Chapter 12

Finding Your Balance

IN THIS CHAPTER

check Uncovering how diabetes and aging can impact your balance

check Homing in on how to increase your balance

check Adding balance training into your daily life

check Practicing balance with some simple exercises

When you talk about balance in the diabetes world, it’s usually related to your blood glucose. This chapter, however, is about physical balance — that is, how to stay on your feet and avoid falls.

People with diabetes have an elevated risk of falling, and falls can lead to injury or even death. Having some loss of sensation in your feet from long-term diabetes, aging, chemotherapy, or another cause increases those risks.

Staying flexible and doing exercises that improve your balance as you age is key. Even though having a strong core is important (see Chapter 11), the best way to prevent falling and its related injuries is to include balance training as part of your regular workouts. Thankfully, you can improve your balance with simple exercises, at least some of which you can fit into your busy schedule.

remember When you have diabetes, your risk of falling is even greater, especially if you have some nerve damage to your feet. But doing strength and balance training lowers your risk and may keep you from falling.

warning Make sure you always have something you can grab onto to keep from falling when doing any balance exercises. If you’re very unstable, you may need to have someone stand close by in case you ever feel unsteady, especially with your eyes closed, when doing balance exercises.

Examining the Effects of Aging and Diabetes on Balance

Think your balance is terrific? If you’ve been working on it regularly, it may be. If not, you may have lost more of your balance than you know. Even if you started out as a gymnast or just someone steady on your feet, you may be surprised to find out how much time has taken its toll on your balance ability.

Understanding that your balance declines as you get older

Sadly, due to the normal effects of getting older, everyone’s ability to balance begins to decline past the age of 40. Even as soon as you reach 30, your balance and posture start to become more important. Poor balance is associated with an increase in falls and injuries like wrist and hip fractures, even in people who are only at the midpoint of life (middle-aged).

remember Even if you don’t have balance issues yet, it’s never too early to start working on your steadiness. Regardless of your age, you can regain much of your ability to balance with practice.

Recognizing that diabetes adds to loss of balance

Having diabetes increases your risk of losing your balance and falling for many reasons. Some people sustain damage to their central nervous system (brain and spinal nerves) that makes them unsteady on their feet. Even losing the feeling in your feet (through peripheral neuropathy) affects your ability to balance and walk correctly.

As I discuss in Chapter 9, having spikes in your blood glucose can change the structure of joint surfaces, making them more brittle and prone to injury and less flexible over time. Having diabetes speeds up the declining flexibility that comes with aging because no one’s blood glucose is perfectly normal all the time. Being less limber makes you less able to recover your balance when you start to fall while walking or during another activity.

Checking your own balance

So how can you tell whether your balance has declined? To see where your balance currently stands, try this exercise:

  1. Stand on one leg.
  2. Shut your eyes.

warning Don’t try this test without something nearby to grab onto if you need it.

If you can’t stand steadily on one leg for at least 15 seconds — with or without your eyes closed — then you need to start practicing as soon as possible to improve your balance, regardless of how young you are.

To balance effectively, you need adequate strength in your ankle and hip muscles, good feedback from the nerves in your feet (to help your brain with its kinesthetic, or position, sense), and a functioning cerebellum (part of the brain that fine-tunes your movements). You rely more heavily on your eyes to compensate for negative changes in your ability to balance over time.

tip Start doing more exercises that maintain or improve your balance (as outlined in this chapter). Do some flexibility (Chapter 13) and resistance (Chapter 11) training, including core exercises, as well.

Improving Balance to Stay on Your Feet

Maintaining your balance is important during almost all physical activities. You can lose your balance easily enough when you’re standing or walking, but most falls occur when you’re moving, not just standing. Your head, trunk, and arms constitute two-thirds of your body weight, but with every step you take, that weight is carried and supported mainly by the hip muscles of your stationary leg.

remember Your balance during walking and other activities largely depends on how well you can balance on one leg at a time.

If your hip muscles are weak, you may tilt to the side. If you slip when you’re already leaning, you’re more likely to fall. Being strong and flexible is the only way you’re able to counter tilting, slipping, leaning, and other imbalances without ending up on the ground.

Knowing which muscles to focus on

The most important muscles for balance are the ones that lift your legs to the side, lift your toes, and keep you moving forward — basically, the muscles that drive your hip, knee, and ankle strength. Strengthening muscles in those areas of your body and keeping them strong throughout your lifetime dramatically lowers your risk of falling at any age.

technicalstuff The primary muscle that lifts your legs to the side is one of the gluteal (buttocks) muscles, the gluteus medius. Your main toe lifter is the tibialis anterior, on the front of your shins. The gastrocnemius muscle on the outside back of your calves keeps you moving forward with its power and strength.

tip To strengthen the critical muscles in your legs that balance you, make sure to do side leg raises, toe raises, and calf raises.

Like a stork: Practicing standing on one leg

You can improve your balance with very basic exercises that are quite easy to do. Testing your balance by standing on one leg is the simplest move (refer to “Checking your own balance” earlier in this chapter). Now it’s time to improve your ability to do it.

Bringing out your inner stork

Balance practice can be as simple as working at standing on one leg at a time. For best results, do this exercise two to three times a day, alternating legs.

tip Hold onto or brace your hand against a table, chair, wall, or another sturdy object when you first begin practicing this activity. You can find an illustrated version of this exercise in the later section “Working on Balance in Your Spare Time.”

Taking it to the next level

As you become steadier on one leg, challenge yourself by using only one fingertip for support, followed by no support at all (but have something sturdy nearby to hold onto if necessary).

Using more advanced techniques as you feel able helps you boost your balance ability even further. When you’re easily able to stand on one leg while holding on with both hands without getting too tired or losing your balance, try these progressive challenges:

  1. Hold on with only one fingertip.
  2. Don’t hold on at all (see the “Single Leg Balance” exercise in Figure 12-1 later in this chapter).
  3. If you’re very steady, close your eyes (with or without holding on).
image

Illustration provided by the American Diabetes Association and David Priess.

FIGURE 12-1: Single leg balance.

Supercharging Your Balance with Anytime Exercises and Activities

This section gives you lots of exercises that can help improve your balance, regardless of how young and steady you still are. You can do them almost anytime, in your home, and as often as you like with minimal or no equipment; just make sure you have something sturdy nearby to hold onto if needed.

The more of these exercises you do, the better your balance becomes. Doing even a few of them regularly improves your balance more than practicing your stork moves by themselves. (See the earlier section “Like a stork: Practicing standing on one leg” for this exercise.)

I’ve also included a chin-tuck exercise that helps improve your posture and remove or lessen an excessive bend in your upper back likely caused either by slumping or by getting older.

tip The exercises and activities in this section are critical for keeping the balance muscles in your legs strong. Practice them daily for best results.

Boost your glutes with side leg raises

Stand behind a sturdy chair with your feet slightly apart, holding on for balance. Slowly lift one leg out to the side with your toes facing forward. Lower your leg and repeat. Switch legs. Note: You can also do this exercise while lying on your side if you prefer.

Kick back with toe raises

Standing with your hand on the back of a chair or against a wall, straighten one leg so that your foot is off the floor in front of you and flex your ankle to point your toes up at the ceiling. Hold this position as long as you can. Relax and repeat until fully fatigued. Do these toe raises using the other leg as well.

Keep moving forward with calf raises

Stand with your toes on the edge of a step while holding something stable. Raise yourself up as high as you can and lower yourself slowly back down. Repeat ten times and then try doing it with the other leg. You can also work one calf at the same time. These are a more challenging version of the “Standing Calf Raises” resistance exercise shown in Chapter 11 because you do them with your toes on a step instead of standing on the floor (but still while holding on). Note: To make these raises even harder to do, hold a weighted object, like a dumbbell or full water bottle, in your free hand.

Grab a towel with your toes

Place a towel on the floor and practice grabbing it with the toes of each foot, alternately, while sitting. Repeat the exercise while standing.

Stand on a cushion

Find some cushions or pillows of varying firmness. Put them on the floor and stand on them with your legs alternately together and farther apart. Keep moving your position periodically to give your ankle muscles more practice at various odd angles.

Change the way you stand

Try various things that change how your body deals with standing still. Try standing with your eyes open or closed. Tilt your head to one side or keep it straight. Talk or keep silent. Keep your hands at your sides or move them out from your body.

Get up with sit-to-stand exercises

Practice standing up and sitting down from a stable chair that has no arms. Don’t use your hands or arms for support or balance — only your legs. Lean forward slightly when attempting to stand up.

Walk heel-to-toe

Position your heel just in front of the toes of your opposite foot each time you take a step. Begin doing this exercise following along handrails or with a wall next to you, just in case you start to feel unsteady.

Travel backward

Try walking backward along a wall or a kitchen counter without looking back. Use the wall or counter to steady yourself as needed.

Practice posture by tucking your chin

You may not realize how much having poor posture is also affecting your balance, but it is. Over time, your body tends to bend forward, moving your center of balance the same direction, making your body unstable as you walk, and increasing your chances of falling. Good posture makes you feel better and is very important to preventing back and neck pain and maintaining better balance.

Here’s how to practice this chin-tuck posture exercise:

  1. Stand with your back to the wall with your heels 2 inches from it.
  2. Hold your chin down onto your chest.
  3. With your chin tucked in, try to touch the wall behind you with the back of your head.

remember Don’t despair if you can’t do this posture activity right away or that well. Most people over 50 years old don’t succeed in doing it. But it’s still a good posture exercise to practice daily anyway.

Using Yoga or Tai Chi to Boost Flexibility, Strength, and Balance

As I note throughout the chapter, getting more flexible improves your balance and prevents falls. Yoga and tai chi both include movements that work on flexibility, strength, and balance at the same time. Working your joints and muscles with yoga, tai chi, or stretching to maintain and increase your range of motion around joints helps prevent injuries, along with keeping you on your feet.

tip Getting involved in tai chi or any form of martial arts training allows you to practice your balance while gaining lower body strength. Look for yoga and tai chi programs at your local Y or other health club, community center, or senior center.

technicalstuff If practiced in its true spirit, yoga can balance your body and mind, which enhances both your physical performance and mental well-being by counterbalancing the effects of your sympathetic nervous system (the fight-or-flight one). If you’re mentally stressed, practicing such techniques can help you relax and calm down. Vigorous styles of yoga that are a workout in themselves aren’t as good for relaxing and maximizing the effects of your parasympathetic nervous system activity, which works as the counterbalance to the sympathetic nervous system. Go for the kinder, gentler yoga moves for maximal relaxation.

Working on Balance in Your Spare Time

You have many options when it comes to practicing exercises to improve your balance. Some of the ones in this section are variations on ones you already discovered in earlier sections, and the rest are new ones to try.

Single leg balance

This exercise (Figure 12-1) also works on bringing out your inner stork, but it starts at the point where you’re not holding on at all. If you need to hold on with one or both hands when you start out, certainly do so.

  1. Stand with a chair in front of you to hold onto it for balance, if needed.
  2. Bend your right knee and lift your right foot off the ground.
  3. Hold that position for about 10 to 20 seconds.
  4. Lower your right leg and raise your left foot for 10 to 20 seconds.
  5. Repeat Steps 2 through 4 several times.

Three-way leg swing

This leg swinging activity (Figure 12-2) is harder to do than you think, but it really benefits your balance if you practice it often. Start out cautiously with something nearby to steady yourself on until you get good at doing it.

  1. Stand on one foot, hands on your hips (or hold onto a chair or the wall).
  2. Swing your other foot forward and hold it in that position for 5 seconds before returning it to the starting position, and repeat this move ten times.
  3. Next, lift that same leg out sideways ten times, holding for 5 seconds each time.
  4. Finally, lift the leg backward ten times, holding for 5 seconds each time.
image

Illustration provided by the American Diabetes Association and David Priess.

FIGURE 12-2: Three-way leg swing.

Stand on your other foot and follow Steps 2 through 4 to practice with both legs equally.

Balance/reach

When you’re younger, you take your ability to do a lot of movements without falling over for granted. When you get older, you need to work on reaching for things while staying on your feet, as shown in Figure 12-3.

  1. Bend your knees and lower your body while reaching across your chest with your right arm; hold this position for 5 seconds.
  2. Return your right arm to its starting position and then reach across with your left hand; hold this position for 5 seconds.
  3. Repeat Steps 1 and 2 ten times.
image

Illustration provided by the American Diabetes Association and David Priess.

FIGURE 12-3: Balance/reach.

Forward lean

Even leaning forward can be harder to do well when your balance declines. Improve your ability by practicing this exercise (Figure 12-4).

  1. Stand on both feet with your hands on your hips.
  2. Bend forward as if to touch your forehead to the wall.
  3. Hold this position for 10 to 15 seconds.
image

Illustration provided by the American Diabetes Association and David Priess.

FIGURE 12-4: Forward lean.

Toe raise

Much of your ability to balance while standing also depends on the strength and flexibility of the muscles in your feet. Make them stronger by practicing the exercise shown in Figure 12-5.

  1. In a standing position, point your toes toward the ceiling and rock back on your heels.
  2. Return to standing on your full feet, and repeat this cycle 20 times.
image

Illustration provided by the American Diabetes Association and David Priess.

FIGURE 12-5: Toe raise.

Heel raise

This exercise is a lot like the one mentioned in the “Keep moving forward with calf raises” section earlier in this chapter, but this one is more focused just on balance ability because you don’t hold on while doing it (Figure 12-6). It’s fine to start with holding on at first if you need to, though, and also try it raising one heel at a time for a different challenge.

  1. Standing on both feet, rise on the balls of your feet, lifting your heels.
  2. Repeat this movement 20 times.
image

Illustration provided by the American Diabetes Association and David Priess.

FIGURE 12-6: Heel raise.

tip You can also try this exercise one leg at a time by raising one heel five times and then doing the same with the other heel.

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