Steady on your feet: New ways to improve balance and avoid falls

The Bottom Line

  • Pilates exercises (involving controlled movements to build flexibility, strength and posture) appear to have the potential of improving balance in older adults.
  • Balance-recovery training aims to improve reaction time after a loss of balance and also appears to help lower risk of falls.
  • More high quality studies are needed to learn more about whether Pilates and balance-recovery training may help to reduce the risk of falling. 

When it comes to keeping your feet safely on the ground – metaphorically and literally – it’s all about balance. But like many other things we take for granted when we’re young (strength, endurance, bone density, a full head of hair...) our sense of balance declines as we age. That’s one reason why older adults are at greater risk of falling and potentially becoming seriously hurt or even dying as a result (1).

Past research has shown that regular physical activity can help prevent falls, particularly when it includes exercises and movements designed to improve balance (2;3). Tai Chi for example, is recommended for its various benefits, including improving strength and balance through slow, controlled movements (4;5).

But if Tai Chi isn’t for you, there are other options you many want to consider. One systematic review of 15 randomized controlled trials measured the benefits of Pilates (6), a mind-body exercise that has been popular since the early 20th century. Like Tai Chi, it involves controlled movements and concentrates on flexibility, strength, posture and breathing (7). Each study included in the review revolved around older adult participants who took part in group Pilates sessions. The exercises varied (mat exercises as well as exercises using elastic bands, foam rollers, balls, or other equipment), and generally involved 60 minute Pilates sessions done 2-3 times a week. The study participants were either compared to folks who kept up with their usual daily activities but did not take Pilates, or folks doing task-oriented trainings such as yoga, stretching, aerobic exercises, and more (6).

Another emerging form of balance training that is gaining attention for its novel approach is “perturbation-based balance training” or balance recovery training. It focuses on improving people’s reaction time and helping them better recover from a loss of balance. Training can include equipment (such as moving platforms), or manual interference (such as nudges by a therapist) to enhance your ability to react and stop yourself from falling.

A systematic review of eight randomized controlled trials examined whether perturbation-based balance training lowers the risk for falls in older adults as well as people with neurological disorders such as Parkinson’s disease. More than 400 people between the ages of 50 and 98 took part in perturbation-based balance training and were compared with those in control groups who participated in other types of balance enhancing exercises (8).

What the research tells us

Both Pilates and perturbation-based balance training appear to be promising strategies (6;8)!

The review on Pilates suggests that compared to doing basic daily activities, Pilates may help older adults improve their dynamic balance (staying balanced while moving around or changing positions), as well as their static balance and stability (staying balanced when in an upright position or when doing things without moving your feet). The findings also support the idea that Pilates training may be better than other task-oriented trainings at improving overall balance, however more research is needed before we can say whether Pilates may help to reduce one’s chance of falling (6).

Another important thing to note is that although Pilates was conducted in group sessions within most of the research studies, this form of exercise can also be done from the comfort of your own home. This is super handy during times when accessing in-person classes is not feasible or appropriate, like during a quarantine and when policies around physical distancing are in place. For example, instructor-led online Pilates classes and videos are great ways to still engage in this form of exercise remotely, while also benefiting from some professional tips and guidance. Remember to start slow and take it easy if you are a beginner.

So far the evidence on perturbation-based balance training is also encouraging: participants completing the training reported fewer falls and were less likely to fall, compared with those in the control groups. Further research is needed but there is cautious optimism that this approach may help people react and recover their balance more quickly so that a slip or trip doesn’t necessarily have to end in a fall (8). This type of training uses specialized equipment and help from a trained physical therapist, so it may be worth keeping in mind for when you are able to access services in-person. 

Not sure which balance training exercises are best for you? Consider asking your physical therapist for guidance on where to start, but expect longer response times in instances such as the COVID-19 pandemic. At the same time, be aware of hazards and take the necessary precautions (e.g. good lighting, clear pathways, secure handrails etc.) so that you remain surefooted and safe as you enjoy an active lifestyle (9).

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  1. Centers for Disease Control and Prevention (CDC). Falls among older adults: An overview. [Internet] 2012. [cited Dec 2015] Available from: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html 
  2. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; 9:CD.007146.
  3. Sherrington C, Michaleff ZA, Fairhall N, et al. Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. Br J Sports Med. 2017; 51(24):1750-1758.

  4.  Mat S, Tan MP, Kamaruzzaman SB, et al. Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: A systematic review. Age Ageing. 2015; 44:16-24.

  5. Leung DP, Chan CK, Tsang HW, et al. Tai chi as an intervention to improve balance and reduce falls in older adults: A systematic and meta-analytical review. Altern Ther Health Med. 2011; 17:40-48.
  6. Moreno-Segura N, Igual-Camacho C, Ballester-Gil Y, et al. The effects of the pilates training method on balance and falls of older adults: A systematic review and meta-analysis of randomized controlled trials. J Aging Phys Act. 2018; 26(2):327-344. doi: 10.1123/japa.2017-0078. 
  7. Barker, AL, Bird M, Talevki J. Effects of Pilates exercise for improving balance in older adults: A systematic review with meta-analysis. Arch Phys Med Rehabil. 2015; 96:715-723.
  8. Mansfield A, Wong JS, Bryce J, et al. Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Phys Ther. 2015; 95:700-709. doi: 10.2522/ptj.20140090. 
  9. Public Health Agency of Canada (PHAC). You Can Prevent Falls. Ottawa, Canada. [Internet] 2011. [cited Dec 4, 2015] Available from: http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/prevent-eviter/index-eng.php

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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