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Strength training

Most people lose 20 to 40 per cent of their muscle mass by age 80. This is partly to do with disuse – doing less and less physical activity. Anyone at any age can increase muscle strength.

Improving ankle, knee and hip strength will greatly reduce your chances of falling. It will also improve your gait, increase your ability to do more physical activity, and help you to maintain your independence.

To strengthen your muscles, you need to make them work harder. This is called loading. If you load muscles they will get stronger.

Instead of avoiding activities or simplifying things to make life easier, look for ways you can make your muscles work harder. This will gradually strengthen the muscles.

In this program you will usually be using your body as the weight to load your muscles.50

Which muscles need to be strengthened to help prevent falls?

The muscles that are most important for preventing falls are the muscles in your legs.

The muscles around the ankle, including:

• the muscles in the front of the shin – the dorsiflexors. These muscles lift your toes and feet up and this helps your feet to clear the ground and avoid shuffling.
• the muscles in the calf – the plantarflexors. You use your calf muscles to push off with your toes when you walk.

The muscles around the knee, including:

• the muscles at the front of the knee – the quadriceps. These muscles are important in standing up and sitting down, climbing stairs and squatting.
• The muscles at the back of the knee – the hamstrings. These muscles are important for controlling the knee during walking.

The muscles around the hip, including:

• the muscles at the side of the hip – the hip abductors. These muscles are important for keeping the leg and hip stable in standing and walking.
• the muscles in the buttocks and lower back – the hip extensors. These muscles are important for keeping the leg and hip stable in standing and walking.

In the LiFE program you will be thinking about your daily tasks and routines and ways that you can strengthen your muscles while doing these activities.51

LiFE principles of strength training

The main principle of strength training is that you need to load your muscles.

The harder your muscles work, the stronger they will get. In the LiFE program you will generally use your body as the weight and work against gravity, or use objects around your home to provide resistance.

How to load your muscles

You can load muscle in a number of ways. You can:

• Increase the number of times that you use a muscle, for example, going up and down stairs more often.
• Move slowly. Moving a weight slowly loads your muscles more than moving the same weight quickly. For example, sitting down slowly makes your muscles work harder than ‘plonking’ into a chair.
• Use fewer muscles to move the same weight. For example, standing up from a chair without using your hands makes your leg muscles work harder.
• Increase the amount of weight you have to lift or move.

You need to look for ways that you can load your muscles in your daily routines instead of looking for ways to lessen the load.52

LiFE strength activities

For the LiFE program, loading your muscles has been divided into a number of different activities to make it easier to include them as part of your daily routine.

The activities involved in loading your leg muscles in the LiFE program are:

1. Bend your knees

Bend at the knees every time you do something when you would normally bend your back. For example, when you pick something up or get things out of a cupboard below waist height you should bend your knees.

Partial and full squatting is an easy way to improve and maintain your knee strength. Partial or full squat whenever you can.

• The slower you bend your knees, the more you load the muscles.
• The further you bend your knees, the more you load the muscles.
• If you hold the knees bent for longer it makes the muscles work harder.

2. Sit to stand – normal chair and low chair

You can strengthen your leg muscles by standing up from a chair while not using your hands and not rocking. The lower the chair the harder your leg muscles can be made to work.

• Try to stand without using your hands. If you need to use your hands, try to decrease the amount of push that you get from your hands.
• Slowly stand up without using your hands – this works the muscles harder than doing it quickly.
• Avoid rocking to get yourself out of the chair. Concentrate on using your legs to lift you up.
• When you sit down try not to drop or ‘plonk’ into the chair. By keeping control you work the muscles harder. It also helps your balance.

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3. On your toes – standing and walking

Stand onto your toes. Walk on your toes.

• Standing up onto your toes is a very good way to strengthen your calf muscles. When doing a task above waist height, lift up onto your toes.
• The longer you can hold the ‘on your toes’ position, or the more times you can go ‘on your toes’, the stronger your calf muscles will get.
• Walking on your toes improves your balance while also strengthening your calf muscles. The more you do it, the further you will be able to go. At first you might need to use support, but as your muscles get stronger and your balance gets better, you should decrease the amount of support that you need.

4. On your heels – standing and walking

Stand on your heels. Walk on your heels. Standing and walking on your heels will strengthen your shin muscles. It is also a good balance activity.

• Your toes should be off the ground.
• The longer or the more times you can be ‘on your heels’, the stronger your shin muscles will get.
• You will need support at first because it is hard to balance, but as your muscles get stronger and your balance improves it will get easier.

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5. Up the stairs

Using stairs is a good way of strengthening the knee muscles.

• Concentrate on using your legs rather than pulling up with your hands.
• Gradually try to decrease the amount of support that you use. For example, if you hold on to the rail very firmly, then try to lighten your grip to use the rail only for support. If you use the rail lightly, try to let go altogether or use fingertip support only.
• Go up the stairs slowly as this loads your muscles.
• Look for ways you can increase the number of stairs that you climb.
• Try to go up stairs two at a time – this makes you lift your weight through a greater range.

6. Walk sideways

Most of the time we move our bodies in a forward / backward direction. By moving our bodies sideways we can strengthen our hip abductors.

7. Tighten muscles

By tightening muscles that are resting you are increasing the load on them and strengthening them.

When you are sitting you can work on strengthening the gluteal muscles in your bottom, the quadriceps muscle around the knee, as well as the muscles around the ankles.56