By Hayley Nicholson, Exercise Physiologist, Credentialled Diabetes Educator

As we age, our bone density and muscle mass decreases, which increases the risk of falls and possible fractures. Falls can have a huge impact on mobility and independence, but there are steps that can be taken to reduce the risk. Common causes of falls include tripping over raised obstacles, slipping on wet floors, stumbling on stairs, and falling from ladders.

Reduced muscle strength, impaired balance or gait, poor vision, reduced reaction time and the use of multiple medications can all contribute to the risk of a fall. Inappropriate footwear and other environmental hazards can also have an impact, as can diabetes. Diabetes may cause problems with eyesight and reduce feeling in the feet and legs, particularly when blood glucose levels fluctuate quite a bit. This can make it more difficult to move around safely.

An estimated $2.3 billion is spent annually in Australia on treating injuries due to falls experienced by people aged 65 years and older. However, the good news is that most falls are preventable.

Recommendations

Exercise is a great way to reduce the risk of falls but how much and what type of exercise is best?

Exercise programs that include functional balance and muscle strengthening are the most effective in preventing falls. The exercises should be progressively challenging and of sufficient dose to maximise the benefits of reducing falls. It’s important to note that exercise participation needs to be ongoing, as benefits are lost when short-term programs are ceased.

It is recommended that exercises have a moderate to high intensity challenge to balance. That is, an exercise program should include exercises undertaken while standing or transferring weight (as opposed to seated). If possible, exercises should include a narrow base of support (eg: feet close together) but minimise the need for upper body support. Studies that have included exercises with a high challenge to balance for at least three hours per week were found to reduce falls by 40%.

Putting it into practice

Below are some exercises that could help you improve your balance. Before starting any exercise program however, it is important to get medical clearance from your doctor.

Single leg holds

Stand behind a chair on a flat stable surface. Shift your weight onto one foot and lift the other foot off the ground. Gently rest your hands on the back of the chair of required. Maintain this position for as long as possible (you might start with 10-30 seconds initially). As you become more confident, try holding this position for longer. Switch legs and repeat the exercise.

Tandem stand

Stand next to a wall on a flat stable surface. Stand with one foot directly in front of the other, heel to toe. Try to focus on a fixed point in front of you to maintain your balance. Use the wall for support initially, gradually reducing your support as your balance improves. Hold this position for 10-30 seconds. Switch feet and repeat the exercise.

Calf raises

Stand behind a chair on a flat stable surface. Lift your heels off the ground and slowly lower them back  to the starting position. Count two seconds to rise and two seconds to lower. Use the chair for support initially, gradually reducing your support as your balance improves Repeat 10 times.

Step ups

Step onto a raised platform (step) with one foot, pushing through your heel to lift yourself onto the step. Bring your other foot up so both feet are on the step. Step down with the leading foot, then the other, in a controlled manner back to the starting position. Repeat 10 times leading with each foot.

Sit to stands

Sit on a sturdy chair with your feet shoulder width apart and toes pointing forward. Place your arms across your chest. Lean forward, push through your heels and stand up. Slowly lower yourself back into the chair. Repeat 10 times.

The above exercises can be progressed by increasing the number of repetitions or changing the surface. Alternatively, the exercise can be made easier by utilizing the chair or wall for additional support.

This video show some useful exercises for building balance. If you are a beginner take it slowly and do half the number of repetitions of each exercise.

Other tips for preventing falls

In addition to increasing your balance through exercise, it’s also important to create a safe environment in and around your home. This might include ensuring you have adequate lighting, removing trip hazards like floor mats and electrical cords, installing grab rails, reducing clutter and wearing appropriate footwear. It could also be a good opportunity to have your eyes, hearing and feet checked if it’s been a little while since they were assessed. If you have experienced a few falls in the past, remember there are also lots of assistive devices available for extra support, such as walking sticks and wheelie walkers.

Need some assistance?

If you would like to reduce your risk of falls and you’re not sure where to start, you can reach out to your doctor for a referral to an Accredited Exercise Physiologist, under a diabetes care plan. They can assess your capabilities and limitations, review your medical history and formulate an appropriate exercise program tailored to you. If exercise is new to you, this is a great way to build your confidence under supervision so that you can participate safely on your own in the comfort of your own home.

References

Exercise is Medicine website – falls prevention https://exerciseismedicine.org.au/wp-content/uploads/2020/05/EIM-FactSheet_Falls-Prevention_Professionals.pdf
Tiedeman, A. et.al (2024). Exercise and Sports Science Australia updated position statement on exercise for preventing falls in older people living in the community, Journal of Science and Medicine in Sport, https://doi.org/10.1016/j.jsams.2024.09.003