By Dr. James Lu, DPT, LAc
Do you or your family member has balance problems? Each year 1 in 3 people over the age of 60 experience a fall! Falls are the second leading cause of accidental or unintentional injury deaths worldwide. In 2000, direct medical costs for fall injuries totaled $20 billion. By 2020, the costs are projected to reach $44 billion. The good news, however, is that many of these falls can be prevented with the right training or exercises.
What are the reasons that make one feel dizzy, spinning of the room or difficult to maintain balance? Disturbances of the labyrinth in the inner ear, brain, cerebellum, blood circulation or peripheral nervous system are all the common causes for the balance problems.
Arthritis, joint pain, stroke, visual impairment, back or neck problems, myelopathy due to cervical spondylosis, parkinsonism and fall of blood pressure on standing (orthostatic hypotension) are other causes of balance problems and can contribute to risk of falls among the elderly.
Certain medications that depress the central nervous system may also increase the rate of falls by increasing the lack of coordination.
Research have found the evidence for the effectiveness of several exercises in improving clinical balance outcomes in elderly:
- Gait training
- Co-ordination and functional tasks
- Strengthening exercise
To keep the trainings adherence up, it is suggested to look for an approach with a ‘fun factor’. Some examples:
- Music-based exercise program – such as line dancing or folk dancing.
- Balance training using a virtual-reality system – a review in 2013 found this to be an effective method to train the balance in older fallers. This method is intended to compliment other fall prevention programs. 
- Tai chi – Tai chi has been proven to be an economic and effective way for training balance in older people. 
To ameliorate balance in elderly it isn’t enough to just follow a conventional exercise intervention such as muscle strengthening, stretching and aerobic exercises. It is better to also include static and dynamic balance exercises.
Examples of static balance exercises: Mini-squats, two-leg half tandem stance and one leg stance in a hallway (about 3 feet from wall to wall). Maintain each position for 30 seconds and repeat 3 times. For advanced training, you can perform these exercises while turning your head from side to side, or even with eyes completely closed.
Examples of dynamic exercises: lunges, sideways stepping, forward/backward stepping or crossover in a zigzag line. 
All of these exercises can be performed on even surfaces initially and progress to uneven surfaces.
Please note that before attempting any of these exercises, it is recommended to see a specialist or physical therapist first for a comprehensive assessment, advice and guidance.
Some of these exercises will not be suitable for everyone, and some are only suitable for certain conditions.
- Howe T.E. et al., Exercise for improving balance in older people, Cochrane Database Syst Rev, 2011fckLRLevel of evidence: 1
- Liu H. and Frank A., Tai chi as a balance improvement exercise for older adults: a systematic review, J Geriatr Phys Ther, 2010fckLRLevel of evidence: 1
- Zheng J. et al., Strategic targeted exercise for preventing falls in elderly people, Journal of International Medical Research, 2013fckLRLevel of evidence: 2
Dr. James Lu is Director of Rehabilitation at Zhu’s Neuro-acupuncture and Rehabilitation Center. He has been practicing for 18 years in rehabilitation settings integrating acupuncture and physical therapy. The facility, based in San Jose, CA, focuses on treating patients with stroke, spinal cord injury and other neurological and orthopedic disorders. He can be contacted at Dr.Lu@scalpacupuncture.org.