You put in three or four days a week of cardiovascular work, squeeze in two sessions of strength training, even find time in a busy schedule to do some stretching. Isn't that enough to keep an aging body healthy?
Sorry, it isn't. Everyone from gerontologists to personal trainers say you need to work on your balance as well.
If you're in you're 40s, 50s or early 60s, you probably move through life securely without even thinking about it. But studies show that balance declines with age, especially if the complex system that governs it isn't challenged regularly. For most of us, it isn't. When is the last time you had to stand on one foot for any length of time, or negotiate a narrow pathway?
The results of that decline can be catastrophic. One out of three people age 65 and older falls each year, and 20,400 people in that age group were killed in falls in 2009. Falls are the top cause of injury death among that population, according to the Centers for Disease Control and Prevention.
Men are more likely than women to be killed in falls. But women suffer nonfatal injuries or fractured bones much more frequently. Women are almost three times as likely to fracture a hip, one of the most debilitating results of falls among older adults.
According to the American Academy of Orthopaedic Surgeons, 9 percent of people who suffer hip fractures die within 30 days, a figure that rises to 43 percent for those who contract pneumonia in that period.
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Your ability to stay upright and move through space is determined by a complex combination of muscle strength, visual inputs, the inner ear and the work of your proprioceptive system - specialized receptors in the nerves of your joints, muscles, ligaments and tendons that orient you in relation to other objects.
It's all sorted out in the sensory cortex of your brain, which takes in the information from those sources and orchestrates your response. It's why, for example, you can walk up a flight of stairs without looking down at them, how you know where your hand is without seeing it, how you adjust when you find yourself navigating rough terrain.
But aging dulls those senses. The functioning of those receptors declines, and the processing of the information sent over neural pathways slows.
"We've done a series of studies that show that proprioception gets worse with aging, it gets worse with arthritis, and the composition of your ligaments and tendons changes" in ways that can impair balance, said Robert Barrack, a professor of orthopedic surgery at the Washington University School of Medicine in St. Louis.
One study showed that "disruption of proprioceptive input was the most important determinant" of balance in people older than 80. As they become less stable and mobile, some older people also experience a corresponding loss of confidence and adapt by using canes or limiting their movements.
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What can you do? As with most physical abilities, you can either use it or lose it. You don't often think about practicing your balance, but you should, experts say, the same way that you ride a bike to strengthen your heart and lungs or lift weights to stave off sarcopenia, the natural loss of muscle mass that accompanies aging.
According to a 2007 review of multiple studies conducted by researchers at the University of Porto in Portugal, regular physical activity "seems to have a role in the preservation of proprioceptive function," even if the mechanism isn't well understood. Moreover, Barrack said, strength training helps muscles react better when your balance is thrown off; it also stabilizes joints and helps maintain bone density.
"The message for your reader is: The more active you are, 1/8the more3/8 you can slow that process," he said.
If you have a balance problem that is not tied to illness, medication or some other specific cause, simple exercises can help preserve, and perhaps improve, your balance.
• Standing on one foot for 10 seconds. Do 10 repetitions, then switch to the other foot. You can do this while brushing your teeth or waiting around somewhere. In the beginning, you might want to have a wall or chair to hold.
• Heel-toe walk: Take 20 steps while looking straight ahead. Think of a field sobriety test.
• Exercising on a half-ball, which is hard and flat on one side but rounded on the other.
It's never too early — or too late — to start. You can benefit, whether you're in your 20s, 50s or 80s. But starting early is always the best choice.