. E.g. BOSU ball, or a soft mat.
Step up exercises.
Any of the above with the addition of cognitive tasks (counting, reading etc.)
Exercises Whilst Standing
Standing in a circle, either on one or two feet, and passing a ball, balloon between each other.
As above, but with an unstable surface underfoot. E.g. Cushions under one or both feet.
As above, but adding unilateral exercises such as lunges, when instructed at random.
As above, but adding cognitive tasks such as reading or counting at the same time.
Take Home Messages
Clearly, balance can be an issue at any age, but it appears as though we should target our focus towards those over the age of 50. Whilst cardiorespiratory and resistance exercises do contribute towards the development of balance, a specific balance protocol will add variety to exercise sessions and optimise balance maintenance and improvement.
Halvarsson A, Dohrn IM, Ståhle A. Taking balance training for older adults one step further: the rationale for and a description of a proven balance training programme. Clin Rehabil. 2015 May;29(5):417-25. doi: 10.1177/0269215514546770. Epub 2014 Sep 8. PMID: 25200877; PMCID: PMC4419050.
After 10 years of a daily yoga flow my tree pose (foot on thigh, arms over head) is finally feeling stable.
Day after day, week after week, year after year.