Strength and balance exercises for seniors: where to start

Strong and steady: the two halves, and which one to start with

Two different problems get bundled into one phrase, and they need different training. Weak legs are a strength problem: you push off the arms of the chair, and you look at a low sofa twice before you sit down on it. Poor balance is a skill problem. The legs have enough in them, but you wobble turning in a doorway, and at some point you notice your hand has gone onto the wall without being asked.

Keeping them apart matters because the training pulls in opposite directions. Strength work wants load and effort, with the last few repetitions feeling genuinely hard. Balance work wants a narrow base and a small wobble you catch and correct yourself, and straining at it only gets in the way. People who do only one of the two have usually picked the one they were already better at.

So choose by what goes wrong in your own day. Unsteady on your feet, or frightened of falling? Start on the balance side. If it is the chair and the stairs that stop you, start on the strength side.

Both programs are here in full. Balance and falls prevention holds the staged balance program and strength training for older adults holds the staged strength program, with video on every exercise. This page is the signpost, not a third program.

How often should older adults do strength and balance exercises?

The two halves come with different numbers, from different sources, and both ask for more than people expect. For strength, the NHS tells adults aged 65 and over to do activity that improves strength, balance and flexibility on at least 2 days a week, on top of being active in some way every day. For balance, the World Falls Guidelines are more specific and more demanding: balance-challenging and functional exercise, with standing up from a chair and stepping given as their examples, three times a week or more, individualized, made harder over at least 12 weeks and carried on beyond that for a bigger effect (Montero-Odasso 2022).

In practice that usually means short sessions on most days, not three long ones, and it means planning for this to be permanent. Every repetition, hold and set on this site comes from the exercise page it belongs to, and your physio will adjust this to you.

Where to start if you feel unsteady on your feet

Start at the first stage of the balance and falls prevention program, with a kitchen counter or a sturdy chair within easy reach, and tell your doctor you feel unsteady before you do anything else. That page owns the stages, the stance and stepping technique, and the rule for when to move up.

Narrowing your base is where the balance training actually happens. Semi-tandem stance moves one foot forward about half its length, tandem stance puts one foot directly in front of the other, and single leg stance is the far end of that road, not the place to begin. The balance and walking exercises library has all of them if you want to see what exists first, and balance conditions lists the programs that touch balance.

If the unsteadiness is more spinning than wobbling, that is a different problem with a different treatment: see dizziness and BPPV.

Where to start if getting out of a chair is the hard part

Start at the first stage of strength training for older adults, which begins seated or with the armrests taking some of your weight. Sit to stand using the armrests is the one to learn properly, because the fault in it is so common: people try to rise straight upward instead of bringing the head forward over the toes first. The chair squat follows it.

Progress at home is mostly about taking help away, not adding weight, and our guide to how a physical therapist progresses an exercise explains why that order works. If a painful hip is what limits you and not weakness, the gentler seated and standing exercises for older adults set is written for an arthritic hip. If sitting down to a session is what never happens, exercise snacks makes the case for a minute at a time through the day. Readers on a weight-loss medicine have their own page: older adults on GLP-1 medicines.

Does exercise really prevent falls?

The right kind lowers the number of falls, and nobody can promise you will not fall. The Cochrane review of exercise for older people living at home found that exercise cut the rate of falls by around a quarter, a 23% reduction, and cut the number of people who fell at least once by about a sixth, 15%, both rated high-certainty evidence (Sherrington 2019). Programs built mainly on balance and functional exercises reduced the rate of falls by 24%, and programs that combined several types, usually balance and functional work plus strength training, probably reduced it by 34%, with less certainty. The same review was uncertain about strength training on its own, and that is the line we would underline on this page: a gym habit with no balance work has not been shown to cut falls.

Two things belong with those numbers. This is something you keep up rather than something you finish, which is why the World Falls Guidelines ask for a program carried on beyond the first 12 weeks for a bigger effect (Montero-Odasso 2022), and these were trial programs that were supervised, individualized and progressed, not a list printed off and done twice. The full evidence section, including the dose comparisons and what the guidelines ask of a program, is on balance and falls prevention.

Checking your balance, and getting up from the floor

Two questions come up so often that each has its own page in this hub. Balance tests for older adults goes through what the quick clinic tests measure and what they do not, and the two best known have their own pages with their norms and their limits: the Timed Up and Go test and the 30-second chair stand test. No single test decides your falls risk, so read those cut-offs next to a clinician and not on your own.

The second is the one people are most reluctant to raise. Getting up from the floor covers why the route back onto your feet is worth rehearsing before you need it, and the getting up from the floor exercise page has the movement itself with video. Practice it with a physio the first time, and after that only with someone at home.

What a falls plan covers besides exercise

Exercise is the part you control, and it is not the whole plan. The NHS lists weaker muscles, conditions that affect mobility or balance such as arthritis, stroke and Parkinson's disease, low blood pressure, side effects of some medicines, problems with eyesight or hearing, and dementia among the common causes of falls in older people. Most of those are somebody's job, not yours.

Your home comes first, because it is where the trips happen: clutter and loose wires off the floor, rugs dealt with, a light you can reach for the trip to the toilet. Your medicines are a conversation with your doctor or pharmacist, never a change you make yourself, and the same goes for an eye test, a hearing check and a look at painful or numb feet. Weak bones are the other half of the story, since the fall and the fracture are separate risks: see osteoporosis for how to bend, lift and load safely, or muscle and bone loss in midlife if you are earlier in that story. After a broken hip, follow hip fracture rehab rather than this page. Each of those sections is covered properly on the page that owns it, and balance and falls prevention has the home, medicines, eyesight, hearing, feet and vitamin D paragraphs in full.

Before you start: the setup, who needs to ask first, and when to stop

The setup comes first in this section and the stop signs come last, and both of those are for everybody. In between are the paragraphs on who should ask a doctor or physio first and on what to do if you fall, and all of it comes before the four exercises below.

Set up the same way every time, because on the exercises below the setup is the safety. A firm, heavy chair that will not slide or tip, with its back against a wall. A counter or solid worktop within arm's reach for anything done standing. Flat shoes that fit well and grip, not socks, tights or bare feet. The rug, the trailing cable and the pet bowl moved out of the space before you start rather than halfway through a set.

If you have fallen in the past year, feel unsteady on your feet, or take medicines that make you dizzy, keep a hand on the support throughout, practice only when someone else is at home, and ask your doctor or physio about a falls check.

If you have osteoporosis, whether or not you have fallen, have someone nearby for the two balance holds and keep a hand on the support throughout them. For the two chair exercises, put the chair next to a counter or wall you can reach once you are upright. With thin bones it is the fall that breaks something, so the hold where you might wobble is the one that needs another person in the house, and that matters more than how hard an exercise feels. Ask your doctor or physio about a falls check as well, even if you have never fallen, because the World Falls Guidelines say adults with osteoporosis should have their falls risk assessed (Montero-Odasso 2022).

If you live alone, that rule still stands, so plan around it rather than ignoring it. Do the exercises that ask for someone to be at home at your physio appointments or in a falls prevention class instead, keep to the seated and supported work when you are on your own, and ask your physio which of the standing exercises you may do alone. Keep your phone in a pocket rather than in another room, so you can reach it from the floor, and ask about an alarm you wear.

If you do fall and cannot get up, or you think you may have hurt your head, neck, back or hip, stay where you are, keep warm and call emergency services, or get someone to call for you. Do not let anyone haul you up first. That line and the rest of the fall routes, including what to do if you got up fine and only hurt later, are in the warning signs below.

With a heart condition or high blood pressure, check with your doctor before you start. This matters most if your blood pressure is not under control. If you have high blood pressure, breathe steadily through every repetition and never hold your breath. If you have had an operation recently, or have broken a bone that is still healing, follow the program from your surgeon, fracture clinic or physio rather than this one.

If you have had a hip or knee replacement, get the go-ahead from your surgeon or physio before you try the sit to stand exercises, the chair squat, the semi-tandem and tandem stance holds, stairs, step ups or getting up from the floor. Some operations limit this kind of work for the first months, so the timing depends on your surgery. Ask them as well what seat height suits you, because it is a low seat that takes the hip past a right angle.

Getting up from the floor needs that go-ahead after more operations than those two. A broken hip that was pinned or replaced, surgery on your spine, heart or chest surgery, and an operation on your shoulder or arm each set their own limits on kneeling, on bending, or on pushing up through your arms, so after any of them the floor transfer waits for your surgical team. How to get up from a fall sets out which limit belongs to which operation, and what to do if you are on the floor now.

If you have had a hip replacement, or a broken hip or leg fixed with screws, a nail or a plate, ask your surgeon or physio how much of your weight may go through that leg before you try any of the four exercises below. If you have been told to put only part of your weight through that leg, or none of it, or to keep using a frame or crutches for now, these are not yours yet, whatever the leg feels able to do: rising out of the chair sends your weight through both legs even with the armrests taking some of it, and both balance holds are done standing on them.

Stop at once if you get any of these: chest pain or pressure, dizziness or feeling faint, a racing or irregular heartbeat, or being far more out of breath than the effort should cause. Sit or lie down. If chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked.

The balance holds have their own stop sign. You feel dizzy, lightheaded, faint or sick, or the room seems to spin. Hold your support, sit down and get medical advice the same day before you practice again. If you faint, it does not settle within a few minutes of sitting still, your vision suddenly blurs or goes double, or you cannot stand or walk steadily, call emergency services.

Rising out of the chair is treated differently, because a brief wooze as you stand is common. You feel dizzy, lightheaded or faint as you get up. Sit back down and wait for it to pass. If it does not pass within a minute or two, or it keeps happening, get medical advice the same day before you practice again. If you faint, or it does not settle within a few minutes of keeping still, call emergency services.

A sudden loss of balance is different. Call emergency services straight away for any sign of a stroke, even if it goes away: sudden dizziness with unsteadiness or falling over, a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack).

Exercises that can help

Four exercises to show you what each half feels like, two from the strength side and two from the balance side. Each page gives its own starting numbers: sit to stand using the armrests often starts at 2 to 3 sets of 5 to 10, the chair squat at 2 to 3 sets of 8 to 12, semi-tandem stance at 10 to 30 seconds per hold, 3 to 5 holds with each foot forward, and tandem stance at holds of 10 to 30 seconds, 2 to 3 times with each foot in front. Those numbers are the whole day, not each time you try: the two chair exercises once a day or on most days, the two balance holds once or twice a day. Start with the sit to stand before the chair squat, and with semi-tandem stance before tandem. The setup and the stop signs in the section above come before any of them, the numbers on each exercise page come first, and your physio will adjust this.

When to see a physio (physical therapist) or ask about a falls assessment

Book an appointment when getting out of a chair or up the stairs has been getting harder, when you feel unsteady, or when you cannot tell which stage of either program you belong in. The NHS says to see a GP if you are worried about your balance or mobility, or if you have had a fall. A fall counts even when nothing was hurt and nobody saw it. People under-report this almost without meaning to.

A GP can look for the causes that exercise will not fix, check your balance and walking, and refer you to a specialist falls service. A physio or physical therapist will set which stage you start at, which of the standing exercises you may do on your own, and when to take support away. If you want something to work from in the meantime, the home exercise sheet maker will print the exercises you choose with their instructions and warning signs on one page. The warning signs below come first, and each one sets its own timing.

In this topic

• Balance tests for seniors: what a result means and what to do next

  What a balance test for seniors can and cannot tell you, how to check your balance at home with support, and when to ask for a falls assessment.

• How to get up from a fall: what to check before you stand

  How to get up from a fall: what to check before you move, the safe route onto your feet, what to do if you cannot get up, and how a helper should help.

Related exercise programs

• Balance and falls prevention
• Strength training for older adults
• Osteoporosis
• Hip fracture rehab

Common questions

References

1. Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019;(1):CD012424. doi:10.1002/14651858.CD012424.pub2
2. Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing. 2022;51(9):afac205. doi:10.1093/ageing/afac205
3. NHS. Physical activity guidelines for older adults. https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-older-adults/
4. NHS. Falls. https://www.nhs.uk/conditions/falls/
5. NHS. Symptoms of a stroke. https://www.nhs.uk/conditions/stroke/symptoms/
6. NHS. Fainting. https://www.nhs.uk/symptoms/fainting/
7. NHS. Low blood pressure (hypotension). https://www.nhs.uk/conditions/low-blood-pressure-hypotension/
8. NHS. Complications of a hip replacement. Page last reviewed 6 March 2024. https://www.nhs.uk/tests-and-treatments/hip-replacement/complications-of-a-hip-replacement/
9. American Academy of Orthopaedic Surgeons. Infection after joint replacement. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/joint-replacement-infection/

Written and checked by the PocketPhysio editorial team. Last updated 2026-10-18.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.