How to improve balance: the exercises that work, how to make them harder, and how to test it

Balance is a skill you can train at any age

It uses your eyes, your inner ear and the sense of where your feet and joints are, plus leg and trunk strength, and practice improved it in older and younger adults alike.

Sources 1, 2, 3

The falls evidence is strong

Exercise cut falls by 23% across 108 trials: balance and functional exercises by 24%, and by about a third with strength work added. Programmes that challenged balance for more than 3 hours a week did best.

Sources 4, 5

How much

Exercise that challenges your balance 3 or more times a week, made harder over at least 12 weeks and kept up. The UK guidelines ask older adults for strength and balance work on at least 2 days a week.

Sources 6, 7, 8

Make it harder, one step at a time

Use less hand support, a narrower stance, head turns, then eyes closed, then moving, reaching and a second task to think about.

Sources 9, 10, 11

Tai chi works too

Tai chi cut falls in the Cochrane review, and a balance-focused tai chi programme cut them in a trial of 670 older adults.

Sources 4, 12

Get help for falls and dizziness

See a GP if you've had a fall or are worried about your balance. Call 999 after a fall with a possible head, neck, back or hip injury, if someone can't get up, or for sudden unsteadiness with signs of a stroke.

Sources 13, 14

Three senses and your muscles

Keeping your body over your feet, standing still or moving, depends on your eyes, the balance organs of your inner ear, and sensors in your muscles, joints and the soles of your feet. Your brain weighs them for each task, makes small corrections before and during movement, and needs more attention when the task is harder. Leg and trunk strength turn those corrections into action, and the UK guidelines note that strength training in middle age improves balance.

Sources 1, 8

Four kinds of balance

Staying steady standing still, staying steady while you walk or move, bracing for a movement you've planned (such as reaching), and recovering from a trip or a push. Balance training improved all four in older adults.

Source 2

Why it changes with age

Muscles weaken with age, and conditions such as arthritis, a stroke, Parkinson's disease, low blood pressure, side effects of medicines, eyesight or hearing problems and dementia all make falls more likely. How long people can stand on one leg falls with age, balance declines quickly after the mid-50s, and 1 in 5 adults aged 51 to 75 couldn't stand on one leg for 10 seconds. At least one in three people over 65 living at home falls each year.

Sources 13, 15, 16, 4

After an injury or illness

After an ankle sprain, people whose ankle keeps giving way balance worse on that side. Problems with the inner ear cause dizziness and unsteadiness that specific exercises help. Numb feet, side vision lost to glaucoma and a stroke all change balance too, and each has its own guide.

Sources 17, 18

Exercise prevents fallsStrong evidence

In a Cochrane review of 108 trials with 23,407 people averaging 76, exercise cut the rate of falls by 23% and the number of people who fell by 15%, with high certainty. Balance and functional exercises cut falls by 24%, programmes mixing balance with strength work probably by 34%, and tai chi by 19% (low certainty), with 20% fewer people falling (high certainty). Programmes of mainly strength training, dance or walking had uncertain effects.

Source 4

Fewer injuries from falls, perhapsEmerging evidence

Exercise may cut fall-related fractures and falls needing medical care, with low certainty. Side effects were mostly minor aches.

Source 4

Challenge your balance, and do enoughStrong evidence

Across 88 trials of 19,478 people, programmes that challenged balance and added up to more than 3 hours a week cut falls by 39%. An earlier analysis of 44 trials defined challenging balance as standing with the feet closer together or on one leg, using the hands less, and practising controlled movements of the body; programmes with this, a total of more than 50 hours and no walking programme did best.

Sources 5, 9

The Otago home programmeStrong evidence

Otago, a home programme of leg strength and balance exercises with walking, cut falls by about a third (32%) and deaths over 12 months in 7 trials of 1,503 people averaging 81.6 years. Keeping going is the hard part: after a year, 36.7% of those still in the trials were exercising 3 or more times a week.

Source 19

Balance improves at any ageEmerging evidence

Balance training improved steady, anticipatory and reactive balance in healthy adults over 65 (23 trials), with the biggest gains from about 11 to 12 weeks of 3 sessions a week. In healthy adults aged 16 to 40 (25 trials), it improved balance from untrained people to elite athletes, with the biggest gains in elite athletes, and the most effective programmes used 11 to 15-minute sessions of 4 exercises, 2 sets each of 21 to 40 seconds. These are comparisons across trials of modest quality.

Sources 2, 3

Tai chiEmerging evidence

In 670 adults aged 70 or over at high risk of falling, a balance-focused tai chi programme (Tai Ji Quan, two 1-hour classes a week for 24 weeks) cut falls by 58% compared with stretching and by 31% compared with a mixed exercise programme. Across 10 trials, tai chi cut falls by about 43% in the first year and by about 13% over longer periods.

Sources 12, 20

YogaEmerging evidence

Across 6 trials of 307 people aged 60 and over, yoga improved balance a little and mobility moderately. The authors said more research was needed to know whether that prevents falls.

Source 21

Adding a second taskEmerging evidence

Practising balance or walking while doing something that needs thought, such as counting back, improved balance and walking and reduced falls in older adults across 44 studies of 2,782 people, though the certainty ranged from very low to moderate.

Source 11

Ankle sprainsStrong evidence

In 522 athletes who had sprained an ankle, an 8-week home balance programme cut repeat sprains over a year by 35% (22% against 33%), even though only 23% finished it in full. In athletes aged 18 to 35, balance training cut ankle sprains by 38% across 8 trials, and an overview of 46 reviews found moderate evidence that this kind of training prevents repeat sprains.

Sources 22, 23, 24

Walking alone is unlikely to prevent fallsStrong evidence

The World Falls Guidelines say general physical activity such as walking is unlikely to prevent falls on its own, and the Cochrane review was uncertain whether walking programmes do. Walking is good for your health; balance needs practice that challenges it.

Sources 6, 4

Dizziness from the inner earStrong evidence

Across 39 trials of 2,441 people, exercise-based vestibular rehabilitation was safe and helped dizziness from an inner-ear problem on one side. Our vertigo guide covers it.

Source 18

The World Falls Guidelines

Balance-challenging and functional exercises, such as sit-to-stands and stepping, 3 or more times a week, suited to you and made harder over at least 12 weeks, then kept up. Add tai chi or progressive strength training where you can.

Source 6

The UK guidelines and the World Health Organization

The UK asks older adults for activities that improve strength, balance and flexibility on at least 2 days a week; for active older adults, it suggests things like standing on one leg, walking backwards, tai chi and dance. The World Health Organization (WHO) asks older adults for varied activity that emphasises balance and strength on 3 or more days a week, such as walking backwards or sideways, or standing on one foot while you do an arm exercise.

Sources 8, 25, 7

The NHS's five exercises

Sideways walking (10 steps each way), the grapevine (5 crossing steps each side), the heel-to-toe walk (at least 5 steps), the one-leg stand (hold for 5 to 10 seconds, 3 times each side) and slow step-ups (up to 5 each leg), at least twice a week, near a wall or a sturdy chair.

Source 10

Other guidance

The US National Institute on Aging suggests about three balance sessions a week, with a chair, a person or a wall nearby. NICE (the National Institute for Health and Care Excellence) asks for falls programmes that are tailored, get harder over time and review progress. Australia's exercise scientists say programmes should be progressively challenging, ongoing and of a big enough dose. For people at risk of falls, the UK osteoporosis consensus suggests about 3 hours a week of highly challenging balance and strength training, supervised, for at least 4 months.

Sources 26, 27, 28, 29

How long it takes

Balance improved most with about 11 to 12 weeks of training, 3 sessions a week, and falls programmes run for at least 12 weeks. You may feel steadier sooner, but keep going: our older adults guide notes the benefits fade when you stop.

Sources 2, 3, 6

Our editorial starting point

Pick 4 or 5 balance exercises, hold or repeat each for about 20 to 40 seconds, twice, 3 times a week, and make one thing harder every week or two. Use the hardest version you can hold for about 30 seconds without grabbing your support.

Sources 3, 6

Standing still

Each step is harder than the last:

• Feet together, a hand on the counter.
• Semi-tandem stance (one foot half a step ahead): 2 holds of 20 seconds each way round (our vestibular routine).
• Heel-to-toe stance: hold for 10 to 30 seconds (our strength and balance exercises for seniors).
• One-leg stand: 10 seconds with a hand on the support, then 10 seconds without, then 30 seconds without (the Otago-based table).
• One-leg stand with slow head turns, once the hold is easy (editorial).
• One-leg stand with your eyes closed and a hand hovering over the counter, once that's easy (editorial).
• Tree pose: 20 seconds each side (our balance exercises routine).

Source 30

Moving

Along a counter, so a hand is always near:

• Side-stepping: 10 steps each way (the NHS).
• Walking backwards: 10 steps, 2 or 3 times (our strength and balance exercises for seniors; the Otago table uses 10 steps, 4 times).
• Heel-to-toe walking: 5 to 10 steps with a hand on the counter, then 10 without (our strength and balance exercises for seniors and the Otago table; the NHS asks for at least 5).
• Walking on your heels: 10 steps (our strength and balance exercises for seniors).

Sources 10, 30

One leg, with strength

These build the strength to recover a wobble:

• Sit to stand: 5 with your hands for support, then 10 with none (the Otago table).
• Step-ups: 2 sets of 8 each side, a hand on a rail at first (our strength and balance workout); the NHS asks for up to 5 slow steps each leg.
• Single-leg reach matrix: 3 rounds of 5 reaches in each direction, each leg (the move page's editorial starting point).
• Single-leg Romanian deadlift: 2 sets of 6 to 8 each leg, fingertips on a wall at first (editorial).
• Hip airplane: 2 sets of 5 slow turns each leg, holding a wall while you learn (the move page's editorial starting point).

Sources 30, 10

Landing and wobble

For active people, and after an ankle sprain once you can walk without a limp and your clinician agrees. In the ankle sprain trial, the home programme ran 3 sessions a week of up to 30 minutes for 8 weeks, getting harder each week, and used a balance board.

• Single-leg hop and stick: 2 sets of 3 hops forward and 3 sideways each leg, holding each landing for 2 seconds (editorial).
• Balance board: several holds of 20 to 30 seconds on most days, only once one-leg standing on the floor is steady (the move page's editorial starting point).

Source 22

Getting up from the floor

Practising getting down to the floor and back up, 5 to 8 slow times and changing the leading leg (the move page's editorial starting point), is worth doing as you get older, with someone there at first.

Tai chi

Tai chi has the best falls evidence of the mind-body practices. The balance-focused programme that cut falls used two 1-hour classes a week for 24 weeks, so learn it in a class.

Sources 4, 12

Yoga

Yoga improved balance a little in small trials of people aged 60 and over, but it hasn't been shown to prevent falls. If falls are your worry, choose balance-challenging exercise or tai chi, and add yoga if you enjoy it.

Source 21

Dance and sport

The UK guidelines count tai chi and dance among the activities that build balance, and moving in all directions, as in many sports, challenges it too.

Source 8

After an ankle sprain

Once you can walk without a limp and your clinician agrees, practise single-leg balance 3 times a week for at least 8 weeks, a little harder each week: a home programme like this cut repeat sprains by 35%. Our ankle sprain and chronic ankle instability guides cover the rest of the rehab.

Sources 22, 17

Dizziness or vertigo

See a GP first, as dizziness has many causes. Exercises for the inner ear help when that's the cause, and our vertigo guide covers them.

Sources 18, 31

Osteoporosis

Falls are what break bones. The UK consensus says people at risk of falls should build up targeted strength and balance training, ideally supervised, before brisk walking. Our osteoporosis guide has the detail.

Source 29

Other conditions

A stroke, Parkinson's, numb feet from neuropathy and glaucoma each change balance in their own way, and their guides set out what to do.

A quick self-check

Stand barefoot next to a counter with your arms crossed and time how long you can stand on one leg, up to 45 seconds. Take the best of 3 tries and compare it with people your age, as our balance test does.

Source 15

What the 10-second test shows

In 1,702 adults aged 51 to 75, the 1 in 5 who couldn't stand on one leg for 10 seconds were more likely to die over about 7 years, after allowing for age and illness. That's a link, not a verdict: a reason to practise, and to tell your GP if you've also fallen or feel unsteady.

Source 16

If you're unsteady

If you've fallen in the past year or feel unsteady with your feet together, use the 4-stage version of our balance test with someone beside you. Times vary a lot from one day to the next, so look at the trend over months.

Eyes closed

Try it with your eyes closed only once eyes-open standing is easy, with the counter right beside you: our balance test notes healthy adults over 60 average only 2 to 4 seconds with their eyes closed.

Older adults

Balance work matters most for falls, and the amount that works best, more than 3 hours a week, is more than most people do. The UK guidelines say new exercises may be best supervised at first if you live with frailty, moderate to severe dementia, past spinal fractures or regular falls. Our older adults guide covers it all.

Sources 8, 5

Young adults and athletes

Balance training improves balance and helps prevent ankle sprains. Our knee control warm-up builds it into a sports warm-up.

Sources 3, 23

Pregnancy

Avoid activities with a high risk of falling. Our pregnancy guide suggests balance work next to a counter, and skipping one-leg stands if you have pelvic girdle pain.

Source 32

Parkinson's

Our Parkinson's guide suggests balance work next to a counter 3 or more times a week, in an "on" time when your medicines are working, and leaving out walking backwards if you often freeze. It also passes on Parkinson's UK's advice to avoid walking and talking at the same time.

Numb feet

Practise in well-fitting shoes with a hand on the counter, as our balance test advises, and leave out the hops. Our peripheral neuropathy guide covers balance training and foot care.

Call 999 (911 in the US)

If someone has fallen and may have hurt their head, neck, back or hip, or can't get up. For sudden unsteadiness with signs of a stroke: a face drooping on one side, weakness in one arm, or speech problems; also sudden blurred vision or loss of sight, feeling dizzy or falling over, or a severe headache. Call even if the signs stop. And for vertigo with double vision or loss of vision, hearing loss, trouble speaking, or weakness, numbness or tingling in an arm or leg.

Sources 13, 14, 33

Get help from NHS 111 or an urgent GP appointment

If someone has fallen and may be in pain, injured or unwell, or for vertigo with a severe headache, being sick, or a very high temperature. In the US, contact your doctor or urgent care.

Sources 13, 33

See a GP

If you've had a fall, or you're worried about your balance or getting about; you may be able to refer yourself to a local falls service. See a GP, too, for dizziness that won't go away or keeps coming back, or that comes with hearing loss or ringing in the ears, double or blurred vision, numbness or weakness, fainting or headaches. NICE says a full falls assessment should be offered if you've fallen in the past year and live with frailty, were injured and needed medical treatment, lost consciousness, couldn't get up on your own, or have fallen twice or more in that year.

Sources 13, 31, 27

During balance practice

Stop if you feel dizzy or light-headed. Keep a counter or wall within reach, and have someone nearby for the hardest moves if you've fallen recently (our suggestion, as in our older adults guide).

"Balance can't improve once you're older"Strong evidence

Balance training improved balance in 23 trials of healthy adults aged 65 and over, and the Otago home programme cut falls by about a third in people averaging 81.6 years. Exercise cut falls by 23% across 108 trials of people averaging 76.

Sources 2, 19, 4

"Walking is enough to keep your balance"Emerging evidence

Walking is good for your health, but the World Falls Guidelines say walking alone is unlikely to prevent falls, the Cochrane review was uncertain whether walking programmes do, and programmes without a walking programme did better in an earlier analysis. Balance needs practice that challenges it.

Sources 6, 4, 9

"Balance training is only for older people"Strong evidence

It improved balance in 25 trials of adults aged 16 to 40, cut ankle sprains by 38% in athletes, and cut repeat sprains by 35% in a trial of 522 athletes.

Sources 3, 23, 22

"You need a wobble board or special kit"Emerging evidence

The NHS's balance exercises use a wall, a chair and a step, and balance and functional exercises without equipment cut falls. A board is one option, as in the ankle sprain trial, not a requirement.

Sources 10, 4, 22

"Strength training alone will fix your balance"Mixed evidence

Strength helps, and the UK guidelines note it improves balance in middle age, but programmes of mainly strength training had an uncertain effect on falls. Balance and functional exercises, alone or with strength work, did best.

Sources 8, 4