Balance decline can begin subtly in your 40s and 50s, becoming more noticeable after 60, due to age-related changes in the inner ear (vestibular system), muscle loss (sarcopenia), vision changes, and nerve signal weakening, with studies showing reduced one-leg standing time starting around age 50 and worsening with age, though regular physical activity can significantly slow this process.
Balance Exercise
1. Feet apart: Stand with feet about shoulder-width apart, eyes open, and hold steady for 10 seconds, working your way up to 30 seconds. If you find yourself swaying or reaching for the wall or counter frequently, just keep working on this exercise until you can do it with minimal swaying or support.
The study's authors note this quick, simple and free test — balancing on one leg with your eyes open — is something individuals can do to assess their own balance. “If you can balance on your leg for 30 seconds and you're over 65, you're doing very well,” Kaufman says.
Balance disorders may be caused by a head injury, ear infection, medications, certain health conditions or common vestibular disorders, such as Ménière's disease, that are related to problems in the inner ear.
"As we age, our muscles atrophy and their connection to our brain and the vestibular system weakens," she says. When the vestibular system weakens or becomes damaged, balance problems can arise.
Balance begins to decline as early as age 50.
Certain conditions, such as diabetes, heart disease, stroke, or problems with your vision, thyroid, nerves, or blood vessels can cause dizziness and other balance problems.
Losing your balance while walking, or feeling imbalanced, can result from: Vestibular problems. Abnormalities in your inner ear can cause a sensation of a floating or heavy head and unsteadiness in the dark. Nerve damage to your legs (peripheral neuropathy).
Based on your diagnosis, your best treatment may include eye and head exercises, walking exercises, balance exercises, and education about your dizziness problem. Exercises are progressed as you improve so that you are less dizzy when you sit still and when you do your daily activities.
When you're ready to try balance exercises, start with weight shifts:
The number one exercise for older adults is often cited as the squat, especially bodyweight or chair squats, because it builds essential leg strength for daily function, balance, and fall prevention, directly improving independence. However, a well-rounded routine also needs balance work (like Tai Chi), cardiovascular exercise (walking, swimming), and other strength training (resistance bands, push-ups) for overall health, as experts emphasize functional movement and power.
According to the National Institutes of Health (NIH), healthy seniors should walk 7,000 – 10,000 steps per day. That's an average of three to three and a half miles throughout the course of a day.
The 333 walking method, also known as Japanese Interval Walking Training (IWT), is a simple yet effective workout alternating 3 minutes of slow walking with 3 minutes of brisk (fast) walking, repeated several times (often 5 times for 30 mins), to boost cardiovascular fitness, strength, and metabolism without high impact, improving heart health, muscle tone, and glucose control. It's a low-impact, time-efficient routine developed by Japanese researchers for improving fitness and preventing lifestyle diseases, ideal for all ages.
The number one exercise to increase balance in seniors is the Single-Leg Stance, as it directly challenges stability and retrains the brain for better balance, with the goal being to stand on one leg for up to 30 seconds, using support as needed and gradually reducing it. This simple yet effective move, along with variations like heel-to-toe walking, builds core strength and confidence, significantly reducing fall risk, says Healthline.
The first thing an otolaryngologist will do if you have a balance problem is determine if another health condition or a medication is to blame. If so, your doctor will treat the condition, suggest a different medication, or refer you to a specialist if the condition is outside his or her expertise.
Walking Can Help
The good news is that there are ways to improve balance. Walking is the easiest way to start and counts toward your aerobic activity goals. Walking can help build lower-body strength, an important element of good balance.
The cerebellum is located behind the brain stem. While the frontal lobe controls movement, the cerebellum “fine-tunes” this movement. This area of the brain is responsible for fine motor movement, balance, and the brain's ability to determine limb position.
Common examples include antiseizure medications, some anti-infectives, and diuretics. Other medications that can cause vertigo include pain relievers, proton pump inhibitors, and some mental health medications. Some blood pressure, Parkinson's disease, and cancer treatments may also cause this side effect.
Feeling off-balance without dizziness can have many causes, including medication side effects, low blood pressure, benign paroxysmal positional vertigo (BPPV), Ménière's disease, and labyrinthitis. It may also be the result of a perilymph fistula, central nervous system issues, or peripheral nerve damage.
Inner ear disorders usually cause issues with orientation. The most common disorder is called Benign Paroxysmal Positional Vertigo (BPPV). This type of disorder occurs when particles in our inner ear have moved into the wrong position.
The key for building balance is to step up and down slowly and in a controlled manner. Perform up to 5 steps with each leg.
A vestibular assessment is used to understand the problems you are having with balance and dizziness. A vestibular assessment can take up to two hours. The tests performed will depend on the problems you are having. The tests look at the way your brain combines information from your balance organ, vision and body.
It is also very important for our sense of balance: the organ of balance (the vestibular system) is found inside the inner ear. The vestibular system is made up of three semicircular canals and two otolith organs, which are found diagonally under the semicircular canals.
When should I see my healthcare provider? If you often feel unsteady or off balance, talk to your healthcare provider. It's especially important to let them know if your symptoms aren't improving with treatment — or if they're getting worse. You could be dealing with an underlying issue that needs a different approach.