Chapter 12
IN THIS CHAPTER
Uncovering how diabetes and aging can impact your balance
Homing in on how to increase your balance
Adding balance training into your daily life
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.
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.
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).
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.
So how can you tell whether your balance has declined? To see where your balance currently stands, try this exercise:
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.
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.
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.
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.
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.
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.
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:
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.
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.
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.
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.
Place a towel on the floor and practice grabbing it with the toes of each foot, alternately, while sitting. Repeat the exercise while standing.
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.
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.
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.
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.
Try walking backward along a wall or a kitchen counter without looking back. Use the wall or counter to steady yourself as needed.
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:
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.
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.
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.
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.
Stand on your other foot and follow Steps 2 through 4 to practice with both legs equally.
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.
Even leaning forward can be harder to do well when your balance declines. Improve your ability by practicing this exercise (Figure 12-4).
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.
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.
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