Balance in Aging: Balance Testing and Strategies for Improvement

In a nutshell

  1. In this article, we’ll explore the changes in balance and stability with aging, simple balance testing techniques to assess your current balance, and factors that affect it.
  2. A variety of professional tests exist for assessing balance and stability, but you can also perform several straightforward at-home tests to get a clear understanding of your equilibrium and stability. Some of these simple tests can even provide insights into your longevity prospects.
  3. We explore what changes happen in our bodies during aging, leading to an increased risk of falling and injuries and how to prevent it.

Our balance and stability progressively decline as we age, emphasizing the need to preserve and enhance our physical fitness. Balance typically deteriorates more rapidly after the mid-50s, increasing the risk of falls and other adverse health outcomes. Good balance and stability are not only vital for preventing falls and injuries but also for improving overall quality of life, mobility, and independence.

This article will explore the importance of balance and stability, delve into the factors affecting these components, and discuss age-related changes. We will also outline methods to assess balance and stability in older adults and provide an overview of effective exercises and lifestyle factors to improve these areas.

Understanding Balance and Stability

Balance and stability are closely related concepts, but they have distinct differences. Let’s explore each term and how they differ from each other.1 Anderson K, Behm DG. The impact of instability resistance training on balance and stability. Sports Med. 2005;35(1):43-53. doi: 10.2165/00007256-200535010-00004. PMID: 15651912. PubMed Source

Balance refers to the ability to maintain control of your body’s position, whether you are stationary or moving. It involves the even distribution of your body weight to prevent falls and ensure that you can perform various physical activities safely and efficiently. Achieving balance requires the coordination of various sensory inputs, such as vision, proprioception, and the vestibular system, as well as good muscular strength and control.

On the other hand, stability is maintaining a steady position while resisting external forces or disturbances. It is an essential component of balance, as it helps you maintain equilibrium in the face of various challenges, such as uneven surfaces or sudden shifts in your body weight. Stability depends on factors such as your base of support, the center of gravity, and coordination between your muscles and nervous system.

In summary, balance is the overall ability to control your body’s position and maintain equilibrium. At the same time, stability is a specific aspect of balance that focuses on maintaining a steady position in the face of external forces or disturbances. Both balance and stability are crucial for performing daily activities, preventing falls, and ensuring long-term physical fitness and well-being.



As we age, various factors can contribute to a decline in balance and stability.2Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013 May;75(1):51-61. doi: 10.1016/j.maturitas.2013.02.009. Epub 2013 Mar 22. PMID: 23523272. PubMed Source

Decreased muscle strength. Muscle mass and strength can decline with age, leading to weakened muscles that are less capable of providing stability and maintaining balance.

Reduced sensory input. Age-related changes in vision, hearing, and proprioception can impair our ability to perceive our environment accurately, negatively impacting our balance.

Slower reaction time. As we get older, our reaction time may slow down, making responding quickly to sudden changes in our environment more difficult. Also, aging leads to a significant decline in the size and number of so-called fast-twitch muscle fibers.3 Lexell J. Human aging, muscle mass, and fiber type composition. J Gerontol A Biol Sci Med Sci. 1995 Nov;50 Spec No:11-6. doi: 10.1093/gerona/50a.special_issue.11. PMID: 7493202. PubMed Source They are usually responsible for producing rapid, forceful movements. They are particularly important when reacting to unexpected situations, such as stumbling on an object or slipping on a wet surface. A decline in the fast-twitch muscles leads to an increased risk of losing balance and falls.

Impaired coordination. During aging, coordination, which is the ability to execute smooth, controlled movements, gets impaired. Age-related changes in the nervous system, such as a decrease in nerve conduction velocity and the loss of nerve cells, can impair the communication between our muscles and nervous system, affecting coordination.

Balance Testing Tecniques

Balance testing provides you with valuable insights into your stability and overall physical function, enabling early identification of balance impairments and potential fall risks. Additionally, it offers a baseline measurement for assessing your progress and the effectiveness of interventions aimed at improving your balance and reducing the risk of falls as you age.

A healthcare or fitness professional can assess your balance and stability using various tests and tools such as Berg Balance Scale, Functional Reach Test, or Timed Up and Go (TUG) test. Here, we will focus on simple at-home tests to help you assess your balance and stability.

Single-Leg Stance Test

The Single-Leg Stance Test evaluates an individual’s balance and stability by assessing their ability to maintain equilibrium while standing on one leg.4Jonsson E, Seiger A, Hirschfeld H. One-leg stance in healthy young and elderly adults: a measure of postural steadiness? Clin Biomech (Bristol, Avon). 2004 Aug;19(7):688-94. doi: 10.1016/j.clinbiomech.2004.04.002. PMID: 15288454. PubMed Source

Stand near a wall or chair for support if needed. Perform this test with eyes open and hands on the hips. Lift one foot off the ground and try to maintain balance on the other foot for as long as possible. Repeat with the other foot. Difficulty maintaining balance for at least 30 seconds on each foot may indicate balance issues. You can check the video on how to perform it here.

It appears that this test is very informative when it comes to longevity. A new study suggests that later in life, the inability to stand on one leg for 10 seconds is associated with almost twice the risk of death from any cause within the following decade.5 Araujo CG, de Souza E Silva CG, Laukkanen JA, Fiatarone Singh M, Kunutsor SK, Myers J, Franca JF, Castro CL. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. Br J Sports Med. 2022 Sep;56(17):975-980. doi: 10.1136/bjsports-2021-105360. Epub 2022 Jun 21. PMID: 35728834. PubMed Source

The Sitting-Rising Test

The Sitting-Rising Test serves as an excellent indicator of musculoskeletal fitness, assessing an individual’s ability to sit down on the floor and then rise back up to a standing position without the aid of external support.6Brito, Leonardo Barbosa Barreto de et al. “Ability to sit and rise from the floor as a predictor of all-cause mortality.” European journal of preventive cardiology vol. 21,7 (2014): 892-8. doi:10.1177/2047487312471759 PubMed Source

To conduct the test, find a clear and flat space. Begin by standing and then lower yourself to sit on the floor, and rise back up to a standing position. Points are deducted for each support (like hands or knees) used while sitting down and rising. The maximum score is 10, combining the scores from both sitting and rising. The video illustration of how to perform it can be found here.

The Sitting-Rising Test is showing its value in predicting how long people may live. A study found that people between the ages of 51 and 80 who had trouble with this test were more likely to die earlier. In simpler terms, for every point you improve on this test, you have a 21% better chance of living longer. The researchers checked on people for about 6 years to come to this conclusion.

Tandem Stance Test

The Tandem Stance Test evaluates an individual’s balance, stability, and coordination by assessing their ability to maintain equilibrium.7 Jonsson E, Seiger A, Hirschfeld H. Postural steadiness and weight distribution during tandem stance in healthy young and elderly adults. Clin Biomech (Bristol, Avon). 2005 Feb;20(2):202-8. doi: 10.1016/j.clinbiomech.2004.09.008. PMID: 15621326. PubMed Source

Stand with one foot directly in front of the other, heel to toe. Hold this position for as long as possible, aiming for at least 30 seconds. If you struggle to maintain balance, it may indicate issues with stability. A good illustration can be found here.

Sit-to-Stand Test

The Sit-to-Stand Test evaluates an individual’s lower body strength, balance, and functional mobility by assessing their ability to repeatedly stand up from a seated position and sit back down within a specified time frame.8Bohannon RW, Bubela DJ, Magasi SR, Wang YC, Gershon RC. Sit-to-stand test: Performance and determinants across the age-span.8 Isokinet Exerc Sci. 2010;18(4):235-240. doi: 10.3233/IES-2010-0389. PMID: 25598584; PMCID: PMC4293702. PubMed Source

Sit on a chair with your arms crossed over your chest. Stand up and sit back down as many times as possible within 30 seconds. This test helps evaluate your lower body strength, balance, and stability. The illustration video can be found here.

How to Improve Your Balance and Stability?


Balance training exercises are essential for improving stability, particularly as you age. These exercises help to strengthen the muscles responsible for maintaining balance, enhance the function of the sensory systems involved in balance (vestibular, visual, and proprioceptive systems), and improve coordination between muscle groups.

Regular balance training can enhance your ability to maintain equilibrium during static and dynamic activities, reducing the risk of falls and injuries.9 Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, Cumming RG, Herbert RD, Close JCT, Lord SR. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. 2017 Dec;51(24):1750-1758. doi: 10.1136/bjsports-2016-096547. Epub 2016 Oct 4. PMID: 27707740. PubMed Source Incorporating specific exercises to improve your balance into your workout routine is very important.

Some studies have even suggested that balance training may contribute to better cognitive function in older adults, as it requires integrating multiple sensory systems and cognitive processes.10 Law LL, Fong KN, Yau MM. Can functional task exercise improve executive function and contribute to functional balance in older adults with mild cognitive impairment? A pilot study. British Journal of Occupational Therapy. 2018;81(9):495-502. doi:10.1177/0308022618763492 Source

It is important to remember that many other factors contribute to your balance and stability. Effectively managing stress and maintaining good mental health are essential for optimal balance and stability. High-stress levels can negatively impact your body’s ability to maintain balance, as stress can cause muscle tension, impair concentration, and decrease reaction times.11 Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017 Jul 21;16:1057-1072. doi: 10.17179/excli2017-480. PMID: 28900385; PMCID: PMC5579396. PubMed Source

In addition to stress management, adequate sleep is essential for optimal balance and stability. Sleep plays a vital role in the recovery and repair of the nervous and muscular systems, both of which are critical for maintaining balance.12Ołpińska-Lischka M, Kujawa K, Maciaszek J. Differences in the Effect of Sleep Deprivation on the Postural Stability among Men and Women. Int J Environ Res Public Health. 2021 Apr 5;18(7):3796. doi: 10.3390/ijerph18073796. PMID: 33916500; PMCID: PMC8038654. PubMed Source

Also, remember a well-balanced diet that provides the essential nutrients required for muscle strength, bone health, and overall physical function.

Recap and final thoughts

As we age, our balance and stability can change, making it essential to engage in specific exercises to maintain and improve these skills, especially for older adults. Incorporating targeted exercises can help prevent falls, promote independence, and enhance overall well-being. Factors such as proper nutrition, adequate sleep, and effective stress management also play a crucial role in supporting balance and stability.

References

  • 1
    Anderson K, Behm DG. The impact of instability resistance training on balance and stability. Sports Med. 2005;35(1):43-53. doi: 10.2165/00007256-200535010-00004. PMID: 15651912. PubMed Source
  • 2
    Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013 May;75(1):51-61. doi: 10.1016/j.maturitas.2013.02.009. Epub 2013 Mar 22. PMID: 23523272. PubMed Source
  • 3
    Lexell J. Human aging, muscle mass, and fiber type composition. J Gerontol A Biol Sci Med Sci. 1995 Nov;50 Spec No:11-6. doi: 10.1093/gerona/50a.special_issue.11. PMID: 7493202. PubMed Source
  • 4
    Jonsson E, Seiger A, Hirschfeld H. One-leg stance in healthy young and elderly adults: a measure of postural steadiness? Clin Biomech (Bristol, Avon). 2004 Aug;19(7):688-94. doi: 10.1016/j.clinbiomech.2004.04.002. PMID: 15288454. PubMed Source
  • 5
    Araujo CG, de Souza E Silva CG, Laukkanen JA, Fiatarone Singh M, Kunutsor SK, Myers J, Franca JF, Castro CL. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. Br J Sports Med. 2022 Sep;56(17):975-980. doi: 10.1136/bjsports-2021-105360. Epub 2022 Jun 21. PMID: 35728834. PubMed Source
  • 6
    Brito, Leonardo Barbosa Barreto de et al. “Ability to sit and rise from the floor as a predictor of all-cause mortality.” European journal of preventive cardiology vol. 21,7 (2014): 892-8. doi:10.1177/2047487312471759 PubMed Source
  • 7
    Jonsson E, Seiger A, Hirschfeld H. Postural steadiness and weight distribution during tandem stance in healthy young and elderly adults. Clin Biomech (Bristol, Avon). 2005 Feb;20(2):202-8. doi: 10.1016/j.clinbiomech.2004.09.008. PMID: 15621326. PubMed Source
  • 8
    Bohannon RW, Bubela DJ, Magasi SR, Wang YC, Gershon RC. Sit-to-stand test: Performance and determinants across the age-span.8 Isokinet Exerc Sci. 2010;18(4):235-240. doi: 10.3233/IES-2010-0389. PMID: 25598584; PMCID: PMC4293702. PubMed Source
  • 9
    Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, Cumming RG, Herbert RD, Close JCT, Lord SR. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. 2017 Dec;51(24):1750-1758. doi: 10.1136/bjsports-2016-096547. Epub 2016 Oct 4. PMID: 27707740. PubMed Source
  • 10
    Law LL, Fong KN, Yau MM. Can functional task exercise improve executive function and contribute to functional balance in older adults with mild cognitive impairment? A pilot study. British Journal of Occupational Therapy. 2018;81(9):495-502. doi:10.1177/0308022618763492 Source
  • 11
    Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017 Jul 21;16:1057-1072. doi: 10.17179/excli2017-480. PMID: 28900385; PMCID: PMC5579396. PubMed Source
  • 12
    Ołpińska-Lischka M, Kujawa K, Maciaszek J. Differences in the Effect of Sleep Deprivation on the Postural Stability among Men and Women. Int J Environ Res Public Health. 2021 Apr 5;18(7):3796. doi: 10.3390/ijerph18073796. PMID: 33916500; PMCID: PMC8038654. PubMed Source
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