You can improve your balance as you get older. It doesn’t have to get so bad that you can no longer walk safely or live alone.
It does take some work, but, in this article, I’ll share with you a few tests that you can do to see where your balance is at.
I’ve written extensively about why balance for seniors is so important and, when it gets worse, why this happens in another article that I encourage you to read here, once you’re done with this one. You can also check out this one for an upper-body strength training routine. Additionally, if you’re curious as to when you should start working on balance, read this one.
Key Takeaways
- Test your balance with the four-stage balance test as a preliminary test. Make sure you are in a corner of your home with a stationary chair in front of you if needed for balance.
- Get a comprehensive balance assessment done by a physical therapist, ideally, they use the DGI, berg balance test, four-stage balance test, and a reactive balance test to get a full picture. Berg may not be necessary if you are more advanced. In this case, doing the Fullerton balance test may be more appropriate.
- It can take several months to see large changes in balance and for huge life-changing changes it can take a year or longer. A little a day keeps the falls away 😉
- The highest level of balance would be a demonstration that you’re able to successfully complete agility exercises, walk on uneven surfaces, and quickly react to destabilizing forces in everyday life.
- Increasing your lower body strength (with resistance training) is also an important part of improving balance and maintaining independence.
How To Test Your Balance
There are several different balance tests out there that your physical therapist might have put you through.
I like to start everyone with a very basic one called the four-stage balance test (link to exact instructions.)
Four-Stage Balance Test
The four-stage balance test consists of four different types of balance exercises that you are meant to hold for at least 10 seconds.
If you pass the final stage you are not at a high risk of falling. This doesn’t mean you shouldn’t work on balance, this just means you might need a different test to challenge you a bit more.
The stages are:
- Standing feet together, eyes open, on a stable surface with arms crossed across chest
- Standing with feet semi-tandem, eyes open, on a stable surface with arms crossed across chest
- Standing with feet heel to toe (tandem), eyes open, on a stable surface with arms crossed across chest
- Standing on one leg, eyes open, on a stable surface with arms crossed across chest
You pass this test if you can hold single leg balance for 10 seconds without losing balance or having to touch anything with your upper body.
Personally, I like to test my clients for 30 seconds as this shows that not only do you have the ability to balance, but you also have muscular endurance. Many people fall when they are tired and this shows that you will have a lower likelihood of that happening (my opinion).
If you passed this test, the next one to test is likely the Dynamic Gait Index (DGI).
Dynamic Gait Index
The DGI is a clinically validated measurement tool of balance that tests walking, turning, head turns, stepping over objects, and more. It adds a layer of difficulty and tests your dynamic balance (as the name suggests).
The DGI consists of the following movements:
- Gait on a level surface
- Changes in Gait Speed
- Gait with horizontal head turns
- Gait with vertical head turns
- Gait and Pivot Turn
- Step over obstacles
- Step around obstacles
- Steps (up and down)
This takes about 15 minutes to complete and ideally, you are doing this one with your physical therapist. Most if not all PTs should be trained in administering it as it’s an important part of preventing falls and grading your risk.
For complete instructions please follow this link.
Another balance test I like to do if my clients are able to complete each of those successfully is reactive balance testing.
I’ve discussed reactive balance at length in this article that I encourage you to check out.
Reaction time is incredibly important in the ability to catch yourself when you fall and this is usually an issue with most older adults.
I’ve met a few seniors who are able to accomplish this task without issue, however even if they complete it safely (or you), I’d recommend still working on agility-based exercises.
Fullerton Advanced Balance Test
To learn about this test I recommend you read and watch the videos on this website — FAB – physio-pedia.
I’ll expand on the FAB in future edits of this article.
How to Stay Safe When Working On Your Balance At Home
If you are practicing static balance make sure that you are either in a corner of your home with a stable chair in front of you or that you feel comfortable enough to practice the specific exercise while being able to catch yourself.
Additionally, if your balance is severely impaired then you should only practice balance exercises with a trained professional or someone who has been trained by a professional to ensure that you do not fall.
Where To Start On A Balance Program?
This is a challenging question as there are so many different points to start.
Generally, I will give everyone a combination of the below type balance exercises. These are applicable to most of the population of 65 and older however if you’ve had a stroke or TBI and it’s happening recently you will likely need more guidance on that. This is more so for the general population of older adults with minimal to severe balance impairment.
Static Balance training
Static balance training consists of staying in a spot, usually standing, and holding it for a specified period of time.
I generally start my clients with some exercises from the four-stage balance test on a stable surface. If you did the four-stage balance test then I would recommend selecting the exercise that you could complete successfully, but, that you still had some challenges with.
Usually, this challenge comes with the semi-tandem or tandem stance, and then it becomes too difficult with a single leg.
If you can hold single-leg balance for 2-5 seconds without holding onto anything I would say you could even include working on single-leg balance.
If you can’t even hold it for two seconds then this is too difficult to start with and I would start with semi-tandem or tandem.
Dynamic Balance training
Dynamic balance is balance while moving. Dynamic balance can be anticipatory (which is what most of it is) or reactive as I’ll describe below.
The DGI (dynamic gait index) is a good test and also has a few movements in it that would be good to practice, as well.
Walking with head turns is a good one as this is a very functional thing that you do in everyday life.
Going up and down stairs, as well as avoiding obstacles or stepping over objects successfully, all of these things are important to practice as if you don’t do them, you can get worse at performing them.
Reactive Balance Training
Reactive balance training is just as it sounds. Instead of anticipating a balance disturbance, you are reacting to it.
This is (in my opinion), the most important type of balance to work on, aside from agility.
When you react, your brain doesn’t have as much time to plan out the best way to respond to a balance disturbance or change in equilibrium.
Your brain has to quickly respond and then cause your body to respond in the appropriate fashion.
People who can react quickly, usually don’t fall. I’ve tested over a hundred people in reactive balance at this time and I’ve had 80-year-olds who are incredibly fast at the draw and have never fallen. On the flip side, I’ve had early 70-year-olds who are very slow and have fallen many times and have a large fear of falling.
I’ll share a video below of a type of reactive balance and then I’ll also provide a link to a product that can help you do this on your own. You can of course watch the video that I made and just use that, but that might get a little boring, ha.
I generally have folks practice reactive balance for one minute at a time.
Advanced Level Balance Training (agility)
Once you’re able to balance on one foot or it’s improving and you’ve shown a decent score on the DGI and you’ve been consistently practicing reactive balance, it’s time to take it to the next level (if you want to).
Most of the seniors (older adults) I work with want to stay as independent and highly functional as possible.
This means that you should likely include some agility work into your workouts.
What is the difference of reactive balance training and agility?
Well, the truth is, they can be one in the same. Agility can be done with a preset drill where you know the exact movements that you need to do (just fast). But it can also be done with a reactive balance approach.
A simple example would be a lateral shuffle drill using two orange cones. These orange cones can be setup between 10-20 feet apart from each other.
Once you have the cones set up, the objective is to shuffle quickly side to side, touching each cone as you approach it.
The goal is to improve the number of touches you get within a time frame of 30 seconds or one minute depending on your endurance and fitness level.
There are many other cone drills that I put my clients through that I will share in future edits of this article. Please comment below if you’d like me to add more of those and if that interests you.
Oh, and I recently reviewed HASfit and Jenny McClendon, two larger youtube channels and websites that have created TONS of resources for seniors and older adults. I think you’ll find their resources very helpful in your fitness journey, too!
Thank you for reading! Here is another article about heavy lifting and whether it’s good for you!
