DEAR DOCTOR K:

I'm 70 and regularly do cardiovascular and weight-training exercises. Now my doctor wants me to add balance exercises to my routine. Why?

DEAR READER:

You've asked a good question, and it has a simple answer: Poor balance can cause falls. Every year, one in three adults 65 or older falls at least once. Especially in older people, falls can be serious. More than 90 percent of hip fractures result from falls. Falls also often lead to fractures of the spine, forearm, leg, ankle, pelvis, upper arm and hand. These injuries can undermine your independence. Hip fractures, in particular, also can increase the risk for early death.

Balance is the ability to distribute your weight in a way that enables you to hold a steady position or move at will without falling. From the moment we sit or stand up as infants, gravity is always pulling us downward, tending to cause us to fall. Our ability to balance keeps this from happening -- most of the time.

Our daily balancing act requires multiple different body systems to be constantly working together. These include the central nervous system (brain and spinal cord), the vestibular system (brain and inner ear), the visual system (brain and eye) and a vast web of position-sensing nerves. Muscles and bones are pressed into service as well.

Balance is like muscle strength: The more you use it, the less likely you are to lose it. Worse, it can become a vicious circle. You feel a little unsteady, so you curtail certain activities. If you're inactive, you're not challenging your balance systems or using your muscles. As a result, both balance and strength suffer. Simple acts, such as strolling through a grocery store or rising from a chair, become trickier. That shakes your confidence, so you become less active ... and so the vicious circle continues.

Good balance, by contrast, helps prevent potentially disabling falls. It builds confidence and fosters independence.

It sounds like you're an active person. Most likely, you already engage in some activities that help hone balance. Yoga, golf, biking and tai chi all require some degree of balance. But even people who are not already active can improve their balance through exercise or balance training.

I've put some beginner balance-training exercises on my website, AskDoctorK.com. They are a good first step toward improving shaky balance and can be done by people of many ages and abilities, including those who are elderly or frail. As your balance improves, you can add challenges to make your balance training progressively harder. For example, try an exercise standing on one leg instead of two.

Even if you are conscientious about doing regular aerobic and muscle-strengthening exercises, if you feel that your balance isn't what it used to be, talk to your doctor or to staff at the gym about learning balance exercises. They could help protect you against falling.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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