Balance & Fall Prevention Training for the Older Adult

by: Josie Gardener & Joy Prouty

The inclusion of fun, effective and safe balance training in programs for seniors is critical. As the older adult population increases exponentially, the health care costs associated with a lack of balance and resultant falls totals a staggering 19+ billion dollars.

For the most transferable and useable functional balance training, exercises need to engage multiple muscles and stimulate the body's response in a manner that requires both to work together. This results in efficient movement. Both the BOSU® Balance Trainer (BT) and BOSU® Ballast® Ball (BB) are great tools to incorporate into programming in order to accomplish this goal.

Performing balance exercises on an unstable surface, or dome side up of the BT, results in unpredictable challenges to the body. Introducing this type of proprioceptively rich training and physical stimulus results in head-to-toe integrated strength gains, and helps to develops body awareness and reactive capability. Developing high levels of body control is an important goal. Proprioception is defined as the unconscious perception of movement and spatial orientation arising from physical stimuli (similar to standing on the dome of the BT), and the feedback provided by the body's feedback mechanisms including visual, vestibular and somato sensory systems. This type of training integration not only challenges the individual and is fun, but it also enhances the individual's ability to balance and move in a functional way, transferring to an older adult's real life needs. Older adults must be able to move through space, change direction, focus and react to everyday physical challenges on an ongoing basis. 


Both the BT and BB provide the participant the best of both worlds from a training perspective. The older adult is able to work on an unstable surface, but at the same time feel confident and secure in knowing that the unstable surface will stay in place underfoot. This allows for unstable training in a controlled, safe environment which is ideal to prepare the older adult for the daily physical challenges of life.

The following exercises may be simple or quite challenging for older adults. It is important for instructors to progress or regress each exercise as needed, to keep the participant safe, challenged and successful.

Balance Exercises on the BOSU® Ballast® Ball (BB)

1. Knee Lift: Sit on the BB with both feet a comfortable distance apart. Rest hands on sides of the BBor on hips. Lift R knee toward the ceiling, while maintaining balance and correct posture. Hold for 2 to 4 counts. Repeat with L knee. To increase challenge, close eyes. Cueing & Teaching Tips: Contract/tighten core muscles before lifting knee. Feel control first, then it will be easier to maintain balance with lifted knee. To increase challenge, bring both arms out to the side. Then, bring one arm forward and one arm backward in opposition. This modification requires unconscious/reflexive control needed in activities of daily life, as they are unpredictable. Ease into the challenge of closing eyes by squinting first. Then, close eyes completely when feeling secure. 2. Leg Extension with Rotation Sit on a BB with both feet a comfortable distance apart. Extend R leg in front with R heel resting on the floor. Rotate torso to the R, maintaining a neutral spine, return to the front and bring R leg back to starting position. Repeat with L leg. To increase challenge, close eyes as exercise is performed. Cueing & Teaching Tips: Contract/tighten core muscles before extending leg in front. Be mindful and set neutral alignment. Once a balanced position is set with the split stance of the legs, rotate torso slowly, going only as far as controllable. Use both arms to assist with balance. For example, if arms extend out to the side and the trainer moves with the participant during torso rotation, this helps to create a sense of balance and security. Ease into challenge of closing eyes by closing one eye (winking) first. Then, focus on core muscles before closing both eyes.

Balance Exercises on the BOSU®Balance Trainer (BT)

1. Unilateral Heel Raise Stand with L foot on the BT. Extend R leg behind with heel on the floor. Place hands on hips or extend out to sides. Lift R heel and lower to the floor. Repeat 6 to 8 times, maintaining balance and alignment. Bring both legs together on the floor to rest. Repeat on L side. To increase challenge, close eyes while lifting heel, but open eyes when lowering heel back to the floor.  Cueing & Teaching Tips: While in the beginning exercise position, or split stance, use the entire core to stabilize before lifting heel. Keep hips even throughout the exercise. The knee, ankle and toes of the back leg should be in a straight line, or facing forward. When lifting the back heel, lift the body straight up to avoid over flexing or overloading the front knee. Perform the exercise with control before closing eyes. 2. Split Stance with Torso Rotation Stand with L foot on the BT. Extend R leg slightly behind with heel on the floor. Place hands on hips. Rotate torso to the R, hold and return to starting position. Repeat 3 to 5 times. Repeat on opposite side (R foot on the BT, L leg extended slightly behind with heel on the floor). To increase challenge, extend arms out to the side. Then, close eyes during torso rotation. Cueing & Teaching Tips: While in the beginning exercise position, or split stance, use the entire core to stabilize before rotating torso. Keep hips even throughout the exercise. The knee, ankle and toes of the back leg should be in a straight line, or facing forward. Although torso rotation is very small (to protect the alignment of hips and extended leg), be aware of the proprioceptive challenge to maintain balance and alignment. To increase challenge, close eyes and maintain balance before rotating torso.

As with any series of exercises, progress slowly when introducing these balance moves into senior programming. Balance represents a double edged sword. When afraid of falling and unsure of balance, older adults often limit movement patterns, and actually become more likely to fall. So, while balance training should be integrated into a complete conditioning program for older adults, slow progressions are the key to building strength, balance, confidence and success.

About the Authors:
Josie Gardiner, a former Reebok Master Trainer and member of the Reebok University Development Team, is the 2002 IDEA Group Exercise Fitness Instructor of the Year and 2005 ACE Instructor of the Year. Gardiner served on the Massachusetts Governor's Committee on Physical Fitness and Sports for ten years. With over 35 years presenting for the fitness industry, Gardiner is recognized for her creative dance style and expertise with the 50-plus market.

Joy Prouty, a former Radio City Music Hall Rockette, has been a fitness instructor and trainer for 40 years. Prouty operates Fitness Programming, Inc., where she develops fitness programs for individuals and corporations, and conducts fitness instructor education. As a former member of the Reebok University Training and Development Team, Prouty taught fitness programs to trainers and consumers around the world. Certified by ACSM as a Health Fitness Director, she also holds certifications from ACE and AFAA, and is a certified and licensed Wellcoach.

Gardiner and Prouty have 14 fitness DVDs and eight music CDs on the international market mostly focusing on 50-plus and de-conditioned individuals. Partnering with Dr. Carolyn Kaelin, Director of the Comprehensive Breast Health Center at the Brigham and Women's Hospital in Boston, and Francesca Coltrera, medical writer, Gardiner and Prouty co-authored The Breast Cancer Survivor's Fitness Plan published by McGraw-Hill and Harvard Medical. They also co-developed the Zumba Gold training program, and are members of the Beamfit Advisory Board, to cater to program development for the active older adult.