As we age, there is typically a slight reduction in cognitive and physical functions, including decreased muscle strength, coordination, gait assurance, and balance control that may affect the lower extremities [1-3]. In combination with impaired cognitive abilities, these changes may lead to a higher risk of falling, especially among aging adults [3, 4].
According to reports, individuals aged 65 years and older experience an average of at least one fall per year [5]. To prevent the long-term complications that are associated with these events, it is vital to encourage the implementation of strategies that help reduce the risk of falling. Physical inactivity is a significant contributor to the decline of physiological function, and it is strongly associated with impaired balance control. On the other hand, regular physical activity has been shown to support sustained coordination and balance, even into late adulthood [4]. Higher levels of physical activity are also associated with reduced health issues, as well as a 30-50% lower risk of falls, with the majority of studies indicating that regular exercise, including recreational activities, helps maintain balance and prevent falls [6-8].
Accordingly, research shows that leg strengthening and balance training are promising strategies that lower the risk of falling [1]. As balance control supports the ability to maintain upright posture and coordinate movement, it plays a central role in reducing fall risk. A wide range of exercises, such as Pilates, aerobic dancing, stair climbing, and vibration training, are linked to noticeable improvements in balance, and they demonstrate how physical activity helps decrease the incidence of falls [8, 9-12].
In addition to enhancing balance, multi-component exercise programs provide several important benefits that include [1]:
- Faster reaction times, which helps individuals stabilize themselves during a loss of balance
- Improved coordination, which helps prevent falls or reduce injury severity
- Increased muscle mass, which offers greater protection to bones and joints during impact
- Enhanced bone strength through resistance training leads to more resilient bones
Each of these factors lowers the likelihood of falling and suffering from fractures [6-9]. Regular exercise also supports cognitive function, and improved mental clarity helps individuals avoid situations that increase the risk of falling.
Beneficial Balance Exercises
Key balance exercises can be incorporated into daily routines to improve stability and strength. For instance, the single-leg stance involves standing on one foot for 10 seconds while using a stable surface for support, gradually increasing the hold to 60 seconds. Repeat this exercise on both sides. Another beneficial technique is heel-to-toe walking, which is performed by walking in a straight line and placing the heel of one foot in front of the toes on the other foot. This method enhances coordination and postural control.
Heel raises are also beneficial and involve standing behind a chair and holding it for support. Next, slowly raise both heels to stand on the toes and hold this position for 3-5 seconds. Repeat this movement 10-15 times to help strengthen the calf muscles and improve ankle stability. Weight-shifting exercises also help improve balance by transferring body weight from one side of the body to the other. Performing this exercise involves standing with the feet shoulder-width apart, slowly shifting bodyweight to one side while lifting the opposite foot, and then alternating sides. Sit-to-stand movements begin by sitting in a chair with the feet flat on the floor, then rising to a standing position without using the hands, and then slowly sitting back down.
Finally, leg raises, performed by standing behind a chair, holding it for support, keeping the back straight, and lifting one leg out to the side, target hip muscles and further enhance stability. To maximize safety and effectiveness, individuals should always perform these exercises near a stable support such as a wall, countertop, or sturdy chair. Working with a physical therapist is recommended, particularly for those recovering from a fall or managing existing health conditions that affect balance and coordination. Physical therapists ensure proper posture and movement by assessing the way an individual moves the body as well as identifying muscle imbalances, improper gait, joint limitations, and then designing a physical therapy regimen that involves targeted corrective exercises.
Individuals who are recovering from a major fall that caused an injury or fracture, a serious accident, or major surgery may be referred for physical therapy, with one of the main goals being fall prevention. Adhering to the program is critical to avoid future injuries and reduce fall risk [15].
References
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2. Daley MJ, Spinks WL. Exercise, mobility and aging. Sports medicine. 2000;29:1-2.
3. Zecevic AA, Salmoni AW, Speechley M, et al. Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature. Gerontologist. 2006;46:367-76.
4. Kendrick D, Kumar A, Carpenter H, et al. Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst Rev. 2014;11:CD00984810.1002/14651858.CD009848.pub2.
5. Gillespie LD, Gillespie WJ, Robertson MC, et al. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev. 2003;4:CD00034010.1002/14651858.CD000340.
6. Bembom O, van der Laan M, Haight T, et al. Leisure-time physical activity and all-cause mortality in an elderly cohort. Epidemiology. 2009;20:424-30.
7. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD00714610.1002/14651858.CD007146.pub3.
8. Bellafiore M, Battaglia G, Bianco A, et al. Improved postural control after dynamic balance training in older overweight women. Aging Clin Exp Res. 2011;23:378-85.
9. Bird ML, Fell J. Positive long-term effects of Pilates exercise on the aged-related decline in balance and strength in older, community-dwelling men and women. J Aging Phys Act. 2014;22:342-347.
10. Donath L, Faude O, Roth R, et al. Effects of stair-climbing on balance, gait, strength, resting heart rate, and submaximal endurance in healthy seniors. Scand J Med Sci Sports. 2014;24:e93-101.
11. Granacher U, Muehlbauer T, Bridenbaugh SA, et al. Effects of a salsa dance training on balance and strength performance in older adults. Gerontology. 2012;58:305-312.
12. Yang F, King GA, Dillon L, et al. Controlled whole-body vibration training reduces risk of falls among community-dwelling older adults. J Biomech. 2015;48:3206-3212.
13. Sadaqa M, Nemeth Z, Makai A, et al. Effectiveness of exercise interventions on fall prevention in ambulatory community-dwelling older adults: a systematic review with narrative synthesis. Front Public Health. 2023;11:1209319.
14. Sherrington C, Tiedemann A. Physiotherapy in the prevention of falls in older people. J Physiother. 2015;61:54-60.
15. Karinkanta S, Piirtola M, Sievänen H, Uusi-Rasi K, Kannus P. Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol. (2010) 6:396-407.
