Balance is moment by moment

Serelee Hefler, at right, teaches a stretch and balance class at Evolutions Body Clinic. The exercises help maintain balance, which can deteriorate as one ages.

Serelee Hefler tells the students in her class, including a 66-year-old man and a woman who is six months’ pregnant, that they are on a ship in the Chesapeake Bay and a storm has just blown in.

“You are all on the deck, and you are trying to keep your balance,” she tells the group, as they shift from one foot to the other.

Balance. Keeping it is one of the goals of Hefler’s twice-weekly “Stretch and Balance” class at Evolutions Body Clinic in Annapolis.

Balance keeps you walking without staggering. It allows you to get up from a chair without falling over. And it allows you to climb steps without tripping and falling.

But it is also, like muscle tone, something you lose a little more of every year. And, like muscle tone, you have to work it to keep it.

“Kids practice balance all the time in the games they play outdoors. Dodge ball, hopscotch, tag,” Hefler said. “Adults don’t get much practice, and suddenly they realize they have to sit down to put their pants on because they don’t have the strength or the balance to stand on one leg.”

Hefler’s class is rare. Balance training is not part of most group exercise classes, except for practices such as yoga, tai chi or qigong. But two medical studies — one of them in the Journal of Rehabilitation Research in 2010 — found that balance can improve remarkably with regular practice.

“I tell people they don’t have to take a class,” said Hefler. “They can stand on one leg and then the other while brushing their teeth, combing their hair or doing the dinner dishes.”

“One way to test balance is to test your gait,” said Maureen McBeth, a physical therapist at Baltimore’s Mercy Center for Restorative Therapies. “Up until the age of 70, the speed at which you walk is pretty consistent. Then it takes a nose dive.”

Balance tests are simple to do, and should be a part of routine medical exams, said Dr. Alicia I. Arbaje, associate director of Transitional Care Research in the Johns Hopkins Division of Geriatric Medicine and Gerontology.

“It is something to bring up with your doctor if you have any concerns,” she said. “It can be a marker of other things going wrong. And it is a matter of your quality of life.”

One of Hefler’s students, writer Iain Baird, 66, of Annapolis, recognizes how important balance is in his life. “It is easy to find classes that provide aerobic exercise. This kind of class is hard to find,” he said.

“There are four things you need [to be mobile,]” he said. “Stamina, strength, flexibility and balance. They are all equally important because a fall can be a life-changing event.”

Baird is correct. A fall can be devastating to an older adult. Abroken hip can be the start of a downward spiral of dependence and ill health. Just the fear of falling consigns some older adults to a life of inactivity and isolation.

Unintended falls among those 65 or older cause more than 18,000 deaths and nearly 450,000 hospitalizations a year, according to theCenters for Disease Control in Atlanta. A bathtub or the curb on a sidewalk can be an injury waiting to happen.

However, standing on one foot for a minute or two every day is only part of what is needed to maintain and improve balance because so much is involved in this mysterious ability: vision, touch, temperature, blood pressure, the sense of where the body is in space, strength and flexibility.

And so much can impair balance: medication, inner-ear problems, poor vision, diabetes, peripheral artery disease.

Balance involves complicated skills such as timing and coordination that need to be learned and practiced. Even so, the goal of good balance is pretty simple: to keep you upright in tricky situations.

“There is so much education we can do,” said McBeth. “And there is balance retraining that we can do.”