Your ability to sit on the floor and get back up is more important than you may think!

Getting to the ground and back up is a fairly complicated motor skill which can vary in difficulty based on one’s surroundings and physical limitations. There are many ways to accomplish this task involving movements such as squatting, lunging, kneeling, or bending over, and it requires lower body mobility, strength, and stability as well as a certain amount of comfort being on the floor. Not only is one’s ability to get to the floor and back up an important predictor of mortality, but it is also crucial for many activities of daily life as well as for recovery in the event of a fall (de Brito et al., 2012; Wang et al., 2016). Fall risk is a great concern, especially in older adults due to the injuries, disability, and reduction in quality of life that a fall can cause. Many studies have reported that reduced muscle strength in the lower extremities raises the risk of failing (Wang, D. et al., 2016).

Sit-and-Stand-test.jpg

A study by de Brito et al. (2012) scored 2,002 adults ages 51 to 80 years old on their ability to sit down on the floor and get back up. They were scored out of 10 possible points and deductions were made for the use of another body part or the floor for support while getting down or back up. The researchers followed up with the individuals over the next six years, and 159 of the participants died. Every point increase in a person’s test score correlated with a 21% reduction in his or her risk of death in the next six years. While this is a correlation study and evidence of correlation isn’t evidence of causation, the association between movement ability and mortality is hard to ignore.

Try it out now. Start by standing up. Sit down on the floor using your hands or other objects as little as possible. Every time you use something for assistance, subtract one point from five. Stand up from the floor using as little help from hands and objects as possible. Subtract one point from five each time you use hands or objects for assistance. Add your results from getting down (a number out of 5) and getting up (a number out of 5) for your score out of 10. Each point less than 10 increases the probability of death in the next six years by 21%. Are you ok with your score? Keep reading to learn how to improve!

If getting down to the floor and/or up is nearly impossible for you: 

Here are three simple exercise progressions you can work through over the next 6-8 weeks.

  1. Sit to stand
  2. Lowering and raising in a split stance (similar to a lunge)
  3. Step ups

Sit to stand

Select a box or chair that is a comfortable height. Sit down to it and stand back up without using your hands or assistance. Progress to tapping your butt on the box instead of entirely transferring your weight onto it, and gradually lower the box to increase the distance you raise and lower yourself. This increases comfort with getting down to and up from progressively lower seats and strengthens the leg muscles necessary to do so. If you progress to the point where you can lower and raise yourself to a point at more than 90-degrees of knee flexion, progress this exercise to include lying down. In this variation, sit/squat down to the low position, transfer all your weight to the box, and lie all the way down. To reverse the movement, sit up from lying supine and squat up from that position.

4067082_orig

Lowering and raising in a split stance

Slightly lower and raise your body (bending the front and back knees) in a split stance position using TRX straps for support. With practice, increase the distance you lower and raises your body, and then decrease the amount of assistance used to stabilize from two TRX straps to one strap to no assistance. This exercise increases comfort and stability in the split stance position one uses to get up from the ground, and it strengthens the leg muscles which are important for the movement.

trxbacklunge

Step ups

Step up to a small platform using one leg. Similar to the other exercises, this will increase leg strength, stability in a single leg stance, and comfort in a movement pattern one can use to get up from the ground. Progress by increasing the repetitions of step ups performed on each leg and the height of the platform you are stepping up to.

step-up.jpg

The next step:

Once you can get down to the ground and back up with relative ease, I’d suggest including a Fall Matrix in your workout warm-up once a week.

  1. Start standing. Place one hand on your same-side knee. Lay down, with your back against the floor and stand back up without removing the hand from your knee. Then lay down with your stomach on the floor without removing the hand from your knee, and stand back up. Optional: Lay down with your right side on the floor, and stand back up. Then repeat on the left side.
  2. Repeat these 4 variations touching the other side’s hand to its same-side knee.
  3. Repeat these 4 variations touching one hand to the opposite side knee.
  4. Repeat these 4 variations touching the other side’s hand to its opposite side knee.

Progress these exercises by touching your hand to a body part lower than the knee, for example, place your hand below the knee, on your shin, on your ankle, on your toes.

Like many things with our bodies, if you don’t use it, you lose it. Get on the ground and back up regularly so you don’t lose your ability to!

References
de Brito, L. B., Ricardo, D. R., de Araujo, D. S., Ramos, P. S., Myers, J., & de Araujo, C. G. (2012). Ability to sit and rise from the ground as a predictor of all-cause mortality. European Journal of Preventive Cardiology. doi: 10.1177/2047487312471759
Wang, D., Zhang, J., Sun, Y., Zhu, W., Tian, S., & Liu, Y. (2016). Evaluating the fall risk among elderly population by choice step reaction test. Clinical Interventions in Aging, 11, 1075-1082. doi: 10.2147/CIA.S106606
Advertisements

Osteoporosis, Age, Parkinson’s decrease dynamic balance and increase fall risk

Motor abilities influence an individual’s success in the performance of certain motor skills (Magill & Anderson, 2013). A motor ability of interest is dynamic balance, or the ability to maintain stability while one is in motion, as there is a strong correlation between poor balance and falls (although it is not the only factor), which are a large health concern among many populations (Ünlüsoy et. al 2011). I have had many clients with various conditions, including age, Parkinson’s disease, and osteoporosis, who were unsteady during locomotion due to poor dynamic balance.

All three of these conditions, age, Parkinson’s disease, and osteoporosis, have a negative influence on the dynamic balance category of motor abilities (Paolucci et. al 2014; Ünlüsoy et. al 2011). Age-dependent change in the musculoskeletal, sensory, and neural systems decrease balance ability in older adults (Maki & Mcllroy, 1996). Parkinson’s disease occurs in the brain’s basal ganglia when there is a lack of dopamine production in the substantia nigra, and it causes bradykinesia, akinesia, tremor, and muscular rigidity (Magill & Anderson, 2013).  Paolucci et al. (2014) state that a “balance disorder is one of the most important impairments” in this population due to statistics showing substantially greater incidence of falls among those with PD (70% of individuals with PD fall once a year and 50% of them fall twice a year in comparison to only 30% of healthy adults over the age of 65 who fall once in a year). Osteoporosis is a bone disease where bones become increasingly fragile from microstructure impairments in the bone tissue and decreases in bone mass. Ünlüsoy et. al (2011) demonstrated that dynamic balance in osteoporotic women was significantly worse than in healthy individuals.

There are many factors influencing one’s ability for dynamic balance during locomotion including muscle strength, interpretation of vestibular and proprioceptive information, and visual feedback (Paolucci et. al 2014). In terms of defining dynamic balance or any type of balance as a motor ability, Magill and Anderson (2013) state balance is a “multidimensional ability that is specific to the task or skill in which balance is involved,” and the specificity of motor abilities hypothesis postulates that individual motor abilities are relatively independent of one another. Given these assumptions, it is challenging to articulate the specific balance ability or abilities influencing locomotion.

If a client or patient came to me requesting help with dynamic balance while walking, I would perform various tests to rule out (or in) factors that may contribute to difficulty walking. I would assess muscular strength and endurance, especially in the lower extremity, observe the patient’s normal walking gait for noticeable abnormalities, and inquire into the patient’s medical history to rule out diseases or conditions, including those previously discussed, that may impact dynamic balance. I would also question the patient about lifestyle factors (i.e., recent accident or trauma, change in medication, etc.) that may be contributing to the deficit. If the patient has good muscle strength in the lower extremity, adequate gait mechanics, and no red flags in his or her medical history, this would indicate a problem with the motor ability of dynamic balance.

Additional ideas of assessments for dynamic balance related to gait were reviewed in a study by Bloem et. al (2016). This study recommended clinical tests including the UPDRS-derived Postural Instability and Gait Difficulty score, Berg Balance Scale, Mini-BESTest, Dynamic Gait Index, Freezing of Gait Questionnaire, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Survey of Activities, Fear of Falling in the Elderly-Modified, 6-minute and 10-m walk tests, Timed Up-and-Go, and Functional Reach (Bloem et. al, 2016). Further research on my part is needed into these methods, but any would be reliable assessments of dynamic balance.

Motor abilities limit a person’s success in performing a motor skill. In the case discussed, dynamic balance is a motor ability that, if affected, can decrease one’s success at walking without falling. I believe it is important to note that while motor abilities may limit achievement in another skill, motor abilities themselves can be practiced, coached, and improved which would also benefit the motor skill performance. The most important part of treating a motor ability deficit is identifying and distinguishing it from other possible causes of poor motor skill performance.

References

Bloem, B. R., Marinus, J., Almeida, Q., Dibble, L., Nieuwboer, A., Post., B.,…Schrag, A. (2016). Measurement instruments to assess posture, gait, and balance in Parkinson’s disease: Critique and recommendations (abstract only). Movement Disorders. doi:10.1002/mds.26572

Magill, R. A. & Anderson, D. I. (2013). Motor learning and control: Concepts and applications (10th ed.). New York, NY: McGraw Hill.

Maki, B. E. & Mcllroy, W. E. (1996). Postural control in the older adult (abstract only). Clinical Geriatric Medicine, 12(4), 635-58.

Nakano, W., Fukaya, T., Kobayashi, S., & Ohashi, Y. (2016).  Age effects on the control of dynamic balance during step adjustments under temporal constraints. Human Movement Science, 47, 29-37. doi:10.1016/j.humov.2016.01.015

Paolucci, T., Morone, G., Fusco, A., Giuliani, M., Rosati, E., Zangrando, F., & … Iosa, M. (2014). Effects of perceptive rehabilitation on balance control in patients with Parkinson’s disease. Neurorehabilitation, 34(1), 113-120. doi:10.3233/NRE-131024

Ünlüsoy, D., Aydoğ, E., Tuncay, R., Eryksel, R., Ünlüsoy, İ., & Çakcı, A. (2011). Postural Balance in Women with Osteoporosis and Effective Factors. Turkish Journal Of Osteoporosis / Turk Osteoporoz Dergisi, 17(2), 37-43.