Balance exercises for healthy ageing: start with support

Have you fallen or noticed new unsteadiness?

NICE guidance published in 2025 covers everyone aged 65 or over and adults aged 50 to 64 at higher falls risk. After a fall in the previous year, it recommends comprehensive assessment for people with frailty, an injury requiring treatment, loss of consciousness, inability to get up independently or two or more falls.

Without those features, it still recommends checking walking and balance. If impairment is found, it recommends a falls-prevention exercise programme and consideration of home hazards. Programmes should be progressive, tailored, professionally delivered and regularly reviewed. Professional input can support a plan that includes practice between appointments.

Do not wait for a second fall simply because repeated falls appear in those criteria. The NHS falls advice recommends seeing a GP after a fall or if you are worried about balance or mobility. Some areas allow direct access to a falls service; ask your practice about the local route.

Tell the clinician when it happened, what you were doing, whether you felt dizzy or blacked out and whether you could get up. If part of the event is unclear, say so. 'I felt lightheaded when I stood up' is an observation; 'my leg muscles must be weak' is an explanation that the assessment has not yet established.

After a fall, call 999 if you cannot get up or may have injured your head, back, neck or hip. NHS 111 can advise if you may be in pain, injured or unwell. These are the NHS routes for help with the fall itself, rather than a reason to try a balance exercise to check whether everything is all right.

Four exercises with support nearby

The NHS illustrated balance routine provides these examples. Use its pictures alongside the descriptions, starting gradually and keeping support available:

• Sideways walking: start with feet together and knees slightly bent. Step slowly to one side, bring the other foot alongside, and avoid letting the hips drop. Aim for ten steps each way, or across the room.
• Heel-to-toe walking: place one heel immediately ahead of the opposite toes, looking forward. Use fingertips against a wall if needed. Begin with at least five steps.
• One-leg standing: face a wall with fingertips touching it. Lift one leg, keep the hips level and slightly bend the supporting knee. Hold five to ten seconds; practise three on each side.
• Step-ups: use a step with a railing or nearby wall. Step up with one foot, bring the other alongside, then return to the starting position. Move slowly, working towards five with each leading leg.

Those counts describe the NHS examples. Choose a manageable amount rather than continuing after you lose control. If the step-up setup is unavailable, leave that exercise out instead of substituting a loose box or a chair. Practise beside a clear wall for the walking movements, with enough room to finish and turn safely.

A first attempt might be a short sideways walk and a few supported heel-to-toe steps. Read each exercise before starting, then finish one movement before looking back at the instructions. That is a starting session; a tailored falls-prevention programme may involve more exercises and professional support.

Set up a clear, comfortable practice space

Move bags, cables and loose obstacles out of the practice area. Check the whole route, including where you will turn and return. Use a stable support within comfortable reach, and make sure the floor allows your feet to move without slipping or catching.

Choose a moment when you can concentrate. A phone conversation or someone carrying items through the room makes the task different. You can practise attention-demanding activities within a tailored programme later; there is no need to introduce them while learning where your feet should go.

If you live with someone, explain where you are about to practise so they do not unexpectedly move the chair or walk into the route. Keep any usual walking aid available and follow advice you have been given about using it. A general illustration does not cancel an individual instruction about support.

When to make the exercise harder

The NHS routine recommends building repetitions gradually and practising at least twice weekly. For heel-to-toe walking, it gives moving away from the wall as a progression. That comes after you can manage the supported version; retaining fingertip contact is a useful starting arrangement.

For your first sessions, repeat the same movement and support so you can recognise what is changing. You may find the sequence easier to follow before you are ready to reduce support. You can also build towards the demonstrated count rather than changing the exercise entirely.

Suppose you completed a few heel-to-toe steps with fingertip contact and felt controlled throughout. Next time, repeat the arrangement and work towards a few more steps within the demonstrated routine. Once that is comfortable, consider the stated progression while keeping the wall close enough to use if needed. If you feel unsafe, return to the supported version and seek advice about an appropriate next step.

Keep the distinction clear in any notes. Ten seconds with support and ten seconds without support are different tasks. For accompanying strength work, our guide to recording progression explains the same principle: write down what changed so a larger number does not hide a different exercise.

Balance involves more than strong legs

The US National Institute on Deafness and Other Communication Disorders explains that the brain combines signals from the eyes, inner ear and sensors in muscles and the legs. These signals help control posture and movement. Muscle weakness, slower responses, medicines and problems with these sensory systems can all affect steadiness.

That helps explain the variety in balance practice. A side-step asks you to move weight between the legs. A narrow heel-to-toe walk changes the space available for keeping balanced. Standing briefly on one leg asks you to maintain position on a smaller support. Each movement asks you to control your balance in a different way.

The National Institute on Aging also describes how fear of falling can lead people to avoid walking, shopping and social activity. Tell the person assessing you what you have stopped doing. That identifies the daily activities you want help returning to, alongside the physical findings.

Can balance training reduce falls?

A 2019 Cochrane review included 108 trials and 23,407 older adults living in the community. Across exercise types, falls rates were about 23% lower than in comparison groups. The evidence was strongest for balance and functional exercise; programmes combining types of exercise, often adding resistance work, probably also reduced falls. Tai chi may help, while the evidence for resistance-only or walking-only programmes was uncertain.

These are falls rates across groups, which can include repeated falls by the same person. The result is different from saying 23% of people will avoid any fall. It also describes the programmes studied, not the measured effect of the short NHS starter sequence. The review searched evidence up to May 2018, so it should not be presented as a new 2026 research update.

A useful individual example is the LiFE trial, published in 2012. It enrolled 317 people aged 70 or over who had recurrent or injurious falls. Participants learned tailored balance and strength activities integrated into daily routines, with five professional sessions, two booster visits and two calls over six months.

Over twelve months, the LiFE group had about 31% fewer falls per person-year than the gentle-exercise control group: 1.66 versus 2.28. The rate ratio was 0.69, with a 95% confidence interval of 0.48 to 0.99. The professional input, tailoring and higher-risk population matter when deciding how the findings apply. This was more support than reading a list of exercises and trying them alone.

The practical implication is to look for an appropriate programme when falls are a concern. A local strength-and-balance class or falls service can provide a route to tailored practice, depending on what is available and what your assessment identifies. Ask who delivers it, how exercises are adapted and how progress is reviewed.

Choose an everyday task you want to feel better doing

Describe a task you want to feel more confident doing: turning in a hallway, stepping down from a kerb, dressing or walking to a nearby shop. That gives a professional something concrete to assess and helps you recognise whether practice is making daily life easier.

The NHS explains that falls support may include checking muscle weakness and eyesight, reviewing medicines, strength-and-balance work and changes to the home. Discuss suspected medicine effects with a GP or pharmacist instead of stopping treatment yourself. Our guide to NHS eye tests after 60 explains routine eligibility and symptoms that need earlier attention.

For general strength work alongside suitable balance practice, the two-day home routine covers legs, pushing, pulling, hips and trunk control. Strength work can complement balance practice. New unsteadiness still needs its cause assessed.

Before the next session, write down the movement, the support and the amount you intend to practise. Afterwards, note what you could control and any difficulty. If the main issue is a recent fall or new balance concern, use that note to help arrange an assessment rather than making the routine harder on your own.