Core Curriculum: Strengthening your midsection can help improve balance and prevent falls.

Batcheller, Lori J.

doi: 10.1097/01.NNN.0000515869.93567.9e
Departments: The Waiting Room

On the Move: Certain exercises can build a strong core, which helps improve balance and prevent falls.

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The secret to good balance is a strong core, says Patricia Baiano, a certified specialist in Pilates-based exercise for multiple sclerosis (MS) and other neurologic conditions in Toms River, NJ. And strengthening the core goes well beyond creating six-pack abs. It also involves strengthening the muscles of the lower back, abdomen, and hips—all of which help control posture and gait, Baiano says. The result? Better balance, which can help prevent falls, a common and potentially lethal risk for people with neurologic disorders.

Exercises that incorporate mindfulness such as tai chi, yoga, and Pilates are particularly beneficial, says Allen C. Bowling, MD, PhD, professor of neurology at the University of Colorado, and author of Optimal Health with Multiple Sclerosis (Demos Health, 2014). “They are low impact and could potentially rewire the brain for confidence and stability,” he says.

Before starting any fitness program, discuss it with your doctor and look for a teacher who specializes in your condition and can adapt the exercises to fit your abilities. And when you do start, go slow, says Peter A. Harmer, PhD, MPH, professor of exercise science at Willamette University in Salem, OR, and associate research scientist at Oregon Research Institute. “The more you exercise, the more you gain, but start conservatively. If the intensity is too low, increase it. If it's too challenging, back off.”

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TAI CHI

What it is: Developed centuries ago in China, tai chi is a martial art that emphasizes both defense training and health benefits through movements called forms.

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How it works: It involves slow, rhythmic movements and deep breathing with forms that target both balance and walking. Technique matters more than strength or flexibility, making it accessible even to those with physical limitations.

Evidence: A study published in the New England Journal of Medicine in February 2012 found that a tailored program of twice-weekly tai chi training resulted in improved postural stability, better walking ability, and reduced falls in a group of people with Parkinson's disease.

Forms to try: The training in the study incorporated several well-known tai chi forms such as Wave Hands Like Clouds and Grasp the Peacock's Tail that require practitioners to continually rebalance while moving, says Dr. Harmer.

How to get started: Moving for Better Balance® (http://tjqmbb.org) is a research-based tai chi training regimen designed for older adults and people with balance disorders.

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YOGA

What it is: Developed centuries ago in India as a means to calm the body in preparation for meditation, yoga focuses on breathing, posture, and movement.

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How it works: Postures improve flexibility and strength, and deep breathing calms the mind. The practice can also be modified to be done in a chair.

Evidence: A study published in The Journal of Alternative and Complementary Medicine in December 2014 found that a bi-weekly hour-long therapeutic yoga program that included standing, sitting, and lying poses improved postural control and mobility in a group of older adults.

Poses to try: Poses such as Warrior I target the quadriceps, hamstrings, and hips, which are all important for balance. Tree pose strengthens the ankles and calves and works on single-leg balance. Downward-facing dog is particularly good for people with MS because it stretches the calves, which often develop spasticity, says Mariska Breland, a certified Pilates teacher and founder of Pilates for Neurological Conditions, who was diagnosed with MS in 2002.

How to get started: Get Fit Where You Sit (http://getfitwhereyousit.com) is a chair-based yoga program.

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PILATES

What it is: Developed during World War I by German boxer Joseph H. Pilates to help wounded soldiers recover from their injuries, Pilates emphasizes the core.

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How it works: A system of simple repetitive exercises mostly done lying on your back or side or on your knees that focus on what Pilates called the powerhouse—two inches below and above the navel, back to front—to build muscle strength, endurance, and a stable core.

Evidence: In a study published in the journal NeuroRehabilitation in 2014, people with MS who trained in Pilates for eight weeks saw improvements in balance, mobility, and muscle strength in their legs and arms.

Poses to try: Most beginner poses such as the Hundred and Stand to Sit target abdominal muscles, the buttocks, and quads and stabilize the hips, which all contribute to better balance.

How to get started: Pilates for Neurological Conditions (http://pilatesforMS.com) adapts Pilates to help people who may have neurologic-related limitations.

© 2017 American Academy of Neurology