- in fitness , guest/interview by allan
Carol Clements on maintaining balance
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- Judy Murphy
The statistics around falls for seniors is staggering. On todays episode, we meet Carol Clements and discus her book, Better Balance for Life. If we want to be well and maintain our independence, we must focus some effort on maintaining balance.
Allan (0:56): Carol, welcome to 40+ Fitness.
Carol Clements (0:59): Thank you. Happy to be here.
Allan (1:02): I was so happy to see your book that when I reached out I was like, “Yes, we’re not talking about this enough.” Everybody’s talking about getting stronger, building endurance, being able to do what we want to do in our lives. But in my mind, and I’ve even said this on the podcast a couple of times, my balance is not what it needs to be. And I’ve always known that; it’s only now that I’m in my 50s that I’m starting to say I have to start doing some work on this, because it’s not going to get better by my acknowledging the problem. I actually have to do something about it.
Carol Clements (1:47): Right. It’s definitely trending in media; there’s lots of scary statistics about falling and aging and balance. Then of course in the fitness industry there’s a big trending balance. You’ve got the BOSU training balls, you have stability balls, and Stephen Curry standing on a wobble board and shooting baskets. So everyone knows that this balance training edge is very productive because of the unifying of the body to become stable on unstable apparatus, which is what they call it at the gym. But I didn’t want my book to be about what you would do at the gym, so I had to create the instability in the person’s daily life that would be safe and they could practice balancing.
Allan (2:53): A few of the statistics I saw when I was doing the research on the topic of balance, it was something like one in four people over the age of 65 fall each year.
Carol Clements (3:04): One in three.
Allan (3:05): One in three, okay. So it’s going up, I’m sure. And then the other problem is they end up going to the hospital. I think it was 300,000 in the United States per year, and 29,000 deaths attributed to falls.
Carol Clements (3:25): That’s what I mean about the scary statistics. It’s a phenomenon that needs to be addressed as a preventative.
Allan (3:38): Yes. I tell people this, that your likelihood of falling over the age of 65 is just astronomically high. Why do we fall?
Carol Clements (3:49): That’s very complicated, because it can be inner ear issues, it can be visual impairment, it can be medication, or disease, a pathology of some kind – in the most extreme examples Parkinson’s or MS. Actually my book does not encompass that kind of reason for fear of falling or balance issues. It really addresses more a physical, more straightforward situation, where as the person ages they become less active and maybe they sit more, their balance system isn’t turned on because they’re sitting in a stable position too much of the time. I can’t cover all the reasons for falling, because they’re beyond what my book really addresses. But even if you had medication or a condition –neuropathy in your feet or something – you could still do a lot of these activities and improve your balance.
Allan (5:13): That was what I liked about this, because when I’ve talked to a lot of people about falls, it typically comes down, like you said, to those medical style conditions that we have. The second stage of it is that we’ve lost some strength, and that’s going to contribute to the fall. And unfortunately without the muscle mass, we’re more likely to hurt ourselves when we fall. Then of course there’s the fact that when we’re afraid to fall, we’re more likely to fall because we shorten our gait, we get tighter, we tense our body. I’ve lived in the south for a vast majority of my life, and whenever I travel up north and there was ice, I’m walking like a duck. I know that’s not the right way to do it, but I can’t help myself because I’ve fallen before and there’s this fear of falling that’s in there. And then the fact is that we just don’t practice.
Carol Clements (6:18): Right. So, all of those things that you said are right on. It’s lower body strength. In terms of predictors for falling, according to the research, and they do an arbitrary test where, say, you have to stand up from sitting without using your arms. And then five years later the people who couldn’t do that have fallen. The studies were in some ways a little arbitrary, like they would do a test for agility, and the agility test was how quickly you could walk around a chair.
Allan (7:02): I’m a certified functional fitness specialist. That’s still the test that they teach us, is to get up, walk around the chair and sit back down. It is not a bad test. The problem is from somewhat of a liability perspective, you don’t want the client to fall. So you know that they’re going to walk slower when their perception of falling is worse, and typically their perception is correct. So really what you’re looking for is for that person to give you indicators that we need to spend time on gait and balance because they’ve given some of that up.
Carol Clements (7:46): Right. Then you’ve got the lower body strength, you have the coordination agility factor, we’ll just call it, and then as you pointed out, the fear of falling is an enormous indicator of whether you will fall in the future. So I thought as I was writing, how can I help the reader feel more confident so that they remain active and they get the opportunities of being active that provide balance practice, strength, all the things we’ve talked about, and the confidence so that they won’t be so fearful? Those are really the three major goals.
Allan (8:36): You’re right. The question I have now, in the book, you use what you call the “five principles of a body in balance”. I think in a sense for me, that created a really good framework to explain what we’re going to be able to actually do at home. We’ll talk about those activities in a moment, but this set a really good framework. I thought if someone actually sits down, goes through and understands these five things, they’re going to genuinely know the things they should be adding to their activity level. Can you talk through those five principles, because I do think they are fundamental for our move forward in understanding this?
Carol Clements (9:22): They’re in some ways postural connections, so that when the reader gets to the 10-week plan, they have some kind of functional way of aligning their body. For instance, I start at the top, with the head, and compare it to a helium balloon. It’s really lining up and finding the arms and the back, and your neck and chest, which would be a curved-over, hunched position. And then ways to stretch the front of the chest so that you can get your shoulders to be part of your back. By that I mean the shoulder blades and the, you and I would call them “lats”, but you can think of it as the side of the back. And then there’s this very difficult one, which I was labored to write, because it’s hard, about the abdomen and how there’s a connection between your upper body and your lower body. I want for the participant reader to feel like that comes from the front, because as you age you begin to be more lax about what we call the front body core, and use the back to kind of hold you up and keep you in stance. So, it was difficult and I’m hoping the reader doesn’t get too frustrated with that section, but it was too important to leave out. Then I move on to the hip, because as you age, you begin to hinge at the hip forward. Imagine someone with a cane – they’re bent over and then they can’t access the glutes, the buttocks muscles. So I’m trying to get linked in front of the hip. And then the feet, because your feet and shoes sometimes become less active. You’re not really using the foot in an articulate way to push off. So those are the five; I wanted to make sure there was a consciousness about those body parts and how they work together, because you’re going to need that when you get to the 10-week plan and do the balancing and strengthening.
Allan (12:03): Yes. Again, that’s where the light came on for me as I was going through the book, was I know the shorter, tighter gait is a problem, but I had not really put together the entirety of the whole system, which I should as a personal trainer. Actually, that’s what I should be thinking about all the time. It is when I’m working with my clients, but I didn’t turn that same logic onto myself, that it’s about your posture and your ability to hold good posture. And so, looking at those imbalances: Is your head leaning forward? Are your arms collapsed forward? And as your waist is leaning forward, your hips are now in a bad position because you can’t use your glutes when you’re walking. And now your feet are not strong enough and nimble enough. I know that we say this all the time, and I need to start practicing. I do walk barefoot a good bit here in Florida. I could probably pick up a marble with my toes, but I couldn’t do a lot of the things that I should be able to do from the top to the bottom. That’s where the light came on for me, that this is a whole body posture thing. It’s not just a practiced balance thing. It’s all of it.
Carol Clements (13:29): All of those principles I felt like were going to give a foundation from which to build the strength, the coordination and the balance that we’re going to work on. You can’t think of everything at once; that’s why I said that about getting frustrated. But it’s just a process. I even said in the book, “Be patient with yourself.” The whole idea that not being able to maintain the balance at first is really a success, because the whole point is to be in an unstable position and to recruit, like I said, all these sensory, physiological and musculoskeletal aspects of what makes a person centered within themselves to balance, and practice that. So it’s okay if you fall – not fall; I don’t mean the bad kind of fall – that you teeter out of your balance, because that’s an experience that you’ll be able to use. Say if you step on a curb and you feel like you’ve lost your balance, you’ve had practice with doing that. Your body knows more what to do.
Allan (14:59): Yes. It’s like just about anything you do. When you first got in the car to drive, there was this fear. I know it gripped me the first time I got behind a stick shift. The Driver’s Ed teacher wants to put you up on a hill and have you do the clutch gas thing. I don’t want the car to die. And when you’re in town and it’s doing it, the car behind you is kind of laughing at you. It says “Driver’s Ed” on the car, so he knows what you’re going through. But over time, you practice being in that position. It’s not dangerous, but you get more comfortable and less fear.
Carol Clements (15:40): Right. The natural automatic responses of driving – now you don’t even have to think about driving, right?
Allan (15:54): Which can get scary in and of itself when you get somewhere. It’s like, “My brain was somewhere else while we were doing this drive, but I’m glad I’m here safe.”
Carol Clements (16:03): The body remembers and will do it, so we’re trying to get that automatic response going in the person’s body with balancing.
Allan (16:17): I was completely open and honest that I know my balance is an area that I need to put more and more focus on going forward. Now, don’t do this if you’re driving, but when you’re home or at a certain place. Always do your balance test in a safe place, so if you do actually lose your balance, you’re not going to hurt yourself. But if someone wanted to do the basic balance test, what would you tell them to do?
Carol Clements (16:46): The one that I use in the book is really more an assessment personally of the person, not like I’m trying to rate how good is the person’s balance, but how do you feel when you’re wavering? So I have the person stand behind this very sturdy chair and place your hands on the chair back, and then put feet right next to each other so there’s a very narrow base. And then gradually let go of the chair and cross your arms over your chest. If you close one eye, and if you feel okay, the other eye – you will feel the wavering of the body, the body balancing going slightly forward and backward and sideways. How do you feel about that? Is it scary? Does it make you want to suddenly go stiff, or can you relax into that wavering motion, the instability, and be okay seeing it from the inside, experiencing it? For me that was the better test. We can’t see what everyone’s doing that’s using the book, but they can experience and see for themselves how they feel about balancing.
Allan (18:09): Absolutely. Like I said before, your general perception when you’re in a situation like that is probably reality. If you’re not comfortable on your wavering more than you feel like you should, and you had that urge to want to tense up and grab that chair – those are indicators that this is a modality that you can start working on.
Carol Clements (18:31): Right. And it’s good to grab the chair because we don’t want you to fall. But it just gives you the experience to say, “Yes, I do feel tense about this.” And then maybe try it again and go, “Okay, I can stay with this a little bit longer until it really feels too threatening.” But definitely, always opening the eyes, or coming off of one leg, or whatever the balance situation is. You want to trust your instincts that you need to come out of that challenge when you need to.
Allan (19:13): Yes. I guess the tagline of this book in some lines should be, “You can fix it. You can get better at balance.” Now, you talked about the implements that are in the gym, and honestly a lot of folks don’t want the gym membership, and they don’t want to go over into the corner with that odd-looking contraption and try to figure out some exercises. Because they’re on a padded floor they fall over, and that’s not fun in a lot of cases. But we can do things to work on our mobility, our strength and our balance. We can do that in our own home. And what I like is that in the book you made this, I want to say, functional, but not exactly functional, but if fits within the lifestyle of what we’re probably already doing. We’re just double-dipping by doing these activities at the same time we would be doing something we were already going to be doing. Can you go through some of the types of activities and things that you would have them doing over the course of the 10-week plan?
Carol Clements (20:26): If the person can associate the activity with, we’ll call it an exercise, even though in the book I try not to call it an “exercise”.
Allan (20:37): Nobody likes the word “exercise”. So I’m glad you used the word “activity”.
Carol Clements (20:44): The association is like a reminder. For instance, one of the very first ones is “kitchen counter flat back”. So when you’re waiting for the toast or the microwave or the water to boil, you’re in the kitchen – you do this activity, which is really just creating traction though your spine. I won’t describe it; that is described in the book of course. And that’s really going to help with body awareness and the feeling of links, and to understand the opposing forces, which are what a lot of balance is made of. For instance, in this “flat back”, you go out through your scull, but you go the opposite direction, through your tail, the very end of the spine. So you’re lengthening in opposite directions, and when you balance, you really have to do that. You have to go down through your leg that you’re standing on and go up through your spine and head. Otherwise you have no dynamic; you’re just standing on your foot without the opposing force that gives a connection and a dynamic for balancing. I don’t really talk about that so much because it sounded too technical. I just try to give the experiences. When it’s associated with an activity, like brushing your teeth, I have five different “brushing your teeth” balances that are progressively more challenging. Everybody brushes their teeth, or at least we assume they do. So, they get to the first week, do brushing teeth balance number one. In the second week… Or maybe that didn’t happen until the second week because you have some other things to prepare first, I forgot. So those associations with activities, like getting dressed and talking on the phone or texting – I made sure that it was something I thought that most people would do, so that they’d go, “Oh yeah, when I do this, I stand this way and I do this experience.” That’s for a week. And by the end of that week, you’ve mastered it or gotten better at it, and you can go on to the next week. And then there’s usually a new activity, or a same one like the “brushing your teeth”, just with a new progression.
Allan (23:31): I liked it, because as you said, you’re brushing your teeth, you’re at the counter, you’re on the phone. All of those are normal daily activities. With this book, there’s not a ton of them; we’re talking I think no more than maybe four activities in any given week. But you practice those things – so a certain way that you’re going to work your back, or manage your glutes, or you’re going to work with your feet, or look and pay attention to your head, or at this point start balancing on one foot in a supported position – slightly supported, and then you’re going to reduce that support. It’s this progression that over the course of the 10 weeks you’ll feel and see that you are improving because you’re practicing.
Carol Clements (24:16): And hopefully feel more confident, go out more and do more things and not restrict yourself according to what you think you’re not capable of doing. Besides those four activities, there are also these sidebars, and one of them is “Your Striding Gait”. Not every week, but some of the weeks there’s a “Your Striding Gait” sidebar, which is some cue to use while you’re walking, which is going to help connect and strengthen. For instance, one is that big toe push-off I was talking about. So you cue yourself while you’re walking to push off with your big toe to fall forward from one foot to the next. And just to be aware of that and practice it when you’re walking. The other sidebar is “Relax and Reward”. Some of the weeks have a “Relax and Reward”, where you do a very passive kind of stretch situation, like have your legs up the wall so that your hamstrings get a little feeling of spaciousness. So besides the four activities per week, there are these sidebars that crop up. All of that works together.
Allan (25:51): Putting your sock on while you’re still standing up – that was maybe one of my favorites, along with, you call it something else – when you criss-cross your legs as you walk side to side.
Carol Clements (26:05): You mean “tight rope walking”?
Allan (26:07): No, you were crossing over sideways. You’re moving sideways, so your right foot goes slightly over…
Carol Clements (26:12): Lateral, yes. People lose their ability to step sideways, because think about it – we’re always going forward. Then when you do have a stumble, you are so inexperienced in stepping sideways or having to step backwards. So again, it’s practice. There’s a little thing where every time you get to a certain hallway in your home, you step to the side, meaning laterally, and then you get more comfortable with that and you’ve increased your range of transferring your center of gravity sideways, not just forward like we do when we walk, as we’re accustomed to.
Allan (27:03): You talked about things you do and don’t do. If you’re walking through a grocery store or a Walmart parking lot, and the car just doesn’t see you and you’re walking forward, your only choice perhaps is to move to the side. And so you need to be generally confident and competent that you can take that side step so the driver hopefully sees you, but you don’t fall, because that’s maybe the worst case. We have these obstacles in our lives and we don’t want to limit our lives. This is great if you’re working on your balance, if you’re doing these exercises. Every one of them is great. Like I said, I had a couple of favorites. I won’t ask you what your favorite is, because I know people don’t like picking between their babies. But I do have a question I want to ask, and it can be from the book or it can be from anywhere. I define “wellness” as being the healthiest, fittest and happiest you can be. What are three strategies or tactics to get and stay well?
Carol Clements (28:08): I wish I had some cute slogan or some inventive quick fix, but really it’s about building a lifestyle around healthy living. If you wanted to be a farmer, you’d live on a farm. People think in theory, they want to be healthier, they want to have a better diet, or they want to have more activity. But if it’s a theory, you have to change the real circumstances of your life. For instance, if you like to dine out, find the healthier places to go; maybe not the salty, fatty pizza place or something like that, and make that part of even your social life. In the book at the end I give this little pep talk and say, try a marching band, try croquet. It’s a little tongue in cheek. Basically I’m saying, find something that engages you, that’s active, so that you can get your balance practice. Tai chi is the perfect example because they’ve done so many studies with tai chi. This improves your balance because you’re standing, you’re moving. It really doesn’t take much. Ping pong would be great. Just find something that makes a fun, engaging thing and then cultivate your friends and relationships around that framework. Really make a lifestyle change, if that’s what’s necessary.
Allan (29:58): Thank you for that, really. The book is Better Balance for Life. Carol, if someone wanted to learn more about the book, learn more about you, where would you like for me to send them?
Carol Clements (30:10): I’m having a meeting with someone tomorrow about creating a website for the book and myself. So I don’t have that yet. The book actually is released on November 20th. You can order it on Amazon or Indie Books or Barnes & Noble, but it won’t actually go out until November 20th, which is right around the corner. Right now I would say, wait a while and try the website or contact me through the publisher.
Allan (30:48): Okay. Carol, we’ll do this. We’ll stay in touch and when the book is available, I’ll have a link to the book for sure. When your website’s available, I’ll have a link to your website, www.carolclements.com.
Carol Clements (31:02): That would be great.
Allan (31:04): Go to 40PlusFitnessPodcast.com/357, and I’ll be sure to have those links there as soon as they’re available. Carol, thank you so much for being a part of 40+ Fitness.
Carol Clements (31:18): Thank you so much. Have a great day.
Allan (31:21): You too.
I hope you enjoyed that conversation with Carol. Balance is something that I’m going to be focusing much more time on, as far as my fitness routines go. And I hope you do too. Falling, hurting ourselves, the numbers are just astronomical. So it is something that you need to be aware of and something that we do need to focus on as we get older.
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Also wanted to let you know that the book, The Wellness Roadmap, is just about to drop live. This goes live on December 3rd. The book will go live tomorrow. So you can go ahead and pre-order the ebook. You can order the other ones and get them as well. Right now there is hardbound and a paperback. The audiobook is submitted and it should be out there really, really soon. So you can go to 40PlusFitnessPodcast.com/Book, or you can just go to Amazon and search for Allan Misner or The Wellness Roadmap and you can find the book that way. But if you just want an easy way to get there – 40PlusFitnessPodcast.com/Book. Thank you.