Balance Training: More Than Standing on One Leg
Balance is a skill, not a personality trait. It's influenced by strength, vision, sensation, coordination, reaction time, confidence and the environment — and it can be trained progressively and safely at any age.
Good balance training is progressive and specific. Strength training helps, but doesn't replace practising the skill of balance itself.
Four types of balance worth training
1. Static balance
Maintaining a position with a stable base.
- Feet together
- Semi-tandem stance
- Tandem stance
- Supported single-leg stance
2. Dynamic balance
Maintaining control while moving.
- Step and return
- Direction changes
- Controlled walking patterns
- Reaching while standing
3. Reactive balance
Responding to an unexpected loss of balance. This usually requires appropriate supervision and shouldn't be practised alone at first.
4. Dual-task balance
Moving while completing another task — talking, counting backwards, carrying an item. Introduce this only after the basic movement is safe.
A Cochrane review of 108 randomised trials found that exercise programs can reduce the rate of falls in community-dwelling older adults by roughly 23%, with the largest benefits coming from programs that provide a meaningful challenge to balance and are sustained over time [3]. Walking-only programs, by comparison, don't reliably reduce falls — and can even dilute the benefit if they replace balance-specific work.
What actually makes a balance program work
Systematic reviews suggest that challenge level matters more than sheer volume. Effective programs progressively narrow the base of support, reduce hand support, add multidirectional and dynamic movement, and gradually layer in dual-task or reactive elements [3].
Evidence-based programs worth knowing
Otago Exercise Programme
An individually prescribed home-based program of progressive strength and balance work, originally developed in New Zealand and delivered by a health professional. Randomised trials reported roughly a one-third reduction in falls and fall-related injuries in adults aged 65+ [12].
Tai Chi
A six-month randomised trial of Yang-style Tai Chi in adults aged 70–92 reported a substantial reduction in fall risk compared with a stretching control group [13]. Group-based, low-cost and enjoyable enough for many people to sustain long-term.
Lifestyle-integrated Functional Exercise (LiFE)
Balance and strength tasks woven into everyday routines — such as standing on one leg while brushing teeth or performing controlled sit-to-stands during the day. In a randomised trial in high-risk older adults, LiFE reduced fall rates by about 31% compared with control [14].
How much is enough?
The WHO 2020 physical activity guidelines recommend that adults aged 65+ perform multicomponent activity emphasising functional balance and strength training on three or more days per week to enhance functional capacity and prevent falls [2]. Meta-analytic evidence suggests roughly two to three hours per week of balance-challenging exercise, sustained over months rather than weeks, is the practical target [3].
Standing on one leg for 30 seconds a day is not, on its own, a balance program. And walking, while excellent for many things, is not a substitute for balance-specific training when fall prevention is the goal.
- Practise near a stable support (bench, wall, sturdy chair) when needed
- Seek assessment if you've had repeated falls
- Seek assessment for unexplained dizziness, fainting, new neurological symptoms or major walking changes
- 1.Balance improves with practice — like any other skill.
- 2.Progressive difficulty matters more than time on the clock.
- 3.Programs like Otago, Tai Chi and LiFE have real, replicated evidence for reducing falls.
- 4.Aim for balance-challenging activity on three or more days a week, ongoing.
Evidence and references
- [3]Exercise for preventing falls in older people living in the community — Sherrington C et al. Cochrane Database of Systematic Reviews, 2019.
- [2]World Health Organization 2020 guidelines on physical activity and sedentary behaviour — Bull FC et al. British Journal of Sports Medicine, 2020.
- [12]Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls (Otago Exercise Programme) — Robertson MC et al. BMJ, 2001.
- [13]Tai Chi and fall reductions in older adults: a randomized controlled trial — Li F et al. Journal of Gerontology: Medical Sciences, 2005.
- [14]Integration of balance and strength training into daily life activity to reduce rate of falls in older people (LiFE study): randomised parallel trial — Clemson L et al. BMJ, 2012.
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