想脱鞋? 站稳了别坐下更别倒下

If you find yourself needing to sit down to take off your shoes, it might be time to start paying attention to your sense of balance.

如果你发现自己脱鞋时必须坐下来的话，你可能到了该关注身体平衡问题的时候了。

People don't usually think about balance until they fall, but little signs such as relying on handrails to go up and down stairs can be early warnings that stability is starting to go, says Jason Jackson, a physical therapist at Mount Sinai Hospital in New York. These changes won't show up on the formal assessments that doctors use for people with balance disorders, such as the Berg and Tinetti scales. For most people, good ways to gauge include the need to lean on armrests when getting out of a chair or feeling wobbly while standing with feet very close together.

纽约芒特西奈医院(Mount Sinai Hospital)理疗师贾森・杰克逊(Jason Jackson)说，人们总是到了摔倒的时候才想到身体平衡问题，但是一些细微的信号比如上下楼需要紧握扶手可能是肢体稳定性下降的早期信号。这些小的变化不会体现在医生用于平衡失常者的正式评估表上，例如伯格氏平衡量表(Berg scale)和蒂内提测试(Tinetti test)。对于大多数人来说，合理的自测标准包括从椅子上站起来是否需要依靠扶手，或者两脚距离很近站立时是否感到晃动。

An important age range for improving balance is the 30s and 40s. While most people don't develop serious balance problems until well into their 50s, experts recommend that otherwise healthy people keep active and do simple exercises to challenge the body and keep steady into old age.

增强平衡感的重要年龄段是30到40岁。尽管大多数人50好几之前不会有严重的平衡问题，专家还是建议健康人士经常活动、做一些简单的练习来挑战自身，步履稳健地步入老年。

In the U.S., falls are the leading cause of injury for people over 65, according to a 2005 report by the Centers for Disease Control and Prevention. Every 17 seconds, someone in this age group is treated in an emergency room for a fall. Every 30 minutes, one will die from injuries caused by falling.

美国疾病控制与预防中心(Centers for Disease Control and Prevention)2005年的一项报告显示，在美国，摔倒是导致65岁以上人士受伤的主要原因。每17秒就有一个该年龄段的人因摔倒而去急救室接受治疗。每30分钟就有一个人死于摔倒造成的创伤。

Balance is controlled by the brain's cerebellum, a region of the brain that is responsible for movement and coordination. According to McGill University physiology professor Kathleen Cullen, the cerebellum coordinates information from three systems: the visual, the vestibular (or inner ear) and the proprioceptive (or sense of body position). In addition, it works with the spinal cord to adjust for unexpected information -- for instance, a slippery surface -- and maintain balance.

平衡由小脑控制，这是脑部负责运动和协调的区域。麦吉尔大学(McGill University)生理学教授凯瑟琳・卡伦(Kathleen Cullen)表示，小脑通过三个系统处理信息：视觉系统、前庭系统（或者说内耳）以及本体感受系统（或者说对身体姿势的感知）。另外，小脑还与脊髓相配合来应对意外情况──比如光滑的地面──并保持平衡。

All these systems start to erode after 40. And people also become more sedentary as they age and begin to rely on the visual system more heavily. The problem: The visual system doesn't work as quickly as the vestibular system, so people start getting shaky and risk falling. 'People then don't trust their own balance, so they become more sedentary,' says Dr. Cullen. 'And by becoming less active, you actually lose the ability to use or take advantage of [sensory information], and your balance gets worse.'

这些系统在40岁以后就开始退化。随着年龄的增长，人们坐着的时间越来越长，也开始更加依赖视觉系统。问题在于，视觉系统的反应速度不及前庭系统，所以人们就开始站不稳甚至摔倒。卡伦博士说：“于是人们就不再相信自己的平衡感，所以更愿意坐着。并且由于活动减少，你实际上失去了利用感官信息的能力，平衡感就更差了。”

Exercises can isolate these different systems and make the body work harder to keep them in top shape. Experts suggest doing exercises in a couple of five- to 10-minute bouts each day.

锻炼可以强化不同的系统，也会促使身体努力运转从而让这些系统保持最佳状态。专家建议每天以五到10分钟为一组，锻炼几次。

For people in cities with public transportation, avoid clutching tightly on to the poles in subway cars. A lighter grip will challenge your body to maintain stability on its own. Another option: Walk on many differences surfaces, says Mr. Jackson of Mount Sinai. When at a park, for example, alternate between walking on the pavement and the grass because the unstable surface will make the muscles work more.

在城市里乘坐公共交通的人尽量不要紧握地铁车厢里的扶手杆。少用扶手杆会促使你依靠自身来保持平衡。芒特西奈医院的约翰逊说，另一个方法是在不同的路面上行走。例如，在公园的人行道上和草坪上交替行走，因为路面的变化会增加肌肉的运动量。

Other exercises:

其他锻炼：

-- Stand and lift your right arm straight out in front of you while swinging your left leg back and forth, and vice versa, to work on coordination, says Mr. Jackson. Then try it with your eyes closed to help decrease your reliance on vision for balance.

约翰逊说，身体直立并将右臂向前平伸，同时前后摆动左腿，反之亦然。这是为了锻炼协调能力。之后试着把眼睛闭上来减少对于用视觉感知平衡的依赖。

-- Strengthening the hips -- an important component of preserving balance -- can be done next to the kitchen counter, says Jennifer Brach, an associate professor of physical therapy at the University of Pittsburgh. Hold on to the counter while standing on one leg and lift the other leg to the front, then the side, then back and then up with your knee bent like you're marching. This works four separate groups of muscles in the hips: the hip abductors, hip adductors, hip extensions and hip flexors. (These muscles can also be strengthened by using the hip abductor and adductor weight machines at the gym.)

匹兹堡大学(University of Pittsburgh)理疗学副教授珍妮弗・布拉克(Jennifer Brach)说，强健臀部肌肉，这是保持平衡感的重要环节，这项运动可在厨房操作台边完成。手扶着操作台，同时单腿站立，另一条腿前伸、侧伸、后伸，再抬腿屈膝，就像列队行进一样。这样能够使臀部的四组肌群得到运动：臀部外展肌、臀部内收肌、臀部伸肌和屈肌。（这些肌肉也可通过健身房的臀部伸展器械进行锻炼。）

For office workers, simply getting up from a chair 10 times in a row can be useful, says Mr. Jackson. Alternate between getting up with your feet in wide stance, which provides more support, and getting up with a narrow stance with your feet touching.

杰克逊说，对于白领一族，只要连续从椅子上起立10次就很有效果。先将双脚分开一定距离起立，这会给身体提供更多支撑，再双脚并拢起立，两者交替进行。

'It's much more difficult to maintain balance with a narrow base of support, so those little variations test your coordination,' he says.

他说：“双脚并拢时保持平衡要困难得多，所以双脚距离的变化就是考验你的协调性。”

Good balance also requires 'exercise for the nervous system,' says Dr. Brach. 'To practice their balance, people should be working with timing and coordination,' she says.

布拉克博士说，良好的平衡感也需要“锻炼神经系统。为了训练平衡感，人们应该在节奏感和协调性方面下功夫”。

An exercise she has patients do in her clinic is the 'stepping pattern.' Stand with feet shoulder-width apart. Put the right foot in front of the left, and shift weight onto the front foot so that the left heel is off the ground. Do this 10 times. Then repeat with the left foot in front of the right.

她在诊所里对病人做的一项训练是“步伐练习”。两脚与肩同宽站立，再将右脚放在左脚前面，将身体重心移到右脚，从而让左脚跟离地，重复做10次。之后将左脚放在右脚前面做相同的动作。

For a more difficult variation, alternate sides -- go right-left-right-left -- to get your body accustomed to switching weight more quickly, she says. You can also do make the move more challenging by stepping backward.

她说，另一种难度更高的版本是左右移动，按照左-右-左-右的节奏，从而让身体更快地适应重心的转换。你也可以向后移动，使其更具有挑战性。

The stepping pattern is similar to moves found in ballroom dancing and 'forces you to think and coordinate and time your body,' says Dr. Brach. Exercises that encourage learning new moves and adjusting to the environment -- such as tennis or gymnastics, as opposed to long-distance running -- may be better for maintaining balance. But, says Dr. Brach, 'we don't have the research to say for sure that one is better than another.'

布拉克博士说，这种步伐与交谊舞的步伐相似，“让你思考、调整身体并把握节奏”。可以让人学会新的动作并增强环境适应能力的运动──例如网球和体操──似乎更适合训练平衡感，长跑则不太适合。但布拉克博士也说：“没有研究确切表明某一项运动优于另一项。”

Walking in a circle or oval around the living room or backyard can be good practice because it is more challenging to walk on a curve.

在客厅或者后花园绕圈走也是不错的锻炼，因为沿着弧线行走对身体更具挑战性。

There is also a mental component to regaining balance, says Arlene Schmid, an associate professor of occupational therapy at Colorado State University. This mental aspect is a bigger factor for people with impaired balance due to advanced age or illness.

科罗拉多州立大学(Colorado State University)作业疗法学副教授阿琳・施密德(Arlene Schmid)说，心理因素也影响着平衡感的恢复。对于因年龄和疾病造成的平衡感下降的人来说，心理因素的影响更大。

In a study published by the medical journal Stroke in 2017, Dr. Schmid's team taught yoga to post-stroke patients for eight weeks. Of the 34 patients, 19 initially had balance impairment as measured on the Berg balance scale. After training, 11 had impaired balance.

在一项研究中，施密德博士的团队对中风康复患者进行了为期八周的瑜伽教学。在34名患者中，19人经伯格氏平衡量表评估为平衡感受损。在训练过后，平衡感受损的人数减为11人。该研究论文于2017年发表于医学杂志《卒中》(Stroke)。

Dr. Schmid said she believes the patients were successful in large part because they felt confident they could do the movements.

施密德博士说她认为这些患者的成功很大程度上是因为他们对自己能够取得进步抱有信心。

'We really were trying to focus on making everyone feel successful from day one to build their confidence, so for the first few weeks we only had sitting postures,' she says.

她说：“我们真的非常努力地让每个人从第一天起就获得成就感，从而建立起信心，所以在最初的几周我们都只练习了坐姿。”

Yoga can boost balance ability because it increases flexibility and its many poses integrate movements that strengthen a lot of different muscles, including those in the hip, says Dr. Schmid. But the emotional component is key.

施密德博士说，瑜伽能够增强人的平衡感，因为它增进了灵活度，同时瑜伽的各种体式融合了可以强化各种肌群的动作，包括臀部的肌肉。但是情感因素才是关键。

'People are afraid of falling and they don't want to move anymore -- and the biggest preventative piece is just not being afraid to get moving,' she says.

她说：“人们害怕摔倒就不再活动了，而最好的解决办法就是不要害怕。”

Balance-Boosting Exercises

增强平衡感的练习

Walk in a circle or oval. Make the circle or oval smaller and smaller so the curve becomes tighter.

绕圈（正圆或椭圆）走，并且让圈子越来越小，这样弧度也就越来越大。

Stand on one leg (hold on to a counter if you need to) and do leg lifts to the front, side, back, and up like you're marching. This exercises four groups of muscles in your hips, which are important to preserving balance.

单腿站立（如果需要的话可手扶台面），另一条腿前伸、侧伸、后伸，再抬腿屈膝，就像列队行进一样。这些动作能够使臀部的四组肌群得到运动，对于保持平衡感非常重要。

Get up from your chair 10 times in a row without leaning on arm rests. Alternate between your feet in wide stance and close together. Make it more difficult by closing your eyes.

从椅子上连续起立10次，并且不依靠扶手。双脚分开、并拢交替站立。闭上眼睛来增加难度。

Put five cones (or other objects) in a straight line and weave between them.

将五个圆锥形物体（或者其他东西）排成一条直线，并在其间绕行。

Stand with feet shoulder-width apart. Put your right foot in front of your left, and shift your weight onto your right foot so that the left heel is off the ground. Do this 10 times. Repeat with left foot in front of the right foot. Variations: Do the exercise alternating feet or stepping backward or with your eyes closed.

两脚与肩同宽站立，将右脚放在左脚前面，将身体重心移到右脚，从而让左脚跟离地，重复做10次。之后将左脚放在右脚前面做相同的动作。变换形式：左右脚替换，或者向后移动，或者闭上眼睛。