Surprising Things That Affect Your Balance

Building strength and increasing flexibility are not the only ways to reduce your chances of a fall

group of people doing a balance exercise in a fitness class

Betsie Van der Meer / Getty Images

By:

Sari Harrar

En español

Published December 20, 2021

Feel a little wobbly sometimes? Sneaky, age-related balance changes start in midlife — earlier than medical experts used to think, recent research shows. That can mean grabbing stair railings more often, feeling less confident on a rocky walking trail or uneven sidewalk, and even boosting risk for a dangerous tumble. Fight back with strategies that fine-tune your sense of balance from head to toes.

“Oftentimes people don’t realize they’re having balance problems until they have that first fall,” says Debra Rose, chair of the Department of Kinesiology and codirector of the Fall Prevention Center of Excellence at California State University, Fullerton. “You may just feel like your feet aren’t under you as well as they used to be.”

When 775 women and men tried to stand on one leg for 60 seconds without extra support for a 2017 Duke University study, this classic balance test revealed a big age divide. Participants in their 30s stayed upright for an impressive 57 seconds and 40-somethings lasted 52 seconds. But those in their 50s lost their balance after 44 seconds, 60-year-olds wobbled after 40 seconds and 70-year-olds after just 27 seconds. That could mean big trouble. There’s a growing realization that injury-causing falls aren’t only a threat for older adults. They’re common at midlife too, sending 2.1 million people ages 45 to 64 to U.S. emergency rooms in 2017.

Building strength and mobility, challenging your body’s system and rooting out balance-robbers (like poor sleep) can help you maintain or restore this crucial sense, says Ryan Glatt, a brain health coach and certified personal trainer at the Pacific Brain Health Center in Santa Monica, California. “You can get sustained balance improvements and increase your confidence,” he says, noting it takes more than doing a couple of single-leg stands once a week or some ankle pumps before you get out of bed.

Balance 101

Every time you successfully cross the office (or your living room) with a full cup of coffee or safely navigate a rain-slick parking lot, you can thank the crew of behind-the-scenes players that work together to make staying balanced possible.

Among them: Your vestibular system in your inner ear, which uses fluid-filled canals lined with microscopic hair cells and tiny floating crystals to track and stabilize your head and body. Proprioceptors along muscles throughout your body, which tell your brain where your body is in space. Pressure-sensing receptors in the skin on the soles of your feet, which help your brain figure out fast whether you’re on a carpet with plenty of traction or on a wet, slippery floor. Even your eyes and ears get involved, feed your brain a steady stream of visual and audio data about the three-dimensional world you’re moving through, Rose says. And as your balance command center, your brain’s busy ‘round the clock, making large and small adjustments to keep you upright.

But that’s not the whole team. “A big part of balance is plain old-fashioned strength,” notes Manhattan-based personal trainer, dance therapist and choreographer Carol Clements, author of Better Balance for Life: Banish the Fear of Falling With Simple Activities Added to Your Everyday Routine. Muscle strength of the lower extremities — the hips and thighs — is one of the most important factors in risk estimation for falls, she says.

Also key: Flexibility of your ankles, knees and other joints. “Foot mobility is your base for balancing,” Clements says. “There are 26 bones in the foot. It’s their relaxed micromovements that help you balance.”

Fine tune your sense of balance

Get beyond balance basics with these expert-endorsed strategies. Of course, check with your doctor before starting a new exercise routine if you’ve fallen, are worried about falling due to balance problems or dizziness, or have chronic health conditions.

Add balance moves to your workouts. “If I’m walking on a treadmill to increase aerobic fitness and holding onto handrails, or using an elliptical trainer or recumbent bike, it won’t improve balance,” Rose says. You have to challenge your sense of balance to get improvements, she says. Get started with exercises to restore agility, including exercises that take 10 minutes or less.

Increase the challenge at your own pace. If you’re new to balance exercises, position yourself in the corner of a room where there’s empty floor space to move across and you’re close enough to touch the walls for support, Rose suggests. Put a sturdy chair in front of you so you can hold on if you have to. Use supports less and less as you’re able. “If I’m holding onto a chair, it’s not doing much for balance,” Rose says. “If I put two fingers on the chair, I’m putting more emphasis on the balance system. If you’ve got white knuckles, lower the challenge!”

Build strength. Work on your calf, thigh and hip muscles as well as your core, which keeps your body stable when standing still and in motion. In a 2019 Canadian study of 344 older adults, those who did an at-home strength and balance routine for one year went on to have 74 percent fewer falls the following year compared to those who didn’t get the training.

Get some active fun. Dance, do yoga, learn tai chi, play tennis or Ping-Pong. Activities that challenge your brain and body have big balance benefits, Glatt says. In a 2015 Harvard study of more than 340,000 people age 45 and older, those who did things like gardening or playing golf had a lower risk of nasty falls compared to those who didn’t.

Take a walk with a friend or two. Researchers are finding that exercises where you do two things at once are even better for balance. They mimic real-life balance challenges, like getting distracted by a loud noise as you turn a corner in the supermarket. An easy way to mimic “dual-task” exercise is by taking a walk with another person, Rose says. “You’ll have to turn your head to look at them, without veering into them,” she says.

Get help for vision and hearing problems. Poor vision boosted risk for falls 40 percent in a University of Michigan study of midlife women. “The likelihood of tripping increases because you don’t see the depth of stair or curb,” Rose says. Hearing loss also increases the risk of balance issues and falls.

Review medications and health conditions with your health care practitioner. “Individuals on more than four medications, irrespective of type, are at heightened fall risk,” Rose says. Drugs may make you feel dizzy or interfere with sharp thinking. Health conditions can also mess up balance, such as by damaging nerves in the feet of some people with diabetes or contributing to dizziness in some people with high blood pressure.

Get enough sleep. Skimping on sleep can worsen your sense of balance, according to a 2018 U.K. study. Getting less than five hours per night also increased the risk of falls that caused injuries by 26 percent in a 2017 Korean study, compared to getting eight hours or more of sleep.

Exercises for Balance

Thigh- and hip-strengthening exercises recommended by Rose and Clements:

Sit-and-Stand Elevators

This sit-and-stand exercise strengthens muscles in your thighs and hips.

illustration of a woman doing a sit stand elevator balance exercise

Getty Images

Basic move:

Sit in a sturdy chair, with your feet on the floor about hip-distance apart.
Activate the muscles in your core and buttocks, and lean slightly forward from your hips.
Press your weight evenly into your feet and stand up slowly. Use your hands on the chair to steady yourself if needed. Rise as much as you can, even if it’s just an inch or two.
Reverse, sitting back down slowly by moving your hips back and bending your knees.

Variation: Try rising to various heights — such as a few inches, halfway, or fully standing — before sitting back down. For a bigger challenge, rise partway and pause; then rise to fully standing before sitting back down. As you get stronger, cross your hands on your chest and don’t use them during the exercise.

Repeat several times.

Flexible Feet and Ankles

illustration of a woman doing a seated foot flex exercise

Getty Images

Strong, flexible feet and ankles provide a foundation that help you stay balanced while standing and walking.

Sit in a chair with a footstool or coffee table in front of you. Take off your shoes and socks, and rest your right foot on the stool or coffee table. (Note: Put a folded towel under your heel for more comfort.) Fan your toes out so they don’t touch each other. Relax. Repeat 10 times, then do the exercise with your left foot.
Rest your right foot on the stool or coffee table. Flex your ankle, pushing out with your heel and pulling your toes toward your shin. Slowly relax your foot. Then extend your ankle and foot, and gently point your toes. Reverse the order from pointed toes back to flexed toes and ankle so that you repeat flexion and extension up to 10 times. Switch to your left foot and repeat.

Variation: Use a resistance band at the ball of the foot as you flex and extend your feet.

Better Posture

illustration of a woman doing a seated chest opening stretch exercise

Getty Images

Good posture — shoulders gently pulled back and your head in line with your spine, shoulders and hips — supports good balance. Help correct hunching with these steps:

Chest opener: Sit in a sturdy chair with your buttocks against the seatback and your feet firmly on the floor. Inhale and stretch your arms overhead; then lean back slightly against the back of the chair, keeping your head in line with your arms (don’t flop your head back!). Next, place your hands behind your head and, with your elbows out to the sides, cradle your head briefly.
Pick your head up with your hands to return to a normal sitting position.