You clutch the banister when climbing stairs, need 10 minutes to work out the kinks after getting out of bed in the morning, or cut back your weekend walks to give that wonky knee a break. Hey, we all expect to slow down as we grow older. But is a gimpy joint or teetering balance a normal part of aging, or a sign that you need help? The answer to that question matters — a lot.
A loss of mobility can kick off a cycle of trouble, says Mary O'Connor, M.D., director of the Center for Musculoskeletal Care at Yale New Haven Hospital. “Your knee hurts, you become less mobile and decrease your physical activity, but you're eating the same amount of food, so you gain weight. That added weight puts more pressure on your knee joints, which causes more pain.” And the results go beyond any arthritis, O'Connor notes. “Less physical activity, combined with obesity, can lead to heart disease, diabetes and hypertension."
Mobility challenges can take a psychological toll. Lindsey Yourman, M.D., an internist and geriatrician, in La Jolla, California, who's affiliated with the Jacobs Medical Center at University of California San Diego Health, points to something known as “life space,” which is the distance that you can walk to safely — which determines the environment that is available to you on a regular basis.
"Decreased life space can mean decreased interactions with other people and decreased engagement in activities, which can lead to isolation and depression,” she says.
And then there's the dreaded f-word. “Balance and mobility keep us from falling, and when older people fall, very bad things happen,” O'Connor says. “You could break a hip, require surgery, have to go to a rehab facility and lose your independence.”
According to the Centers for Disease Control and Prevention, in 2015 alone, more than 1 in 4 older adults reported falling, and more than 28,000 of them died as a result — that amounts to 74 older adults every day. And then there is this sobering stat, notes O'Connor: 20 percent of patients who break their hip die within a year.
Clues to consider
How good is your mobility? Gauging yourself can be tricky, although difficulty getting up from a kitchen chair or needing to hold onto furniture as you walk around a room are telltale signs of a problem. To get a more objective (read: accurate) appraisal of where you stand, ask a family member or close friend to watch while you walk across a room. They should be taking note of your gait speed and the movement of your feet, as well as these factors:
- Are you shuffling or dragging your feet? Does the heel of one foot clear the toe of the other foot when you're walking?
- How far apart are your feet when you're walking? “When someone spreads their feet really far apart — the standard I use is greater than 6 inches — that tends to indicate difficulty in balance,” Yourman says.
- How symmetrical is your stride? “If you're favoring one leg because you can't fully tolerate bearing weight on one leg or the other, it can indicate a mobility issue, perhaps soreness from arthritis,” says Barbara Resnick, a registered nurse and professor at the University of Maryland School of Nursing.
- Do you have difficulty pivoting? “If you walk down the hall and come back, how many steps does it take to turn? Generally, more than three steps tends to correlate with a mobility issue,” Yourman explains.
Testing your own strength and balance
"Mobility is affected by a lot of different things — balance, coordination, response time and reflexes, among them,” says Greg Hartley, professor of physical therapy at the University of Miami Miller School of Medicine and president of the Academy of Geriatric Physical Therapy, a component of the American Physical Therapy Association. “But the most likely culprits, when mobility starts to decline, are tightness or weakness in muscles.”
Indeed, people start to lose muscle during their early 40s. The trick is to address problems before they progress to a loss of mobility. Here are some tests to try at home to gauge where you stand.
30-second chair stand: Sit in the middle of a chair, with your back straight, arms crossed in front of you, feet flat on the floor. Rise to a full standing position, then sit back down again. Repeat this for 30 seconds. Count the number of times you come to a full standing position in 30 seconds.
- Men ages 60 to 64 should be able to do at least 14; women, at least 12.
- Men 65 to 69 should be able to do at least 12; women, at least 11.
- Men 70 to 74 should be able to do at least 12; women, at least 10.
- Men 75 to 79 should be able to do at least 11; women, at least 10.
- Men 80 to 84 should be able to do at least 10; women, at least 9.
- Men 85 to 89 should be able to do at least 8; women, at least 8.
- Men 90 to 94 should be able to do at least 7; women, at least 4.
Tandem stand: While standing next to something sturdy that you can hold onto if you to lose your balance, put the heel of one foot on the toe of the other foot. Try to hold for more than 10 seconds, without swaying or having to move your feet. Repeat with the other foot.
One-legged stand: Make like a stork and try standing on one foot. “Not being able to hold the position for at least five seconds not only suggests a risk for falls, but also falls with injury,” Yourman says.
How to Take Action
Tips for holding onto the mobility you have, now and in the future
Those who already have a mobility deficit should see a physical therapist for an evaluation and exercises to improve balance, flexibility, and strength. “A physical therapist can offer an exercise program tailored to your needs,” Yourman says. “It can be a one-time or two-time consultation to get a personalized plan you can do at home.” To find a physical therapist in your area, visit ChoosePT.com. Along with seeing a pro, try these exercises and tips to stay strong.
For strength …
Sit-to-stand: This is a great exercise because it strengthens the quadriceps muscles in your legs, which are some of the most important muscles for preventing a fall. “Seated in a chair, arms folded across chest, rise to a standing position; then return to a sitting position, as quickly as you can, five to 10 times,” Hartley says. “Do it again, five to 10 times, this time in slow motion. Alternate between the two.”
The wall slide: Lean against a wall, facing outward, feet 12 to 15 inches in front of you, with your back against the wall, supporting you. Squat and slide down the wall. (People who have weakness need to be careful that they don't slide too deeply, because then they may have trouble getting back up.) Do it 10 to 12 times, take a little break; do two to three sets.
For flexibility …
"Generally, we have very sedentary lives compared to our grandparents. And by the time we're in our 50s, 60s, 70s and beyond, we have been seated for a large chunk of our lives,” Hartley says. “That can lead to tightness — and a decrease in our range of motion.” The two muscles that tend to be the biggest culprits in reduced mobility: our hip flexors (the muscles right in front of the hip, on either side, just below your belly button); and calves, thanks to a lifetime of teetering around in heels. These stretches can loosen up both.
Super strides: With your feet shoulder-width apart and hands on your hips, step forward with one leg, taking as long of a step as you can. Repeat with the other leg and continue until you feel tired. “You should feel a stretch in the front of your thigh,” Hartley says.
Calf wall stretch: Stand facing a wall, a little less than an arm's distance away. Put your palms flat against the wall, at shoulder height and shoulder-width apart. Step forward with the right leg, bending it at the knee. Keeping both feet flat on the floor, bend the left knee slightly until you feel a stretch in the calf muscle. Hold the position for 10 to 30 seconds, then switch legs. Continue alternating legs for at least three to five times on each leg.
For balance …
Stork stand: Stand facing a kitchen counter, with fingertips lightly touching it, just in case you lose your balance. Slowly lift one foot off the floor and try to balance for 10 to 15 seconds. Do this five times on each foot. Once that gets easy, do the same move, this time with both eyes closed. “Balance is very affected by vision,” Hartley explains. “When you take vision out of the equation, it makes balancing more of a challenge.
Heel-to-toe walking: Here's something a bit more challenging, Resnick says: With your left foot planted on the ground, lift your right heel and place it just in front of your toes. Focus on a spot ahead of you as you walk. Repeat for 20 steps.
For all of the above …
Try tai chi: “If there's one thing I could do to change the landscape for seniors, it would be that everyone would be required to do tai chi,” O'Connor says. “It helps people with their balance and strength, and gives them a sense of community, because people typically do this in a group.” It can also be modified for a number of mobility levels. There are even moves that can be done while sitting in a chair.