In this blog, I’m going to show you balance, strength, and functional exercises that have been proven to improve balance and significantly reduce the risk of falls, as well as provide you with education about preventing falls that everyone should know.
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Quick Disclaimer
As a quick disclaimer, my number one priority with this blog is safety. If you’re concerned about your safety, please see a local physical therapist who can provide you with a thorough assessment and treatment plan.
Since my priority is safety, all of these exercises should be done in a place where you can use your hands to assist with balance, such as in your kitchen, and you should have a sturdy chair with armrests nearby for rest breaks as needed.
Balance Exercises
Let’s start with the balance exercises, beginning with a single leg balance progression.
Can you stand with one foot in front of the other for 20 seconds without using your hands for assistance? Can you do it on both sides?
If this is too challenging, try a semi-tandem stance in which you bring your feet together but one foot is still partially in front of the other.
If you can accomplish 20 seconds without using your hands for support on both sides, progress to the previous variation.
If you were able to stand with one foot in front of the other without losing your balance, move on to single leg balance. Shift your weight onto one leg, lift the other leg up, keep your arms out for balance, and try to hold this position.
You might only be able to hold this for a few seconds at first. That’s okay. With all of these exercises, just do what you can. The goal, over the course of weeks and months, is to try to build up to 3 sets of 30 seconds on each leg.
The next set of balance exercises has to do with walking, and you’re always going to have that countertop next to you for safety.
For sideways walking, you’re going to take side steps in one direction before stepping back in the other direction.
For backward walking, you’re going to take slow steps backward, turn around, and repeat. When you turn, make sure you turn in the direction of the countertop so you can still use your hands for support. This can be difficult and frightening at first, so go at your own pace.
The last walking exercise is heel-toe walking forward and backward, which should look like walking on an imaginary tightrope.
The general recommendation is 10 steps in each direction for all of these options, but depending on your space, 10 steps might not be possible, so you can also set a timer. For example, you can build up to 3 sets of 1-2 minutes for each option.
For added safety during backward walking and heel-toe walking, you can have that sturdy chair on the other side of you, so both hands are available for support as needed.
The next balance exercise is toe tapping. You can use the same set-up, in which you have the countertop on one side of you and the sturdy chair on the other side, and even a second chair behind you so you can rest as needed. You’re going to alternate tapping an object in front of you, such as a pillow or step, for 3 sets of 10-20 taps or 1-2 minutes.
You can also pretend to tap an object if that’s easier for you. If you become really skilled, you can continue to increase the height of the object you tap to further improve your strength and balance.
The next balance exercise is a combination of the two previous exercises that requires you to step over an object.
Start by practicing side stepping over an object, then forward stepping over an object, and finally backward stepping over an object. Once again, you can step over an actual object and increase the size of that object over time to increase the difficulty, or you can just pretend to step over an object. Use multiple objects if you have the space to do so. You can practice each direction for 3 sets of 1-2 minutes.
The last balance exercise involves using an actual step. You can go up and down the step, up and over the step, sideways over the step, or even up, over, and backward, building up to 3 sets of 10-20 steps or 1-2 minutes. These are helpful for navigating stairs, curbs, and other environmental steps that you might have to step up on or off of.
I know I just provided a lot of information. Before moving on to the strength and functional exercises, I want to give 6 important tips and considerations:
- Try to stay upright while performing these exercises. You want to stand tall, if you can.
- Consider where you’re looking. You might need to look down initially, but eventually, the goal would be to look straight ahead, so you don’t have to completely rely on your vision for balance.
- The exercises should be challenging but safe. If they’re not hard to some extent, your balance probably won’t improve. Use your hands as much as you need at first, but over time, hopefully you can use them less and less.
- Since the exercises should be challenging, you’ll likely need to rest. Take 1-2 minutes or longer between sets if that’s what you need.
- Just a reminder that you’re slowly building up the reps or durations. If 3 sets of 10 repetitions seems absolutely daunting, it’s okay to start with 1 set of 5 repetitions. You’re just doing what you can safely.
- The exercises should cause minimal to no pain, so make sure things are comfortable for you.
Strength and Functional Exercises
Let’s move on to the strength and functional exercises, which can also improve balance and make daily life easier.
The most important exercise here is the sit-to-stand because it’s an activity that you do multiple times every day. The easiest starting point is to elevate the height of your chair by sitting on pillows, foam pads, or towels. As you get stronger, you can remove that extra height.
If you’re going to use 2 hands to help push yourself up initially, make sure to scoot to the front of the chair, lean forward a bit, and get your nose over your feet. Otherwise, it’s hard to stand up when your weight is shifted so far back. The goal would be to progress to using 1 hand, no hands, and then maybe even holding a light weight in your hands.
Depending on your current capabilities, you can do 3 sets of 5-20 repetitions here.
The next exercise is the standing heel raise. Rise up on the balls of your feet as high as you can and lower back down while using your hands for support as needed.
You can work up to 3 sets of 10-20 repetitions and if they get too easy, you can start practicing on a single leg.
From there, you can do the opposite movement in standing by lifting the front of your feet and toes off the ground. This movement is known as dorsiflexion. Aim for 3 sets of 10-20 repetitions.
Similar to the side stepping, you can do a movement called hip abduction that involves kicking your leg out to the side. Once again, you want to stand tall for this exercise and do the movement on both sides.
To make it harder over time, use less support and place a weight around your ankle. Aim for 3 sets of 10-20 repetitions.
The last two exercises focus on strengthening the muscles of the thigh. In standing, flex your knee by bringing your heel toward your butt to strengthen the hamstring muscles on the back of the thigh.
In sitting, straighten your knee by kicking your leg out to strengthen the quad muscles on the front of the thigh. Sitting on an elevated surface can help with making sure your foot clears the ground. Ideally, you would add a cuff weight to your ankles for these exercises so your muscles feel challenged. Aim for 3 sets of 10-20 repetitions for each.
What About Upper Body Training?
Let’s start with spinal motion.
A commonly recommended movement is neck rotation. Slowly rotate your head and neck in each direction slowly as far as you can comfortably go. Working on your neck range of motion is important for scanning the environment when walking and helping to maintain balance.
If you’ve become really good at single leg balance, you can actually perform this at the same time.
Similarly, you can practice trunk rotations as if you were trying to look behind you. This time you’re letting your entire upper body move instead of just your head and neck.
Lastly, you can try side bending in each direction with your hands by your side, across your chest, or while reaching overhead.
All three of these movements can be performed daily for 5-10 repetitions in each direction.
For general upper body strength, rows with a band in sitting or standing are great. Any band works as long as you can anchor it to a sturdy object.
There are some options that have handles and an anchor point that you can stick into a closed door.
If that’s too much of a hassle, you can pull the band apart instead, while thinking about opening up your chest. Aim for 3 sets of 10-20 repetitions.
The other exercise for general upper body strength is push-ups. You can start by doing planks against your countertop. The further your feet are from the countertop, the harder the exercise will be to hold. You may need to put a soft surface like a towel across the edge of the countertop for comfort. Just make sure it’s not going to slide and compromise your safety.
When you feel like you’ve mastered the plank, you can start doing push-ups through as much range of motion as possible for 3 sets of 5-10 repetitions.
The last upper body exercise is shoulder abduction, which requires you to lift your arms out to your side. You can practice slowly with bodyweight and then gradually add weight, even if it’s household items like cans of soup or bottles of water, and increase the speed.
Alongside lower body training, a researcher named Jonathan Lee has proposed the importance of training this movement because when a slip happens, the opposite arm must rapidly abduct to the side to help maintain and restore balance. The trunk also side bends, which is why it’s helpful to train that spinal range of motion.
Exercise Parameters and Programming
Now that I’ve shown the balance, strength, and functional exercises, let me describe how to practically apply this information, discuss research-based recommendations, and answer questions you likely have to ease any potential concerns.
How often should you perform the exercises?
- A recent clinical practice guideline recommends that men and women over the age of 50 should perform these types of exercises at least twice per week to reduce the risk of falls.
Do you have to do the exercises in the order described?
- No, you can do them in any order that works best for you.
Do you have to do every single exercise?
- No, at least not initially. You’re going to do what’s safe, comfortable, and appropriate for you, and hopefully slowly progress to doing more exercises over time.
Do you have to do the exact sets and repetitions I recommended?
- No. Like I said previously, 3 sets of 10 repetitions might be unrealistic for you. It’s okay to start with less sets and reps if that’s what is required. I’m just setting goals for you to work toward.
How hard should the exercises be?
- As I’ve mentioned, they should be challenging but safe. If you’re too reliant on your hands, you’re likely not sufficiently challenging yourself and your balance may not improve. Similarly, if you perform 20 repetitions of the seated knee extensions but feel like you could do 100 repetitions, you need to add more weight to make the exercise harder. Nothing should ever feel too easy because you’re always trying to make things harder by adding more sets, repetitions, weight, making the exercises more difficult, etc.
How long will it take for the exercises to make a difference?
- You should expect it to take 50 hours of total training. If you’re exercising 2-3 hours per week, it might take 4-6 months. I tell you this not to discourage you. Rather, I want to encourage you to keep going if you don’t notice immediate changes. Keep at it week after week and your future self will thank you. This is one of the most important things an older individual can be doing for themselves.
A lot of this can be summarized by saying that more is technically better, but something is always better than nothing. Find your starting point and slowly progress over time.
What Else Can You Do?
Aside from structured exercises, what else can you do?
Any amount of physical activity is helpful, especially if it challenges your balance.
If you love gardening and yard work or walking your dog to the dog park to play fetch – both are great!
If you want to try Tai Chi in the park with a group, it will improve your balance.
My 66-year-old dad started playing pickleball 3 years ago and now he’s healthier and fitter than before.
Research has even shown that exercising using video games can improve your balance. This can be a fun activity to do with grandkids!
General physical activity is also a good way to combat other health-related factors that may increase your risk of falls.
Additional Considerations
Additional considerations that should be discussed with your physical therapist, primary healthcare provider, or medical specialist include, but are not limited to:
- Blood pressure
- Medication usage and dosage
- Vision problems
- Depression
- Urinary Incontinence
- Shoewear
Addressing environmental hazards in your home like poor lighting, slippery surfaces, and steps or stairs without railings can significantly reduce the risk of falls.
Similarly, many individuals who have an assistive device fall when they’re not using that assistive device when they should. You can work on improving your balance and potentially have aspirations to one day stop using that assistive device, but still continue to use it when indicated to maximize your safety. These things aren’t mutually exclusive.
Preventative Exercise Routine
What if you’re not currently at risk of falling, but want to get ahead of it before issues arise?
I’ll tell you exactly what to do.
The consensus recommendation is that adults should be performing at least 2 days of resistance training and at least 150 minutes of moderate intensity physical activity each week.
The goal is not only to prevent falls, but improve heart health, brain health, muscle mass, strength, bone density, etc. to keep you as healthy as possible for as long as possible.
As part of your moderate intensity physical activity each week, try to do these 2 things, at least on occasion:
- Break a sweat, which might just mean brisk walking in your neighborhood for 30 minutes.
- Do something dynamic that requires you to move quickly and challenges your hand-eye coordination. I didn’t discuss it earlier because it’s difficult to do independently for someone who is already at risk of falling, but activities that require you to anticipate and react to objects, the environment, perturbations, etc. have been shown to improve balance.
With regards to resistance training in the gym, exercises can look similar to the ones demonstrated previously. Examples include:
- Squats or Split Squats
- Deadlifts with a barbell, kettlebell, or dumbbell
- Leg Extension Machine
- Hamstring Curl Machine
- Calf Raises using a machine or free weights
All of these can be performed for 2-3 sets of 10-15 repetitions with 1-2 minutes of rest between sets or exercises if you do them as a circuit.
To challenge your balance, you can perform single leg exercises like single leg deadlifts, forward, reverse, or lateral lunges, step ups or step downs, reaching movements as far as you can outside your base of support, or even just throwing and catching a ball against the wall. These movements can be performed for repetitions or time.
Lastly, lower body training should include some form of jumping and hopping, whether that’s forward, backward, sideways, in place, onto a box, off a box, in a four square, etc. You can keep it simple by doing 2-3 sets of 5-10 repetitions or timing yourself for 30-60 seconds.
For upper body training, you want to do four primary movements:
- Pulling yourself up or pulling something down, like a lat pulldown.
- Pulling something toward you, like a cable row or a TRX row.
- Pushing something overhead, like an overhead press.
- Pushing something away from you, like a push-up or flat dumbbell press.
Then you can incorporate any isolation type exercises you want, like the shoulder abduction movement.
As you might have guessed, you can perform these exercises for 2-3 sets of 10-15 repetitions.
Finally, you can do a suitcase carry, in which you pick up a weight in one hand, walk back and forth until you’re fatigued, switch hands, and then repeat that a few times.
If there’s something you can’t do because you’re limited by pain, range of motion, or some other factor, that’s okay – pick a different exercise or modify as needed. This is just a basic framework.
Other than that, you can make the gym as fun as you want with medicine ball throws and slams, sled pushing and pulling, and using whatever equipment available to you.
ADDENDUM:
In case the programming for this section wasn’t clear, you DON’T have to do all the exercises listed each time you workout. Here’s an example program for someone training twice per week:
Monday
- Box Jumps (2-3 sets of 5 repetitions)
- Squat (2-3 sets)
- Kettlebell Deadlift (2-3 sets)
- TRX Row (2-3 sets)
- Standing Overhead Press (2-3 sets)
- Calf Raises (2-3 sets)
Thursday
- 4 Square Hops (2-3 sets of 30 seconds)
- Split Squat (2-3 sets)
- Single Leg Deadlift (2-3 sets)
- Push Ups (2-3 sets)
- Lat Pulldown (2-3 sets)
- Shoulder Abduction (2-3 sets)
This is just a random example that might NOT work for you, so you would have to individualize the program as needed. Ideally, an effortful training session should take 30-60 minutes.
3 Final Tips/Reminders
Here are my 3 final tips/reminders:
- Whatever you do, make sure it’s challenging but safe. If it gets easy, you have to progressively make it harder.
- Something is always better than nothing. Take it one step at a time – pun intended.
- Change takes time. Be as consistent as possible because this is one of the best things you can do for yourself and your loved ones.
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