Prolonged sitting in a care home or sitting at home for long periods can have a significant detrimental effect on a person’s muscles. Some studies report a 3% loss of muscle mass per day and 3 weeks of bed rest can result in reduced strength which is equivalent to 30 years of ageing.
In the community many GP’s are now referring older patients for balance improvement and strength exercises as a means of prevention of falls.
I can recall back in the day visiting care homes as an inspector seeing people in the lounge sitting for considerable periods of times. I am also aware that people have the right to sit as long as they like, if that is their wish. However, staff have a duty of care to make service users aware of the benefits of exercise to their health and wellbeing.
Evidence supporting the benefits of balance and exercise programmes
According to NICE 2019 Strength and balance exercise interventions can prevent some falls and fractures, resulting in improved health outcomes and independence for older people, and reduced demand for health and care services. However, audits have shown variation in coverage and uptake and there is an absence of data on the quality of the interventions being delivered.
The World Health Organisation notes that physical activity is a key protective factor supporting healthy ageing. Preserving musculoskeletal function through physical activity and exercise is a necessary requirement for maintaining mobility and independent living during later life. Muscle weakness and impaired balance are significant risk factors for falls. A review of the literature found that low levels of muscular strength, power and balance in older adults were associated with increased risk of a first fall, recurrent falls and falls that lead to injury.
The Cochrane Library systematic review on falls prevention and exercise states that there is moderate certainty evidence that balance and task training exercise combined with resistance exercise reduces the rate of falls by 34%.
Paths for All
This organisation wants to support health and care staff to encourage mobility and activity with patients and build strength and balance and short walks into daily practice and care. They claim that it can lead to better health and wellbeing outcomes for people and improve the financial sustainability of the health and social care system.
They provide a starter pack cue cards and leaflets and can arrange half day strength and balance training courses.
NHS Inform Scotland
This organisation promotes the benefits of exercise and suggests that age is no barrier to exercise. At any age, you can see improvement in your strength, balance, stamina, flexibility and more importantly the mental health benefits of exercise should never be underestimated.
NHS Inform provide a whole range of resources including a balance test and exercise programme.
Other benefits of strength and balance programmes
Apart from the physical benefits, the service user’s participation in strength and balance classes can be fun and offer a group social experience as an alternative to sitting for long periods.
Safety of service users
Prior to undertaking any form of exercise service users must receive a person centred assessment including consultation with their GP, to ensure that it is safe for them to do so. Strength and balance exercise classes should only be undertaken by recognised qualified instructors.
There is a great deal of evidence that supports the benefits of strength and balance exercise. Expert medical opinion suggests that preserving musculoskeletal function through physical activity and exercise is a necessary requirement for maintaining mobility. Additionally, it is known to prevent falls and improve mental health. This needs to be taken into consideration by managers of social care services, where people may be sitting for long periods of time.
It should be noted that according to NICE, audits have shown there is an absence of data about services who provide strength and balance programmes, and not sufficient is known about the quality of the interventions.
Albert Cook BA, MA & Fellow Chartered Quality Institute Managing Director Bettal Quality Consultancy