How to improve coordination: what it is, hand-eye and whole-body coordination, practice and learning skills, children and older adults, and when clumsiness needs a check

Coordination is a skill, and skills are specific

You get better at what you practise, and the gains spread to other tasks less than people hope. Choose the skill you want (catching, a dance step, your sport) and practise that.

Sources 1, 2

You're not stuck with what you were born with

Genes explain a good share of the differences between people in the few twin studies, but taught movement programmes improved children's skills, and practice explained 18% of the differences in sport performance: important, not everything.

Sources 3, 4, 5

Practise little and often, then vary it

Break a skill into parts and practise them regularly, as the NHS describes for children with dyspraxia. Once you can do it, mix up how you practise; that helped people keep a skill in lab studies, though less clearly in real-world practice.

Sources 6, 7

Brain-training apps and juggling have limits

Commercial brain-training and vision devices make you better at their own tasks, with little evidence that it carries over to sport. Learning to juggle changes the brain, but no trial shows it improves other skills.

Sources 8, 9, 10

Children, dyspraxia and older adults

About 5 in 100 children have developmental coordination disorder (DCD, dyspraxia), and practising everyday tasks helps most. For older adults, balance and functional exercise cut falls by 24%, as our balance guide says.

Sources 11, 6, 12

Sudden or gradual?

A sudden loss of coordination or balance is a 999 call: it can be a stroke. Clumsiness, a tremor or unsteadiness that builds over weeks or months needs a GP, not more drills. See the warning signs.

Sources 13, 14

Three kinds

Whole-body (gross motor) coordination is walking, running, jumping, throwing and kicking; hand-eye coordination is catching, hitting and driving; fine motor coordination is writing, doing up buttons and typing. The NHS's dyspraxia page describes the fine and whole-body kinds. Balance is part of it too, and our balance guide covers standing still and moving without falling.

Source 15

How it's learned

Early on, a new movement is slow and needs your full attention; with practice it gets faster, smoother and more automatic. Gains are largest on the task you practised: in trials, balance training improved the trained balance task but had little effect on untrained ones.

Sources 1, 2

What it depends on

Your eyes, your inner ear and the sense of where your limbs are, plus strength, speed, attention and practice. In the few twin studies, genes explained about half the differences in early motor development and 27 to 48% in balance.

Sources 3, 16

How people differ

Children develop movement skills at different rates, and the NHS notes a firm diagnosis of DCD isn't usually made before about age 5. About 5 in 100 children have DCD, more boys than girls. Autistic children and children with ADHD often find coordination harder, as our autism and ADHD guides explain. Older adults learn new skills too: in one study they learned to juggle, less fluently than 20-year-olds.

Sources 6, 11, 17

"Clumsy" isn't a diagnosis

Being tired, stressed, rushed, unwell or drunk makes most people clumsier (our reading), and the NHS lists tiredness, stress, caffeine and alcohol among the things that make a tremor more noticeable. New or worsening clumsiness, or clumsiness with other symptoms, needs a check: see the warning signs.

Source 18

Practice transfers mainly to what you practiseEmerging evidence

In 6 trials, balance training improved the trained balance task by a moderate to large amount but had little or no effect on untrained ones. Across 34 studies, the transfer of practice to new tasks was medium in the lab and small and uncertain in real-world settings.

Sources 1, 2

Mixing up practice helps, more in the lab than on the pitchMixed evidence

Practising skills in a mixed order rather than in blocks helped people keep them across 54 studies, clearly in labs and in adults and older adults, but the effect was small and uncertain in applied settings and negligible in young people. An older analysis of 61 studies agrees.

Sources 7, 19

Focus on the result, not your body: a disputed benefitMixed evidence

Across 73 studies, focusing on the effect of a movement (the ball, the target) beat focusing on your body. But a reanalysis of the same studies that corrected for unpublished null results found the benefit close to zero. It's a reasonable coaching cue, not a proven shortcut.

Sources 20, 21

ImageryEmerging evidence

Across 86 studies of 3,593 athletes, mental rehearsal improved performance by a moderate amount, best at about 10 minutes, three times a week.

Source 22

Sleep and new skillsMixed evidence

After a night's sleep, people tapped a finger sequence faster, and a review of 48 studies found a small benefit of sleep. But other analyses found the gain disappeared once other factors and unpublished results were accounted for. Sleep well anyway, without expecting an overnight jump.

Sources 23, 24, 25, 26

Practice and genesEmerging evidence

Practice explained 18% of the differences in sport performance, and 1% among elite athletes. In the few twin studies, genes explained about 55% of the differences in early motor development, and in 44 female twins the heritability of a thumb control task was 0.68, and of learning it 0.70. Programmes that build skills still clearly improve them.

Sources 5, 3, 16, 27

Juggling changes the brain while you learnEmerging evidence

Learning to juggle changed grey matter in young adults and older adults and white matter in 24 adults over 6 weeks, and the changes didn't track how well people juggled. In 26 active older adults, 4 weeks of juggling (three 45-minute sessions a week) brought modest balance gains and no clear change in reaction time. No trial shows it improves other skills.

Sources 28, 17, 10, 29

Brain-training and vision devicesMixed evidence

Of 43 studies of commercial brain-training devices, only 1 tested a sport task. 3D tracking training improved its own task but not game performance in 62 academy footballers, and in a review of one commercial tracking device, 2 of the 3 studies that tested real-world tasks found no carry-over.

Sources 8, 30, 9, 31

Sport-related visual trainingMixed evidence

In 27 small trials of athletes, visual training improved decision speed and sport-specific performance by moderate amounts, and strobe glasses sped up reaction time but not decisions in 9 studies. The trials were small and varied, and one review's effect was too large to be believable.

Sources 32, 33, 34

Taught movement programmes help childrenStrong evidence

Programmes that teach movement skills improved children's skills, while free play alone didn't in one analysis. School programmes worked best at 60 minutes or more, 3 or more times a week, for 10 to 20 weeks, though many studies had weaknesses.

Sources 4, 35, 36

Dyspraxia: practise the activities themselvesStrong evidence

About 5% of children have DCD (7% of boys and 4% of girls across 18 studies of 31,203 children). Practising the everyday activities themselves worked well, and training underlying abilities worked poorly; international recommendations favour activity-based approaches, with benefits from about 10 sessions.

Sources 11, 37, 38, 39

Falls in older adultsStrong evidence

In a Cochrane review of 108 trials, exercise cut falls by 23%, balance and functional exercise by 24% and tai chi by 19%; programmes that challenged balance for more than 3 hours a week cut falls by 39%, as our balance guide sets out.

Sources 12, 40

Doing two things at once, and exergamesEmerging evidence

Practising balance while doing something that needs thought improved balance in 14 studies of healthy older adults, and exergames (video games you play by moving) cut the number of older adults who fell over a year by 25% in 9 trials, on moderate-certainty evidence.

Sources 41, 42

Choose the skill, then practise it

Hand-eye: catching and throwing. Whole-body: skipping, a jump rope, dance steps or shadow boxing. Your sport: your sport. Practise 10 to 15 minutes on most days (our editorial starting point), keeping it a little hard: if you never miss, make it harder; if you always miss, go back a step.

Source 1

Parts first, then mix it up

Learn a hard skill in parts, slowly, then put it together. Once you can do it, vary the speed, the side, the direction and the order, which helped people keep skills in adults and older adults.

Sources 6, 7

Rehearse in your headEmerging evidence

Picturing the movement for about 10 minutes, three times a week, added a moderate gain in athletes. It adds to practice; it doesn't replace it.

Source 22

How long it takes

Children's programmes ran 10 to 20 weeks, and adults learned to juggle over about 6 weeks. Progress varies with the skill and how often you practise.

Sources 36, 10

Practise catching, throwing and hitting

Hand-eye coordination improves with hand-eye tasks: a ball, a wall and a partner. Devices that train reaction to lights or tracking on a screen improve their own tasks; whether that carries over to catching or your sport is unproven.

Sources 1, 8

A hand-eye ladder

Our editorial progression. Move up a step when you catch most throws:

• Catch a balloon (slower), then a large soft ball with two hands.
• Bounce and catch a tennis ball.
• Throw a ball against a wall and catch it.
• Catch with one hand, then the other.
• Add a step, a turn or a target.
• Two balls, then juggling: two balls in one hand, then three in a cascade.

Video gamesMixed evidence

Action video games speed people up in lab tasks, but the published effects are inflated, and a large review found no evidence that game training improves wider thinking skills. Whether they help coordination in sport or daily life is unproven.

Sources 43, 44

What children need

The NHS asks children aged 5 to 18 for an average of at least 60 minutes of moderate or vigorous activity a day, with a variety of activities to develop movement skills, muscles and bones. For under-5s, active play counts, including throwing and catching, as our children's guide explains.

Sources 45, 46

Teach skills, not only playStrong evidence

Taught movement programmes improved skills more than free play, and children with better movement skills are more active, though shared genes and family habits may explain part of that link.

Sources 4, 36, 47

If coordination is holding a child back

Talk to a GP or health visitor, or a teacher or the school's special educational needs co-ordinator (SENCO), as the NHS advises. An occupational therapist or physiotherapist can assess them; practising the activities they find hard, broken into parts, helps most. The NHS notes DCD often continues into adulthood, though coping strategies help.

Sources 6, 38, 37

Adults with dyspraxia

The NHS says to see a GP if you think you have dyspraxia and it's affecting your home life, work or studies; physiotherapy can help balance, coordination, strength and posture, and occupational therapy helps with tasks at home or work.

Source 15

Balance work is falls preventionStrong evidence

The NHS asks older adults for activities that improve strength, balance and flexibility on at least 2 days a week, and balance and functional exercise cut falls by 24% in trials. Our older adults guide and balance guide have the programmes.

Sources 12, 48

Where to start

The NHS's balance exercises (sideways walking, the grapevine, heel-to-toe walking, one-leg stands and step-ups) are a start, at least twice a week near a wall or a sturdy chair. Add a second task, such as counting back, or a stepping game once they're easy.

Sources 49, 41, 42

New skills still workEmerging evidence

Older adults learned to juggle in studies, and dancing, tai chi and racket sports all train coordination. Choose one you enjoy.

Sources 17, 29

After a stroke

Our stroke guide covers balance, walking and arm practice once your stroke team has cleared you.

MS and Parkinson's

Our MS and Parkinson's guides cover balance and coordination work for each, with the experts' doses.

Autism and ADHD

Our autism and ADHD guides cover movement skills, which trials show improve with practice.

Dizziness or vertigo

Our vertigo guide covers exercises for dizziness from the inner ear, once a GP has checked it.

After a head injury

Our concussion guide covers the graded return to activity and sport.

Numb feet

Our peripheral neuropathy guide covers balance training in shoes and foot care.

Ataxia

Ataxia is a group of conditions affecting coordination, balance and speech, with many causes; the NHS lists physiotherapy among the treatments for movement problems. Follow your specialist team's advice.

Source 50

Sudden loss of coordination or balance: call 999 (911 in the US)

Call 999 (911 in the US) or go to A&E if you have sudden weakness or numbness in one arm, sudden loss or blurring of vision, or sudden problems with balance and coordination: these could be signs of a stroke. Call 999 too for chest pain that feels tight or spreads to your arms, neck or jaw, or severe difficulty breathing.

Sources 13, 14

The signs of a stroke

Call 999 if you think you're having, or have had, a stroke, or you've had signs of a stroke in the last 24 hours, even if they've stopped. The NHS uses FAST:

• Face: one side of your face may droop, and it might be hard to smile.
• Arms: you may not be able to lift both arms and keep them there, because of weakness or numbness in one arm.
• Speech: you may slur your words or sound confused.
• Time: call 999.

Other signs of a stroke

Other signs include weakness or numbness down one side, blurred vision or loss of sight, difficulty speaking or finding words, confusion and memory loss, feeling dizzy or falling over, a severe headache, and feeling or being sick. Don't drive yourself to A&E. In the US, call 911: the CDC uses BE FAST, adding loss of balance and eye changes.

Sudden unsteadiness, or after a fall

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.

Source 51

Clumsiness, tremor, slowness or unsteadiness that builds up: see a GP

Common reasons are weaker legs, less activity, medicines, low blood pressure, eyesight or hearing problems, and conditions such as arthritis, Parkinson's disease or a stroke. See a GP if it's new or getting worse, if you've had a fall, or if it comes with dizziness, hearing changes or numbness. Call 999 if it comes on suddenly with a drooping face, a weak arm or slurred speech.

Any fall or near-fall, new unsteadiness, or a new fear of falling: ask about a falls assessment.

Without a diagnosis

Our suggestion, from the NHS pages: see a GP if a tremor or shaky hands are getting worse over time or affecting daily activities; if you're concerned you may have symptoms of Parkinson's disease (tremor, slowness of movement, stiff muscles); if you think you have symptoms of MS, which include feeling off balance, dizzy or clumsy; or if your movement has changed or got worse.

Sources 18, 52, 13, 15

If you already have Parkinson's or MS

Any fall, even without injury: they can look for the cause and how to prevent another.

Falls, or difficulty with balance: ask about physiotherapy.

A child's coordination

Coordination difficulties are affecting daily life or school: ask about an assessment for developmental coordination disorder (dyspraxia).

Dizziness or a spinning feeling: call 999 (911 in the US)

• Vertigo with double vision or loss of vision, hearing loss, trouble speaking, or weakness, numbness or tingling in an arm or leg.
• Spinning with a face that droops on one side, arms you can't lift and keep up, slurred or garbled speech, sudden problems with the sight in one eye, or feeling very off-balance: possible signs of a stroke. Call even if the signs have gone, if they happened in the last 24 hours.

Sources 53, 54

Urgent GP appointment or NHS 111

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.

• Vertigo with a severe headache.

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.

• Vertigo that won't go away or keeps coming back.
• You keep feeling dizzy or faint, especially when you stand up.
• You've had a fall or you're worried about your balance.

After a knock to the head

Anyone who might have a concussion stops at once and doesn't play, train or do PE again for at least 24 hours. Get them assessed within 24 hours by a healthcare professional or NHS 111, and call 999 for red flags such as getting drowsier, repeated vomiting, a fit or a worsening headache (the full list is below). Fewer than 1 in 10 concussions involve being knocked out.

The UK guidelines call these red flags. They need urgent assessment, by ambulance if necessary. If a neck injury is suspected, only a trained healthcare professional should move the person.

• Any loss of consciousness, or getting drowsier
• No memory of events before or after the injury
• Increasing confusion or irritability, or unusual behaviour
• New problems understanding, speaking, reading or writing, less feeling, loss of balance, weakness or double vision
• A seizure, twitching limbs, or lying rigid or motionless
• A severe or worsening headache, repeated vomiting or severe neck pain
• A suspected skull fracture: a cut, bruise, swelling or severe pain where they were hit
• Previous brain surgery, a bleeding disorder, blood-thinning medicine, or being drunk or on drugs at the time

During 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).

Stop and get medical help

If you get chest pain or pressure, feel faint or dizzy, are unusually breathless, or your heart races or beats irregularly during exercise, as our plans advise.

Call 999 (911 in the US)

For chest pain that comes on suddenly and doesn't go away, feels tight or like squeezing, spreads to your arms, neck, jaw, stomach or back, or comes with sweating, feeling sick, light-headedness or breathlessness; severe difficulty breathing; someone who faints while exercising; palpitations that don't go away, or come with chest pain, shortness of breath or feeling faint; or a headache that starts suddenly and is extremely painful, especially while lifting or straining, or comes with numbness or weakness, difficulty speaking or loss of vision. The NHS says a bleed on the brain may be more likely when lifting something heavy. Don't drive yourself to A&E.

Source 55

Check first

Speak to a GP first if you haven't exercised for some time, or if you have a medical condition or concerns. Get advice first, too, if you have a health problem, an injury or symptoms, have recently had a heart attack or an operation, or are pregnant or have recently given birth.

"Coordination is something you're born with"Emerging evidence

Genes explain part of the differences between people, but taught programmes improved children's skills, practice explained 18% of the differences in sport, and older adults learned to juggle.

Sources 3, 4, 36, 5

"Coordination exercises make you more coordinated at everything"Emerging evidence

Balance training improved the trained task and little else, and transfer to new tasks was small in real-world settings. Practise what you want to get better at.

Sources 1, 2

"Brain-training apps improve your hand-eye coordination for sport"Mixed evidence

They improve their own tasks, but carry-over to sport is unproven, and a tracking device didn't improve game performance in academy footballers.

Sources 8, 30, 9

"Juggling improves your coordination"Mixed evidence

It makes you better at juggling and changes the brain areas involved, and in older adults it gave modest balance gains. No trial shows it improves other skills.

Sources 28, 10, 29

"Clumsy children grow out of it"Emerging evidence

The NHS says DCD often causes continued problems into adulthood, though coping strategies help; practising the activities themselves improves skills.

Sources 6, 38

"Sleep gives you a 20% overnight skill boost"Mixed evidence

That figure came from one finger-tapping study; later analyses found the effect small or explained by other factors and unpublished results.

Sources 23, 25, 26