Exercise as a balancing act

Throughout our lives, being able to go about our daily activities without falling over is something we may take for granted. After all, being able to balance is something we don’t even need to think about. However, as we age, it may become something that we notice more, perhaps because we don’t feel as steady on our feet as we did.

“Maintaining good balance allows seniors to perform daily activities independently, maintain mobility, and enjoy an active lifestyle,” said Dr Amy Carmichael, a nutritional lifestyle medical doctor. “It helps prevent falls, which are a significant cause of injury among this age group.”

In fact, according to Neuroscience Research Australia, falls are the leading cause of injury-related deaths in Australia, costing the health system even more than road trauma injuries.

Dangers of falls due to impaired balance 

As we age, impaired balance resulting in a fall can pose greater risks than before, says Sydney physiotherapist Adam Monteith.

“As we age, bone density generally decreases, which means we’re more susceptible to sustaining a fracture,” he said. “Hip fractures because of a fall can be particularly debilitating, with the one-year mortality rate post-hip fracture in the over-65s estimated to be between 14 and 58 per cent.”

Mr Monteith says the consequences of falls due to impaired balance include, but are not limited to, minor to serious injuries, decreased physical activity leading to increased sarcopenia and frailty, and if serious enough, even death.

“Poor balance in older age can also lead to decreased confidence in our ability to walk, which can consequently reduce cardiovascular fitness, decrease muscle bulk, and thereby diminish quality of life,” he said.

“Alongside ageing, we experience a reduced ability to ‘adjust’ and react in response to a loss of balance. Therefore, the risk of a fall is significantly increased.

“A single fall can exacerbate one’s fear of falling, thereby continuing this cycle of decreased confidence in exercising, leading to poorer balance and increased risk of falling. Falls can also lead to loss of independence and social isolation as one is confined to the home due to injury or worry about falling while exercising.”

Exercises for maintaining balance 

Older people benefit from regular tai chi, group exercise programs, gym sessions, community-based falls-prevention programs or simple exercises at home to improve muscle strength and balance, says Professor Kim Delbaere, President of the Australian and New Zealand Falls Prevention Society.

“Research has also shown that regular exercise can reduce falls in older people by 23 per cent, but slowly building up high-challenge balance exercises can increase the effects of exercise by up to 40 per cent,” he said.

Dr Carmichael advises that seniors should choose activities that suit their abilities and avoid high-impact exercises that may strain their joints.

“Additionally, seniors should consult their healthcare provider before beginning any exercise program, especially if they have underlying health conditions,” she said. “It’s essential to start slowly and gradually increase the intensity and duration of exercise.”

Injury Matters, an organisation of injury prevention specialists, advises that when performing exercises, seniors should ensure they have a stable surface nearby for safety. It recommends activities, such as tai chi or lawn bowls, that involve leaning forward, backward or to the side. It also recommends strengthening the legs, which can be achieved even through everyday activities such as cleaning and gardening.

According to The Royal Australian College of General Practitioners, people with a greater  falls risk may benefit from exercising in smaller groups and closer supervision.

A review it conducted found that tai chi was the only single exercise intervention proven to reduce the risk of falling. It also found that programs including more than one category of exercise (balance training, strength training or walking) were effective in reducing both the rate and risk of falling.

Mr Monteith recommends having exercises prescribed by a trained professional to ensure they’re sufficiently challenging while safe, and to consult a physiotherapist for a balance assessment.

“This helps to determine falls risk and to provide a measure to determine improvement over time,” he said. “A walking aid may be recommended if an individual presents particularly at risk.”

Jason Cram, a Commonwealth Games swimming gold medallist, now runs Swimly, a swim school in Sydney that also caters to seniors.

“Swimming provides seniors with low-impact exercises in the water, which improve stability and coordination while gently strengthening the core, legs and ankles,” he said.

Studies show yoga has also been shown to improve balance, and Professor Anne Tiedemann from the Institute for Musculoskeletal Health in Sydney is currently studying whether yoga prevents falls.

Ryman Healthcare’s retirement villages run a ‘Triple-A’ exercise program, which was designed in conjunction with physiotherapist Dr Jennifer Hewitt for residents to maintain strength, especially in their legs, which can weaken due to increased sitting as they age.

The Ryman program even features effective seated exercises to build strength and improve range of motion. For example, ‘sit to stands’ involve sitting at the edge of the chair, keeping the core tight, then using the hips to stand up slowly, ensuring proper knee alignment, and then sitting back down while maintaining knee placement.


Melbourne-based Accredited Practising Dietitian Jacinta Sherlock says exercise can also help prevent age-related muscle wastage (sarcopenia) and that, where possible, having a meal after exercise may optimise muscle protein synthesis.

This is beneficial for the elderly, she adds, because due to a decrease in appetite, ensuring adequate energy and protein intake is essential in preventing weight and muscle loss.

She points to regular meals and snacks being helpful for this age group to meet their energy and protein requirements.

“Each of the three [daily] meals should ideally have 25-30g of high-quality protein,” she said. “Protein is essential in supporting muscle protein synthesis.”

Ms Sherlock adds that inadequate intake of energy and protein over time can lead to weight loss and low blood sugar levels.

“For elderly people who are on insulin, blood sugar levels should be monitored, a clear hypo management plan should be in place, and insulin regimes reviewed as exercise may reduce the dosage of insulin required,” she said.

“Low blood sugar levels are likely to impact brain function, as the brain requires a consistent supply of glucose. Impaired brain function may increase the risk of falls and accidents, contribute to agitation and confusion, and may increase the risk of a stroke and heart attack.”

Role of pharmacy assistants

Mr Monteith says pharmacy assistants can educate seniors on the risks of poorer balance, recommend physiotherapy to assist in improving balance and offer lifestyle modification advice.

He adds that PAs can promote balance and wellbeing events within their pharmacy, and strongly encourage older adults with the message that “it’s never too late to begin exercising to improve balance”.

Dr Carmichael cautions that it’s essential to stay informed about evidence-based exercises and refer seniors to relevant resources or community programs.

“Collaborating with physical therapists and other healthcare professionals can enhance your knowledge in this area and help you provide valuable advice to seniors regarding suitable exercises for improving balance and reducing fall risks.”

Dr Tiedemann says PAs could play a role in falls risk screening and in raising awareness about effective strategies to reduce the risk, such as participation in balance-challenging exercises, and reviewing medications to reduce the use of high-risk medicines and polypharmacy.

“Pharmacy assistants could direct older people to evidence-based fall prevention exercise opportunities and make them aware of freely accessible resources, such as the Safe Exercise At Home and Active and Healthy NSW websites,” she said

Injury Matters’ Stay on Your Feet website may also be helpful to refer patients to use, in addition to physiotherapist advice.

Ms Sherlock advises that Pas, when talking to seniors about diet, should ask if they’ve experienced a change in appetite and eating patterns and whether or not they’re “finding joy in eating”.

If intake has decreased, she adds, the PA may need to recommend optimising nutrition in the short term with regular meals and snacks, combined with nutritional fluids. The patient may also need to be referred to a GP to rule out any medical causes, or to a dietitian or psychologist to address the changes in eating habits.


  1. Physical Therapy in Movement (Brazil). ‘Yoga implications for preventing falls in older adults’. scielo.br/j/fm/a/WnSs94yS3xLwGbzHbnGxpXf/?lang=en
  2. Injury Matters. ‘Build your balance’.  injurymatters.org.au/programs/stay-on-your-feet/information-for-over-60s/build-your-balance/
  3. NSW Government. ‘Falls prevention’. cec.health.nsw.gov.au/keep-patients-safe/older-persons-patient-safety-program/falls-prevention
  4. Tiedemann A. ‘Reducing trips and slips: healthy exercises to prevent falls as we age’. nhmrc.gov.au/about-us/news-centre/reducing-trips-and-slips-healthy-exercises-prevent-falls-we-age
  5. Injury Matters. ‘Strengthen your legs’. injurymatters.org.au/programs/stay-on-your-feet/information-for-over-60s/strengthen-your-legs/

This feature was originally published in the August issue of RPA magazine.