One in four adults over 65 reports falling every year. For older adults, falls are the leading cause of accidental death and injury. Everyone knows someone who has fallen, has been hurt, is hesitant to walk, has trouble with chairs, or relies on a cane or walker. What is the biggest predictor of falling twice? Falling once. 

Preventing the first fall should be on the top of everyone’s bucket list of life and health goals.

Why Balance Is Not a Sense—And Why It Matters for Fall Prevention

We have five senses that function at birth—sight, hearing, touch, taste, and smell. Our five senses cannot be improved by deliberate attention, but it is not uncommon to maintain all five senses for a lifetime, with no active input.

Despite the expression, balance is not a sense. Our sense of hearing and sight allow us to move toward a louder noise or toward a brighter light. On the other hand, we cannot sense balance as a point in space and move toward it. What we can sense is when we begin to topple over. How does an infant learn to stand erect? By falling a lot and learning (internally) how to avoid it.

We are born with the innate capacity to balance, but it takes a year for the capacity to develop into standing (it takes a baby elephant two hours). Unlike the five senses, balance can be improved by activity or balance can be lost through inactivity. 

In other words, when it comes to balance, it is not a sense and self-help is everything. If you treat balance as just another sense, you have a good chance of losing it.

Balance Loss vs. Vision Loss: Understanding the Difference in Aging

Because older adults have common maladies, it might be tempting to liken balance loss to vision loss. Like diminished eyesight, unhealthy imbalance—not caused by another medical condition—typically manifests later in life.  But that is where the comparison ends.

Diminished eyesight is age related. Though there are certainly exceptions, loss of visual acuity in a healthy adult is not use related or preventable. In most cases, diminished eyesight is correctable.

Unhealthy balance is not age-related; it is use-related and it is preventable. Improving unhealthy balance is more challenging than correcting unhealthy vision.

At 75, I have practiced tai chi as a martial art for more than 48 years. My balance and stability (and those of my classmates) are excellent. Never better. My vision depends on medical science.

The Human Balance System: Why It’s Critical for Preventing Falls

Humans evolved with an extraordinary ability to balance. We are the only species that stands fully erect on two legs, walks on the full foot, moves with only one leg touching the ground at a time, walks with arms relaxed, and has the ability to improve balance for work and for sport.

The act of balancing does not result from a conscious thought. Thinking is too slow. Balancing is not lateral body movement or stepping. Stepping is an indication of imbalance. Balance is not the same as strength. A weightlifter is not automatically a good skier. We do not fall because we are too weak—we fall because we lack balance. Balance is specific. We can have great balance while running, but not while ice skating. 

What Is Balance? How the Body Maintains Stability and Prevents Falls

Balance is an unconscious, involuntary, trainable, biological mechanism that functions body-wide as a reflex arc that rapidly and automatically responds to a fear/sensation of toppling. Balance is down/up and best executed on a single leg. Down refers to creating a downward impulse force, and pressing into the ground. Up refers to holding the body vertical above that point. In tai chi, we call this rooting.

Balance is something you have or do not have at the moment; it is not something you do. While you can direct or will the body’s phasic or action muscles to move in a certain way, you cannot direct or will the body’s postural muscles to balance. Thus, you can lift a leg, but not necessarily balance on the same leg. 

Losing Balance With Age: How to Prevent Falls in Older Adults

We have come to learn that adults do not age gradually; we age in two spurts: first, at age 45, and then at 60. Imbalance is a condition that begins at midlife, brought about by chronic disuse. Key muscles in otherwise strong and healthy adults, including the gluteus and the quadriceps, begin to shrink and atrophy, quite noticeably, slowly losing their ability to balance and stabilize the body. 

It is common to see a strong man with a big chest and broad shoulders, a small buttocks, and spindly legs. In terms of long-term balance, upper body strength does not compensate for the loss of major muscles below the waist, which by mass are eight times larger and which are the foundation of balance and movement. In tai chi, we say that the bottom leads the top, the top follows the bottom.

Falling and loss of healthy balance is a medical epidemic without a medical solution. There are no pills and no surgeries that can restore healthy balance lost from disuse. If we ignore our balance until we start to experience its loss, it may not be possible to restore it. Therefore, to maintain healthy balance, prevention is the best medicine. This means exercising the body’s postural or balance muscles.

Weight-Bearing Exercises: The Key to Fall Prevention and Healthy Aging

When we stand with straight legs, our skeleton supports us. When our bones directly support our body, we do not feel our own weight. When we stand/squat with bent knees and ankles, press into the ground with the ball of the foot and sustain this position, we feel our own weight. This is because our balance muscles, not our bones, are holding the body erect. This is a weight-bearing posture.

Of course, in both ways of standing, we weigh the same. But the sustained bent knee and ankle position makes demands on the body that standing with straight legs does not. Holding a weight-bearing posture for increasing lengths of time (rather than repeating the posture) teaches the postural muscles to balance. Recall the first lesson when learning any sport: Bend the knees! Try brushing your teeth standing only on one slightly bent leg, for two minutes each leg. For reference, my tai chi form consists of 108 moves on bent legs for 45 minutes. 

We have come to learn that the skeleton is an organ, not a frame to hang stuff on. Weight-bearing exercise or a sport characterized by a sustained bent knee and ankle position also stimulates the bones to produce bone cells, thereby becoming denser, as well as producing a range of hormones, such as osteocalcin, which regulate memory, appetite, muscle health, fertility, and metabolism.

Weight-bearing sports and exercises include ice-skating, roller-skating, skateboarding, snowboarding, downhill skiing, cross-country skiing, wave surfing, water skiing, stand-up paddle boarding, tai chi as a martial art, qigong standing exercises such as Zhan Zhuang, and tai chi-inspired exercises such as my own Postural Retraining™. 

In my view, tennis, golf, walking, and jogging are all wonderful activities, but they are not weight-bearing sports. I say this as a former sprinter and a vigorous urban walker. Hiking on a rocky trail, where challenging single leg balancing is required, is weight-bearing. Any standing leg exercise in a gym that is repetitive or involves strength building with weights or machinery is likely not weight-bearing. Weight-bearing exercises, which are integral to tai chi as a martial art, are the perfect example of where less is more.

Invest in Balance Training: Daily Practices for Preventing Falls

Take heart: Humans evolved to balance on one leg, not to fall. We are not genetically destined to topple over as we age. You know how to save money for retirement. Now save your healthy balance for retirement!

There are two paths to a life of healthy balance. The first is luck. The second is intentional and focused balancing every day. 

To invest in future healthy balance, if you are in midlife, aim for at least 30 minutes a day in a weight-bearing sport or exercise. If you are a senior, aim for 60 minutes. The improvement to balance and stability will become obvious, and in turn, you will become motivated to exercise.