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Afraid to Make a Move? Don’t Fall for It

A fall can injure and immobilize an older person. Even fear of falling sidelines seniors and keeps them from pursuing activities that could improve balance and coordination, thus reducing their risk of taking a tumble.

Aging joints and spine, pinched nerves and small, unrecognized strokes are among the most common disorders that trip folks up in later life, says Frederick Frost, MD, of Cleveland Clinic’s Department of Physical Medicine and Rehabilitation. As early as their 50s, he notes, some people feel unsteady on their feet.

Too often, they brush these issues aside, delaying the help they need. In Cleveland Clinic’s falls prevention program, “we see two groups of patients: those who have suffered multiple falls and those brought in by concerned family members who recognize the risk,” Dr. Frost says.

He and his colleagues assess program participants’ personal risk. For those at minimal risk, simple reassurance or referral to tai chi or Arthritis Foundation exercise classes may be all the treatment they need. At the other end of the spectrum, a small percentage of patients are so frail that they are advised to use a wheelchair.

In the middle is a group that may benefit from a short course of physical therapy focused on falls prevention. Dr. Frost and internal medicine specialist Stephen Hayden, MD, lead a team that hopes to flag these patients among those who see internists and family physicians at four Cleveland Clinic sites. Results from the course are promising, building on recent research in New Haven, Conn., that showed similar programs are effective in reducing injuries.

“Almost all patients can reduce their risk of injury from a fall,” says Dr. Frost. “It’s uplifting, for them and for us, when they see themselves making progress and getting into better shape.”

“Exercise for the Brain” May Help Parkinson’s Patients

Sally Terrell was reading in bed five years ago when she noticed a tremor in her right hand. That was the first sign of Parkinson’s disease.

Although forced to give up tennis, “I knew that exercise keeps Parkinson’s disease at bay,” she says. “I walk 3.5 miles a day, and I do Pilates and weight training. It’s really helped slow the progression of the disease.”

Last year, Mrs. Terrell added cycling to her routine — not for recreation, but for research. Three times a week, she bikes in a Cleveland Clinic laboratory as part of a “forced exercise” program for Parkinson’s patients.

The program grew out of observations that Jay Alberts, PhD, made during a 450-mile cycling trip across Iowa. A cyclist with the disorder told Dr. Alberts her hand tremor lessened and her handwriting improved after she rode a tandem bike with him, pedaling faster than her usual rate. Dr. Alberts, a biomedical engineer, then designed a stationary tandem bike that forces users to quicken their pace, and he recruited volunteers to test the theory that motor function improves in Parkinson’s patients pushed to exercise beyond their normal limits.

Mrs. Terrell signed on and has since joined another, longer-term trial in the lab.

Early results are good: Volunteers have averaged a 35 percent improvement in motor function, and improvements have lasted four weeks after they stopped forced exercise.

“We have evidence to indicate forced exercise is altering brain function in Parkinson’s disease patients,” Dr. Alberts says. ”In essence, forced exercise may be exercise for the brain.” To further study this phenomenon, he and his group are collaborating with Micheal Phillips, MD, Head of Imaging Sciences.

Mrs. Terrell says she has noticed improvement, but she wants to complete the program before assessing its effect. She has drawn one conclusion: “This program offers such a positive way to live with this disease. I feel empowered.”