We all recognise the benefits of regular aerobic or cardiovascular exercise to support our heart and lung health. Being active is also good for our social and mental health. And strength training promotes strong bones and muscles.

But as we age, we also need to train our balance to avoid falls.

Around one in three people aged 65 and over have a fall each year.

Falls are a common cause of disability and loss of independence in older age and can lead to an older person moving from living independently into living in a residential aged care facility. More than 6,000 older Australians die each year from falls.

But many falls are preventable. So exercise that targets balance and strength is crucial.

How much do we need to do?

International guidelines recommend all older people exercise to prevent falls, even if they’ve never fallen. Prevention is far better than cure.

Other guidelines recommend people aged 65 and over do “functional balance and strength training” on three or more days a week, to improve their ability to do day-to-day activities, stay independent, and prevent falls.

Since balance starts to decline at around age 50, it’s even better to start training balance before the age of 65.

In order to increase our muscle strength, we need to progressively lift heavier weights. Similarly, to boost our balance, we need to practise activities that progressively challenge it. This improves our ability to stay steady in difficult situations and avoid falling.

Functional training means doing a physical activity that imitates everyday activities, such as standing up out of a chair, or stepping onto a step.

When you practise the everyday activities necessary for living independently, you improve your ability to perform them. This reduces the likelihood of falling when doing those activities, and therefore helps you maintain your independence for longer.

What exercises can you do?

The best exercises to challenge our balance system and reduce the risk of falling are performed while standing, rather than seated.

For example, you can stand with your feet close together or on one leg (if it’s safe to do so) while also performing controlled upper-body movements, such as leaning and reaching. This is a functional balance exercise and it can be made progressively more challenging as your balance improves.

Here are some exercises you can practise at home:

Sit to stand

Practise standing up from a seated position ten times every hour or so. See if you can do it without using your arms for support. To increase the balance challenge, place a cushion under the feet.

Heel-raises

Rise up onto your toes and hold the position for a few seconds. Hold on to a bench or wall for support if you need to but gradually remove the support as your balance improves. To increase the balance challenge, try doing this with your eyes closed.

Heel-toe walking

Practise walking along an imaginary line, with one foot placed in front of the other. Hold on to a bench or wall for support if you need to but gradually remove the support as your balance improves.

Stepping in different directions

Practise quickly stepping forwards, sideways and backwards. Being able to move our feet quickly can help avoid a fall if you trip on something. If you are able, more challenging activities include stepping up or jumping onto a box.

Squats and lunges

Squats and lunges improve balance and leg strength. Add some hand weights to increase the challenge.

These examples and others can be found on the Safe Exercise at Home website.

Make it regular – and tailor it to your needs

It’s important that balance challenging exercises are performed regularly, at least three times per week. The benefits of exercise are lost if you stop doing them, so ongoing practice is important.

People of all abilities can safely undertake balance training exercise, however extra guidance and support is recommended for people who have physical limitations, are frail, or who are at a higher risk of falls.

For younger or fitter people, agility activities such as rapid stepping, dancing and running are likely to improve co-ordination and balance too.

So next time you are carrying out your exercise routine, ask yourself: what am I doing to improve my balance? Investing in balance training now can help you avoid falls, and lead to greater independence in older age.

Anne Tiedemann, Professor of Physical Activity and Health, University of Sydney; Cathie Sherrington, Professor, Institute for Musculoskeletal Health, School of Public Health, University of Sydney, and Geraldine Wallbank, Study Manager, PhD Candidate, Physiotherapist, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Getting a headache and feeling sick are common side-effects for many medicines. Indulging in risky sexual behaviour or pathological gambling – not so common.

But a BBC investigation has highlighted that some drug treatments for restless leg syndrome and Parkinson’s disease can lead to such risky behaviour.

Over 150,000 people in the UK live with Parkinson’s – a degenerative condition that affects the brain. The main part of their brain that is damaged is the area that produces dopamine, a chemical messenger that regulates movement. Less dopamine in the brain can lead to symptoms such as tremors, muscle stiffness, slow movements and problems with balance.

Another movement disorder is restless legs syndrome (RLS), which affects between 5% and 10% of people in the UK, US and Europe. Twice as many women as men have RLS among those aged over 35.

People with RLS feel they need to uncontrollably move their legs, and may experience a crawling, creeping or tingling sensation in them. Usually, the symptoms are worse at night when dopamine levels tend to be lower. Although the exact cause of RLS is unknown, it has been linked to genes, underlying health conditions, and an imbalance of dopamine.

One of the main treatments for movement disorders is a group of drugs called dopamine-receptor agonists, which include cabergoline, ropinirole, bromocriptine and pramipexole. Dopamine-receptor agonists increase the levels of dopamine in the brain and help regulate movement.

Dopamine is known as the “happy” hormone because it is part of the brain’s reward system. When people do something fun or pleasurable, dopamine is released in their brain. But using dopamine-receptor agonist drugs can elevate these feelings, leading to impulsive behaviour.

While common side-effects include headaches, feeling sick and sleepiness, these drugs are also linked with the more unusual side-effect of impulse-control disorders. These include risky sexual behaviour (hypersexuality), pathological gambling, compulsive shopping, and binge eating. Hypersexuality encompasses behaviour such as a stronger-than-usual urge to have sexual activity, or being unable to resist performing a sexual act that may be harmful.

Previous reported cases include a 53-year-old woman taking ropinirole and exhibiting impulsive behaviour such as accessing internet pornography, using sex chat rooms, meeting strangers for sexual intercourse, and compulsive shopping. Another case highlighted a 32-year-old man who, after taking ropinirole, started binge eating and gambling compulsively, such that he lost his life savings.

When the drug was first being prescribed in the early 2000s, it was thought that impulse-control disorders were a rare side-effect associated with these drugs. But in 2007, a UK Medicines and Healthcare Products Regulatory Agency (MHRA) public assessment report advised that “healthcare professionals should warn patients that compulsive behaviour with dopamine agonists may be dose-related”.

Between 6% and 17% of people with RLS who take dopamine agonists develop some form of impulse-control disorder, while up to 20% of people living with Parkinson’s may experience impulse control disorders.

But the true figures may be even higher, as many some patients may not associate changes in behaviour with their medication, or may be too embarrassed to report it. Case reports show that in most instances, impulsive behaviour stops when the drug is stopped.

Lawsuits

There have been several individual and class-action lawsuits against pharmaceutical companies including GlaxoSmithKline, which produces ReQuip® (ropinirole), and Pfizer, which makes Cabaser® (cabergoline). Patients taking action against these companies claimed they were unaware of these impulsive behaviour side-effects.

For example, in 2012, a French court ordered GlaxoSmithKline to pay £160,000 in damages to Didier Jambart, after he experienced “devastating-side effects” when taking the firm’s Parkinson’s drug Requip. And in 2014, an Australian federal court approved a settlement against Pfizer for a class-action lawsuit regarding its Parkinson’s drug, Cabaser. 150 patients claimed they did not have warning of potential side-effects – including increased gambling, sex addiction and other high-risk activities – of taking Cabaser.

It is now clearer in the patient information leaflets given with all prescribed medication for movement disorders that impulsive behaviour can occur in some patients.

In 2023, the MHRA advised there had been increased reports of pathological gambling with a drug called aripiprazole. This antipsychotic drug, used in the treatment of schizophrenia and mania, partly acts as a dopamine-receptor agonist.

Any drug that increases dopamine levels could theoretically be linked to impulse control disorders, and it is important to keep monitoring patients and their behaviour in such cases.

Not everyone will experience side-effects. Before you begin any course of treatment, your doctor or pharmacist should explain the potential side-effects – but it is also important to read the information leaflet with any medicine. And if you experience any impulsive behaviours with these medicines, speak to your doctor or pharmacist immediately.

Dipa Kamdar, Senior Lecturer in Pharmacy Practice, Kingston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Ten million people are diagnosed with dementia worldwide each year – that’s more than ever. According to the Alzheimer’s Society approximately one million people in the UK are currently living with the disease. Studies predict this figure will rise to 1.6 million people by 2050.

Alzheimer’s disease is the most common cause of dementia and leads to a decline in memory and thinking skills. This is a physical illness that causes the brain to stop working properly and gets worse over time. Identifying the onset of Alzheimer’s early can help patients and caregivers find the right support and medical care.

One way to detect Alzheimer’s early is by spotting changes to people’s use of language. This is because new speech problems are one of the first signs of a mental decline that could indicate the onset of this disease.

Here are five early, speech-related signs of Alzheimer’s disease to look out for:

1. Pauses, hesitations and vagueness

One of the most recognisable symptoms of Alzheimer’s disease is trouble remembering specific words, which can often lead to frequent or long pauses and hesitations. When a person with Alzheimer’s is struggling to remember a word, they may talk vaguely such as saying “thing”, or describing and talking around a word. For example, if someone is having trouble remembering the word dog, they may say something like “people have them as pets … they bark … I used to have one when I was a child”.

2. Using words with the wrong meaning

Trouble remembering the right word can be an early feature of Alzheimer’s. People with Alzheimer’s might replace a word they are trying to say with something related to it. For example, instead of saying “dog”, they might use an animal from the same category, saying “cat” for instance. In the early stages of Alzheimer’s disease, however, these changes are more likely to be related to a broader or more general category such as saying “animal” instead of “cat”.

3. Talking about a task rather than doing it

Someone with Alzheimer’s may struggle with completing tasks. Instead of performing a task, they may talk about their feelings toward the task, express doubts, or mention past abilities. They might say, “I’m not sure I can do this” or “I used to be good at this”, rather than discussing the task directly.

4. Less word variety

A more subtle indicator of Alzheimer’s disease is the tendency to use simpler language, relying on common words. People with Alzheimer’s often repeat the same verbs, nouns and adjectives instead of using a broader vocabulary. They can also use “the”, “and” or “but” frequently to connect sentences.

5. Difficulty finding the right words

People with Alzheimer’s can have trouble thinking of words, objects or things that belong in a group. This is sometimes used as a cognitive test for the disease. For example, those with Alzheimer’s may struggle to name things in a specific category, such as different foods, different parts of the body or words that start with the same letter. This gets harder as the disease progresses, making these tasks increasingly challenging.

Age is the biggest risk factor for developing Alzheimer’s – the chance of developing the disease doubles every five years after the age of 65. However, one in 20 people diagnosed with Alzheimer’s disease are under the age of 65. This is referred to as younger – or early-onset Alzheimer’s disease.

While forgetting words now and then is normal, persistent and worsening problems remembering words, speaking fluently, or using a variety of words could be an early sign of Alzheimer’s disease. Identifying these signs early can be particularly important for people at higher risk of developing Alzheimer’s disease as they age, such as people with Down Syndrome.

Sarah Curtis, Doctoral Candidate, Language use in Down Syndrome and Alzheimer's Disease, School of Arts and Humanities, Nottingham Trent University

This article is republished from The Conversation under a Creative Commons license. Read the original article.