Improve Balance After 60

Balance tends to slip quietly. A wobble on the stairs, a hand reaching for the wall while putting on socks, a new hesitation on uneven ground. For Humanic Blue, the question is how balance responds to training and what a simple test can—and cannot—tell you about fall risk.

Balance is trainable, and the useful evidence measures fewer falls—not a prettier test score. A Cochrane review found high-certainty evidence that balance and functional programs—practice with movements used in daily life—reduced falls in older adults living at home. An Oregon trial found fewer falls with one tailored tai ji quan program, a form of tai chi, than with stretching in adults 70 or older at high fall risk. The Centers for Disease Control and Prevention (CDC) four-stage balance test can screen function: inability to hold a heel-to-toe stance for 10 seconds signals increased fall risk. It is not a diagnosis or a stand-alone exercise prescription. For living longer and better, structured training can help protect mobility and independence.

What can a balance test tell you?

The CDC’s four-stage balance test is a clinical assessment in its STEADI fall-prevention toolkit. An assessor demonstrates each position, helps the person get steady and stays ready to catch a loss of balance. The person is asked to hold progressively harder positions for 10 seconds each without moving their feet:

1. Feet side by side.
2. The instep of one foot touching the big toe of the other.
3. Tandem stand: one foot directly in front of the other, heel touching toe.
4. Standing on one foot.

CDC STEADI classifies an older adult who cannot hold the tandem stance for 10 seconds as being at increased fall risk. The CDC instructs the assessor to stop when the person cannot hold a position for 10 seconds without moving their feet or needing support. A nearby wall alone does not reproduce that supervised assessment. The CDC suggests considering physical therapy or a tested fall-prevention program after a concerning result; the test is not a home training plan.

The one-leg test and mortality. In a Brazilian clinic study following adults ages 51–75, about one in five could not complete a specified 10-second one-leg stance. Deaths during follow-up were more common in that group, even after researchers accounted statistically for age, sex, body size and existing illnesses. Most participants were men. The study did not control for recent falls or physical activity and cannot show that balance caused survival differences or that practicing this test adds years.

Where does a balance screening result stop short of explaining overall fall risk?

What did balance-training trials actually test?

Balance and functional exercise. The Cochrane review found that balance and functional programs lowered fall rates by 24%. Programs combining several exercise types—usually balance and functional work plus resistance—probably lowered rates by 34%, based on moderate-certainty evidence. Fall rate counts all falls over time, including repeated falls by the same person; a lower rate does not mean that many fewer people fell. Across the review, effects were larger in studies delivered by a health professional, usually a physiotherapist; that comparison was not itself a randomized test of professional delivery. Functional exercise practices movements used in daily life, such as standing from a chair, stepping and turning.

Tai ji quan. In the Oregon trial, adults living at home who had fallen in the previous year or had difficulty moving took twice-weekly, hour-long classes for 24 weeks. They averaged about 78 years old; most were women and nearly all were white.

• Tai Ji Quan: Moving for Better Balance: the fall rate was 58% lower than with stretching.
• A combined program of balance, aerobic, strength and flexibility work: falls were 40% lower than with stretching.
• In the direct comparison, the tai chi program had 31% fewer falls than the combined program.

The study tested a therapeutically tailored program, not every style or class labeled tai chi. Lead author Fuzhong Li disclosed that he founded and owns a consulting company that receives licensing fees for the program.

The Otago program. This home-based strength-and-balance program was evaluated in a 2010 review of seven trials in adults living at home, averaging about 82 years old. It found fewer falls and also reported fewer deaths over a year. The death finding was secondary to the main exercise question and came from a small set of trials in which participants knew their treatment. It does not establish that balance training extends life. Among participants still being followed at a year, fewer than four in ten were exercising three or more times a week.

Perturbation training. This approach creates controlled losses of balance so people can practice recovery, often using specialized equipment and safety systems. A 2026 review of randomized trials in community-dwelling adults 65 or older estimated 23% fewer falls and 24% fewer injurious falls; certainty for the fall-rate result was low. Programs totaling at least six hours appeared more effective in a comparison of groups of trials, but that was not a direct test establishing the minimum training time needed. The review called for more accessible, high-quality trials.

Which tested program features matter beyond an exercise simply being called balance training?

What else does balance depend on?

Fall risk is not a balance score alone. The 2024 US Preventive Services Task Force (USPSTF) recommendation lists walking, balance, vision, blood-pressure changes with standing, medications, surroundings, thinking and memory, and psychological health among factors that may be addressed in an assessment of several fall risks. It recommends exercise interventions for community-dwelling adults 65 or older who are at increased fall risk and individualized decisions about broader programs addressing several risks. More detail appears in How Can Older Adults Prevent Falls?, while strength is covered in Build Muscle After 60.