Balance and Strength Exercises for Healthy Aging

It’s a natural part of aging, and it happens to everyone. But there are tools you can use to counteract degeneration: Balance and strength-training exercises can help you stay strong and active well into your later years.  

“We see an awful lot of skeletal muscle injuries and fractures as people get a little older,” said Cedars-Sinai primary care sports medicine specialist Joshua Scott, MD. “A lot of it is the result of osteoporosis, which is the loss of bone mineral density and makes the bones more brittle, as well as sarcopenia, which is the natural loss of muscle mass.”

We see an awful lot of skeletal muscle injuries and fractures as people get a little older.

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‍Women are particularly at risk for osteoporosis, which often accelerates after menopause, said Sara Espinoza, MD, medical director of the Healthspan Clinic and the Center for Translational Geroscience at Cedars-Sinai.  

“Exercise, especially resistance training, is the one thing we know will slow down the bone loss and the muscle loss, as well,” she said.

Scroll down for resistance-training exercises demonstrated by Gary Weaver, lead exercise physiologist at the Cedars-Sinai Healthspan Clinic.

Why Balance and Strength Training Are Important as You Age

Physical activity guidelines from the U.S. Department of Health and Human Services and the National Institutes of Health say adults should perform at least 150-300 minutes of moderate-intensity or 75-150 minutes of high-intensity aerobic exercise each week and at least two days a week of strength training. But as you age, supporting muscle strength and balance becomes increasingly important for maintaining your ability to perform everyday physical activities, such as standing up from a chair, walking or running, climbing stairs, and lifting objects. As you lose strength with age, it also becomes easier to slip and fall.

“The reduction in skeletal muscle mass can cause significant balance issues,” said Scott. “If you stumble or trip and you’re not strong enough to react and catch yourself, you can quickly end up on the ground with a hip fracture or some other injury.”

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Resistance training stresses your muscles and bones, and the body responds to the stress by increasing muscle mass and bone mineral density, which improves your body’s natural ability to stay balanced and upright.

At What Age Should You Start Strength and Balance Training?

Espinoza says resistance training is valuable at any age.

“A little muscle and bone loss may not be that noticeable in middle age, but the sooner you can start thinking about this and taking preventive steps to improve your muscle and bone health, the better,” she said. “That said, if you haven’t started, it's never too late to exercise.”

There’s no reason why someone in their 60s, 70s, 80s or beyond shouldn’t be lifting weights.

Scott agrees that strength training is not only for the youthful among us.

“A lot of my patients feel like this is for young 25-year-old bodybuilders who want to look good in the mirror. But this is a lifestyle change for long-term health,” said Scott. “There’s no reason why someone in their 60s, 70s, 80s or beyond shouldn’t be lifting weights.”

In fact, he says this population may benefit the most from these kinds of exercises.

Warming up before and stretching after resistance training can help reduce the risk of injury.

How Often Should You Be Strength Training?

The American College of Sports Medicine recommends resistance training at least two times a week. But if you’re new to it or haven’t been doing it for a while, it’s important to start slow and progress gradually.  

“People often try to go too hard too fast and then quit after a few weeks or injure themselves,” said Scott. “Go at a pace you can sustain.”

“It’s a good idea to check in with your doctor or physical therapist before starting a new exercise routine,” said Espinoza, “especially if you have osteoporosis, arthritis, heart disease or balance problems.”  

The Healthspan Clinic at Cedars-Sinai conducts numerous studies and clinical trials on healthy aging, many of which involve supervised training with an exercise physiologist at the facility’s gym two or three days a week. To learn more about the clinic or find out more about ongoing clinical trials, call 310-423-3870.  

The Exercises

The following exercises cover all the major muscle groups in the body. You do not need to do all of them at each training session. Instead, break them up into groups of 4-10 exercises per session.  

Most of these exercises can be performed with little or no special equipment. If you belong to a gym and prefer to use exercise equipment, a recommended machine version of most exercises is included.

As you get stronger, increase the number of repetitions, sets or weight for each exercise or progress to a more challenging exercise.  

Engage your abdominal muscles, or core, as you do each exercise. Breathe out during the difficult, or lifting, phase. Breathe in as you return to the starting position. Don’t hold your breath while you work.

Exercises to Improve Balance and Strengthen the Lower Body

Sit-to-Stand (1-4 Sets of 5-20 Repetitions)

(Quadriceps, gluteus maximus, adductors and hamstrings; calves and core assist)

Sit near the front of a sturdy chair with your feet about hip-width apart. Lean slightly forward, press through your feet and stand tall. Lower yourself back down to the chair with control. Don’t drop back down. Start with a taller chair or a chair with arm support, as necessary. Progress by not using arm rests and increasing repetitions and sets.

Progression Exercise: Body-Weight Squats

Stand with your feet about shoulder-width apart and your toes pointing slightly outward. Tighten your abs, push your hips back and bend your knees as though sitting down into a chair. Keep your chest lifted, your knees pointing in the same direction as your toes, and your heels on the floor. Go down only as far as you can comfortably manage while maintaining control, then push through your feet to stand back up.

Progression Exercise: Goblet Squats  

Holding a kettlebell or dumbbell close to your chest, perform the same movement as the body-weight squat. Keep the weight close to your body. Don’t let your knees collapse inward.  

Machine Option: Leg Press  

The leg-press machine works many of the same muscles, but because it supports the body’s weight, it doesn’t help train your balance, coordination and core as much as the sit-to-stand and squat exercises.

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Single-Leg Stand for Balance

(Gluteus medius and minimus, calves, foot and ankle stabilizers, and core)

Stand beside a counter or sturdy chair. Using your fingertips to help you balance, shift your weight onto one leg and lift the other foot. Keep your hips level, stand tall and hold your position. Switch to the other leg when you’re ready.  

Progress by:

• Taking your hand away from the support  

• Increasing the time you spend on each leg

• Adding controlled movement

• Standing on a balance pad or a balance trainer

Progression Exercise: Step-Up to Balance (1-4 sets of 5-10 repetitions)

(Quadriceps, gluteus maximus, gluteus medius, gluteus minimus, hamstrings and calves; core, hip and ankle stabilizers assist)

Put your whole right foot onto a low step or platform. If you need to, hold a railing or other support to help you balance. Press down on your right foot to rise, bring your left knee forward and balance on your straight right leg. Step your left foot back down slowly. Do one set of repetitions and then switch legs.

Progress by reducing the amount of support you use, increasing the height of the step, and increasing repetitions and sets.  

Progression Exercise: Step-Up to Balance With Weight (1-4 sets of 5-10 repetitions)

Perform the same movements as the step-up to balance exercise above while holding dumbbells or a barbell. Focus the effort on your standing leg. Don’t jump or push too much off the trailing leg.

Machine Option: Leg Extension  

The leg-extension machine isolates the quadriceps but does not train the glutes, balance or coordinated hip-and-knee movement the way step-ups and squats do.

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Lateral Lunge (1-3 Sets of 6-12 Repetitions)

(Adductors, quadriceps, gluteus maximus, gluteus medius and hamstrings)

Take a wide step to the side, bend the stepping knee and push your hips backward while keeping your other leg relatively straight. Keep your chest up and your bent knee in line with your foot. Push through the bent leg to return to standing. Repeat on the other side. Progress by adding repetitions and sets.

If you need an additional challenge, add weight by holding a dumbbell or kettlebell with both hands close to your body and high on your chest.

Machine Option: Hip Adduction and Abduction

These machines target the inner and outer hip muscles, but they provide less balance, coordination and whole-leg strengthening than a lateral lunge.

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Romanian Deadlift (RDL) (2-4 Sets of 6-10 Repetitions)

(Hamstrings, gluteus maximus, adductor magnus and spinal erectors; assistance from upper back, forearms and grip)

Begin with no weight or light weight, depending on your comfort level. Stand straight with your feet hip-width apart. If you’re using dumbbells, hold them in front of your thighs. If you’re using a barbell, grip it just to the outside of your hips. Bend your knees slightly, engage your core and hinge forward at the hips. Push your butt back while keeping your back and neck neutral (straight). The dumbbells or barbell can graze your thighs and stay close to your shins as you descend. Don’t lower the weight all the way to the floor. Instead, stop when you feel a stretch in your hamstrings and your back wants to start rounding. Squeeze your glutes and drive your hips forward to return to standing. Don’t lift with your lower back.

Progress by increasing repetitions, sets and weight.

Trap bar: A trap bar (also called a hex bar or cage) provides the same benefits as a regular barbell but is designed to reduce lower back strain by centering the weight on your spine. The movement is the same, but your hands are placed at your sides rather than in front of your body.  

Machine Option: Leg Curl

The leg-curl machine isolates the hamstrings but does not strengthen the glutes, back and trunk the way an RDL does.

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Farmer’s Carry (Measured by Weight and Duration)

(Forearms, grip, trapezius, shoulders, abdominals, obliques and spinal stabilizers; glutes, quadriceps and calves assist)

Hold a weight in each hand, stand tall, brace your core and walk with short, controlled steps. Keep your shoulders down and level and avoid leaning your body or swinging the weights.

Progress by adding weight and distance.

Progression Exercise: Suitcase Carry

Do the same exercise holding a weight in only one hand. Again, work to stay tall with shoulders down and even. Use your core to keep yourself from leaning toward or away from the weight. Repeat on the other side.

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Calf Raises (2-4 Sets of 6-10 Repetitions)

(Gastrocnemius and soleus; foot and ankle stabilizers assist)

Stand tall with your feet comfortably parallel. Push slowly up onto the balls of your feet, hold there for a count of three and then lower your heels slowly back down. Use a wall or other stable support to help you balance, if you need to.

Progression Exercises

Do the exercise on the edge of a stair or step so that your heels can go lower than the front of your feet. Progress by adding repetitions, sets or weight. Progress further by doing the exercise on one foot—this will require a wall or other stable support to help you balance.

Machine Option: Standing or Seated Calf-Raise

Calf-raise machines provide more controlled resistance but less balance and stabilizer training than calf raises performed standing on the floor or a step. Standing machines emphasize the gastrocnemius. Seated machines emphasize the soleus.

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Exercises to Strengthen the Upper Body

Push-Ups (1-3 Sets of as Many Repetitions as You Can Manage While Maintaining Good Form)

(Pectoral muscles, triceps, front deltoids and serratus anterior; core and glutes help stabilize)

Place your hands slightly wider than shoulder-width apart on whatever surface you are using: a wall, counter, bench or floor. Brace your core to keep your pelvis neutral or slightly tucked. Keep your body in a straight line as you bend your elbows and lower your chest as far as you comfortably can while maintaining good form. Keep your elbows angled slightly back rather than flared straight out. Press through your hands to return to the starting position.

Progress by increasing repetitions or moving to lower surfaces. For example, progress from a wall to a counter or bench and then to the floor. To make floor push-ups more accessible, perform them with your knees on the floor rather than your feet. The rest of the movement is the same.

Bench Press With Dumbbells or Barbell (Choose a Weight That Allows You to Do 2-3 Sets of 8-12 Repetitions With Good Form)  

Lie back on a flat bench with your feet planted firmly on the floor. Hold a barbell or two dumbbells with your hands slightly wider than shoulder-width apart. Keep your elbows angled 45 degrees away from your chest rather than straight out to the sides. Brace your core and press the weights upward until your arms are nearly straight. Lower the weights slowly and under control until they are around chest level, then press back up.

Progress by adding repetitions, sets or weight.

Machine Option: Chest Press

All the upper-body machines provide a stable, easily adjustable way to strengthen the relevant muscles, but they use core, balance and stabilizer muscles less than body or free-weight exercises.

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Overhead Press (Choose a Weight That Allows You to Do 1-3 Sets of 8-12 Repetitions With Good Form)

(Deltoids, triceps, upper trapezius and serratus anterior; abdominal and back muscles help to stabilize)

Sit tall or stand with a dumbbell in each hand at shoulder height, palms facing slightly inward. Start with your elbows angled a little forward, rather than straight out to the sides, and your hands slightly wider than shoulder-width. Tighten your abdominal muscles and avoid arching your lower back. Press the weights up overhead and slightly forward until your arms are nearly straight, but don’t lock your elbows. It’s fine if the dumbbells come together at the top. Then lower them slowly and under control back to shoulder height.

Progress by increasing repetitions, sets or weight.

Machine Option: Shoulder Press or Overhead Press

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Dumbbell Row (Choose a Weight That Allows You to Do 2-3 Sets of 8-12 Repetitions With Good Form)

(Latissimus dorsi, rhomboids, middle and lower trapezius, rear deltoids, and biceps; forearms and grip assist)

Put your left hand and knee on a bench, or place your left hand on a sturdy surface and keep both feet on the floor. Hold a dumbbell in your right hand with your arm hanging straight down. Keep your back flat and your neck neutral. Keeping your elbow close to your body, pull the dumbbell toward your ribs. Focus on drawing your shoulder blade back to make the movement happen, rather than just pulling with your arm. Lower the weight slowly and under control until your arm is straight, then repeat. Switch sides between each set.

Progress by adding repetitions, sets or weight.

Machine Option: Seated Row or Low Row