Strength and balance training for older adults

Strong legs and steady balance help you get out of a chair, climb stairs and stay on your feet. They also protect you from falls. More than 1 in 4 people aged 65 and older fall each year, and one fall doubles the chance of another.¹

Strength and balance work can lift your mood, too. This page explains what the research shows, gives you a simple routine to try at home, and offers chair versions if standing is hard. It also explains the Otago program, one of the best-tested ways to prevent falls.

Why strength and balance matter as you age

Muscles tend to get smaller and weaker with age, especially if you sit a lot. Balance can slip, too. Weak legs and poor balance make falls more likely.

Falls are not a small problem. About 37% of older people who fall get hurt badly enough to need care or to cut back on activities for at least a day. Falls cause most hip fractures and are the top cause of brain injury from trauma in older adults.¹

Falls can also hurt your mood. Many people become afraid of falling again, even after a fall with no injury. They may stop going out or doing things they enjoy. That makes muscles weaker and raises the risk of another fall.¹ Strength and balance training can help break this cycle. If fear is holding you back, see fear of falling.

What the research shows about falls

Exercise in general

In 2019, a Cochrane review (a careful summary of all the good trials) looked at 108 trials. They included more than 23,000 older people living at home. Their average age was 76.²

The main findings, in plain words:²

• Exercise of any kind cut the number of falls by about 23%. That means roughly 1 in 4 fewer falls. The reviewers rated this evidence as high certainty.
• Balance and functional exercise (moves that copy daily tasks, like standing up from a chair) cut falls by about 24%.
• Mixing exercise types, most often balance plus strength work, cut falls by about 34%, or about 1 in 3.
• Tai chi cut falls by about 19%, but the evidence was less certain.
• Exercise also meant about 15% fewer people had any fall at all.

In 2024, the U.S. Preventive Services Task Force (USPSTF), a national panel of experts, reviewed the evidence again. It recommends exercise for adults 65 and older who are at higher risk of falling. It gave this a "B" grade, which means a moderate benefit.⁵ Most programs in its review met 2 to 3 times a week, often for a year. Side effects were mostly mild aches. Serious harms were rare.⁵

One limit: in these reviews, exercise did not clearly lower the number of broken bones.^2,5 But it did lower falls that caused injury.⁵

The Otago Exercise Program

The Otago program was created in New Zealand. In the first trial, published in 1997, 233 women aged 80 and older were split into two groups. One group got a home strength and balance program, and a physical therapist visited four times over two months. They were asked to exercise about 30 minutes, at least three times a week, and to walk outside three times a week.³

After a year, the exercise group had fewer falls: about 0.87 falls per person, compared with 1.34 in the other group. Women who fell often seemed to benefit most.³

Today, the program uses 17 strength and balance exercises plus walking.⁴ The National Council on Aging (NCOA) describes how it usually works:⁴

• A physical therapist checks you and chooses your starting exercises.
• You have about 4 visits over 8 weeks, at home, in a clinic, or in a group (even online).
• You do the exercises 3 times a week.
• After that, you keep going on your own for 4 to 10 more months, with monthly phone check-ins.

NCOA reports that people in the program have about 35% to 40% fewer falls. It seems to work best for frail older adults.⁴ It is a good fit if you have fallen before, have several health problems, or cannot get to a group class.⁴

Medicare and physical therapy. If a doctor or other qualified provider certifies that you need it, Medicare Part B helps pay for outpatient physical therapy. After the Part B deductible, you usually pay 20% of the approved amount.¹⁰ Ask your doctor whether a falls-prevention program like Otago is right for you.

Can strength training help your mood?

Yes, for many people. A large 2024 review in the BMJ looked at exercise for depression. Strength training eased depression by a moderate amount. People were also less likely to drop out of strength training than out of the comparison activities.⁸

There are limits. The trials were small, and the reviewers had very low confidence in the exact size of the effect. Strength training seemed to help younger people more than older people, and women more than men.⁸ Still, older adults can gain both a steadier body and a better mood. For the bigger picture, see exercise for depression and anxiety.

Exercise does not replace treatment for serious depression. If you take an antidepressant, keep taking it. Talk with your doctor or pharmacist before changing anything. See depression in later life.

How much do you need?

U.S. guidelines for adults 65 and older say:^6,7

• Strength: at least 2 days a week, working all major muscle groups: legs, hips, back, belly, chest, shoulders and arms.
• Balance: activities each week, such as walking heel-to-toe or standing up from a chair.
• Aerobic activity: at least 150 minutes a week of moderate activity, like brisk walking. Our 12-week walking plan can help.
• If health problems limit you: be as active as your body and conditions allow. Some activity is better than none.

The guidelines say programs that mix strength, balance and other activity work best to prevent falls. Easy walking alone does not seem to prevent fall injuries.⁶

Check your leg strength first

Doctors often use a simple test called the 30-second chair stand. You sit in a sturdy chair with no arms, cross your arms over your chest, and count how many times you can stand up fully and sit back down in 30 seconds.⁹

Only try this with someone standing next to you. For example, a score below 12 for men or below 10 for women aged 70 to 74 is below average and suggests a higher fall risk.⁹ If you need your arms to stand, the test is stopped and scored as zero.⁹ That is a sign to talk with your doctor. A low score is a starting point, not a failure.

A simple home routine

This routine uses moves similar to those in the Otago program, such as calf raises, sit to stand, sideways walking and heel-to-toe standing.^4,11 It is not a substitute for a program a physical therapist designs for you.

1. Warm up (2–3 minutes). Sit tall. Slowly turn your head side to side. Circle your ankles. March your feet in place while seated.
2. Sit to stand (strength and balance). Sit near the front of a sturdy chair, feet flat. Lean forward slightly and stand up, using your hands only if you need to. Sit back down slowly. Try 5 to 10 times.
3. Calf raises (strength). Stand holding the counter. Rise up onto your toes, then lower slowly. Try 10 times.
4. Toe raises (strength). Holding the counter, rock back onto your heels and lift your toes. Lower slowly. Try 10 times.
5. Side leg lift (hip strength). Holding the counter, lift one leg out to the side, keeping your body straight. Lower slowly. Try 10 times on each side.
6. Sideways walk (balance). Holding the counter, take small steps sideways along it, then come back.
7. Heel-to-toe stand (balance). Holding the counter, place one foot right in front of the other, heel touching toe. Hold for up to 10 seconds. Switch feet.
8. One-leg stand (balance). Holding the counter with both hands, lift one foot slightly. Hold for up to 10 seconds. Switch legs.
9. Cool down. Sit, breathe slowly, and notice how your body feels. You might try a few rounds of the cyclic sigh.

How to build up over time. Breathe normally during each move. Do not hold your breath. Move slowly and with control. Start with what feels easy, then add a few more repeats each week. As balance improves, hold the counter with one hand, then just a fingertip. Only let go fully if you feel very steady and someone is nearby. Rest a day between strength sessions if your muscles feel sore.

Chair options if standing is hard

If you cannot stand safely, or you use a walker or wheelchair, you can still build strength in a chair. Choose a sturdy chair without wheels.

Gentle forms of tai chi and qigong also have chair versions. See the tai chi lesson on stance and breath.

For people living with dementia

Falls are a common worry for families living with dementia, and exercise is one way to lower the risk. U.S. guidelines note that activity that mixes strength, balance and other movement can help people with dementia think more clearly.⁶ Simple, repeated moves done at the same time each day often work best. A caregiver can do the routine alongside the person. See preventing falls in dementia and exercise for brain health.

When to stop and get help

I fell once but was not hurt. Should I tell my doctor?

Yes. Fewer than half of older people who fall tell their doctor, but a fall is an important warning sign.¹ Your doctor can check your medicines, vision and balance, and may refer you to physical therapy.

How long before I notice a difference?

Many falls-prevention programs ran for months, often a year.⁵ Keep going even if gains feel slow. Many people notice that standing up gets easier first.

Is walking enough on its own?

Walking is good for your heart and mood. But easy walking alone does not seem to prevent fall injuries. Add strength and balance work.⁶

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.