Sumiko at 62: 4 simple exercises to improve balance from a physiotherapist

Just as the bicycle crept up behind me, the rider rang the bell. Shocked, I leapt from the pavement onto the grass verge, lost my balance and fractured my ankle.

That accident three years ago remains vivid in my memory. Since then, I try to walk deliberately, one foot in front of the other, and to stay more aware of my surroundings. My fear of falling is heightened by my osteoporosis because a simple fall can cause serious injury, a reality many older adults face.

Falls are closely linked to balance. “When balance is poor, the body cannot react quickly enough to prevent a fall,” says Dr Grace Lim Choong Yan, consultant in the department of geriatric medicine at Khoo Teck Puat Hospital.

Worldwide, falls are the second most common cause of accidental deaths, after road accidents, and people over 60 are at the highest risk. In Singapore, around one in three persons over 65 and one in two over 80 fall at least once a year. Falls account for about 40 per cent of injury-related deaths among older adults.

Dr Lim says that good balance is a complex, coordinated effort involving the brain, muscles and sensory systems.

Balance depends on three primary systems which send continuous feedback to the brain to help you stay upright.

• The vestibular system in the inner ear senses motion and orientation, helping you know if you are tipping forwards, backwards or sideways.
• The visual system – your eyes – tells your brain where your body is in space.
• In the proprioceptive system, or body awareness, nerves in the muscles, joints and feet inform the brain about the position of your limbs and the pressure they are under.

This is why standing on your toes with your eyes closed, like in a yoga class, can feel wobbly.

Closing your eyes removes visual cues about your position. Standing on your toes reduces the space to balance on — what experts call the “base of support” — so your nerves in your feet and ankles give less information. Your inner ear still senses motion, but with the other two systems limited, it is harder for your body to stay steady.

Balance can be affected when muscles, joints, nerves or the sensory systems are not working optimally.

Dr Lim says weak muscles, especially in the hips and thighs, make it harder to stand, walk or recover from a stumble. Stiff or painful joints, such as those affected by arthritis, can alter the way a person moves and reduce stability.

Nerve, vision and inner ear problems can further affect balance. Conditions like diabetic neuropathy reduce sensation in the feet, while changes in eyesight or inner ear function make it harder to judge distance, orientation and movement. “People wearing bifocal lenses may also experience balance issues,” Dr Lim notes.

Certain medical conditions can add to the risk. Stroke, dehydration, low blood sugar, infections or anaemia can all affect balance. Medications, including blood pressure medicines or drugs for sleep or anxiety, may cause dizziness or drowsiness, further affecting stability.

Poor balance can show up in subtle ways, says Dr Lim. You might feel unsteady when walking, notice yourself widening your stance – standing or walking with your feet farther apart to stay steady – or take slower, shuffling or uneven steps. Turning, stopping or changing direction may feel tricky.

Difficulty with everyday activities such as standing up, bending, reaching or climbing stairs – along with the need to hold on to furniture for support – can signal balance problems. Frequent falls or near misses when you almost fall but catch yourself are also warning signs, as are a stooped posture, a constant need to hold on to something and a general sense of unsteadiness.

Sometimes, people notice that one side of their body feels less steady than the other. When I do taiji, for example, I am much wobblier on my right side. Dr Lim explains that this is normal – most people have a stronger side due to natural dominance or medical conditions, say, a previous nerve injury.

“Balance is not only about keeping both sides in check,” she says. “It is also about keeping the centre of gravity stable against potential unwanted movements.” In other words, it is more important that your whole body stays centred and reacts quickly to small shifts to prevent falls.

To address balance problems, doctors assess overall health, medications, movement, vision, strength and body awareness to create a personalised plan. This may include physiotherapy, exercise, medication adjustments, referrals for eye or heart checks, and home safety tips.

Dr Lim says that as we age, muscles naturally weaken, so strengthening the core and legs helps support balance, posture and stamina. She also advises starting exercise early, eating well and keeping up with regular health check-ups.

The good news is that most healthy adults can improve their balance with simple exercises.

Physiotherapist Chan Wan Wee from the Singapore General Hospital’s department of physiotherapy helps older adults improve both balance and confidence. Many patients with balance issues have weak leg and core muscles, joint pain or stiffness, vision problems, medication side effects, inner ear issues or reduced sensation in their feet.

Being afraid after a fall or near-fall can make people move more carefully, which can actually make balance worse.

Physiotherapy strengthens posture-supporting muscles, improves flexibility and joint mobility, sharpens body awareness and fine-tunes vision and inner ear function. Gradual, safe challenges help reduce fear and build confidence.

Balance training focuses on everyday movements – standing, stepping, climbing stairs or navigating uneven surfaces – while walking practice can involve changing speed or direction, stepping over obstacles or gentle exercises for dizziness.

The exercises may seem simple, but that is what makes them effective. “Balance relies on basic movements and core strength,” explains Ms Chan. “Starting with simple exercises helps you do them correctly, progress steadily and avoid overloading your body. They are also easy to do at home, so people are more likely to keep up with them.”

Most older adults notice improvements within four to six weeks, starting with stronger muscles and growing confidence. Bigger gains usually appear over eight to 12 weeks, depending on fitness, health and consistency.

Safety is key. Use a sturdy chair or counter for support, make sure the area is well-lit and free of hazards, and have someone nearby if needed.

Ms Chan adds that balance is not just about preventing falls.

“Good balance boosts confidence in daily activities like getting dressed or picking things up, and allows older adults to stay active and social, which is important for both physical and mental well-being,” she says.