Volledige transcriptie van 19: Does yoga improve balance?

let's keep this information. 00:04:48.411 --> 00:04:56.141 Let's be good critical thinkers and say,"Okay, I'm gonna incorporate that knowledge and also look at the wider body of knowledge" which is what we're gonna do today. 00:04:56.442 --> 00:05:03.411 So let's start by looking at first, you know, what is balance, and I think most people would probably say balancing on one leg," right? 00:05:03.711 --> 00:05:05.122 But it's actually more than that. 00:05:05.422 --> 00:05:14.362 A classic textbook definition is keeping the body's center of mass over its base of support. 00:05:14.661 --> 00:05:16.041 It's a nice simple definition. 00:05:16.062 --> 00:05:18.531 Now, your base of support can change. 00:05:18.831 --> 00:05:21.622 It could be two feet, okay? 00:05:21.922 --> 00:05:24.771 Two feet parallel hip distance apart, which would be what? 00:05:24.882 --> 00:05:26.091 Tadasana pose, right? 00:05:26.391 --> 00:05:27.882 But then it could also be one foot. 00:05:27.911 --> 00:05:35.401 That's just a different base of support, and the fewer bases of support you have, the more difficult balance becomes. 00:05:35.701 --> 00:05:41.471 Similarly, the closer, the smaller the base of support, so if you bring your feet closer together, that will be harder. 00:05:41.771 --> 00:05:47.201 Or if you bring one foot in front of the other, that will be harder than having your feet wider apart. 00:05:47.232 --> 00:05:55.812 And in fact, people who tend to have bad balance tend to have their feet a little bit wider because they tend to feel more stable in that wider base of support. 00:05:55.872 --> 00:06:00.401 But your base of support could also be two hands, which is of course a handstand. 00:06:00.701 --> 00:06:06.132 Your base of support could be one hand and the outer edge of one foot, which would be side plank. 00:06:06.411 --> 00:06:06.732 Yeah? 00:06:06.831 --> 00:06:11.721 So balance is not just being on one foot, though of course y- you know, that's often what we think of. 00:06:12.021 --> 00:06:30.322 But it's basically being able to balance out all of the opposing forces on the body, gravity pulling you down to the center of the earth forward forces if you're leaning forward, backwards forces, side to side, balancing of all of those out so that you can remain over your center, over your base of support. 00:06:30.622 --> 00:06:33.711 And this is an I think this is an interesting little thing. 00:06:34.012 --> 00:06:35.521 There is a cone of balance. 00:06:35.531 --> 00:06:39.711 So if you think about your base of support, and let's, let's just think about tree pose to make it really simple. 00:06:40.012 --> 00:06:48.502 Your base of support is one foot, and then there's a cone of balance inside which your center of mass can be, and you can be in balance. 00:06:48.802 --> 00:06:51.322 So your center of mass can shift over to the side. 00:06:51.322 --> 00:06:53.851 So if you shift your hips over to the side, you'll still be in balance. 00:06:54.081 -->

00:06:57.021 Hopefully, as long as you're inside that cone, and then the other side. 00:06:57.291 --> 00:07:04.982 But there is some point outside that cone where no matter what, if your center of mass is outside that cone, you have to fall. 00:07:04.982 --> 00:07:05.411 You will fall. 00:07:05.411 --> 00:07:06.541 That's simple physics. 00:07:06.641 --> 00:07:20.851 But also what's interesting is that cone of balance can increase with training, and it tends to decrease as we get older or if we detrain, if we don't train, if we don't exercise, if we don't move. 00:07:21.151 --> 00:07:23.122 So that's a little aside. 00:07:23.322 --> 00:07:39.651 Another thing to bear in mind about balance is it's not just purely a mechanical thing like, like I described, but actually it is a constantly changing interaction of your nervous system, your body, the task that you're doing, and actually also your environment. 00:07:39.672 --> 00:07:42.851 'Cause if there's a strong gust of wind that will affect your balance. 00:07:43.151 --> 00:07:45.812 So there are two important elements to balance. 00:07:45.841 --> 00:07:55.291 There is the sensory information that we receive, and then there is the muscular output that your brain gives in order to maintain your balance. 00:07:55.591 --> 00:07:58.411 So vision is important in our balance. 00:07:58.502 --> 00:08:07.031 We are sensing where our horizon is, and we'll notice with our vision if our horizon goes off to the side because that means our head is tilting to the side. 00:08:07.331 --> 00:08:14.221 We have the vestibular system, which is located in the inner ear, and this is really fascinating, I think. 00:08:14.521 --> 00:08:21.291 There are these donut-shaped structures inside your inner ear, and they don't really have anything to do with hearing. 00:08:21.291 --> 00:08:26.541 So we think of inner ear as having to do with the ear and hearing, but they're kind of separate to that. 00:08:26.581 --> 00:08:28.581 That's just hap- where they happen to be located. 00:08:28.882 --> 00:08:32.902 But you have these donut-shaped structures filled with a small amount of fluid. 00:08:33.201 --> 00:08:42.022 And so if you imagine you tilt the donut structure to the side, then the fluid will drain to one part of the donut. 00:08:42.322 --> 00:08:48.062 And then we have sensors all throughout the inner ear which are sensing where that fluid is moving. 00:08:48.361 --> 00:08:51.621 And so that sensory information will be sent to the brain. 00:08:51.922 --> 00:09:10.192 And so for an issue like vertigo, where someone feels dizzy, there might be a problem with that information being sent to the brain or it being processed inside the brain We also receive sensory information from joints, so what you know of as, as proprioception. 00:09:10.201 --> 00:09:12.672 Like, you can tell if your head is leaning to one side. 00:09:12.971 --> 00:09:15.981 You can tell if your arm is lifted up, if your knee is bending. 00:09:16.282 --> 00:09:23.731 We also can sense our muscles, and I think this is really interesting, skin also plays an important role in balance. 00:09:23.741 --> 00:09:29.111 So you can feel if wind or air is brushing across your skin and you know, oh, I'm falling. 00:09:29.412 --> 00:09:41.412 Now, all of those things taken together, the brain will synthesize that information and say,"I am in balance," or,"I am out of balance." And then it will choose what it does next. 00:09:41.711 --> 00:09:44.032 And your brain is just an incredible thing, right? 00:09:44.081 --> 00:09:50.241 Um, another thing is that it will not rely equally on those three systems. 00:09:50.542 --> 00:09:57.451 So for example, standing on a firm floor in good lighting differs from standing on soft ground in darkness. 00:09:57.501 --> 00:10:13.851 And so your brain will choose to prioritize, uh, the visual information, visual feedback, in a well-lit room on a hard surface, versus it'll choose to increase the proprioceptive information that it receives if you're in a darker room. 00:10:14.042 --> 00:10:18.261 Again, balance is, I'm hoping you're, you're starting to realize, a, a very complex thing. 00:10:18.392 --> 00:10:27.251 It's more than just a mechanical thing and more than just one system involved Now that your brain has that information, it decides what to do with it. 00:10:27.552 --> 00:10:49.581 So your brain can send motor signals down to muscles to produce muscular force, to contract muscles, um, to increase joint stiffness, to move its center of mass, to change your posture, to take a recovery step if needed, to reach for support, all of these different things that we know that we tend to do when we feel like we're losing our balance. 00:10:49.881 --> 00:10:59.692 Now a little task I like to do when teaching anatomy on a teacher training is for everyone to stand up and to balance on one foot, and then to look down at that foot. 00:10:59.741 --> 00:11:15.091 And so as long as you're not driving, I encourage you to do this, or the next time you're at home with no socks and shorts on, lift one foot and look at all the muscles that are engaging and the tendons that you'll see moving underneath your skin to maintain your balance. 00:11:15.392 --> 00:11:30.802 As a matter of fact, your foot is a bit like a puppet, and the puppet masters which control your foot, they have these strings, so the tendons, which originate on the foot or even beneath the foot and go all the way up the sides and the front of the calf. 00:11:31.101 --> 00:11:34.302 And then the puppet masters are at the top of the calf. 00:11:34.601 --> 00:11:43.731 So your evertors and invertors like the tibialis anterior, your plantar flexors, dorsiflexors, they are moving, pulling up and down to keep your foot in balance. 00:11:44.032 --> 00:11:51.621 And so when you look at your foot while you're trying to balance on one foot, you will see that balance is not a passive thing. 00:11:51.841 --> 00:11:53.381 It is constant

movement. 00:11:53.682 --> 00:11:55.111 It is a constant wobble. 00:11:55.142 --> 00:11:57.412 It's a constant shifting right and left. 00:11:57.711 --> 00:12:01.792 And what's incredible is we don't even have to think about that consciously at all. 00:12:01.792 --> 00:12:06.011 It's all just happening Now, factors can influence our balance. 00:12:06.022 --> 00:12:08.392 So these include our strength and power. 00:12:08.692 --> 00:12:12.511 So It's one thing to sense that you are out of balance. 00:12:12.511 --> 00:12:17.621 It, it's another thing to have that muscular strength to be able to pull yourself back into balance. 00:12:17.922 --> 00:12:27.902 Certain really important muscles in one-legged balance are all around the shin, like I was mentioning, those tibialis anterior muscles, the fibularis muscles. 00:12:28.201 --> 00:12:33.032 And then also muscles higher up into the hip, particularly as you bend forward. 00:12:33.182 --> 00:12:46.591 So muscles involved in balancing Warrior III are gonna be high up in the hip versus being vertically stacked like in tree pose are gonna be further down on the ankle and the calf And so if you have stronger muscles to begin with, they'll be able to engage. 00:12:46.601 --> 00:12:51.751 And also power refers to how quickly a muscle can engage, how quickly it can produce force. 00:12:51.822 --> 00:12:55.631 So if you can do those more quickly, then theoretically your balance will be better. 00:12:55.932 --> 00:13:01.282 But also what matters is your reaction time, your attention, and your cognitive load. 00:13:01.292 --> 00:13:06.111 So something I'm always talking about in balance in a yoga class is to focus. 00:13:06.412 --> 00:13:09.721 Focus on one point, but also to focus on the thing that we're doing. 00:13:10.022 --> 00:13:16.981 And I almost feel like I can see when people's thoughts shift and they start thinking about something else, and then their balance wobbles. 00:13:17.042 --> 00:13:17.902 Now it could be something else. 00:13:17.902 --> 00:13:23.851 It could be a muscle thing, but I often see there's like a shift of the eye or something, and then boom, they lose their balance. 00:13:24.152 --> 00:13:29.272 Um, also cognitive load, so if you're carrying a lot cognitively, in your mind, that will also affect your balance. 00:13:29.572 --> 00:13:31.792 Confidence and fear affect your balance. 00:13:32.091 --> 00:13:38.991 I was just in the States visiting family, and I was there with my mom, who's in her 70s now, towards her late 70s. 00:13:39.292 --> 00:13:45.241 We were walking on a little beach towards a lake, and she had her arm in mine. 00:13:45.542 --> 00:13:54.782 And as we were getting to a place with an uneven terrain and sand, I could feel her grip on my arm get really tight. 00:13:55.081 --> 00:13:57.692 And so she had a decreased confidence. 00:13:57.701 --> 00:14:05.412 Now, that could actually be a useful thing because it tells your body, your brain is saying,"Okay, I need to be more alert now. 00:14:05.701 --> 00:14:08.042 There, you know, this is a less safe terrain. 00:14:08.042 --> 00:14:09.841 I need to be more careful." That could be a positive thing. 00:14:10.142 --> 00:14:13.542 But also, as we know with fear, we can over-engage. 00:14:13.542 --> 00:14:14.341 We can tighten up. 00:14:14.371 --> 00:14:16.142 We can take smaller steps. 00:14:16.142 --> 00:14:19.471 We can do things that actually might not help our balance. 00:14:19.772 --> 00:14:38.261 So confidence and fear do play a role in balance, both in a good and potentially a, a, a less helpful way Also things like fatigue, pain, medication, previous injury, and also the environment, like I said before, like a gust of wind or the terrain that you're on will all affect your balance. 00:14:38.562 --> 00:14:49.211 So the take-home message for this little segment on the introduction is basically balance is not one single system, but it's lots of things involved, both sensory and motor. 00:14:49.511 --> 00:14:51.322 There are also different types of balance. 00:14:51.471 --> 00:14:54.511 There is static or steady state balance. 00:14:54.812 --> 00:15:02.111 So this is quite often what we focus on in yoga, put your foot on your thigh in tree pose, look forward, don't move. 00:15:03.032 --> 00:15:03.282 Right? 00:15:03.328 --> 00:15:07.769 That is one way of doing balance, and if you do that, you'll probably get better at doing that thing. 00:15:07.769 --> 00:15:08.548 But that's only one way. 00:15:08.849 --> 00:15:12.859 There's also dynamic balance, which is controlling the body while it's moving. 00:15:13.158 --> 00:15:16.979 So instead of just holding the pose, going into a pose and coming out of it. 00:15:16.989 --> 00:15:21.798 So for example, going into half moon and then coming back up to tree pose. 00:15:22.099 --> 00:15:32.349 That works a different type of balance There is proactive or anticipatory balance where you are preparing f- for a predictable movement that will disturb your balance. 00:15:32.649 --> 00:15:40.308 So if you think about throwing a baseball or throwing something and you know you're gonna be stepping onto one foot, so you can expect that. 00:15:40.318 --> 00:15:46.849 That is predictive balance And then there's also reactive balance, which is responding to an unexpected disturbance. 00:15:46.849 --> 00:15:52.359 If that's bumping into a pole, someone accidentally pushing you or purposefully pushing you, hopefully not. 00:15:52.658 --> 00:15:57.788 But anyway, y- th- y- your balance can be disturbed, and how good is your reaction to that balance? 00:15:57.798 --> 00:15:59.899 So all of these are different elements of balance. 00:16:00.068 --> 00:16:03.568 There's not just one thing of do this one thing and you'll get better at all of them. 00:16:03.869 --> 00:16:07.058 Each one will probably improve based on w- how you do it. 00:16:07.359 --> 00:16:15.369 And then there's also what's called functional balance, which is a, a, a bit of

a vague term, but it's things that are more tied to specific things that you would do in your life. 00:16:15.609 --> 00:16:27.109 For example, if you need to step over a bathtub to get into a shower, that i- then that movement would be considered a functional movement So now onto the question of does balance decline with age? 00:16:27.408 --> 00:16:30.178 And, on average, the sad answer is yes. 00:16:30.479 --> 00:16:39.938 I know it can be a bit depressing talking about aging and hearing about things, and as someone who is now closer to 50 than 40, I, I'm starting to think about my later life. 00:16:40.239 --> 00:16:42.489 And, and the reality is we are all aging. 00:16:42.769 --> 00:16:58.668 We are all a day closer to, to our grave, And I know that can sound a bit depressing, but while we're on the topic, you know, there are some interesting yoga texts that talk about how coming to terms with death actually can help, uh, liberate us in life. 00:16:58.969 --> 00:17:05.138 So again, that's a bit of an aside, but nonetheless, we are on this, this steady path towards death. 00:17:05.439 --> 00:17:07.689 Nice and enlightening podcast episode for you here, isn't it? 00:17:07.989 --> 00:17:09.778 But the good news is you're still alive. 00:17:10.865 --> 00:17:11.005 You know? 00:17:11.169 --> 00:17:19.169 Let's celebrate the fact that we are still here, and I'm grateful that I'm close to, closer to 50 and I'm still here, I'm still kicking. 00:17:19.179 --> 00:17:20.449 I'm still doing yoga. 00:17:20.749 --> 00:17:26.679 And I hope to have all the problems that come with being a 100-year-old and that I'm still alive then. 00:17:26.699 --> 00:17:28.509 I know I've said that in a previous podcast episode. 00:17:28.509 --> 00:17:34.429 But anyway, yes, balance does decline with age is the point, I guess, that I was going to get to. 00:17:34.699 --> 00:17:43.128 But there's a lot that we can do to help slow it down and actually maybe even reverse it if you're someone who hasn't done balance training. 00:17:43.429 --> 00:17:52.778 You know, possible factors that affect- whether or why balance changes with age, uh, has to do with changes in vision'cause vision is an important part. 00:17:53.078 --> 00:17:57.669 Reduced vestibular function, so that inner ear donut thing I was talking about. 00:17:57.969 --> 00:18:02.219 Lower muscle strength and power, and that's something that we can control, as we know. 00:18:02.519 --> 00:18:03.989 Slower reactions. 00:18:04.288 --> 00:18:10.588 So there are some adaptations that happen with the nervous system when you start training and when you start training for quicker movement. 00:18:10.598 --> 00:18:15.848 So that can be trained also, so don't think,"Oh, it's just, uh, all downhill from here." No. 00:18:16.148 --> 00:18:20.739 Uh, reduced physical activity, again, a thing that we can change, can-- thing that we can influence. 00:18:21.038 --> 00:18:25.219 Medication and health conditions, now, you know, that, that's

just part of life, innit? 00:18:25.519 --> 00:18:30.548 And greater difficulty dividing attention between movement and another task. 00:18:30.548 --> 00:18:30.929 Okay? 00:18:31.229 --> 00:18:35.009 That's another factor But let's not catastrophize here, okay? 00:18:35.308 --> 00:18:39.499 So age-related changes are normal and, and they are real, yeah? 00:18:39.798 --> 00:18:41.588 But it is not a cliff edge. 00:18:41.628 --> 00:18:46.368 It is not, as soon as you get to a, a certain age it's all boom, it's all going to pot. 00:18:46.669 --> 00:18:56.598 A- and actually physical activity and exercise and practice can meaningfully improve balance in older adults, and that's supported by the literature. 00:18:56.898 --> 00:19:01.669 And also, as you kn- probably know, people of the same age can vary enormously. 00:19:01.969 --> 00:19:08.499 Y- I'm sure you can think of an 85-year-old with great balance and then a 60-year-old who, uh, has, has poor balance. 00:19:08.798 --> 00:19:10.368 So y- th- there's... 00:19:10.419 --> 00:19:18.479 We've also seen examples of people in their 80s and 90s with great muscle mass, people in their 20s with very little muscle mass. 00:19:18.778 --> 00:19:22.189 So a lot of it comes down to what we do with our bodies. 00:19:22.489 --> 00:19:27.759 As I mentioned, balance is also important for younger people It's not just a senior's disease. 00:19:28.058 --> 00:19:53.509 So young people need balance to run and change direction, land from a jump, play sports, dance respond to physical contact, navigate uneven ter- everything that adults do and older adults do And interestingly, 2018 systematic review evidence has found that balance training produces moderate to large improvements in static and dynamic balance in younger people. 00:19:53.808 --> 00:20:05.739 So the effects are not just restricted to older adults And really good news another systematic review suggests balance and neuromuscular programs can reduce ankle sprains, particularly in sporting populations. 00:20:05.749 --> 00:20:10.338 So another reason that more than just older adults need to be doing balance training. 00:20:10.638 --> 00:20:13.409 Which brings us to the question of, does balance training work? 00:20:13.509 --> 00:20:16.058 And the research actually does say it does work. 00:20:16.358 --> 00:20:20.118 And as I'm gonna get to shortly, that might be a little bit different to falls, okay? 00:20:20.169 --> 00:20:36.919 But several reviews have found that in both healthy older adults and adults with health conditions, balance training improves static balance, dynamic balance, like I mentioned earlier, proactive and reactive balance And it seems the more you do it, the better, to some degree. 00:20:37.219 --> 00:20:41.308 So based on the research, 11 to 12 weeks of training. 00:20:41.608 --> 00:20:43.919 Is much better than just a couple of weeks. 00:20:44.219 --> 00:20:54.038 And doing it three times per week, so three sessions of balance training yields better results than just one per week, which does not tend to have meaningful results. 00:20:54.338 --> 00:21:04.338 Also, sessions should be, according to this research, around 30, 30 to 45 minutes, and if it's more than 60 minutes, you're not getting any more benefit out of it. 00:21:04.638 --> 00:21:12.338 You know, this doesn't mean you need to drop everything and, you know, we've always got this benefit-cost analysis. 00:21:12.638 --> 00:21:13.769 You can't do everything in the world. 00:21:13.769 --> 00:21:15.959 You can't do every single exercise. 00:21:16.108 --> 00:21:19.028 You can't do every single self-care treatment. 00:21:19.148 --> 00:21:22.989 You can't be taking a bath and relaxing while also going out for a run, you know? 00:21:23.219 --> 00:21:31.808 So we always have this cost-benefit analysis, and so we're, remember in research, we're just looking at one specific question, what is the dosage? 00:21:31.838 --> 00:21:33.288 How much has to be done? 00:21:33.588 --> 00:23:03.639 And these systematic reviews have found that information about the 11 to 12 weeks of training and doing it three times per week. 00:23:03.659 --> 00:23:06.109 That's gonna be more beneficial than doing it once per week. 00:23:06.409 --> 00:23:11.479 I think where this all keeps pointing to is the value of moving and of not just sitting down, right? 00:23:11.778 --> 00:23:20.129 Of going to yoga classes and going to your exercise classes and everything else But what the research also points to is specificity. 00:23:20.429 --> 00:23:24.479 So if you do static balance, you will get better at static balance. 00:23:24.479 --> 00:23:48.669 If you do dynamic balance, you'll get better at dynamic balance And so if you generally wanted to help someone with a very specific task, like I want you to be able to comfortably step over the bathtub to get into your shower, then doing things that involve that would be really useful, like stepping over yoga bricks, considering the sensory, mechanical, and cognitive demands of that task, and getting away from holding onto the wall. 00:23:48.839 --> 00:24:02.549 As useful as touching a wall can be or having support from the wall or support from a chair, and as useful as chair yoga can be, nothing will be as good for balance as just letting go of that thing and trying to balance on your own. 00:24:02.849 --> 00:24:13.099 Which brings us to one of our last segments and, you know, ties back into that initial Iyengar study with the question, you know, does actually improving balance prevent falls? 00:24:13.399 --> 00:24:21.798 And incredibly, falls, as in slips, trips and falls, are the number one cause of accidental death of people over 65. 00:24:21.818 --> 00:24:30.044 And just last year I lost my own aunt as a result of a fall where she was alone in her house going to the kitchen in the middle of the night. 00:24:30.054 --> 00:24:34.148 So, if we can decrease fall rates, it's gonna be really beneficial... 00:24:34.448

--> 00:24:37.948 so let's look at what the research says So just to be clear, there is... 00:24:37.958 --> 00:24:38.788 two different things, right? 00:24:38.798 --> 00:24:41.858 There's improved balance test performance. 00:24:42.158 --> 00:24:45.948 Like, it's one thing to have someone do dancer pose, right? 00:24:46.248 --> 00:24:47.828 And then measure them. 00:24:47.878 --> 00:24:50.298 Let's do this little study where someone does dancer pose. 00:24:50.298 --> 00:24:58.718 We measure how long they can do it for, and then we have them do dancer pose three times a week, uh, you know, in, as part of a yoga program, and we measure it 12 weeks later. 00:24:58.928 --> 00:25:00.807 They will probably get better at dancer pose. 00:25:01.088 --> 00:25:03.628 Like, that's pretty much guaranteed, and that's what the research supports. 00:25:03.928 --> 00:25:05.698 So balance makes you better at balance, right? 00:25:05.968 --> 00:25:10.748 But do improved balance test scores actually translate to decreased falls? 00:25:10.898 --> 00:25:12.678 Let's finally get to the punchline. 00:25:12.688 --> 00:25:14.928 Let's get to the point of this podcast episode. 00:25:15.228 --> 00:25:18.978 And the question is, you know, can we actually reduce our fall risk? 00:25:19.038 --> 00:25:29.768 Because that's ultimately what can lead to problems both, you know, if you're an older adult, but also just, falls are what cause injury, wh- when you land on your elbow, when you land on your hand, right? 00:25:30.148 --> 00:25:35.168 So if you've listened to podcasts with me or done a course with me, you would know there are different levels of evidence. 00:25:35.418 --> 00:25:43.038 The systematic review is considered the highest level of evidence, and even within systematic reviews, there are still different levels of quality. 00:25:43.338 --> 00:25:46.948 There's one by the Cochrane Library, the Cochrane Reviews. 00:25:47.248 --> 00:25:56.057 Cochrane Reviews have a reputation of being the most rigorous, and they tend to come with the most conservative conclusions, right? 00:25:56.288 --> 00:26:09.688 So they tend to be more cautious in saying,"This treatment," whether it's a drug or, you know, a, a, a movement modality like yoga,"this thing will do that effect, will have that effect." They tend to be more conservative. 00:26:09.988 --> 00:26:16.018 And here is what their 2019 review, Sherrington et al., concluded. 00:26:16.318 --> 00:26:35.268 They looked at, first of all, exercise in general for older adults, and they found that exercise reduced the rate of falls in older community-dwelling adults, as in people who are still living in private homes, living with their families, living on their own, not in nursing homes. 00:26:35.568 --> 00:26:39.178 Exercise reduced the rate of falls by approximately 23%, right? 00:26:39.208 --> 00:26:48.368 So we can pretty confidently say that if you exercise and if you move in lots of different ways, you probably will reduce your risk of falls. 00:26:48.668 --> 00:26:49.888 That's a relative risk. 00:26:50.188 --> 00:27:06.228 And they also looked at more specific balance training and, quote-unquote,"functional exercise," finding that balance and functional exercises reduced the rate of falls by approximately 24%, so really not much more. 00:27:06.528 --> 00:27:08.278 So- What does this all mean? 00:27:08.288 --> 00:27:16.208 Maybe we don't need to be looking specifically at balance, and when we look at balance, maybe we should look at it in a slightly different way. 00:27:16.508 --> 00:27:32.868 And that review also found some characteristics of promising programs, which included that, number one, balance is sufficiently challenged, that exercise is progressive, as in it, it's not just the same thing every single day, but it becomes harder. 00:27:32.898 --> 00:27:34.598 You do more challenging things. 00:27:34.618 --> 00:27:36.628 You work to build more strength. 00:27:36.928 --> 00:27:49.468 Functional movements are included, so things that are-- you find in your everyday life, again, like stepping over the tub or reaching across while balancing on one foot, if that's something you do, which most of us tend to at some point. 00:27:49.768 --> 00:27:51.128 You know, reaching into your car. 00:27:51.428 --> 00:27:59.138 Also promising aspects are when strength is included where appropriate, practice is repeated consistently. 00:27:59.438 --> 00:28:04.528 So, you know, it's not like you can do all your exercise in one week and then rest the rest of the year. 00:28:04.568 --> 00:28:07.218 No, we need to keep at it week in, week out. 00:28:07.518 --> 00:28:12.268 And the overall amount or dose is sufficient, right? 00:28:12.318 --> 00:28:14.268 So it's not just a little bit here and there. 00:28:14.568 --> 00:28:19.008 Balancing on one foot while brushing your teeth two minutes a day might not be enough. 00:28:19.307 --> 00:28:33.557 And also another authority for guidance is the World Health Organization, which looks at all of the evidence and comes up with guidelines as they have, for example, for physical activity, 150 minutes plus two days of strength training every week. 00:28:33.568 --> 00:28:38.758 That is the standard guidelines that a lot of countries have then adopted from the World Health Organization. 00:28:38.788 --> 00:28:47.458 And what they say specifically is adults aged 65 plus should undertake varied multi-component physical activity. 00:28:47.758 --> 00:28:57.826 So multi-component refers to components like balance, strength, aerobic activity, and also functional movement such as stepping, turning, and getting up from a chair. 00:28:57.836 --> 00:29:00.167 I think those are quite good guidelines. 00:29:00.467 --> 00:29:07.137 And the World Health Organization also recommends doing this on three or more days per week. 00:29:07.437 --> 00:29:11.957 And so this is broader than simply practicing static balance poses. 00:29:12.257 --> 00:29:16.097 And into our,

our last two segments, you know, does yoga actually improve balance? 00:29:16.137 --> 00:29:20.687 And then what should we be doing differently in our yoga practice, if anything? 00:29:21.864 --> 00:29:32.334 In answer to the question, yeah, yoga probably does improve balance to some degree But the certainty and the practical application of the evidence varies. 00:29:32.634 --> 00:29:40.403 A 2016 systematic review looked at six trials that involved yoga, and so there were 307 participants. 00:29:40.403 --> 00:29:42.394 So remember, this is before the Iyengar study. 00:29:42.694 --> 00:29:47.034 And they concluded that yoga produced a small improvement in balance. 00:29:47.114 --> 00:29:47.534 Okay? 00:29:47.754 --> 00:30:11.624 And they also f- determined that yoga produced a medium improvement, so better than just a small improvement, in physical mobility, which is also important as we get older, the ability to bend down, pick something up, or to squat down and get something from the lower cupboard But the researchers explicitly stated that it was unclear whether these improvements translated into fewer falls And as you all know, there's so many different styles of yoga. 00:30:11.924 --> 00:30:14.153 People do yoga at different frequencies. 00:30:14.454 --> 00:30:15.794 Class lengths can vary. 00:30:15.944 --> 00:30:19.274 And then even within the research, there are different balance tests. 00:30:19.294 --> 00:30:27.544 And quite often yoga studies can be quite small, and it can even be difficult to identify which element of yoga is responsible. 00:30:27.594 --> 00:30:39.153 Is it the one-legged balance, which seems the most obvious, or is it actually the combination of the one-legged with the two-legged balances, w- with the arm balances you know, like with a side plank or a crow? 00:30:39.454 --> 00:30:42.694 There are plausible reasons that yoga could help balance, you know? 00:30:42.694 --> 00:30:55.494 Like repeated one-legged standing, narrow base of support, shifting the center of mass and all that stuff But I think we need to be a little bit cautious to say that yoga will definitely prevent falls at this point. 00:30:55.794 --> 00:31:06.124 And as for what we might do differently, first of all, I don't think it's for me to tell you how to change your yoga practice or to how to teach differently. 00:31:06.424 --> 00:31:07.484 That that's up to you. 00:31:07.634 --> 00:31:10.214 And you might love your practice just as it is. 00:31:10.514 --> 00:31:26.634 However, if you would like to try some different things, and based on everything that we've explored today, here are a few things that you could add in to your yoga practice/yoga teaching So of course, we're already holding poses statically in yoga, you know, balance poses. 00:31:26.934 --> 00:31:32.153 We already have that nailed, but what about trying something like reaching during a balance pose? 00:31:32.163 --> 00:31:34.214 Reaching over to the right side, reaching to the left side. 00:31:34.514 --> 00:31:41.014 Transitioning between poses rather than just holding that pose, going in and out of it, especially between balance poses. 00:31:41.014 --> 00:31:42.284 That could be really challenging. 00:31:42.584 --> 00:31:43.854 Maybe adding a step. 00:31:44.153 --> 00:31:49.194 So stepping forward, sideways, or even diagonally into a pose and then out of it. 00:31:49.494 --> 00:31:51.464 Another element may be turning. 00:31:51.614 --> 00:31:54.574 So you could first look in different directions. 00:31:54.584 --> 00:31:59.934 You can change that sensory information, but you could also turn your entire body while in a balanced pose. 00:31:59.934 --> 00:32:08.624 This could be something that could make it a little bit more similar to what, how balance happens in real life And maybe playing a game of following a verbal directional cue. 00:32:08.624 --> 00:32:12.744 So with that reach, for example, maybe people could reach forward or reach sideways. 00:32:13.044 --> 00:32:13.354 I don't know. 00:32:13.374 --> 00:32:15.504 You might think,"No, that doesn't sound like yoga to me. 00:32:15.534 --> 00:32:27.334 I don't wanna do this at all." Or you might think,"Okay, maybe I'll try one or two of those." And I created an asana class and excerpts with three of those inside the Enlightened Yoga Collective. 00:32:27.344 --> 00:32:31.014 So if you're interested and want to see how I would do it, you can check out that. 00:32:31.314 --> 00:32:35.413 Also, we don't talk about progressive changes in yoga very often. 00:32:35.413 --> 00:32:38.034 We just do one thing and then keep doing that same thing, I think. 00:32:38.334 --> 00:32:49.403 But y- For someone with very poor balance, just having feet closer together would be the starting point, or maybe one foot in front of the other, what's called tandem standing could be a starting point. 00:32:49.704 --> 00:32:52.274 Uh, starting with a fingertip on the wall, but moving away from that. 00:32:52.574 --> 00:32:58.824 But at the same time, maybe someone needs to go from holding dancer pose to touching the floor and coming back up, right? 00:32:58.834 --> 00:33:05.074 So let's think about how we could also progress our balance poses and just our asana as in, as well. 00:33:05.374 --> 00:33:11.674 And I know that might rub some people the wrong way, the idea of progressing and regressing, and I totally get you. 00:33:11.974 --> 00:33:20.824 But I'm thinking about it purely not like this is better, that is worse, but really purely from a physical capability point of view. 00:33:21.124 --> 00:33:33.324 And knowing that physical capability can lead to those better quality of life markers that we're talking about, like reducing your risk of falls And something I always like to say is notice the wobble. 00:33:33.384 --> 00:33:35.574 And like the wobble is the balance. 00:33:35.874 --> 00:33:38.894 If you're wobbling, that doesn't mean you're doing it badly. 00:33:38.903 --> 00:33:41.554 Y- your body is doing what it's supposed to be doing. 00:33:41.854 --> 00:33:44.284 And don't worry, you're not the only one feeling wobbly. 00:33:44.324 --> 00:33:45.074 We all are. 00:33:45.374 --> 00:33:53.224 So in summary of today's episode, a few things that we've touched on is first of all, that balance is not one thing. 00:33:53.334 --> 00:34:02.734 It's a dynamic process and it emerges from sensory information, motor responses, cognition, the task, and the environment. 00:34:03.034 --> 00:34:46.014 Balance does on average decline with age, but there's a lot that we can do to change that, and a lot of balance actually remains trainable Though it's difficult to say yet whether yoga and particularly just holding tree pose will reduce falls, though we probably can't say that based on the evidence, we do know that exercise programs in general containing challenging balance and functional exercise can reduce falls And if nothing else, I hope you've maybe l- you're leaving today's episode thinking, Maybe I'll, I'll explore some different ways of looking at balance and actually moving well in balance." And if you want to explore it more, you can check out the Enlightened Yoga Collective. 00:34:46.063 --> 00:34:58.983 Members receive facts to share with clients, a practical teacher cheat sheet on all this stuff that we've been talking about, class themes and progressions, balance sequences, and a full asana class. 00:34:59.284 --> 00:35:02.083 So just check out the links in the show notes. 00:35:02.204 --> 00:35:07.733 And with that, we will conclude, and I hope you have found this interesting. 00:35:07.744 --> 00:35:14.163 Like I said from the beginning, I learned a lot while doing the research on this and it was different to what I expected to learn. 00:35:14.463 --> 00:35:23.844 And I'll probably stop saying a couple things, and I'm gonna add a few things into my own teaching So keep questioning, keep learning, and I'll see you next time. 00:35:27.344 --> 00:35:30.793 Thank you for listening to the Enlightened Anatomy Podcast. 00:35:31.384 --> 00:35:35.203 We would be grateful if you would leave a review and a five-star rating. 00:35:35.963 --> 00:35:42.353 Be sure to tune in next time for more science-based knowledge to get enlightened and help others