Balance Training in Older Adults
Introduction
It’s no secret that as we age, we begin to experience a more rapid deterioration of our bodies: joint pain, loss of muscle mass, vision problems, and more. However, one significant change we may also face is balance impairments. According to Webster’s dictionary, balance is the ability to maintain physical equilibrium. This means that when one can no longer maintain equilibrium or experience imbalance, a fall can occur. Furthermore, as we discuss this topic more closely, it is essential to note that falling is not a normal phenomenon associated with aging, although it is a common occurrence.
Falling in Older Adults
According to Pereira et al, ~30% of older adults above 65 years old will experience a fall annually. The percentage then increases to 50% in older adults >80 years old, with both populations experiencing mild to severe injuries as a result. Falls are a large portion of emergency room visits, as they are the leading cause of TBI and spinal cord injuries in older adults as well. Some falls can even result in death. But why are older adults losing their balance in the first place? What is contributing to this loss of equilibrium?
As a physical therapist who has worked in hospitals and nursing homes, falls can cause a plethora of injuries. I’ve treated patients for total hip replacements, rotator cuff repairs, ankle sprains, and much more outside of the typical neurological injury. When discussing the cause of imbalance, it is essential to first understand what helps you maintain balance in the first place.
Postural Stability
Balance is also considered to be your postural stability. This is a coordination in your somatosensory system to maintain your center of mass. There are three important components of this system, and those are your somatosensory system (touch), your visual system (sight), and your vestibular system (inner ear). Let’s look at each of these in more depth
Somatosensory System
Somatosensation in relation to balance controls one’s ability to feel the ground beneath them. This can be impaired through comorbidities such as diabetes, which can cause neuropathy in the hands and feet, and osteoarthritis, which destroys cartilage in the knees, used to assist with control of the lower limb. With impairments in the system, you will see less synergistic movement in the muscular system and increased swaying with mobility. When this system is impaired, your brain relies on the vestibular and visual systems to maintain balance.
Visual System
Vision in relation to balance controls one’s ability to steady themselves via sight. This can include identifying external factors contributing to trips and/or slips. It can also include proper visual input that can prevent dizziness via eye-head coordination. Loss of vision, decreased vision, or visual cuts present can impact the way you maintain balance. When impaired, the brain uses the somatosensory and vestibular systems to maintain balance.
Vestibular System
Vestibular input for balance is related to the organs of the inner ear, which sense your body position based on head movements. These organs work in close conjunction with your cerebellum to maintain balance in this system. When any of these organs are impaired, one may experience dizziness, vertigo, or floating sensations. The somatosensory and visual systems take over whenever the vestibular system is not functioning properly.
Intentional Balance Training
Now that you know how the balance system is classified and functions, how do we train it? According to Aartolahti et al, strength and balance training in conjunction can contribute to the improvement and maintenance of balance as we age. Even training both of these areas once weekly can impact age-related muscle mass loss in individuals 75+. While this fact remains for geriatric populations, we know that consistent activity throughout our lifetime impacts how age-related changes are affected. Therefore, the sooner you incorporate balance and strength training, the more it can act as a preventative measure to maintain balance in the future.
McCrum et al introduces perturbation training as a method to improve and maintain balance. This is based on slips and trips in community-dwelling older adults contributing to increased falls. Perturbation-based balance training uses repeated external mechanical disturbances that may trigger a rapid reaction in an individual to regain their postural stability. This exposes one’s ability to recover from an outside source that may impact their balance. For this to be effective, McCrum requires two things:
External perturbations that induce a sudden motor response
Large enough perturbations that induce a loss of stability that could lead to a fall.
Basically, you need to lose your balance to improve it. Examples of this during a physical therapy session can look like placing intentional tripping hazards or invoking a stepping strategy by applying a large external force, such as a push or bump. In these scenarios, a patient would ideally be caught by a harness or the therapist themself.
Overcoming Balance Challenges
In this post, we’ve learned what contributes to our balance system and how we can train it. What should you do to overcome your challenges with balance? First, it’s important to reiterate that incorporating balance and strength training into your normal routine is a preventative measure to slow balance-related challenges that may appear in the future.
However, if you’ve been reading this, knowing your personal challenges with balance, the next step would be to book an appointment with a physical therapist. Fortunately, JP Fitness and Health offers that service in-home to address your concerns. Here, I can assess your functional mobility, strength, balance, and home environment to outline methods to maintain safety with current balance impairments. Join my email list to receive further information on how to book your first session.
Take Home
If you’ve made it to the end of this post, I hope you leave with this. Falling is an abnormal progression of aging and can be prevented through adequate care of general health. The sooner you incorporate strength training, balance training, and care for overall health in your routine, the more you can prevent balance changes that can lead to an inevitable experience with falling as you age.
Your body is worth taking care of, your functional mobility is worth maintaining, and you have a right to be healthy and age in a healthy manner. Until next time, friends!
References
Pereira CB, Kanashiro AMK. Falls in older adults: a practical approach. Arq Neuro-Psiquiatr. 2022;80(5):313-323. doi:10.1590/0004-282X-ANP-2022-S107. Accessed August 11. 2025
Aartolahti E, Lonnroos E, Hartikainen S, Hakkinen A. Long-term strength and balance training in prevention of decline in muscle strength and mobility in older adults. Springer Nature; 2019. Accessed August 11, 2025.
McCrum C, Bhatt TS, Gerards MHG, Karamanidis K, Rogers MW, Lord SR and Okubo Y (2022) Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. Front. Sports Act. Living 4:1015394. doi: 10.3389/fspor.2022.1015394. Accessed August 11, 2025