Lack of balance can be normal or it can be a serious health concern. Knowing the difference is essential for the personal trainer. The ability to control and maintain the body’s position, whether moving or remaining still, is integral to the overall quality of life. Fortunately, clients often come to us seeking improvements in balance related to stability, so there is room to educate.

The Complex Network of Body Systems

A healthy sense of balance enables us to walk erect and in a straight line, rise from a chair with relative ease, climb stairs, and bend over without tumbling forward. Balance involves the integra­tion of various sensory and motor systems, including vision, the vestibular system in the inner ear (which monitors motion and provides orientation clues, such as which way is “up”) and proprioception (the ability to sense the body’s position relative to space).

Being able to steady oneself after any movement – laterally or up-and-down — also requires good muscle strength and reaction time.

Age As a Factor

Having less than stellar balance is fairly common, and tends to get more problematic as we age, according to Dr. Helen Bronte-Stewart, a specialist in movement disorders at Stanford Medicine.

Often, over time, simply standing or walking results in considerable unsteadiness. For adults ages 65 and over who do not currently reside in nursing homes, one in three tend to fall at least once a year—and 10 to 15 percent of these falls result in serious injury, according to a 2008 Australian research study.

When Poor Balance Indicates a Bigger Problem

Assessing a potential balance problem is fairly straightforward, though many individuals shy away from accepting this idea. “The most concerning outcome is falling, but if you have trouble putting on long pants when you have to balance on one leg, that suggests you may have balance problems,” Bronte-Stewart says.

She goes on to list a few other red warning flags: “If you cannot walk in a straight line, tend to bump into things, or if you have trouble standing with your feet together and eyes closed, it is time to consult a physician.”

Hidden Culprits

Unbeknownst to many older adults, regularly taking medications or coping with chronic conditions can interfere with balance. Some of the more common conditions are:

  • Complications of the inner ear (vertigo, infection of the labyrinth, Meniere’s disease or acoustic neuroma, a non-cancerous growth on the vestibular nerve which connects the inner ear to the brain)
  • Eye problems (cataracts, glaucoma, diabetic retinopathy, incorrect eyeglass prescription or macular degeneration)
  • Numbness in feet and legs (neuropathy)
  • Arthritis
  • Circulation/cardiac disorders
  • Long-term diseases of the nervous system (cervical spondylosis, Parkinson’s disease or Alzheimer’s disease)
  • Combination of maintenance medications/prescription drugs
  • Deconditioning/lack of exercise/obesity

Vertigo is often the first sign of a pending stroke. Orthostatic hypotension—low blood pressure that occurs upon rising from a sitting or horizontal position—causes many individuals to feel faint, but is usually harmless and often the result of dehydration.

If consuming adequate fluid does not mitigate such dizzy spells, other more significant disorders leading to low blood pressure or poor circulation could be contributing factors. Cardiovascular disease, heartbeat arrhythmias, and diabetes-related neuropathy or hypoglycemia all have the potential of bringing on such dizzy or lightheaded sensations.

Multiple Sclerosis is an autoimmune disease that affects the entire nervous system, including the brain and spinal cord. According to experts at the Multiple Sclerosis Society of Canada, “The disease attacks myelin, the protective covering of the nerves, causing inflammation and often damaging the myelin.” The myelin sheath is responsible for transmitting impulses. Individuals diagnosed with MS often report that loss of balance or numbness on one side of the body was their first symptom.

The Deconditioned Client

Unrelated to age, balance issues can come about when an individual experiences a significant deterioration in his physical fitness capabilities.The longer this situation is allowed to continue, the more breakdown of muscle mass occurs. Deconditioning extends beyond merely having a desk job, provided the individual makes a concerted effort to exercise regularly, Bronte-Stewart says.

However, the reality of a truly sedentary lifestyle is loss of core strength and decreased power in the gluteal muscles. Struggling to balance during physical activity that involves standing on one leg, or hiking over somewhat challenging terrain, should not be ignored, “It could be because you don’t challenge [these muscles] that often with exercise,” Bronte-Stewart says. “There’s an absolute rule that applies to muscles and the brain: If you don’t use it, you lose it,” she explains.

How Trainers Can Conquer Challenged Balance

You can help identify a balance problem by asking a client some key questions, listed below. Afterward, let him know that any affirmative responses are worth discussing with his physician.

  • Is the client regularly feeling unsteady?
  • Does the client feel as if the room is spinning around him?
  • Is he experiencing a sense of “motion” when standing or sitting still?
  • Have falls occurred recently?
  • Has the client reported lightheadedness, or sensing that he might faint?
  • Has the client’s vision become blurred?
  • Does the client talk about feeling disoriented, or losing sense of time, place, or identity?

Once a diagnosis has been made, whether it is simple deconditioning or a series of comorbid conditions, there are exercises trainers can implement to help strengthen a client’s sense of balance. Participation in a Tai Chi class offers many benefits.

With its approach of strengthening the body while focusing the mind,tai chi has proven to reduce falls in older adults by up to 45%, according to Dr. Peter Wayne, research director of the Osher Center for Integrative Medicine at Brigham and Women’s Hospital and Harvard Medical School.  It can also improve balance in any number of neurological diseases. A recent study published in The New England Journal of Medicine found the program particularly effective for patients living with Parkinson’s disease.

Setting up an obstacle course for a client struggling with balance offers the opportunity to challenge the body as it moves through space in a variety of directions, including stepping over objects or walking on unstable surfaces. Guide the client at first, ready to steady him or catch him in the case of a potential fall.

Sitting on a stability ball or physioball helps facilitate not only balance but proper posture as well. By placing the ball within arm’s length of a wall, the client can feel assured that he has a stable surface on which to rely should a significant wave of dizziness or profound instability sweep over him.

All of us at some point in our lives either have or will experience some loss of balance. Awareness of the hidden issues can help shed light on what changes can be made in terms of health and lifestyle, helping to keep our clientele upright and tumble-free.


Cathleen Kronemer

Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at She welcomes your feedback and your comments!