Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 204

Many conditions in older adults require balance training before aerobic exercise/gait retraining can be adequately undertaken in ways that are both robust enough to improve clinical outcomes and safe. Although beyond the scope of this chapter, in general, the most effective principles of balance training are as follows:

 Narrowing the base of support

 Perturbation of ground support

 Decrease in proprioceptive sensation

 Diminished or misleading visual inputs

 Movement of the centre of mass of the body away from the vertical or stationary position

 Dual tasking: adding a cognitive distractor or secondary physical task while practising a balance task

Balance training must be challenging to decrease fall risk,¹⁹⁹ and therefore the general approach is to practice the most difficult posture or movement without falling in a safe environment (e.g., standing on one leg without hand support) and then move to the next‐harder level, such as closed eyes, as soon as the exercise level is ‘mastered’. This is essentially the same principle that is applied to progressive resistance training: as soon as a load no longer feels ‘hard’ to lift on the perceived exertion scale, it should be increased to ensure continuous, optimum adaptation.