Three equipment options better than the BOSU for mature clients
The BOSU has quickly become one of the most popular and beloved pieces of fitness equipment with trainers today and frankly that baffles me a little bit. I’ve watched many videos and presenters showing hundreds of “creative” uses of the BOSU that just leaves me scratching my head because I just don’t get what they are trying to accomplish. They use all of the right terms, such as balance, proprioception and reactive stability, to support their choice of exercise movements but usually I see a physiological disconnect between what they are saying and what the movement actually accomplishes.
In my personal opinion the BOSU is more of a toy than a tool. Now don’t get me wrong there are definitely some beneficial movements that can be performed on the BOSU but they comprise just a fraction of all of the movements that are actually performed with it. This is all doubly true for mature clients. The BOSU, and instability training in general, seem to be overused and misapplied with this population. For example, I recently completed the BOSU Mobility and Stability for Active Aging program (home study materials) and, as someone who has studied mobility and balance extensively for older adults, I was completely underwhelmed. A large portion of the exercises either didn’t use the BOSU or could have used any number of other pieces of equipment in its place with the same result. And while several components critical for balance and mobility are addressed in the program (e.g. hip and leg strength, ankle stability) others are either insufficiently addressed (e.g. multisensory training; center of gravity control) or not addressed at all (e.g. postural strategies). However, the program could potentially be useful as a basic introduction to balance training for instructors who are new to these concepts. I am concerned, though, because it does not fully nor accurately represent the individual balance components included in a comprehensive program since the focus is on using the BOSU. (I would also state that none of the exercises presented in the program were inherently dangerous or “wrong” for mature clients and I am sure participants would get some results by doing the program but it is generic and sub-optimal.)
Unstable (or labile) surfaces, like the BOSU, need to be used purposefully and selectively with mature clients. Their best use is for vestibular training because in order to fully engage the vestibular system you either need to reduce/remove both somatosensory and visual input OR move the head quickly. A compliant surface reduces somatosensory input so its use is warranted in this situation. Another beneficial use is for ankle and hip stabilization (although some argue against this). Instability definitely turns on the proprioceptors and causes muscular co-contraction. This can be beneficial for those that have deficits in these areas although the proprioceptors can also be turned on using stable surfaces and muscular co-contraction is not always a good thing. So there are pros and cons. The bottom line, though, is that there are other equipment options, like the ones I’ve identified below, that, in my opinion, are more beneficial than the BOSU in accomplishing these tasks.
Number One: High-Density Foam Pad
There are two primary advantages to using foam pads over the BOSU. The first is that foam pads provide a broad, flat surface as opposed to a curved surface. As many before me have stated the curved surface presents some concerns for the ankle and knee joints and its functional relevance is questionable. The flat surface allows for a variety of stance positions including shoulder-width, narrow, side-by-side, semi-tandem, tandem and one-legged. It creates equal instability in all directions instead of “from the center out” with the BOSU. The variety of stance positions possible and the equal instability is really critical in effective vestibular training because we are able to scale/modify the base of support according to the individual’s needs.
The second advantage is the lower level of instability with the foam pad. The BOSU has a greater degree (moderate level) of instability compared to the foam pad. The foam pad will be more appropriate (and much safer) for those who have more severe balance deficits. To increase the amount of instability two foam pads can be stacked together so the instability can be easily and quickly modified. This is very important when working with a group who has varying levels of balance and fall risk. In my opinion it is typically much more appropriate to perform dynamic movements with lower levels of instability compared to moderate or high levels of instability for this population. Performing the mCTSIB test (modified Clinical Test of Sensory Interaction in Balance) also requires stacking two foam pads to assess vestibular control.
Number Two: SPRI Step 360
What I really like about the Step 360 is the broad, hard, flat surface which provides somatosensory feedback in addition to instability. Plus, it allows for a number of different stance positions while providing multi-directional instability which is much more akin to a wobble board. However, it is a little more stable than a wobble board. Some people would argue that the BOSU can be turned hard-side up as well. However, there are some challenges with using the BOSU in this position.
For one, just like a traditional wobble board, mounting and dismounting are difficult because it tilts quite easily and to a significant degree. This is not the case with the Step 360 which can rather easily be mounted by placing one foot closer to the middle of the stepping surface to reduce instability, stepping up with the other foot and then adjusting foot position as necessary. Because of its unique design it doesn’t tilt nearly as much nor as easily. Secondly, there is more of a “dump out” risk. That is, when users allow the BOSU to tilt too far in a given direction (especially forward or backwards) there comes a point where recovery is impossible and the person gets “dumped out”. They must step off the BOSU in order to maintain their balance. This poses a significant fall and injury risk for lower-level clients.
(For more details on the Step 360 visit www.spri.com)
Number Three: The Floor
Yes the floor is one of the best pieces of equipment (if not THE BEST) you can use for comprehensive balance training. It is a broad, firm, stable surface and functionally relevant. We can effectively work on most components of balance with using only the floor and the client’s own body weight. Postural strategies (ankle, hip and step), static and dynamic center of gravity control, multisensory (visual, somatosensory and some vestibular), lower body strength (including ankle, knee and hip stability), gait enhancement, mobility and more can all be trained safely and effectively just by using the floor. It’s not very sexy. It’s not a cool toy or widget. It doesn’t get a whole lot of credit. But it absolutely works!
As I stated earlier, unstable surfaces are really overused and misapplied. Plus the scientific evidence demonstrating their effectiveness for most people is really lacking. This is also true for mature adults. Don’t get swept away by all of the “creativity” that goes into selling a particular piece of equipment when typically the basics are all you really need. Remember that for every “fitness expert” pushing pieces like the BOSU there are just as many other experts who would advise against them. There is really no end to the creativity of fitness professionals but creativity must be balanced with a strong physiological rationale and, ultimately, scientific evidence.
Take Home Message
So, should trainers throw their BOSU out the window? Certainly not. It is important to have tools (not toys) that meet the diverse needs of their clientele and the mature population is the most diverse clientele of all. The BOSU, like many other pieces of equipment, must and can be used safely, purposefully and effectively.
If you want to learn more about evidence-based functional training methods for mature clients then become a certified Functional Aging Specialist. The course is packed with over 10 hours of online content that will teach you how to develop safe and effective functional aging exercise programs. Earn CEU’s from ACE, ACSM, AFAA or NFPT.