Tackling the ice and slippery surfaces in winter. Balance and weak legs – can anything be done?

With the cold, wet and icy weather, surfaces can become more slippery and the risk of falling increases. This can be exacerbated with shorter days and darker evenings where icy patches on pavements are harder to see.

Injurious falls, including 70,000 hip fractures annually, are the leading cause of accident-related mortality in older people. Sarcopenia is the age-related progressive loss of muscle mass and strength. On average, it is estimated that 5–13% of people aged 60–70 years are affected by sarcopenia. The numbers increase to 11–50% for those aged 80 or above. Being physically inactive can contribute to this disease. In this blog, you’ll learn top tips on how to improve your balance, strength and general mobility so that you can tackle the winter with its frosty and icy conditions with confidence.

Did you know that a tailored exercise programme can reduce falls by as much as 54%. Exercise is one of the most important activities to maintain independence in older adults. Despite this, becoming more sedentary with age is often the reality. Staying fit and healthy for as long as possible is proven to increase happiness and quality of life.

Listed below are some key benefits for the continuation of physical exercise:

1. Maintains independent living
2. Better cardiovascular health
3. Assists in cognitive function
4. Reduces anxiety and depression
5. Helps with flexibility
6. Improves strength
7. Improves bone density
8. Prevention of falls
9. Maintains hobbies of day-to-day life

The winter months bring additional challenges with wet, cold weather, falling leaves, ice and snow become hazardous. Below are some weather-related cautions that should be acknowledged before attempting a trip out into the cold weather:

What to look for and do?

• Check for weather updates – harsher climates/snowfalls/drops in temperatures
• Assess the risk of going out in these climates
• Bulk buy on canned goods/long life foods to avoid going out regularly in harsher climates over the winter months
• Travel with another person who can support the more unstable individuals on slippery surfaces.
• Wear suitable footwear – sturdy supportive trainers with good grip.
• Maintaining foot help – visit your local podiatrist.
• Change route if there are known uneven surfaces that can be hazardous on ice.
• Try to stick to going out in the daytime, as when it’s dark it can be hard to see where you are stepping.
• Wear clothing that does not disrupt walking ability – E.g long coats that constrict normal stride length.
• Bring walking aids/ mobile trolleys to carry shopping.
• Source an emergency falls alarm that can notify a close family/ friend member for any fall related incidences.

What not to do?

• Go out alone if you’re at fall risk.
• Brisk walking. Take your time.
• Leave the house without walking aids or mobile trolleys.

Who to ask for help?

• Friends and family who can do the weekly food shop on behalf of the Indvidual.
• Charitable organisations to help individuals that don’t have immediate care at hand.
• Ask a neighbour to check-in when available.

NHS guidelines on Exercise Interventions

Senior individuals, fall risk or not, should be encouraged to take part in a multifactorial intervention. A crucial component of this intervention includes the uptake in fall prevention exercise.

Adults over the age of 65 years should be physically active every day, even if it’s just light activity. Activities should be aimed at improving strength, balance and flexibility, and completed at least 2 days a week. It’s recommended a weekly duration of 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity if you are already active, or a combination of both.

Exercise interventions

As we age, we lose a significant amount of muscle mass. It is important to maintain strength, particularly in the core and legs, to reduce your risk of falls. Your core is made up of your abdominal, buttock, pelvic, and back muscles. These areas work together to keep the body upright and stabilized over your center of gravity. The stronger your core and legs, the better you can stay balanced and move around.

Strengthening exercise can be categorised into 3 main groups. Firstly, functional exercise which mimics daily activities including rising up from a chair, hoovering or house cleaning. Building strength can also be accomplished through weight training. These are exercises that involve using hand weights or machines to target specific muscle groups. And lastly, resistance training. This type of exercise incorporates body weight to challenge muscles further. Examples of this can be demonstrated through a push up or squat.

Strengthening exercise examples and where they target:

• Sit-to-stand (Hip, core and knees)
• Mini squat (Hip and core)
• Calf raises (Ankle)
• Step ups (Hip and knee)
• Sideways leg lifts and extensions (Hip and core)
• Seated knee extensions (Knee)
• Seated forward lumbar flexion (Core)
• Seated hamstring curls (Knee)

Balance exercises can also be used in combination with strength to assist walking mobility. Balance exercises should be practiced near a wall or stable chair for support. Besides core muscle strength, foot and ankle mobility are another important factor in achieving better balance. Exercise programs that have been demonstrated to improve balance include yoga, Pilates and Tai Chi. Some specific balance-training exercises can also be done to target the ability to remain steady while standing still (static) or moving (dynamic).

Balance exercise examples:

• Sideways walking (Hip)
• Heel-to-toe walking (Ankle, hip and core)
• Single leg balance (Hip, knee and ankle)
• Tandem stance (Ankle and hip)
• 3-point toe touches (Ankle and hip)

These fall prevention exercises are encouraged to be completed twice a week and progressively built up over time when able with repetitions and sets.

The need for the uptake of exercise in elderly persons has never been greater. As highlighted throughout the blog, exercise is a fundamental part in preventing the risk of falls especially as the winter months approach. It’s important to assess the situation before going out and ensure all appropriate precautions are in place before doing so.

IMPORTANT NOTE:

1. Use a mobility aid to support balance if needed.
2. Check the exercise is realistic to what you’re physically capable.
3. Check home set up first, or for any trip hazards/anything that can cause further risk.
4.  Always stretch and warm up before any exercise.
5. Unsure of any exercises or need additional help? Ask a friend or family member, web browser for image description, member of the community or an exercise specialist at different levels (Physiotherapist/ Rehabilition specialist/Personal trainer).

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