Regular balance exercise cuts falls in older adults by about a QUARTER. Programs that mix balance with leg strengthening do even better, cutting falls by about a third.
The dose matters. The programs that work best challenge your balance and add up to around THREE hours a week, spread over several days and kept up for months. Walking is good for you, but on its own it doesn’t prevent falls.
More than 1 in 4 adults over 65 fall each year, and many of those falls can be prevented.
This program suits older adults, and people getting back on their feet after a hip fracture or a hip or knee operation once their team has cleared them for standing exercise. After surgery, your surgeon’s and physio’s instructions come first.
Before you start: set up safely
- Use a kitchen counter or another heavy, stable surface, with a sturdy chair behind you
- Wear supportive shoes with a non-slip sole, not socks or backless slippers
- Have someone nearby the first few times you try a harder exercise
- Reduce your hand support gradually: both hands, then one hand, then a fingertip, then hands hovering just above the counter
- Check yourself: stand heel to toe, one foot directly in front of the other, for 10 seconds. If you can’t, your fall risk is higher. Mention it to your doctor and start at Level 1
Level 1: steady standing and leg strength
Aim to do these most days. Start with 10 to 15 minutes.
- Feet-together stand: stand with your feet side by side, touching. Hold 10 to 30 seconds, 3 times
- Half-step stand: place the instep of one foot beside the big toe of the other. Hold 10 to 30 seconds, then swap feet
- Heel-to-toe stand: one foot directly in front of the other, heel touching toe. Hold up to 30 seconds, then swap
- Sit to stand: stand up from a firm chair without using your hands if you can, and sit down slowly. Start with 5 to 10. This is one of the best leg-strength exercises there is
- Heel raises: holding the counter, rise onto your toes and lower slowly. 10 to 15
- Toe raises: holding the counter, rock back onto your heels and lift your toes. 10 to 15
Level 2: shifting and stepping
Move up when you can hold each Level 1 stand for 30 seconds with only light fingertip support.
- Weight shifts: feet apart, slowly shift your weight to one foot, then the other. 10 each way
- Heel-to-toe walk: along the counter, place each heel directly in front of the other toes. 10 steps, 3 times
- Side-stepping: along the counter, 10 steps one way, 10 back
- Single-leg stand: holding the counter, lift one foot. Start with 10 seconds and build to 30, each leg
- Marching on the spot: lift your knees in turn, slowly. 10 to 20 each leg
- Step-ups: onto the bottom stair, holding the rail. 10 each leg
Balance you don’t challenge is balance you lose.
Level 3: harder balance
- Single-leg stand, no hands: up to 30 seconds each leg, near the counter
- Head turns: in the heel-to-toe stand, slowly turn your head side to side
- Reaching: standing, reach forward and to each side as far as you safely can, then come back to the middle
- Walking backward: slowly, along the counter, 10 steps
- Figure-of-eight walk: around two chairs, both directions
- Tai chi: a class is a good way to keep this going. It lowers falls too
How much, and how to progress
- Balance most days, strength at least three times a week. Build toward about three hours of balance and strength work a week in total, spread over the week
- Progress by taking away support: less hand support first, then a narrower stance, then head turns or eyes closed, with the counter right there
- Muscles may ache the next day. That’s normal. Joint pain that is worse the next morning means ease back for a day or two, then carry on
- Stop and sit down if you feel dizzy, faint, short of breath or have chest pain
- Keep going. The benefit fades when you stop
After a hip fracture, hip or knee surgery
- Start when your team says, and follow any weight bearing limits on the operated leg
- Keep your walking aid in reach while you practice
- Leave single-leg stands on the operated leg until last. They are the hardest part to earn back
- Follow any hip precautions you were given after a replacement
- Families can help: stand close for the harder levels. See hip fracture surgery recovery for the rest of the picture
If knee pain is getting in the way of the strength work, see knee arthritis.
Home safety in brief
- Clear the floor: loose rugs, cords and clutter
- Light the way: night lights between the bed and the bathroom
- Rails and grab bars: on both sides of the stairs, by the toilet and in the shower
- Medicine review: some sleeping pills, blood pressure pills and other drugs raise fall risk. Ask your doctor or pharmacist to check yours
- Eyes and feet: keep your eye tests up to date and get foot problems seen to
- Bone health: ask about it if you’ve already broken a bone in a simple fall. Weak bones can also cause a spinal compression fracture
Mayo Clinic has a practical checklist of simple ways to prevent falls around the home.
Call emergency services if
- Chest pain, fainting or sudden severe shortness of breath during or after exercise
- Sudden weakness on one side, a drooping face or slurred speech
- After a fall, you can’t put weight on a leg, or you hit your head while taking blood thinners
Call your surgeon today if you’ve had recent surgery and
- Your calf is painful, swollen or warm: possible clot in the leg
- The wound is red, hot, spreading or leaking, or you have a fever or chills
Talk to your doctor if
- You have fallen in the past year
- You feel dizzy or lightheaded when you stand up
- You feel unsteady, or fear of falling is keeping you at home
- You can’t hold the heel-to-toe stand for 10 seconds
Walking keeps you moving. Balance training keeps you upright.