Key numbers
5.03 seconds
Longer eyes-open one-leg stand on average after programs combining several exercise types (Howe et al. 2011)
-1.63 seconds
Average change in Timed Up and Go time after programs combining several exercise types; lower is faster (Howe et al. 2011)
What Systematic recommends
Where to start
- Stand next to the wall or stable surface with bare feet flat on the ground, with a wall or other rigid surface that will not give way and a fixed visual point directly in front of you to focus on.
- Keep your eyes focused straight ahead on your chosen visual point, maintain awareness of the tripod points of contact through the standing foot, keep the standing knee soft and active, and breathe normally.
- Lift the inside foot approximately 6–12 inches off the ground, use as little pressure through the two fingertips as possible, for 3 sets, begin with a 10-second hold and work toward a 30-second hold.
Condensed from the published Development Pathway (Single-Leg Balance: Two Finger Wall-Assist Tripod Stand). This is a starting point, not a training program or medical advice.
What the trials found
A 2011 Cochrane review by Howe and colleagues pooled trials of exercise for balance in older people, most of them women living in their own homes. Its main outcomes were clinical measures of balance, and some trials tested more than one type of exercise.
By the end of programs that combined several types of exercise, people stood on one leg with their eyes open for 5.03 seconds longer on average (545 participants, 9 studies). Their Timed Up and Go time changed by -1.63 seconds, meaning faster (635 participants, 12 studies).
The Timed Up and Go also got faster after programs built on gait, balance, coordination and functional tasks (by 0.82 seconds; 114 participants, 4 studies) and after strengthening programs (by 4.30 seconds; 71 participants, 3 studies). Those gait and balance programs improved walking speed as well, with a standardized mean difference of 0.43 (156 participants, 4 studies).
A second review, by Lesinski and colleagues (2015), covered balance training in healthy older adults living in the community. Reactive balance improved, with a standardized mean difference of 1.01. A standardized mean difference puts results from different balance tests on one scale.
What kinds of balance were measured
The 2015 review grouped its outcomes. Steady-state balance means holding a steady position while standing or walking. Some outcomes were measured in the lab, such as how far the center of pressure moves during single-leg stance. Others were test batteries that combine several parts of balance, such as the Berg Balance Scale.
What the evidence does and does not show
Most studies reported results only up to the end of the program. The evidence for each balance outcome came from only a few trials in each exercise category, and most trials were judged at unclear risk of selection bias generally because their randomization methods were not reported well enough. In the 2015 review, study quality was rather limited, with a mean PEDro score of 5.
The 2015 review also explored how much training went with the largest gains. A total of 36-40 training sessions went with the largest effect on overall balance (standardized mean difference 1.39). The authors note that dose-response relationships had not been established before, and that it is hard to separate one part of a program, such as how often people trained, from the rest. It is an exploratory finding across varied studies, not a best program for everyone.
For general physical activity such as walking or cycling, and for computerized balance programs or vibration plates, there was no or not enough evidence to draw conclusions. Few adverse events were reported, but most studies did not monitor or report them.
A better score on a balance test is not the same as fewer falls. These trials measured clinical balance tests, not the Systematic balance test, and they do not show the effect of any single Systematic exercise.
The evidence
Each cited source is labeled according to how it supports the particular claim on this page. Direct test evidence, underlying-capacity findings and population reference values are distinguished from Systematic-defined protocols and standards. Historical development notes are retained internally rather than presented as public evidence. A study of an underlying capacity is never presented as validation of the Systematic test itself.
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Underlying-capacity evidence New source
Howe et al. (2011). Exercise for improving balance in older people. The Cochrane database of systematic reviews.
What it found. Exercise programs improved clinical balance measures in older people by the end of the program, for example eyes-open one-leg standing time (5.03 seconds longer) and the Timed Up and Go (1.63 seconds faster).
What it does not show. It is a dated review whose results rest on few trials per outcome. It does not show fewer falls, or whether gains lasted after programs ended.
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Underlying-capacity evidence New source
Lesinski et al. (2015). Effects of Balance Training on Balance Performance in Healthy Older Adults: A Systematic Review and Meta-analysis. Sports medicine (Auckland, N.Z.).
What it found. Balance training improved measured balance in healthy older adults living in the community, including reactive balance (standardized mean difference 1.01).
What it does not show. Its dose findings are exploratory, not a best program for everyone, and better test scores do not automatically mean fewer falls.
The Systematic Healthspan Assessment is a physical baseline. It is not a diagnosis, and it does not estimate a biological age, a disease risk or a lifespan.