Imagine this perfect storm: your significant other forgets to shut the dishwasher, and later that night, you go to the dark kitchen for a drink of water. Your ankle strikes the lowered dishwasher door, and you stumble. Do you catch yourself or crash?
Scenarios like this inevitably happen and pose major risks, partly because the lower body makes up only about one-third of human body mass. “You’re basically a ball balancing on a stick,” says Kenton Kaufman, professor of biomedical engineering at Mayo Clinic.
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Given that each of us amounts to an upside-down bowling pin, our ability to walk, run, and recover from stumbles seems almost magical. To stay upright, our bodies must seamlessly integrate a range of physical systems—including the brain, inner ear, and nervous system.
Until they don’t. As we age, the magic wears off. We topple over, resulting in injuries like broken hips that can lead to immobility.
But the deterioration is preventable. Seniors can recoup lost balance, and young people can shore theirs up to slow these declines and overall aging. Here’s what to know about balance and how to boost it.
The balance command center
Every step you take is a controlled fall. As you lean forward in between steps, your front leg is on a mission to re-establish the body’s base of support. If it fails, you’ll become gravity’s play-thing, plunging toward the ground.
No pressure. We’re designed for this. The brain is mission control, ingeniously coordinating inputs from multiple systems. “It’s the balance command center,” says Teresa Liu-Ambroise, chair of physical activity, mobility, and neuroscience at the University of British Columbia.
One key input is the sloshing of fluid in canals of the inner ear as we move about. The brain registers the sloshing and combines it with visual information—such as changing terrain and obstacles—along with sensory signals from the nervous system that detect the body’s position in space, a trick called proprioception.
Based on this info, the brain automatically directs the eyes in the opposite direction of head motion, which stabilizes vision, and it adjusts muscles throughout the body, down to foot muscles that support the arches as we move. Another system key to balance is cardiovascular: vessels must work well to ensure the brain gets enough blood to avoid dizziness.
Around age 50, though, something goes wrong.
Bye bye, balance
Shaky balance is an early warning system for biological aging. The average 50-year-old can balance on one leg for about 40 seconds. Not bad. But this drops to 20 seconds for 70 to 79-year-olds, and the above-80 set is down to 10.
The onset of these changes at age 50 is an earlier indicator of aging than other measures such as walking speed, which doesn’t typically start declining until about 70, Kaufman says.
A main point of failure is foot agility. We trip or slip because the front foot isn’t quite as quick to recover from unanticipated challenges. It can’t get to where it unexpectedly needs to be. And when we tumble, life-changing injuries may result. “Falls are key reasons why people can’t live independently in their homes anymore,” Liu-Ambrose says.
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They’re the number one cause of fatal injuries for older adults. Data suggest that about one in three people over 65 falls in a given year. When Kaufman studied a community of older adults, he found an even higher rate: 59%. The rate of older people dying from falls went up significantly from 2012 to 2021.
Falls are downstream of wear-and-tear to the physical systems integral to balance, most notably cognition. Older adults who’ve suffered falls have a smaller hippocampus, a brain region that helps with spatial navigation, than those who avoid falling. Fall risk is higher in people with neurodegeneration years before they develop dementia symptoms.
How to test your balance
Time how long you can stand on one leg. Making it for 30 seconds suggests you probably won’t wipe out anytime soon, Kaufman says. People in the 5-10 second range are the ones with a serious risk of falling. “They need to be examined by a doctor,” Kaufman says, in addition to trying exercises to improve balance. “It’s a real warning sign.”
Some other tests, typically given by a physical therapist, yield more thorough assessments of balance. Lord notes the Short Physical Performance Battery as a simple but effective one.
How to improve balance
In theory, balance could be enhanced just by practicing tests like the one-leg stand. You’d certainly improve at holding that one position, but the ultimate goal is to master balance while moving in myriad ways through a world full of icy sidewalks, loose rugs, and misplaced dog toys.
“The most optimized balance is when you feel capable of leading your most robust life safely and confidently,” says Julie Pollard, a physical trainer and co-founder of Ageless Fitness, a studio for balance training headquartered in Santa Barbara, Calif.
Living your fullest translates to more well-being, purpose, and exercise, levers that can unlock additional years of health. And, because working on balance uniquely exerts many physical systems, frequently challenging yourself with harder balance exercises will not only yield better balance, but also strengthen the underlying systems.
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For example, various studies show that people who practice balance enhance their attention, memory, spatial orientation, and overall cognition. “Improving your balance has all of these other benefits to health, including the brain,” Liu-Ambrose says.
Liu-Ambrose suggests starting by standing on one leg, or with one leg right in front of the other. Do it by the kitchen counter with a “fingertip spot” for extra support, becoming increasingly steady without the spot. Some people manage these poses easily, but Liu-Ambrose notes it’s the perfect challenge for her parents, aged 89 and 91.
While on one leg, try lifting your other leg up or back, says Karon Karter, a pilates instructor and author of the book Balance Training. Slowly work up to integrating balance exercises into everyday life. Kaufman recommends the one-leg stand while brushing your teeth or hopping around while getting into socks, underwear, and pants. A program in Australia blending balance exercises with life activities—working up to cooking dinner on one leg—has been shown to prevent falls among older people.
You can also progress to dynamic balance: shifting weight from one leg to the other in increasingly demanding exercises. You could walk in figure 8s; forward and backward; and forward steps followed by side steps, then a diagonal step, then pivot and walk backward. Have fun with it—creativity and spontaneity are fundamental to training for life’s unpredictability, Karter says. “You need to prepare for the unexpected.”
The American College of Sports Medicine recommends getting a few minutes of balance practice daily or at least 2-3 days per week. “Five minutes here and there can really help,” Pollard says.
Simply exercising or playing a sport will improve balance. A 2018 study found that exercise reduced injurious falls by 20%. One reason, Kaufman says, is that cardio directly improves blood flow to the brain, countering dizziness.
If possible, though, complement stationary aerobic machines and sport-specific movements with additional balance moves to ensure the full arsenal of responses to life’s twists and turns.
Train the brain
To maximize the benefits of balance training, combine it with mental tasks.
People have fewer falls when they’re good at multitasking. Even younger adults in their 30s begin to lose this capacity. In a seminal study, researchers found that some older adults needed to stop walking to focus on conversation. In subsequent years, the stop-to-talk group suffered significantly more falls than the walk-and-talk group.
Boosting this mind-body connection is critical in the modern world. Think about how often we’re walking quickly while checking phones—another perfect storm for falls.
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To practice such “cognitive loading,” Liu recommends standing on one leg while counting down by 7s or brushing your teeth. Or try walking figure 8s while reading this article.
“The more novel situations you provide the brain, the better prepared you’ll be,” Liu-Ambrose says.
Advanced moves
Pollard thinks that constantly working to improve her own balance has enabled her to fully enjoy nature. “It’s cool to stand on your leg for five minutes, but it’s cooler to be able to hike or climb a mountain,” she says.
She hears from older adults about another benefit of boosting balance: excelling at golf. Vicki Stensrud of Dallas, age 74, has kept improving at balance through 15 years of pilates training under Karter’s guidance. “I’m hitting the ball much farther,” she says. “You have to be balanced to do that, not swaying.”
In addition to pilates, try these advanced moves after working up to them:
- Tai chi. This exercise improves stability, research shows. It’s mindful and requires constantly shifting balance.
- Yoga. Pollard says her clients with yoga backgrounds tend to have better proprioception and body-awareness (though tai-chi’s balance benefits are more researched).
- Karate moves. A tough test of proprioception, sometimes used in karate training, is retaining your sense of the body in space even when you can’t see. Use a blindfold to make balance practice harder—and make sure you’re surrounded by soft surfaces.
- Tip-toe. Balanced on one leg, try perching on your tip-toes.
- Mix up surfaces. Softer surfaces are tougher to balance on. Progress from hardwood to carpet to grass to gravel to various devices like wobble boards and foam pads available online.
- Throwing a ball while on one foot. With natural arm movement, people practice loosening up while balancing. Too much stiffness could contribute to falling.
Better hearing, better balance
Another critical factor is hearing ability. Recall the role of the inner ear in sustaining balance. Its machinery is separate from parts for hearing, but “the inner ear can’t handle modern-day noise pollution—and the excess noise spills over to damage the parts responsible for inner ear balance,” says Devin McCaslin, an audiologist at the University of Michigan.
Maintaining vision is equally important, says Stephen Lord, an applied physiologist at Neuroscience Research Australia. If you have multifocal glasses, “you have an elective disability,” Lord says, because these glasses blur ground-level obstacles. He’s found connections between poor vision, multifocal glasses, and fall risk. Instead, use single-vision distance glasses when walking outside. “We need to see two steps ahead,” Lord says.
Work on flexibility and address physical pain, he adds; being limber and pain-free “confers a mobility payoff.” He’s had treatment to reduce back pain. Now, at 67, “if I strike an obstacle in my path, I can recover my balance more quickly.”
Kaufman is studying unique balance training in older people and military veterans with amputations: putting them in safety harnesses on special treadmills that move suddenly. By simulating trips, the challenge improves balance more than exercise alone, reducing fall risk by 50%. Lord found a 60% reduction in trips and slips after training older people on booby-trapped walkways.
Remember that life is a balancing act, and prepare accordingly. “Make it part of your exercise routine as you age,” Karter says.