The balance test you can do in your kitchen, and what to do if you fail it

Stand next to a kitchen counter. Put one hand on it. Lift one foot a few centimetres off the floor, and when you feel steady, let go of the counter. Count.

If you are under sixty and healthy, thirty seconds should be unremarkable. Between sixty and seventy, twenty seconds is a reasonable showing. If you cannot manage ten seconds on either leg, that is worth knowing about — a 2022 analysis of a Brazilian cohort found that inability to hold a ten-second one-legged stand was associated with substantially higher all-cause mortality over the following decade, independent of age, sex and body mass index.

That headline was widely misreported as "standing on one leg predicts death", which is not quite it. Balance is not magic. It is a summary statistic — it integrates leg strength, joint proprioception, vestibular function, vision, reaction time and neurological health into a single observable output. When it degrades, something upstream has usually degraded first.

Why balance goes, and why it goes quietly

Three systems keep you upright: your inner ear, your eyes, and the position sensors in your joints and muscles. In youth these are redundant — you can lose one and the others compensate without you noticing. With age, all three degrade slowly, and the redundancy disappears. Which is why a lot of people first discover their balance is poor in a dark bathroom, where vision has been removed from the equation.

Meanwhile the recovery mechanism weakens too. Catching yourself after a stumble is a rapid, forceful movement — it requires fast-twitch muscle fibres firing quickly, and those fibres are preferentially lost with age. So the wobble becomes both more likely and harder to recover from at the same time.

The result is not gradual. Balance holds up reasonably well and then falls off a cliff, usually somewhere between the mid-sixties and mid-seventies, and typically after a period of reduced activity — an illness, a hip replacement, a bad winter, a bereavement.

What actually works

The evidence base for falls prevention is one of the better ones in geriatric medicine, largely because falls are expensive and easy to count. The Cochrane review of exercise for falls prevention in community-dwelling older people, drawing on more than a hundred trials, found that exercise reduces the rate of falls by around a quarter. That is a genuinely large effect for a behavioural intervention.

But it is specific about what kind. The programmes that work share three features:

• They challenge balance directly. Not walking, not cycling, not swimming. Standing on a reduced base of support, moving the centre of mass, reducing hand support.
• They include strength work, particularly for the legs and hips.
• They are frequent and sustained — roughly three hours a week, ongoing. Balance is a use-it-or-lose-it adaptation, and it fades within weeks of stopping.

The best-studied specific programme is the Otago Exercise Programme, developed in New Zealand and delivered as a home programme with periodic supervision. It reduces falls by about a third in the frail elderly. Tai chi also performs well in the trials, probably because it is essentially an hour of continuously shifting weight from one foot to another under control.

A minimal daily practice

You do not need a class to begin. The kettle is a perfectly good timer.

1. Single-leg stand, counter within reach. Thirty seconds each side. When that is easy, do it with eyes closed. When that is easy, do it on a folded towel.
2. Tandem stance — heel directly in front of toe, as if on a tightrope. Thirty seconds each way.
3. Tandem walk — ten steps heel-to-toe along a hallway, one hand near the wall.
4. Sit-to-stand, ten repetitions from a dining chair without using your hands. This is the strength half, and it is not optional.
5. Heel raises, twenty, holding the counter lightly. Calf strength is heavily involved in the small corrections that stop a stumble becoming a fall.

Ten minutes. Every day, or near enough. Progress by removing support and closing your eyes rather than by adding time — a five-minute stand on two feet with your eyes open trains nothing.

The things that are not exercise

A meaningful share of falls in older adults are not primarily a balance problem. Medication is a big one — sedatives, some antidepressants, blood pressure drugs that cause a drop on standing, and simple polypharmacy all raise risk. If you are on four or more regular medicines, a review with your GP or pharmacist is one of the highest-value hours available to you.

Then there is vision. Cataracts, an out-of-date prescription and, oddly, new varifocals all increase falls — varifocals distort the ground when you look down at stairs. Some clinicians recommend single-vision distance glasses for walking outdoors.

And the house itself: loose rugs, trailing cables, dim stair lighting, no bathroom rail. Unglamorous, cheap, and responsible for a great many hip fractures.

Balance is not something you have. It is something you keep doing.