Balance Training

Introduction[edit | edit source]

Balance is defined as an individual's ability to control their centre of gravity within the limit of Base of Support (BOS)[1]. Body balance control is a complex body function that involves regulating posture and movement via the cerebellum by processing sensory inputs from the vestibular visual and proprioceptive systems in the cerebral cortex [2]. Ageing, neurovascular problems, weak muscle strength, limited range of motion, and cognitive decline could adversely affect the static and dynamic balance control ability, which increases the risk of falling and negatively affects the performance of activities of daily living(ADLs)[3][4].

Balance exercise is one of the four types of recommended exercise along with strengthaerobic and flexibility exercises to improve health and physical ability[5].

Balance training is undertaken in order to:* Prevent falls/injury[6]

  • Improve posture[7]
  • Improve strength[8]
  • Improve standing balance and locomotor performance in older adults[9]
  • Improves dynamic trunk control, sitting & standing balance, mobility in person's post stroke[10]
  • Strengthen self-efficacy in balance control leading to improved fall-related self-efficacy, reduced fear of falling, increased walking speed, and improved physical function[11]


Decreased balance is attributable to an age-related decline in multiple physiological systems that contributes to [2][4]:

  • Decreased muscle flexibility and strength,
  • Reduced central processing of sensory information
  • Slowed motor responses.


In addition to an increased risk of falls, diminished balance and mobility may limit[12]:

  • ADL
  • Participation in leisure-time activities.

Accordingly, it is essential that balance exercises be incorporated into the physical activity programs of older adults[13]

Aims[edit | edit source]

Balance training programs aim to[14]:

  • Strengthen balance control in everyday activities leading to improved fall-related self-efficacy, reduced fear of falling and increased walking speed
  • Improve physical function
  • Improve quality of life

For Whom[edit | edit source]

Having good balance is important for many activities people do every day e.g walking, putting clothes on the line, reaching up or down into cupboards, going up and down the stairs.

Full-shot-women-practicing-tai-chi-outdoors-min-min.jpg

Exercises that improve balance can help prevent falls, a common problem in many populations:


Preferably, older adults and those at risk of falls should do balance training 3 or more days a week for at least 45 minutes to reduce falls. Exergames, multimodal exercise training and mind-body exercises can improve balance and reduce fall risk in older people[14][15].

Exercises and Implementation[edit | edit source]

A comprehensive balance assessment should be done prior to commencing a balance exercise programme to provide best available evidence-based and person-centred exercises[16].  There are several clinic tests and laboratory-based procedures to assess body balance control.

Sporty-elderly-man-practicing-yoga-indoors-min.jpg

Clinic tests:


Laboratory-based balance measures:

Based on the literature

  • Older adults be exposed to a program that includes flexibility and balance exercises for 3-5 sessions each week, for periods of at least 8 weeks, as a tool for quality of life improvement.
  • Introduce the exercises gradually, allowing for the proper adjustment of the clients while ensuring their safety.
  • Allow for gradual and safe exposure to new equipment or a new exercise


The program should incorporate exercises that include:

Additionally, it should progressively reach higher levels of challenges in the form of more complex exercises involving both motor and cognitive tasks (dual- and multi-task activities)[20].

Examples of balance exercises include:

  • Standing, weight on one leg and raising the other leg to the side or behind.
  • Putting heel right in front of your toe ie tandem stance
  • Standing up and sitting down from a chair without using hands
  • Walking while alternating knee lifts with each step
  • Doing tai chi or yoga. Tai chi is a time-honoured martial art that involves slow, rhythmic movements, including rotation of the trunk, shifting weight, coordination, and a gradual progression to narrowing the lower extremity stance. It has gained recognition as a good exercise choice for the elderly. Studies have shown that tai chi improves postural stability more so than other exercises. It also offers multiple musculoskeletal and cardiopulmonary benefits.[21]
  • Using equipment, like a Bosu, (or other balance board) which has an inflatable dome on top of a circular platform, which challenges balance
  • The Otago Exercise Program
  • Perturbation-based balance training (an intervention involving repeated postural perturbations aiming to improve control of rapid balance reactions). This training has been proven to improve reactive balance control in post-stroke individuals during the sub-acute phase[22].


Over time, you can make these exercises harder by:

  • Holding the position for a longer amount of time
  • Walking tandem stance with support then without (see Otago)
  • Closing eyes
  • Letting go of chair or other support[23]

Resource[edit | edit source]

References[edit | edit source]

  1. Sturnieks DL. Biomechanics of Balance and Falling. Falls in Older People: Risk Factors, Strategies for Prevention and Implications for Practice. 2021 Oct 31:105.
  2. 2.0 2.1 Neptune RR, Vistamehr A. Dynamic balance during human movement: measurement and control mechanisms. Journal of Biomechanical Engineering. 2019 Jul 1;141(7).
  3. Saftari LN, Kwon OS. Ageing vision and falls: a review. Journal of physiological anthropology. 2018 Dec;37(1):1-4.
  4. 4.0 4.1 Peterka RJ. Sensory integration for human balance control. Handbook of clinical neurology. 2018 Jan 1;159:27-42.
  5. American Heart Association. American Heart Association recommendations for physical activity in adults and kids. Retrieved August. 2018;23:2020.
  6. Sherrington C, Fairhall N, Wallbank G, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb S. Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. British journal of sports medicine. 2020 Aug 1;54(15):885-91.
  7. Jiang C, Huang DB, Li XM, Guo JH, Guo MM, Yu S, Lin ZH. Effects of balance training on dynamic postural stability in patients with chronic ankle instability: systematic review and meta-analysis of randomized controlled trials. The Journal of sports medicine and physical fitness. 2022 Mar 25.
  8. Sadeghi H, Jehu DA, Daneshjoo A, Shakoor E, Razeghi M, Amani A, Hakim MN, Yusof A. Effects of 8 weeks of balance training, virtual reality training, and combined exercise on lower limb muscle strength, balance, and functional mobility among older men: a randomized controlled trial. Sports health. 2021 Nov;13(6):606-12.
  9. Sun M, Min L, Xu N, Huang L, Li X. The effect of an exercise intervention on reducing the fall risk in older adults: a meta-analysis of randomized controlled trials. International journal of environmental research and public health. 2021 Nov 29;18(23):12562.
  10. Van Criekinge T, Truijen S, Schröder J, Maebe Z, Blanckaert K, van der Waal C, Vink M, Saeys W. The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis. Clinical rehabilitation. 2019 Jun;33(6):992-1002.
  11. Halvarsson A, Dohrn IM, Ståhle A. Taking balance training for older adults one step further: the rationale for and a description of a proven balance training programme. Clinical rehabilitation. 2015 May;29(5):417-25.Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419050/ (last accessed 17.10.2020)
  12. Bobić Lucić L, Grazio S. Impact of balance confidence on daily living activities of older people with knee osteoarthritis with regard to balance, physical function, pain, and quality of life–a preliminary report. Clinical Gerontologist. 2018 Aug 8;41(4):357-65.
  13. NeuRa Balance training Available from:https://www.neura.edu.au/health/balance-training/ (Last accessed 17.10.2020)
  14. 14.0 14.1 AHA Balance exercises Available from:https://www.heart.org/en/healthy-living/fitness/fitness-basics/balance-exercise (last accessed 17.10.2020)
  15. Gavelin HM, Dong C, Minkov R, Bahar-Fuchs A, Ellis KA, Lautenschlager NT, Mellow ML, Wade AT, Smith AE, Finke C, Krohn S. Combined physical and cognitive training for older adults with and without cognitive impairment: A systematic review and network meta-analysis of randomized controlled trials. Ageing research reviews. 2021 Mar 1;66:101232.
  16. Molony SL, Kolanowski A, Van Haitsma K, Rooney KE. Person-centered assessment and care planning. The Gerontologist. 2018 Jan 18;58(suppl_1):S32-47.
  17. What is a force plate? What does it measure? Available from: https://www.youtube.com/watch?v=e0SnzvVDr4I&t=3s[last accessed 27/11/22]
  18. Postural Stability Exercises | Management of Cervicogenic Dizziness Available from: https://www.youtube.com/watch?v=fhPl3nJHwzs&t=1s[last accessed 27/11/22]
  19. Stay Active at Home - Strength and balance exercises for older adults Available from: https://www.youtube.com/watch?v=n8s-8KtfgFM[last accessed 27/11/22]
  20. Dunsky A. The effect of balance and coordination exercises on quality of life in older adults: a mini-review. Frontiers in aging neuroscience. 2019;11.Available from:https://www.frontiersin.org/articles/10.3389/fnagi.2019.00318/full
  21. Appeadu M, Bordoni B. Falls and Fall Prevention. StatPearls [Internet]. 2020 Jul 8.Available from:https://www.ncbi.nlm.nih.gov/books/NBK560761/ (last accessed 17.10.2020)
  22. Schinkel-Ivy, A., Huntley, A.H., Danells, C.J., Inness, E.L. and Mansfield, A., 2020. Improvements in balance reaction impairments following reactive balance training in individuals with sub-acute stroke: a prospective cohort study with historical control. Topics in stroke rehabilitation, 27(4), pp.262-271.
  23. Web MD Balance training Available from:https://www.webmd.com/fitness-exercise/a-z/balance-training (last accessed 17.10.2020)