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Best exercises for balance and fall prevention: 7 moves and a sample week

Balance is a skill. It gets better when you practise it, standing up, a little harder each week. Hand on the counter. Strong legs. Keep 1 to 3 reps in reserve.

By Susmit Jalan, coach at Online Fitness Worldwide.

Maybe you had a wobble on the stairs. Maybe a parent fell last winter. Maybe you just feel less sure on your feet than you did. That feeling is worth listening to. Balance can be trained.

WHO advises adults over 65 to do varied, multicomponent activity that puts the emphasis on functional balance and strength, at moderate or greater intensity, on 3 or more days a week, to improve function and prevent falls.[1] The NHS lists muscles getting weaker with age among the causes of falls, and advises strength and balance activities at least twice a week.[2]

A Cochrane review of 108 trials found that exercise cut the rate of falls in older people living at home by about 23%, and the number of people who fell by about 15%. The evidence was rated high certainty. Programmes built mainly on balance and functional exercises worked best. Most were done standing.[5]

A meta-analysis of 88 trials found bigger effects when programmes gave a high challenge to balance and added up to more than 3 hours a week. Together those two features were linked to about 39% fewer falls.[6]

The 2022 World Guidelines for falls prevention recommend balance-challenging and functional exercise, such as sit-to-stand and stepping, 3 or more times a week, individualised and progressed for at least 12 weeks, then kept going. Progressive strength training is recommended alongside when feasible.[4]

This list is coaching, not a falls assessment. If you have already fallen, or you feel dizzy or unsteady, see your doctor first. Read "Before you start".

See also: Best strength exercises for over 60s: 7 moves and a sample week · Best strength exercises for bone density: 7 moves and a sample week

The 7 best exercises for balance and fall prevention

  1. Sit-to-stand

    Why
    Getting out of a chair is the move you need every day. The World Guidelines name it as a functional exercise to use.[4]
    How
    Sit near the front of a sturdy chair, feet hip-width, a counter or table in reach. Lean forward, nose over toes, and stand up. Sit down slowly, under control. Too much? Use a higher seat, or push from your thighs. Easy? Arms folded, then a slower lowering.
    Dose
    2 to 3 sets of 8 to 12. Keep 1 to 3 good reps in reserve (RIR); stop before technique changes.

  2. Heel-to-toe stand, then walk

    Why
    A narrow base is a direct balance challenge. Heel-to-toe walking is one of the NHS home balance exercises.[3]
    How
    Stand at the kitchen counter, fingertips on it. Put one heel right in front of the other toe. Eyes forward, not at your feet. Hold. When that is steady, walk heel to toe along the counter. Too much? Stand with feet side by side, then half a step apart.
    Dose
    3 holds of 10 to 30 seconds each way, or 2 to 3 passes of 5 to 10 steps. Work at the edge of steady: you may wobble, but you never need to grab hard. Hand on the counter always within reach.

  3. One-leg stand

    Why
    Standing on one leg is what you do every step, on stairs, and getting into trousers. It is part of the NHS balance routine.[3]
    How
    Face the counter, fingertips on it. Lift one foot a little. Hips level, standing knee soft. Hold, then swap. Progress in this order: two hands, one hand, one finger, hands hovering. Only then try eyes moving, or a head turn.
    Dose
    3 holds of 5 to 10 seconds each leg, building to 30 seconds. Work at the edge of steady: you may wobble, but you never need to grab hard. Hand on the counter always within reach.

  4. Sideways walking

    Why
    Many falls happen when you turn or step sideways. Side steps train it slowly. They are in the NHS routine too.[3]
    How
    Stand tall beside the counter, knees soft. Step one foot to the side, slowly, then bring the other to join it. Keep the hips level. Go along the counter and back. Too much? Smaller steps, a hand on the counter. Easy? A slow grapevine, crossing one foot over the other.
    Dose
    2 to 3 lengths of the counter each way. Work at the edge of steady: you may wobble, but you never need to grab hard. Hand on the counter always within reach.

  5. Step-up

    Why
    Stairs and kerbs need single-leg strength and control. The World Guidelines list stepping among the functional exercises to include.[4]
    How
    Use the bottom stair with a hand on the rail. Step up with one foot, press through the whole foot and stand tall. Step down slowly with the other foot. Up five, then lead with the other leg. Too much? A lower step, or more hand support.
    Dose
    2 to 3 sets of 5 to 10 each leg. Keep 1 to 3 good reps in reserve (RIR); stop before technique changes.

  6. Calf raise and toe raise

    Why
    Strong ankles help you catch a trip. Strength and balance retraining at home cut falls and injurious falls in women aged 80 and over.[8]
    How
    Hold the counter. Rise up onto the balls of your feet, pause, lower slowly. Then rock back onto your heels and lift your toes. Too much? Do them seated first. Easy? One leg at a time, still holding on.
    Dose
    2 to 3 sets of 10 to 15. Keep 1 to 3 good reps in reserve (RIR); stop before technique changes.

  7. Standing side leg raise

    Why
    The side hip muscles keep your pelvis level when you stand on one leg. Stronger hips give the balance moves something to work with.
    How
    Stand side-on to the counter, one hand on it. Lift the outside leg out to the side, toes forward, body upright. Lower slowly. Swap sides. Too much? A smaller lift. Easy? A light band just above the knees.
    Dose
    2 to 3 sets of 8 to 12 each side. Keep 1 to 3 good reps in reserve (RIR); stop before technique changes.

How much, how hard, how often

WHO, for adults over 65: functional balance and strength on 3 or more days a week, plus 150 to 300 minutes of moderate aerobic activity, and muscle-strengthening work for the major muscle groups on 2 or more days.[1]

World Guidelines: balance-challenging and functional exercise 3 or more times a week, progressed for at least 12 weeks, then continued.[4] Keeping going gives a greater effect.

Dose matters: programmes with a high balance challenge and more than 3 hours a week did best.[6] That can be short sessions most days, plus walking. In healthy older adults, balance training of about 3 sessions a week for 11 to 12 weeks gave the largest gains in balance tests.[7]

High challenge does not mean risky. It means the exercise is just hard enough that you have to concentrate, with support always in reach. Less support, a narrower stance, slower moves, or turning your head make it harder.

Strength progression: when you beat the top of the rep range by 1 or 2, add a little load, about 2 to 10%, or slow the lowering.[9] Keep 1 to 3 reps in reserve. Failure is not the goal.

Walking is good for you, but on its own the Cochrane review could not show that it prevents falls. The clearest benefit was for balance and functional work.[5]

A sample week of balance and strength training

Sample only. Not a prescription. Adjust it with your doctor to your body, your medicines and your history.

  • Monday, about 30 minutes: sit-to-stand, heel-to-toe stand, one-leg stand, step-up, calf and toe raise. 1 to 3 sets of each.
  • Tuesday: walk about 20 to 30 minutes at a pace where you can still talk. 5 minutes of one-leg stands at the counter while the kettle boils.
  • Wednesday, about 30 minutes: sit-to-stand, sideways walking, heel-to-toe walk, standing side leg raise. 1 to 3 sets of each.
  • Thursday: walk, plus 10 minutes of balance holds.
  • Friday, about 30 minutes: repeat Monday.
  • Saturday: a walk, or a tai chi class if one is near you.
  • Sunday: rest.
  • Load cap for this sample week: bodyweight or light weights you can move for 8 to 15 smooth reps, support always in reach. No jumping, no hopping, no balance boards, no eyes-closed work unless a physio sets it.
  • Keep 1 to 3 good reps in reserve (RIR); stop before technique changes.
  • Pain check: mild discomfort that settles soon is fine. Pain that rises during a set means make it easier: less range or less load. Sharp pain, swelling, pain spreading down a limb, numbness, a joint giving way or locking means stop and get it checked. I'm a coach, not a physio or doctor.

Want it coached live?

Iron Hour is 60 minutes, 1:1. Set-up at minute 0: camera so I can see you from head to feet, a sturdy chair and a clear counter. Warm-up from minute 4. Strength work at 14. Balance work at 28, a little harder than last week. Cool-down at 50.

Lean Reset is 20 sessions a month, 1:1, if you want more frequent coached days. Return is 45 minutes, 1:1, 12 alternate-day sessions a month, if you haven't trained in years. Open Floor is a small group.

I'm a coach, not a doctor or physio: if you have fallen, have dizziness, a heart condition, Parkinson's, a stroke or a recent fracture, your doctor or physio sets the limits, and we train inside them.

Coached live on Google Meet, Zoom or FaceTime, in your own living room. In Hindi or English. On IST. Not sure yet? Start with a 30-minute consultation. It is a conversation, not a training session. Booking holds a time; the fee is agreed directly.

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Before you start

General information, not medical advice. ACSM's screening model: if you are inactive, have no symptoms and no known heart, metabolic or kidney disease, you can start light to moderate exercise without medical clearance and build up gradually. If you have one of those conditions, or symptoms such as chest pain, unusual breathlessness or dizziness, get medical clearance first.[10] Whatever that model says, if you have had a fall, feel dizzy or faint, or are worried about your balance, see your doctor first. NHS advice: see a GP if you have had a fall or are worried about your balance. Call emergency services if someone has fallen and may have hurt their head, back, neck or hip, or cannot get up. Speak to a doctor or pharmacist if you think a medicine affects your balance, and have your eyes and hearing checked.[2] Outside the UK, that means your doctor or your local emergency number. Train on a clear, non-slip floor in shoes that grip, with a counter or sturdy chair in reach. If you are unsteady, have someone nearby the first few times. Stop for dizziness, chest pain, sudden weakness or numbness, or a new headache.

ASCA Level 1 (strength and conditioning) and ACE (anatomy and biomechanics). These are credentials held by the coach. Neither body endorses this business or this article.

Sources

  1. [1] World Health Organization. WHO guidelines on physical activity and sedentary behaviour. Geneva: WHO; 2020. https://www.who.int/publications/i/item/9789240015128 (opens in a new tab)
  2. [2] NHS. Falls. nhs.uk. https://www.nhs.uk/conditions/falls/ (opens in a new tab)
  3. [3] NHS. Balance exercises. nhs.uk. https://www.nhs.uk/live-well/exercise/balance-exercises/ (opens in a new tab)
  4. [4] Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. 2022;51(9):afac205. https://doi.org/10.1093/ageing/afac205 (opens in a new tab)
  5. [5] Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019;1:CD012424. https://doi.org/10.1002/14651858.CD012424.pub2 (opens in a new tab)
  6. [6] Sherrington C, Michaleff ZA, Fairhall N, et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. 2017;51(24):1750–1758. https://doi.org/10.1136/bjsports-2016-096547 (opens in a new tab)
  7. [7] Lesinski M, Hortobágyi T, Muehlbauer T, Gollhofer A, Granacher U. Effects of balance training on balance performance in healthy older adults: a systematic review and meta-analysis. Sports Med. 2015;45(12):1721–1738. https://doi.org/10.1007/s40279-015-0375-y (opens in a new tab)
  8. [8] Campbell AJ, Robertson MC, Gardner MM, Norton RN, Tilyard MW, Buchner DM. Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ. 1997;315(7115):1065–1069. https://doi.org/10.1136/bmj.315.7115.1065 (opens in a new tab)
  9. [9] American College of Sports Medicine. Position stand: Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708. https://doi.org/10.1249/MSS.0b013e3181915670 (opens in a new tab)
  10. [10] Riebe D, Franklin BA, Thompson PD, et al. Updating ACSM's recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47(11):2473–2479. https://doi.org/10.1249/MSS.0000000000000664 (opens in a new tab)