Anyone Can Improve Their Balance

Controlling balance during standing, walking, and daily activities is a complex skill that involves many parts of the nervous system as well as muscle strength and sensory integration. In fact, balance control actually involves several different types of control systems such as:

  1. responding quickly and accurately with a step in response to a trip or slip;
  2. shifting weight appropriately in preparation for a step before walking;
  3. leaning safely to maximum limits to reach without stepping;
  4. standing still without excessive postural sway with eyes open or closed, even on an unstable surface;
  5. using foot placement and hip strength to control balance during walking.

Unfortunately most of these types of balance control are eventually impaired in people with Parkinson’ disease (PD), because the disease progresses to affect many brain circuits important for balance control.

We know that balance disorders in people with PD are worse in those who have atypical parkinsonism, cognitive impairment, genetic origins of PD, and/or quickly-progressing types.  We also know that balance impairments are associated with aging and inactivity, so balance is more affected in older people with PD and in those who do not exercise. Since we use so many different muscles, joints, and senses for balance control, any impairment of these other systems (such as back pain, arthritis, a history of head injury or diabetes, etc.) due to aging or injury compound the balance problems in people with PD.  People with freezing of gait also have more balance problems than those without it.

Power through Project workout at WPC 2016

Power through Project workout at WPC 2016


Luckily, many studies show that anyone can improve their balance with practice, even older people with Parkinson’s disease.  Laboratory studies have shown that one day of practice responding to surface slips can improve compensatory stepping responses.  However, people learned faster and retained more balance control after practice while they were taking their levodopa medication,  so it is important to be optimally medicated to benefit from exercise training.  Studies of group exercise classes that challenge balance, such as agility training, dancing, boxing, and Tai Chi also show significant improvement in balance in people with PD.  Tai Chi training (adapted for PD) over 6-12 months has been shown to reduce the risk of falls, showing that significant benefits likely require long-term practice.

Exercises most likely to improve balance usually involve not only balancing, but also cognitive challenges, similar to playing a sport. Sports, like tennis or pickleball, as well as Tai Chi, dance and boxing, involve sharp cognitive skills such as decision-making, anticipating based on experience, inhibiting wrong responses and initiating quickly, correct responses – all cognitive skills impacted by PD. Dual-tasking, such as thinking about something while walking or balancing also has been shown to improve with practice, a sign that walking or balancing has become more automatic with practice. Thus, studies are showing that not only balance, but cognitive skills and attention can improve with devoted practice.


Fay B. Horak, PhD, PT presented at the Third World Parkinson Congress in Montreal, Canada and the Fourth World Parkinson Congress in Portland, Oregon. She is currently a Professor of Neurology and the Director of the Balance Disorders Laboratory at Oregon Health and Science University and the Portland VA.

Ideas and opinions expressed in this post reflect that of the author(s) solely. They do not necessarily reflect the opinions of the World Parkinson Coalition®