Diabetes Forecast

The Power of Balance

Don't forget this important part of staying fit

By Carolyn Butler ,

I spend lots of time thinking about balance: how to juggle my kid and my work, my work and my husband, my husband and my kid, and all three of those things with my own needs. But I must say, it's been quite a while since I actually considered balance—in the sense of the body's ability to maintain equilibrium against gravity.

A growing number of doctors, physical therapists, and health experts contend that balance is in fact an essential, if often overlooked, element of fitness—and every bit as important as aerobic activity and strength training. "We should all be paying attention to balance, especially as we get older," says Scott McCredie, author of Balance: In Search of the Lost Sense. Based on information from the National Institutes of Health, McCredie estimates that 15 to 20 million people experience balance problems that affect the quality of their lives. Being off-balance can lead to falls, he adds, a major concern given that one out of three Americans over 65 take a spill annually, resulting in bruises, broken bones, and even head trauma and death. "Balance peaks in your 20s and then starts to degrade from age 30 on, slowly," explains McCredie. "Starting at 65 it deteriorates much faster, if you don't do anything to compensate."

So how does balance work, exactly? It's surprisingly complicated, involving the brain, muscles, and bones working together to process sensory information. This data comes from several places: vision, the vestibular system in the inner ear, and proprioception, or the sense of where your body is in space. "Good balance requires input from so many portions of the body," says Marilyn Moffat, PT, DPT, PhD, a professor of physical therapy at New York University and coauthor of Age-Defying Fitness, who notes that muscle strength in the lower body, particularly the ankles and knees; good posture; and a strong core are key. "It's almost all-encompassing," she says, "which makes it all the more fun to think about how you can improve it."

The fact is, people can both preserve and restore balance with regular exercise and practice. "The data definitely show that balance can be improved in the same way anything else in fitness [like aerobic conditioning or strength] is improved," says Moffat. Although a growing number of gyms offer classes like Bosu, which use balance balls or boards, you don't need a fitness club membership or special equipment for good training. The Harvard Women's Health Watch recommends these simple exercises, which are easily integrated into everyday life:

  • Stand on one leg whenever you're waiting in line at the theater, bank, or grocery store.
  • Stand on one leg while brushing your teeth: one minute on one leg while brushing the upper teeth, and another minute on the other leg while brushing the lower teeth.
  • Ask someone to toss you a Frisbee or beach ball while you balance on one leg and then on the other.
  • Practice sitting down and getting up from a chair without using your hands.
  • Practice walking heel to toe—that is, like a tightrope walker, placing the heel of one foot just in front of the toes of the opposite foot each time you take a step.

Once you've mastered these exercises, try closing your eyes while you perform them to add another element of difficulty.

If and when you're ready to take your balance training to the next level, you can use the more formal routine at right. You may also want to investigate Tai Chi, which is now offered at many gyms and community centers. This Chinese mind-body practice, which uses precise but gentle, flowing, dance-like movements, has widely been proven to improve balance. For example, a 2005 study in the Journal of Advanced Nursing found that after 12 weeks of regular Tai Chi classes, elderly adults had better physical fitness, stronger knee and ankle muscles, improved mobility and flexibility, and better balance—as well as a reduced risk of falls.

Balance work is essential for people 65 and over, but it's also important for those with diabetes, who are at a disadvantage because they may not get as much information from sensory fibers in the feet that play a role in proprioception, says Celeste Robb-Nicholson, MD, associate physician and associate chief of the General Internal Medicine Unit at Massachusetts General Hospital and editor-in-chief of the Harvard Women's Health Watch. "People with diabetes have increasing problems with balance because of potential foot problems and diabetic neuropathies, and should be especially proactive about improving balance," she says, noting that numerous studies have shown that people with diabetes are more likely to fall as they age. A 2005 report in the Journal of Gerontology, for example, found that 78 percent of nursing home residents with diabetes fell during a 299-day study period, compared to 30 percent of those without the disease. "A [person] with peripheral neuropathies has diminished sensory input from one of the most important places for training balance," says Robb-Nicholson. "Practicing balance exercises can help train other parts of the brain, and compensate for that lack of sensory input."

After a respectable balance test during which I managed to stand solidly on my left leg for 24 seconds and my right for 35, I've started working on some of our recommended exercises at home because, well, it can't hurt, right? (Balancing on one leg while brushing my teeth is a particular family favorite, which my son now loves to mimic!) I figure that even if I can't maintain equilibrium in my relationships and work-life pressures, at least I know I'll literally be standing on firmer ground, from this point on.

Carolyn Butler has written for the Washington Post and the New York Times, among other publications.

Are You On The Level?

So how do you know how truly good—or bad—your own balance is? Dr. Moffat suggests a simple test (to be performed near a stable counter or piece of furniture, just in case):

1. Stand straight, wearing flat, closed shoes, with your arms folded across your chest. Raise one leg, bending the knee about 45 degrees, and then start a stopwatch and close your eyes.

2. Remain on one leg, stopping the watch immediately if you uncross your arms, tilt sideways more than 45 degrees, move the leg you are standing on, or touch the raised leg to the floor.

3. Repeat this test with the other leg.

Now, see if you're hitting the average time for your age: 20 to 49 years old: 24 to 28 seconds on each leg. 50 to 59: 21 seconds. 60 to 69: 10 seconds. 70 to 79: 4 seconds. 80 and older: most cannot do it at all.

Skills and Drills for Balance

Balance is a motor skill like any other, says physical therapist Marilyn Moffat, one that you need to develop with instruction and practice, just like aerobic fitness or playing tennis. She recommends doing as many of the following exercises as possible once or twice daily, adapted from the full program described in her book Age-Defying Fitness: Making the Most of Your Body for the Rest of Your Life, coauthored with Carole B. Lewis. You may notice that your balance is better on one side or the other, says Moffat, who adds that it may not necessarily be your dominant side; in that case, you may want to do a few more repetitions or devote a bit of extra time to your weak side. Remember: As with all exercise, it's important to consult with your health care provider before beginning this program, but especially so if you have neuropathies or other foot problems.

Head Turns

  1. Sit up straight in a supportive chair. Tuck in your chin.
  2. Turn your head to the right and then to the left five times, gradually increasing your speed.
  3. Repeat this movement three times.
  4. Lower your chin to your chest and then raise it toward the ceiling, gradually increasing your speed.
  5. Repeat this movement three times.

Heel-Toe Walking

  1. Find a hallway or other area that's unobstructed for at least 10 feet; it should have firm flooring such as hardwood, linoleum, or low-pile or flat-weave carpet.
  2. Stand up straight. Lift your toes and the balls of your feet off the floor so that you are balanced on your heels.
  3. Walk 10 steps on your heels while keeping your body as straight as possible.
  4. Return to the starting position. Rise onto your toes. Walk 10 steps on your toes, keeping your body as straight as possible.
  5. Repeat these movements one to three times.

Forward Reaching

  1. Sit in a supportive chair. Keeping your arms straight, raise them in front of you to shoulder height.
  2. Keeping your back and arms as straight as possible and your shoulders parallel, reach forward as far as you can. Breathe deeply and hold this position for 10 seconds.
  3. Return to the starting position.
  4. Repeat this movement one to three times.

NOTE: If you have medium to severe osteoporosis, do not do this exercise.


  1. Stand up straight or sit in a supportive chair. Raise your arms out to the side at shoulder height.
  2. Slowly and smoothly touch your right index fingertip to the end of your nose.
  3. Return to the starting position.
  4. Repeat this movement three times.
  5. Return to the starting position. Touch your left index fingertip to your nose.
  6. Repeat this movement three times.

NOTE: To increase difficulty, close your eyes while performing this exercise.



Take the Type 2
Diabetes Risk Test