Balance Training

What it is

Balance exercises challenge a person's ability to stay steady. Reactive balance training uses repeated postural perturbations to train quick balance reactions [1]. Exercises that target balance, gait and muscle strength are the main approach to preventing falls in people living at home [2].

How it might work

Proposed mechanism: training balance reactions and muscle strength may make people less likely to lose their footing. Exercise improved muscle strength and balance in one trial, even though it did not reduce all falls [3].

What the research says

A Cochrane review of 108 trials with 23,407 community-dwelling people aged 60 and over found exercise reduced the rate of falls by 23%, and balance and functional exercises by 24%; the evidence was rated high certainty for falls [2]. Exercise may also reduce fall-related fractures and falls needing medical attention, with low certainty [2].

Reactive balance training reduced falls in daily life across 29 trials (fall risk ratio 0.76) [4]. Perturbation-based balance training in eight trials of 404 people reduced the rate of falls (rate ratio 0.54) [1].

In a two-year trial of 409 women aged 70 to 80, exercise did not reduce all falls, but injurious falls fell from 13.2 to 6.5 per 100 person-years [3]. In residential aged care, a programme of resistance and balance training reduced falls by 55% in one cluster trial [5]. For balance after hip fracture, a meta-analysis of eight trials found improvements in balance and gait [6].

Doses used in studies

Residential-care trial: 50 hours of resistance and balance training over 25 weeks, then a six-month maintenance period [5]. A 12-week programme of proprioception, strength and balance exercise was given three days a week in a trial of pre-frail adults [7]. A 2024 review found the most certain benefit came from supervised programmes lasting more than three months [8]. These are doses from trials, not recommendations.

Safety and interactions

Reactive balance training reported more adverse events than control, with 29% of people reporting one versus 20% in controls [4]. In the Cochrane review, adverse events were mostly non-serious and musculoskeletal; one trial reported two serious events, a pelvic stress fracture and an inguinal hernia operation [2]. Exercise programmes in one 2024 review had little harm for most single-type exercise [8].

The Cochrane review's trials were in people aged 60 and over and excluded trials focused on particular conditions such as stroke [2]. The residential-care trial excluded people with terminal illness, advanced Parkinson's disease, or insufficient cognition for group exercise [5]. The evidence comes from older adults, so it says little about pregnancy or breastfeeding [2]. No upper intake limit applies to exercise, and the trials did not report medicine interactions. People who take medicines that affect balance or blood pressure, or who feel dizzy, should check with a clinician before starting [5].

Caveats and open questions

Most included trials were unclear or high risk of bias on at least one item [2]. Some trials measured fall-risk scores rather than falls [7]. The benefit appears greatest for people at higher risk of falling, and the 2024 review called for data on fractures and adverse effects [8]. Several authors of the Cochrane review ran trials it included [2].