I was tired. I had been traveling. Perhaps I was dehydrated or congested, or maybe the altitude was getting to me. But as I walked down the hallway of the Park City hotel, the floor tilted and threw me against the wall. I stood there for a few minutes, hoping the floor would return to its usual flat and stable position. It was a bout of vertigo, brought on by who knows what. My balance returned as the morning went on and that disconcerting feeling hasn’t returned since, but I vividly remember the disorienting walk down that hotel hallway.
Balance is something we take for granted. Until we lose it.
Maintaining our balance is the result of a remarkable and complex system. It begins with the vestibular system located inside the inner ear, which is comprised of canals, organs filled with fluid, and tiny, sensitive hairs. When our head moves, the fluid shifts, touching the hairs and sending feedback to the brain, which then, almost instantaneously, processes and dispatches that information, instructing the rest of our body to execute the many micro-adjustments needed to navigate the curb, react to a slip, or continue walking upright as we lift our chin to catch a snowflake on our tongue. At the same time, our eyes process everything from the height of the curb and our bodies send additional data about the patch of ice as we begin to slip.
The almost magical complexity of balance is the reason why we have sent telescopes into space that are strong enough to view the beginning of the universe yet have not managed to make a robot that can walk as gracefully as a human being (though as of this writing, we are getting closer).
As we age, the integrated systems that enable us to maintain our balance begin to deteriorate. Our brains don’t process information as quickly, and our muscles don’t respond as quickly, either. If we do fall, the consequences can be worse, as those slower reflexes reduce our ability to catch ourselves. And, to make matters even worse, if we do hit the ground, weaker bones are more likely to fracture.
And here’s the rub: a Duke University study of 775 adults showed that balance begins to decline in the 50s, with other studies suggesting balance decline might begin even earlier.
Poor balance has significant potential health consequences. The CDC reports that about 36 million falls are reported among older adults each year, resulting in more than 3 million emergency room visits and more than 32,000 deaths. And while not all falls can be prevented, maintaining strength and balance can help.
In 2015, a team of researchers from Japan sought to determine whether or not a walking program reduced the risk of falling for older adults. The question is complicated by the fact that more walking presents more opportunities for falling: if you rarely move from the couch, you rarely have an opportunity to fall. The researchers explained it this way: “The problematic nature of a walking intervention aimed at fall prevention is that along with the improvement in physical and psychological functions, it is also accompanied by increased exposure to environmental hazards (e.g., a greater chance of tripping while walking).” To account for this, the researchers sought to measure the likelihood that a trip would result in a fall.
The study included 90 adults ages 65 to 79 who did not exhibit anything that put them at a higher fall risk – no injuries, limited medication, and no history of recent falls.
The participants were broken into two groups. Both groups engaged in a 12-week program that included lectures, a warm up, a recreational activity, the primary exercise, and a cool down. For the exercise portion, the “walking group” walked briskly on a pedestrian road, while the “balance training group” engaged in a program that included strength training and Tai Chi (long considered an effective balance training modality). Both groups were instructed to continue their exercise routines at home and record any incidents of trips or falls for the following year. The result? The walking group showed a “significant reduction” in the risk of falling.
The researchers considered possible explanations for why the walking intervention improved balance and reduced fall risk.
First, the walking protocol helped to build the participants' endurance, and the researchers noted that a person is more likely to fall when they are fatigued. Thus, improved endurance could help prevent falls.
Second, the walking group experienced significantly more trips than the balance group did. At first, this might seem to be a negative. But the researchers noted that the quick initiation of a recovery step after a trip is key to avoiding a fall. In other words, tripping practice could have an “inoculating effect” on the likelihood that a trip results in a fall.
Then there's the possibility that the walking program helps to prevent what Doctor of Physical Therapy Meghan Griech refers to as the downward spiral. “Strength is essential for balance,” she explained to me. “Often, I see a spiral of decline in my patients,” she said. “They suffer a fall or an injury, they become fearful and reduce the amount they walk. Less walking leads to a deterioration in the physical strength needed to respond and adapt, causing more fear, which in turn leads to less walking. This negative cycle can be slow and insidious,” she cautions. “I tell all of my patients, ‘as long as you feel stable in your joints, you need to walk every day, preferably several times each day.’”
Excerpted from Why Walk? Discover the Transformative Power of an Intentional Walking Practice, by Joyce Shulman
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