On balance, mind matters

UNC research suggests mental exercise can reduce falls among older people

CHAPEL HILL -- An agile mind may be as important as strong limbs when it comes to the crucial task of preventing falls.

That's the finding of recent research at UNC-Chapel Hill that had exercise classes trying mind-over-matter exercises such as the "four square step test," a regimen that resembles a Scottish sword dance in its focus on memory, movement and speed.

"This is the most wonderful thing that's been offered here," said Elaine Jerome, 81, taking part in a class at Orange County's Seymour Center for older adults. "I've noticed that my balance is 100 percent better since I started taking this."

Previous studies have shown that balance training can reduce falls. But researchers didn't know exactly why, because apparent risk factors such as weak muscles didn't always show improvement.

New results indicate that improving "executive function" --the ability to react mentally to complex situations -- may be the missing link in designing the best methods for reducing falls. In other words, honing the mind may be as crucial as toning sagging muscles.

"Leg strength is obviously important, but it might be that your ability to interact with the environment is more important," said Tiffany Shubert, a Ph.D. physical therapist at UNC-CH who led the study.

Falls cause $325 million in injuries each year in North Carolina and brought about the death of more than 475 older people in the state in 2007. Any advance in preventing them is significant.

"The idea is to train both systems to work at once," UNC-CH professor Carol Giuliani said of working on both mental and physical skills.

Jerome, a member of the class and a registered nurse, said the idea that cognitive skills are key to maintaining balance makes sense to her.

"When you're older, there's a loss of the senses," Jerome said. "You're wearing bifocals -- it's so easy not to look down. The whole person is still there, but it's the senses that are bewildering them."

For many older people, fear of falls and their often catastrophic consequences has a dampening effect on getting out of the house and exercising. Yet, those activities are crucial to maintaining vitality and social contact.

"We have found that younger and younger people, in their 40s and 50s, have fear of falling and limit activities because of it," Shubert told a packed conference room at the UNC Institute on Aging in Chapel Hill, as she briefed colleagues on the study results.

Shubert cautioned that more research is needed to bear out her findings. But small-scale fall-reduction results are promising. In addition to the positive test data, there's increasing evidence that discounts other possible causes.

"The research is really showing that even changing environmental risk factors doesn't really help," she said.

Dynamic testing

Instead, improvements in concentrating while moving seem to make the most difference.

"A challenging, dynamic balance test might be walking and carrying on a conversation," she said.

If that sounds easy, try one of the balance tests mentioned by Shubert: Reciting every other letter of the alphabet while maintaining walking speed.

The principles being developed by Shubert, Giuliani and others will get a further test if the National Institutes for Health agrees to a proposal to fund more in-depth research.

In the meantime, trainers from the Triangle and beyond are showing up to learn the methods, and researchers are working to help several local assisted-living centers. The goal is to move older people beyond the kind of weight-focused, sitting exercises that don't seem to help reduce falls, Giuliani said.