Whether you are an older adult looking to stay active and independent or simply interested in learning more about balance, mobilty and fall prevention, this is the podcast for you. Dr. Rose discusses the importance of fall prevention and balance assessment and training as part of a broader overall fitness regime. She has developed a program that provides a multidimensional approach to the assessment and treatment of balance-related problems called the Fallproof Balance and mobility Program. And provides some special information for senior adults wh are considering taking up pickleball.
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You are connected and you are listening to specifically for seniors, the podcast for those in the Remember When Generation. Today's podcast is available everywhere you listen to podcasts and with video at specifically for seniors YouTube channel. Now, here's your host, Dr. Larry. Barsh
Falls are a leading cause of injury, disability, and death among older adults. But with the right training, it's possible to improve your balance and reduce your risk of falling. Whether you are an older adult looking to stay active and independent, or simply interested in learning more about balance, mobility, and fall prevention. This is the podcast episode for you. We'll learn more with our guests today on specifically for seniors. Dr. Debbie Rose is the professor and chair emerita in the Department of Kinesiology at California State University in Fullerton and co-director of the Center for Successful Aging. She is founder of the National award-winning Fall Proof, balance and Mobility Program, and author of the book, fall Proof, a Comprehensive Balance and Mobility Training Program, and a surprise to Dr. Rose as well. The publisher of her book, human Kinetics will be giving away a copy of the ebook to a lucky winner. So stay tuned at the end of the podcast for more information. Welcome to specifically for seniors, Debbie.
Debbie Rose (02:03):
Thank you, Larry. It's a pleasure to be with here with you here today.
I think one thing that may confuse a lot of the listeners is exactly what kinesiology is. Can you explain that to us?
Debbie Rose (02:18):
Mm-Hmm. <affirmative>, thank you for asking that question, because if you were to do an internet search on kinesiology, you might find some competing definitions. But kinesiology as it's regarded in higher education in North America, is really at its essence studying human movement. It's a multifaceted field. We look at development of human movement, control of human movement from a social and humanities perspective, but also from a national dis a natural disciplines perspective. So it includes any type of physical activity that an individual might do, which elevates their expenditure levels. It addresses sedentary behavior, which is a big concern among adults in the United States in particular. And it also addresses doing exercise for health and fitness. So there are variety of different ways to study it, but we, we regard it as the academic discipline where physical activity and exercise are the intellectual focus.
One of our main concerns as we age is that we become more at risk for falls. And this is a growing problem in the United States. What's the extent of the problem?
Debbie Rose (03:43):
Well, we know that statistics tell us that approximately one in three adults over the age of 65 years will fall at least once a year. And we know as we age and we get older that the risk for falls does increase, but I'd like to say it's not age alone that increases the risk for falls. There is much that we can do as we age to really prevent falling or at least mitigate injuries that might be associated with falls.
And in older adults, for example, what are the main causes of falls?
Debbie Rose (04:26):
So usually we talk about a top 10 list of factors that tend to increase risks. For falls the greatest, so certainly because of my area of study which is full risk reduction in older adults. Balance and gait problems are very clear risk factors for falls. So an individual who's starting to feel unsteady is not steady when walking is losing strength. They're going to be key factors in terms of full risk. They're not the only factors, though. Where we live can also prevent present risks for falls, for example, if you don't live in a safe home, if you have poor lighting, if there isn't good quality flooring all of these kinds of things can increase risk for falls. Pharmacological considerations. So increase in the medi use of medications, particularly medications that have side effects that affect our attention or affect our alertness. So taking medications to improve our mood antidepressants to control anxiety, to sleep better, do have side effects that can certainly influence risk factors for falls.
So with a multiplicity of causes of balance, problems and falls, what can the individual do to mitigate the risk of falling?
Debbie Rose (06:00):
Well, as soon as they identify that they're having balance problems, they need to take action. And the first line would be to talk to their primary care physician about their concerns about balance whether it's strength as well, whether they're unsteady with walking and look for either a referral to a physical therapist, if it's a significant problem that needs to be addressed by a health professional, or to identify a program in the community that's being led by a trained instructor in the area of balance, mobility, and strength. We know those are the key components of any effective program. And starting early is the best way to prevent falls later on in life.
And there are other factors like nutrition, hydration, sleep, quality,
Debbie Rose (06:55):
Definitely. Hydration is very, very important. Drinking water is important because if the older adult becomes dehydrated, that leads potentially to urinary tracted infections, which in and of themselves can change cognition and increase risk for falls. So hydration is really important. Eating a well-balanced diet is important. Staying away from any faddish diets with the propensity for wanting to lose weight, but really thinking about a well-balanced diet, lots of fruit and veggies good protein there's, there are really easy ways to stay well, stay healthy and stay balanced.
Let's get into your field now a little bit more. What are some of the most effective exercises for improving balance and preventing falls?
Debbie Rose (07:52):
So the research over the last two decades has really looked at hundreds of studies that have been done looking at effective fall risk reduction strategies. And the overwhelming most cost effective strategy is engaging in exercise, but the type of exercise matters. So with respect to reducing falls, the most important exercise is to be engaged in balance exercises combined with resistance exercises and functional activities. So doing activities that mimic or simulate activities of daily living, such as transferring from a chair to a standing position or transferring from one surface to another surface walking on different surfaces, making sure that the major muscle groups that we require for good balance, our thigh muscles, our hamstrings, our what we call our abductors abductors or our lateral stabilizers are kept really strong so that if we should lose balance, we've got a good opportunity to restore balance because we have a sufficient amount of strength, they're found to be the most effective programs.
And this fits into a, a program of broader overall fitness,
Debbie Rose (09:24):
Most definitely. I, I, I'm in the older adult age category myself, so I think long and hard about the kinds of activities that I engage in on a weekly basis. And I'm always involving myself because I enjoy group-based exercise classes in ones that really combine aerobic endurance, so elevating my heart rate, getting my cardiac system working combined with a good dose of balance, some functional strength training. And definitely flexibility is also important because as we lose flexibility as we age, that now starts to change the way we walk our stride length shortens, we don't feel as flexible and mobile. So that to me, there's five essences of the good exercise program, and that's aerobic endurance combined with resistance training, balance flexibility, and really a good active breathing routine as well. Aging can be a very stressful process for many older adults and really engaging activities that really lower anxiety combined with the exercise can be really, really valuable.
So you built these exercises and training procedures into a program that develops a, I guess a multifunctional month multidimensional approach mm-hmm.
Debbie Rose (10:54):
<Affirmative>, right, right.
Both assessing and balance training.
Debbie Rose (11:00):
Yes, exactly. One of the things I found was limiting in the research as I was doing my own research was there weren't any balance assessments out there that were appropriate for older adults starting to experience balance problems. The balance assessments that were out there were really addressing more frail older adults. And I really wanted to get at the heart of the matter and find out why is this person beginning to experience balance problems? So that led to developing the full advanced balance scale which is used extensively now to evaluate early changes in balance among older adults. And of course, my biggest goal was to create a training program that I could certify instructors, both professional kinesiologist and healthcare professionals to implement effective multidimensional balance training programs. And foolproof is a combination of looking at balance in its multiple dimensions, and I'll explain that a little bit more.
Debbie Rose (12:08):
And then combining that with good resistance and flexibility training. So those are the three components of the program. But in terms of balance, the program is way more than standing on one leg. It's great if you can stand on one leg, but that only addresses a very small part of the larger picture of issue. I'm an avid pickleball player, and I know that was one of the topics we were gonna talk about. So for me to be a good pickleball player, I have to be balanced, but dynamically balanced. So doing activities where you are moving and you are working on different planes of motion and also engaging activities where you are doing balance activities on different surfaces. So whether you are standing on a phone pad to create a little bit more imbalance while you're doing activities, to do activities with your eyes closed, because oftentimes when we are moving about at night, we don't have good lighting available to us, so we have to rely on other sensory systems to get us where we need to go, whether that's from our bed to the bathroom in the middle of the night.
Debbie Rose (13:20):
We need to have really good multiple sensory systems, working vision, our somato sensory system, which is our touch system or our proprioceptive system, which tells us where our joints are in space, and also that inner ear system. So when older adults are having dizziness issues, sometimes it's not a blood pressure issue. Sometimes it's dysfunction in what we call the vestibular apparatus or the inner ear. And that's important to function well because it tells us where our head is in space and where our head is relative to our body. So balance is a lot more complex than sometimes it's advertised to be. It's not just about acquiring good static balance, being able to stand still and steady. It's also being balanced while we're in motion.
So as long as you brought it up, and since a bunch of listeners are avid pickleball players to be, what do you recommend specifically to someone who is doesn't have a trainer but is going to start playing pickleball?
Debbie Rose (14:33):
Well, I think the key thing, and I I see this all the time with, with my older adult friends that play pickleball with me is you really need to warm up before you play any sport. And I've noticed that in the pickleball community, there's a tendency for people to arrive at the courts and immediately begin playing. And to me, they're just not warm yet. The the internal body temperature hasn't increased, the muscles aren't warm, and even just your focus of attention hasn't really kicked in as yet. So doing a nice easy stretching routine, stretching out the calves, stretching out the hamstrings and the thigh muscles doing some dynamic types of movements, whether it's just swaying from side to side, doing hip rolls, really getting the body ready for the game. Pickleball is a lot of times underestimated in terms of the level of agility and mobility it requires.
Debbie Rose (15:40):
So I'm always shocked at the, the number of older adults who haven't got good hand-eye coordination and find it very difficult to move around the court, even though it's a significantly smaller court than a tennis court. So for me, the first rule of thumb is warming up before playing, and then there's lots of opportunities in the community to engage in beginner clinics. I really advocate for old adults in particular who may not have a background in court sports to, to get involved in those clinics. I know here in San Clemente, our recreation program offers beginner pickleball clinics. They're so popular across the nation now learn to play the game and also learn what are, what is a good pickleball warmup routine. Once you have that paddle in your hand, I can't express that enough and stop when you start to feel tired, because oftentimes injuries occur as you become more and more fatigue. So your focus is of attention is not as high, and you tend to perhaps not think about your movement's quite as much.
Your program, your fall proof program is available at the Center for Successful Aging in California, correct? I is it available elsewhere as well?
Debbie Rose (17:08):
Yes, absolutely. You have to find out, but a lot of senior living communities in the United States adopted the program, and that really came from me developing a certification program, as I said earlier, for kinesiology professionals and healthcare professionals who really wanted to understand how to deliver balance, effective balance and mobility programs in depth. So that led to a lot of different senior living community organizations picking up the program. It is also available in the community, but it's a little bit more challenging to keep those programs going because the community tends to to be a little bit more of a dynamically evolving environment. Whereas in senior living communities, once they adopt these types of programs and they have the necessary certified instructor in place, they're really able to continue for a good period of time. So you know, many, many, many senior living communities, a across the United States and Canada in particular, have adopted the foolproof program and it's being delivered. It may not be the name foolproof. I have never said to any of my certified instructors that they're required to call their program foolproof, but all of them are certified to teach the tenants, the basic tenants of that program. But senior living communities, for one reason or another, might need or want to trademark the program for themselves. But you'll find out very quickly if the program is actually a foolproof program, not just by asking the instructor, did they go through the foolproof certification at Cal State Fullerton,
How can a health management expert in a senior community find out more about the program?
Debbie Rose (19:04):
The easiest way to do that would be to contact me at Cal State Fullerton. My email is very easy. It's d rose fullerton.edu, and I'd be more than happy to share information that we have about our certificate program and how one can enroll in it as well.
You've written a book about fall proof program now working on a third edition. Mm-Hmm. <affirmative> since your publisher is good enough to offer a copy to a listener, is this book actually for the public
Debbie Rose (19:45):
With caution? There are certainly a number of exercises in the book that would be very safe for an older adult to do, but the book itself really is designed for, would be instructors of balance and mobility programs. Certainly the resistance training chapter has a number of exercise in it that are very well described that an older adult could do safely in their home. The flexibility exercises are also very easy to do by oneself at home. But once you get into some of the more challenging multi-sensory training activities, the gate pattern it's nice to have somebody to supervise, but hey, if you've got a favorite instructor in the community, you could share the book with them and say, how about doing some of these balance activities out of this book in our class? So I think that would be one way to do it as well. But the book, to be perfectly honest with you, is really designed for the healthcare professional or the kinesiology professional who wants to deliver effecti full prevention programs.
So maybe if the winner of the book lives in a senior community, it would be nice to have them give the book to the healthcare professional in their community.
Debbie Rose (21:04):
Absolut, absolutely. That would be a great idea, Larry. Absolutely. Yeah.
Did we miss anything?
Debbie Rose (21:12):
I don't think so. I think that the thing that's really important to know about preventing falls is taking action as soon as you start to recognize changes in your balance and your strength. We also, we talk a lot about how easy it is to know when you're starting to feel inflexible or a little weaker, but oftentimes you don't know you've got a real balance problem until that first fall takes place. And I've certainly fallen on the pickleball court, and I've fall in in other places too, but I'm a very physically active older adult and expect that those kinds of things are going to happen. So not all falls lead to injury, but I certainly don't teach older adults how to fall. I teach older adults how to prevent falls. And I think being flexible, staying strong, really working on balance on a regular basis is the very best way to really reduce your risk for falls. I take my own message with great heat, and I, I hope other people do as well,
Maybe be a little bit more definitive on how someone can tell their balance is off.
Debbie Rose (22:35):
So you get up from a chair and you feel a little unsteady. It takes you a few moments to become a little bit more balanced before you walk. When you're out on a walk, whether it's on a trail or it's on the pavement, you're feeling a little bit unsteady. There's a little bit more motion to the right or left than you're used to experiencing. You don't walk as quickly as you used to. Not that I'm an advocate of brisk walking, unless you're strong and you're very physically active, but you start to see the speed of walking slow down the, the, the base of support becomes a little wider. You widen that base of support as you're walking. I think if you are really observant of your body, we do start to notice changes. And I think it's really, really important not to say I'm getting older, that's what I need to expect.
Debbie Rose (23:28):
I, I don't agree with that philosophy. I think that there certainly are conditions and reasons why some older adults are at greater risk than others for falls. But I certainly believe very strongly that if you stay in tune with your body and you do engage in physical activity, and it doesn't even have to be vigorous or even moderate intensity, any type of physical activity is going to be helpful in terms of raising your awareness about what's changing in your body. My mantra's always been move a little more, a little more often and get up from the chair. We know that on average, older adults spend as much as six hours incidentally, behaviors every day reduce that time and keep that body moving. That's one of the key things that I think about for my own body and I, and I hope for all older adults as well.
This may be a, a sort of silly question, but is there a way to fall? Can, can you protect yourself in a fall?
Debbie Rose (24:42):
You certainly can. It certainly requires a good reaction time, however. So that's the ability to recognize that you're losing balance and take the necessary precautions to avoid that. Easier said than done though, because the tendency when you start to fall is to put those hands out. Okay, that's a good protective strategy actually, because your hands, even though you may sustain a coli's fracture or a wrist fracture is better than sustaining a head injury or fracturing a hip. But certainly reaction time is a key factor in the ability. Some people would say, and I've seen physical therapists showing people how to fall on the internet. It's that whole idea of tucking and rolling. So really trying to bring the body in close and trying to round the body. So falling. Some would even advocate taking martial arts classes.
Debbie Rose (25:43):
Certainly people that are in judo or karate are very good at falling very safely. You see them doing it during a match. Again, it's not something I advocate for an older adult to practice, certainly not practice without a trained professional around them. And again, it comes down to reaction time. How quickly can the older adult recognize that they're losing their balance and take the protective measures? I do teach I do a lot of recovery work with older adults when they're in my presence. So I actually train them to lose balance and regain their balance. And I use a technique use just using a resistance band, because even the, the thing with an old, older adult is who's starting to be fearful or concerned about falls is they're so fearful that they don't want to be out of balance at any point in time. But the issue of it is, is if we are never out of balance, we lose our capability to regain our balance. So that's what's great about pickleball. You oftentimes find yourself in an imbalanced situation. So it's actually helping you hone your reaction time skills, and actually hone your agility skills, being able to restore your balance when you lose it.
Debbie, this has been terrific. You've helped a lot of people.
Debbie Rose (27:15):
Hope. What else to say?
Debbie Rose (27:17):
I certainly hope so. That's always been my goal. It's an area I'm very passionate about. It's an area I've studied for well over 30 years now, and really feel that there are very clear, indefinite ways to improve balance and prevent falls. But it's not a quick fix. It takes time and you need to continue doing it. It's not, I'm gonna take an eight week balance training program and I'm gonna be set for life. It's gonna be, you need to regularly engage in activities, whether it's sports that really are going to improve your balance and your strength.
So there's no age limit to this,
Debbie Rose (27:57):
No age limit. It's never too late. I'm a big advocate of that. But if you're older and you're at a higher risk of falls, you have to progress more slowly. And you do have to look for a healthcare professional with good training that can safely progress you through a balance and mobility training program. Lower risk older adults are gonna do very well in community-based programs with a trained instructor. They don't have to be a healthcare professional. We know that falls can be prevented and that programs delivered by trained instructors are equally as effective as trained health professionals. But as full risk increases, you need to seek out a trained health professional to make sure that your program is being safely progressed and in a one-to-one, not a group-based environment.
Thank you so much for coming on the podcast. Really appreciate your input.
Debbie Rose (28:55):
You're really welcome. Thank you so much for the invitation, Larry. And I look forward to hearing from any older adults or instructors out there that would like to know more about full risk reduction and how to implement effective strategies.
And your email address again is
Debbie Rose (29:12):
D as in Debbie Rose, r o s e as in the Flower dot Fullerton at Fullerton, sorry, Fullerton, f u l l e r t o n.edu.
And to our listeners, if you would like to win a copy of Dr. Rose's book, fall Proof for Comprehensive Balance and Mobility training program that you can share with your healthcare advisor, visit specifically for seniors.com, subscribe to our email list. You've gotta be an email subscriber to win. We'll announce the winners about a week after this podcast drops. So thank you again, Debbie, for coming on the podcast.
Debbie Rose (30:04):
You're so very welcome. Have a wonderful rest of the day, and thank you to all the listeners.
If you found this podcast interesting, fun or helpful, tell your friends and family and click on the follow or subscribe button. We'll let you know when new episodes are available. You've been listening to specifically for seniors. We'll talk more next time. Stay connected.
Debra (“Debbie”) Rose, PhD, is a chair and professor emerita in the Kinesiology Department and director emerita of the award-winning Center for Successful Aging at California State University, Fullerton. She also served as one of three co-directors of the Fall Prevention Center of Excellence established in 2005 with funding from the Archstone Foundation as well as a member of the national steering committee developed by the National Council on Aging to guide the implementation of the FallsFree initiative aimed at preventing falls among older Americans.
Her primary research focus is in the area of postural control, mobility enhancement, and the prevention of falls in later years. Dr. Rose is nationally and internationally recognized for her research in the assessment and treatment of balance and gait disorders. Her research has been widely published in numerous peer-reviewed journals, book chapters, monographs, and professional journals. Dr. Rose has been frequently recognized for her contributions to the scientific literature and to the profession. She has been the co-recipient of the outstanding research writing award on two occasions for research articles published in the Research Quarterly for Exercise and Sport and was recognized by the Erickson Foundation in 2006 for her outstanding contributions to research in the area of fall risk and fracture reduction. The innovative fall risk reduction program she developed called FallProof™ was recognized by the Health Promotion Institute of the National Council on the Aging in 2006 as a “Best Practice” program in health promotion and again in 2008 by the VISN 8 Patient Safety Center of Inquiry at the James A Haley Veterans Affairs Hospital in Tampa, Florida. This program has since been replicated in numerous community-based settings and retirement communities throughout North America. Debra is also the past Editor-in-Chief of the Journal of Aging and Physical Activity and a past-president and active fellow of the American Academy of Kinesiology.