Physical activity for health: framework

Muscle Strength and Balance

The UK Chief Medical Officers Physical Activity Guidelines recognise the critical importance of muscle strength, flexibility and the ability to balance underpin physical function, particularly later in life. The guidelines note that:

“Each attribute contributes independently to overall health and functional ability, and in combination they provide lifelong benefits. Muscle and bone strength play a critical role in ensuring good muscular and skeletal health, and in maintaining physical function. Bone strengthening involves moderate and high impact activities to stimulate bone growth and repair. Strengthening activities are important throughout life for different reasons: to develop strength and build healthy bones during childhood and young adulthood; to maintain strength in adulthood; and to delay the natural decline in muscle mass and bone density which occurs from around 50 years of age, maintaining function in later life”^[13]

Activities which improve strength, balance and flexibility are of great importance to all adults but are particularly critical as we age. These activities help maintain physical function and reduce the risk of falls. Thirty percent of people aged 65 and over will fall at least once a year. For those aged 80 and over this figure rises to 50%. The most important consequences of a fall are the effects on individuals through pain, distress, loss of confidence and lost independence. Falls and fall-related injuries are a serious health care problem because of their association with subsequent morbidity, disability, hospitalisation, institutionalisation and mortality. Around 10% of falls result in a fragility fracture and 2% in a hip fracture.^[14] In the UK as a whole, hip fractures alone account for 1.8 million hospital bed days and £1.1 billion in hospital costs every year, excluding the high cost of social care.^[15]

The importance of muscle strength and balance is a key area of focus in our approach, building on many good examples of initiatives in this area being taken forward across Scotland.

Walking with Strength and Balance – Care Homes

Paths for All, in partnership with the Care Home Collaborative (NHS Greater Glasgow and Clyde) are working to increase physical activity opportunities for care home residents through embedding walking with strength and balance initiatives. Healthcare staff are being supported to develop and embed a whole care home approach which supports behaviour change and improves the culture of physical activity within their home. The achievement of these essential outcomes for older adults to live an active life, are focused on integrating evidence-based strength and balance movements into everyday life which contribute to a reduction in falls or repeat fall.

Ongoing investment in staff training and resource for the Walking with Strength and Balance initiative continues to build capacity across care homes whilst embedding the initiative to make it sustainable.

Data from care homes across Greater Glasgow and Clyde has shown positive results:

• Physical, mental, and social health improvements with more residents opting to take part in walking with strength and balance
• Individual resident data indicates improvements in strength and balance (20-week pilot data using set measures, including Berg scale)
• Emerging positive culture of physical activity amongst staff
• Increased staff confidence through training to support residents to build strength and balance and physical activity levels

Irene’s Story, Mosswood Care Home, Paisley

“Mum had a stroke at the beginning of September 2023 and was in hospital for six weeks. When she returned to her care home she struggled to get up out of a chair and walk. Our family are pleased that mum’s care home partnered with your team and Paths for All who showed residents how exercises could help. Mum attends classes three times a week and loves going along as it’s quite sociable too! At first, she needed help to stand up and she found it difficult to walk and keep her balance. She faithfully did these simple exercises, and she was able to do more each week. She still walks with a zimmer but her balance is much better and she can walk round the unit at a good pace. Sometimes she has been ‘caught’ walking along without her zimmer! I believe she walks better now than she did before she had her stroke. Thank you for helping her get some independence back.” Alyson Craig (Irene’s daughter)