For older adults, falling down is a Big Deal. It's the biggest risk factor for a fracture, and those—particularly when they're in the hip—can be exceedingly dangerous. The one-year mortality rate after a hip fracture is as high as 25 percent. So, argue researchers in a recent analysis published in the medical journal BMJ, preventing deadly breaks should include preventing falls, not just treating osteoporosis with drugs.
Falls happen for many reasons, and studies have suggested that cutting back on medications that may cause dizziness, supplementing with vitamin D and calcium (to build stronger bones), and making sure the home is safe all have their roles to play. But once you've tackled the tripping hazards and railing-less staircases, there's no getting around it—exercise is called for, a program of regular strength and balance training as well a cardiovascular routine to build endurance. Beginners may feel most comfortable starting with a group class, or working with an instructor or trainer with experience or certification in working with older folks. For the do-it-yourselfers, the Centers for Disease Control has a general strength-training program for older adults on its website . It's comprehensive, but the sheer number of exercises may seem daunting for newbies, especially since a recent study suggests strength training really should be done three times a week to get the fall-prevention benefits.
You may want to start out by focusing on a smaller set of key exercises that work the lower body and are thus aimed specifically at preventing falls, suggests Anne Shumway-Cook, a professor in the department of rehabilitation medicine at the University of Washington. One can be done at the kitchen sink: Rise on your toes, then lower your heels to the ground, and then rock back on your heels and lift your toes before lowering again. She also recommends front and side kicks to work the hip. Another is to sit down, then lift and straighten alternating legs. Finally, she says, try easing into and out of a sitting position without using your hands Most people could benefit from ankle or leg weights to increase the resistance, she says.
As for balance, you can begin with something as simple as standing on both feet and focusing on a point on the wall, trying not to move your body to keep steady, says Joseph Scott, an athletic trainer who is outpatient team leader for orthopedics at Southcoast Hospital Group and Rehabilitation Services in North Dartmouth, Mass. That can progress to doing the same thing for 30 seconds with closed eyes, then balancing on one foot for 30 seconds, first with eyes open, then with them closed. "You're getting the body to be aware of itself in space," he says. Both he and Shumway-Cook add that cardiovascular exercise helps people stay and feel stronger; Shumway-Cook recommends the standard prescription for health: working up to 30 minutes of brisk walking most days a week.
Taking up exercise doesn't mean you should ignore other precautions; sometimes a simple change in footwear can cut the odds of falling, says Scott. "Exercise isn't going to solve the problem completely," says Teppo Jarvinen, an orthopedist at Tampere University Hospital in Tampere, Finland, and an author of the recent BMJ study. But it goes a long way, and offers health benefits much more wide-ranging than just preventing fractures.