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Striking a balance: The right exercise program can reduce fall risk

May 2016


Can you confidently stand on one leg for seven to 10 seconds without having to put your foot down? If not, it may be time to step up your ability to balance.

“The statistics are pretty striking: 1 in 3 people ages 65 years and older falls each year,” said Dr. Elizabeth Phelan, UW associate professor of medicine and founding director of the Fall Prevention Clinic at Harborview Medical Center. “This is an under-recognized problem. Working on your balance and strength, starting when you are younger, is very important to prevent falls.”

Falls are the leading cause of injuries and injury-related deaths in older people. People under the age of 65 also fall. There is a natural decline in our balance and muscle strength as we age, beginning in our 30s, according to Phelan. Poor balance is the most common contributor to falling, but research shows it is something people can improve.

Exercise Programs Proven to Improve Balance

  • Otago Exercise Program is a set of leg muscle strengthening and balance retraining exercises progressing in difficulty, and a walking plan. Participants work with a physical therapist to learn the exercises, which take about 30 minutes to complete. The program can be done at home.
  • Tai Ji Quan: Moving for Better Balance® is an evidence-based fall prevention program for sedentary adults and people with movement disorders, like Parkinson’s disease. It is based on an ancient Chinese practice that focuses on health, martial arts and mental conditioning. It is typically practiced in a group but can also be practiced at home.
  • LiFE (Lifestyle-integrated Functional Exercise) teaches participants to do balance and strength activities within everyday life tasks and routines.

Assessing your balance

If you’re feeling unsteady on your feet, feel hesitant walking up or down an incline or stairs, or lose your balance when you turn, speak with your healthcare team. They will want to evaluate medications that might be making you lightheaded or dizzy and identify other factors, such as vision problems, that could be causing balance issues.

In addition, they can do a quick test of your balance and strength. For example, they may have you do these steps developed by the Centers for Disease Control and Prevention to assess balance:

  1. Stand with your feet side by side.
  2. Place the instep of one foot so it is touching the big toe of the other foot.
  3. Place one foot in front of the other, heel touching toe.
  4. Stand on one foot.


According to the CDC, an older adult who cannot hold the tandem stance (one foot in front of the other) for at least 10 seconds is at increased risk of falling.

Finding the right exercise (Hint: It’s not about sweating)

Phelan pointed out three things to keep in mind when looking to improve balance:

  1. You have to exercise while standing to improve your balance. This may be a challenge for people who need to improve lower-body strength and may need to do balance exercise with the supervision of a physical therapist.
  2. You need to progress to more challenging levels of balance exercise, otherwise you’re just maintaining your balance instead of improving it.
  3. You need to be doing balance exercises at least two to three times a week.

Phelan recommends three evidence-based exercise programs for older adults seeking to improve their balance: Tai Ji Quan: Moving for Better Balance® (TJQMBB), the Otago Exercise Program, and LiFE, or Lifestyle-integrated Functional Exercise.  

Those with good balance seeking to maintain or improve it may consider ballet, yoga, Pilates, or folk or ballroom dancing. Phelan says that there is limited evidence on whether these activities improve balance and prevent falls, but studies of dance in particular appear promising. 

“Ballroom dancing has all the features of an exercise that would help people maintain good balance, because you’re moving in multiple directions, you’re focusing on picking up your feet, and you’re challenging both your physical and mental capacities simultaneously,” she said.

Walking, on the other hand, is not an exercise that improves balance.

“I never discourage people from walking, because it helps with overall conditioning and control of chronic conditions like high blood pressure, but it is not effective in preventing falls. It’s really important people understand that improving balance to prevent falls involves practicing a specific type of exercise,” said Phelan.

Once you’ve talked to your healthcare provider and chosen the right balance-improving exercise for you, have patience. It takes about six months of balance practice before you start reaping the benefits and reduce fall risk.

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