Strength and balance exercise programme for falls prevention

Falls team

Appointments

Why do we exercise?

Keeping active is one of the most important things we can do to stay healthy. The exercise programme you will be given will help you to increase your strength, flexibility, stamina, balance and bone density and will work to improve your confidence and well-being. This will then reduce your risk of having further falls. 

How the programme works

The exercises your physiotherapist wishes you to do will be ticked in the left-hand corner of the page. For each exercise there is a diagram and a description to remind you how to do the exercises.

You will be advised how often to do the exercise programme by your physiotherapist. This will ensure it is suitable for you and fits in your everyday life. 

As you feel more confident you may wish to increase your daily activities. This is another way to improve your fitness and general well-being. Speak to the Falls Team before doing something new as they may be able to assist or provide advice. Just increasing your walking would be beneficial, even just walking around your home.

Do not

• Exercise if you are feeling tired, ill or have just had something to eat.
• Overdo it or exercise if it hurts too much. You may experience some stiffness at first, but this will eventually ease off
• Do any sudden or jerky movements, especially tipping your head back or turning your head suddenly
• Stand up too quickly in case you get dizzy

Standing exercises

Always use the side of something stable like the kitchen worktop. You may wish to ensure there is a chair nearby in case you need to sit down. 

Posture

Good posture is essential for your health and wellbeing and maintaining your balance. Before each exercise ensure you are standing or sitting in a good posture

Sitting posture

• Do your exercises in a supportive chair, for example, dining chair
• For all exercises in the chair – shuffle forward into the front 1/3 of the chair
• Make sure your feet are hip width apart and knees at 90 degrees (feet directly underneath your knees)
• Sit tall, pull your abdominals in and keep your shoulders back but relaxed
• Look straight ahead

Standing posture

• Stand facing forward looking straight ahead
• Place your feet hip width apart
• Stand tall, pull your abdominals in and keep your shoulders back but relaxed.

Acknowledgements

We would like to acknowledge the following content resources:
The Otago Exercise Programme, Professor John Campbell and Dr Clare Robertson.
ACC NewZealand, 1997. The Postural Stability Instructor Manual, Later Life Training, 2008.
Author: South Tees Falls Team

Exercise diary

Please complete the following diary to keep a record of:

• Any exercise you have done (mark an E on the day you do your exercises)
• Any other forms of exercise you do
• Any falls you have (mark an F)

[…] Marching

Standing

• Stand with good posture, holding your support if needed
• March gently and consistently for ……………… if able
• If you feel steady, add an arm swing with one or both arms
• Avoid lifting your knees too high

Seated

• Sit upright with good posture, holding the arms of the
  chair if needed
• March gently and consistently for ……………… if able
• Add an arm swing with one or both arms
• Avoid lifting your knees too high

[…] Sit to stand

• Sit on a chair that is supportive and not too low
• Walk your hips forwards so that your bottom is at the front of the chair and bring your feet back slightly
• Lean forwards, keeping your nose over your toes
• Stand up using your hands on the chair if needed
• Pause for a few seconds once you are stood upright
• Make sure the backs of your legs are touching the chair and with controlled movement, slowly lower your bottom back into the chair. Reaching for the chair if needed.

Repeat …..…. times

[…] Head movements

[…] Standing
[…] Seated

• Stand or sit with good posture
• Slowly turn your head to the right, keeping your shoulders still
• Pause briefly and then return to centre
• Repeat movement to the left

Repeat …..…. times to each side

[…] Neck movements

[…] Standing
[…] Seated

• Stand or sit with good posture
• Place one hand on your chin and gently guide your head backwards as though you are giving yourself a double chin (you should feel a stretch at the back of your neck)
• Slowly return to your starting position

Repeat …..…. times

[…] Back extension

[…] Standing
[…] Seated

Standing

• Stand with feet shoulder width apart, keep looking forwards
• If you are able, place the hands on your bottom
• Gently arch your back, pulling your shoulder blades together
• Hold for a few seconds and then relax

Repeat …..…. times

Seated

• Sit towards the front third of the chair, keep looking forwards
• Place your hands behind your back, small of back or place hands on your lap.
• Gently arch your back, pulling your shoulder blades together
• Hold for a few seconds and relax

Repeat …..…. times

[…] Trunk twists

[…] Standing
[…] Seated

• Stand or sit with good posture, feet hip width apart
• Fold your arms in front of the chest or hold on to your support with your left hand
• Lengthen and lift the trunk upwards and slowly turn your head and shoulders to the right
• Return to face the front and repeat in the opposite direction
• Make sure your hips remain still throughout

Repeat …..…. times

[…] Ankle movements

[…] Seated

• Sit with your back supported ensuring good posture
• Straighten one leg so that your foot is held off the floor
• Point your toes forwards and then pull them back

Repeat …..…. times on each side

[…] Front knee exercise

[…] Seated

• Sit with your back well supported
• Begin with your right leg bent back as far as you are able
• Brush the foot along the floor and then lift to straighten (but do not lock out) your knee
• Raise leg for a count of 3 seconds and then slowly lower to the starting position to a count of 5 seconds.

Repeat up to …..…. times on each side

We may make this exercise harder by adding a weight ……… Kg

[…] Back of knee exercise

• Stand with good posture, feet hip width apart
• Hold your support
• Slowly lift your right heel towards your bottom
• Raise leg for a count of 3 seconds and then slowly lower to the starting position to a count of 5 seconds.
• Keep your knees in line with each other throughout the exercise

Repeat up to …..…. times on each side

We may make this exercise harder by adding a weight ……… Kg

[…] Side hip strengthener

• Stand with good posture, feet hip width apart
• Hold your support
• Lift your right leg out to the side keeping the foot pointing forwards
• Avoid leaning the body to the side, don’t lift the leg too high
• Raise leg for a count of 3 seconds and then slowly lower to the starting position to a count of 5 seconds.

Repeat up to …..…. times on each side

We may make this exercise harder by adding a weight ……… Kg

[…] Heel raises

• Stand with good posture, feet shoulder width apart
• Hold on to your support
• Slowly raise up onto your toes
• Make sure your body moves straight up rather than leaning forward

Repeat up to …..…. times

[…] Toe raises

• Stand with good posture, feet shoulder width apart
• Hold on to your support
• Slowly raise your toes so that you are standing on your heels
• Make sure your body moves straight up rather than leaning backwards
• Slowly lower your toes back down

Repeat up to …..…. times

[…] Knee bends

• Stand with good posture, holding your support if needed
• Place your feet hip width apart with your feet pointing forwards
• Bend the knees slowly imagining you are going to sit on a high stool
• Do not allow your heels to lift off the ground
• Slowly raise back up to standing

Repeat up to …..…. times

[…] One leg stand

• Stand with good posture, holding onto your support
• Lift one leg off the floor
• Try to hold this position for ……… seconds
• Change legs

Repeat…..…. times

[…] Toe walking

• Stand up tall beside your support with your feet hip width apart
• Hold on to your support if needed and keep looking ahead
• Lift your heels off the ground keeping your weight over your big toes
• When you feel steady, walk forwards up to 10 steps
• Lower your heels and slowly turn around
• Repeat in the other direction

Complete…..…. lengths of the work top

[…] Sideways walking

• Stand with good posture, holding onto your support
• With your toes and hips pointing forwards, take up to 10 steps to the side
• Repeat in the opposite direction

Complete…..…. lengths of the work top

[…] Heel toe stand

• Stand up tall beside your support, holding on if needed
• Place one foot directly in front of the other foot so that the feet are in a straight line with both feet flat on the floor

Look ahead and hold that position for…..…. seconds

Take the feet back to hip width apart before placing the other foot in front and balancing for another ………. seconds

Repeat …..…. times, on each side

[…] Heel toe walking

• Stand up tall beside your support, holding on if needed
• Walk up to 10 steps forwards, placing one foot directly in front of the other so that the feet form a straight line
• Uncross legs, then turn inwards towards your support and repeat in the opposite direction.

Complete…..…. lengths of the work top

[…] Heel walking

• Stand up tall beside your support with your feet hip width apart
• Hold on to your support if needed and keep looking ahead
• Lift your toes off the ground keeping your knees soft
• When you feel steady, walk forwards up to 10 steps
• Lower your toes and slowly turn inwards towards your support until you are facing the opposite direction

Repeat …..…. times

[…] Backwards walking

• Stand sideways next to your support and hold on with one hand if needed
• Stand with good posture and look straight ahead
• Take up to 10 steps backwards
• Turn inwards towards your support and repeat in the opposite direction.

Complete …..…. lengths of the work top

[…] Heel toe walking

• Stand sideways next to your support, holding on with one hand if needed
• Stand with good posture and look straight ahead
• Place one foot directly behind the other foot so that the feet are in a straight line
• Continue walking backwards in this way for up to 10    steps
• Stop, bring your feet back to hip width apart, turn inwards towards your support and repeat in the opposite direction

Complete …..…. lengths of the work top

[…] Calf stretch

• Sit with good posture, holding the sides of the chair for support if needed
• Straighten one leg and rest the heel on the floor
• Pull your toes back towards your shin and slide your heel further away from your body until you feel a gentle stretch, stretch should be felt in the calf from the knee down the back of the leg.

Hold for …..…. seconds

Repeat on the other leg.

[…] Back of thigh stretch

• Sit with good posture
• Straighten one leg and rest the heel on the floor, keeping the foot relaxed, the stretch should be felt up the back of the thigh. 
• Place both hands on your bent leg for support
• Lift and lengthen your body as you bend forwards from the hips until you feel a gentle stretch at the back of your thigh.

Hold for …..…. seconds

Repeat on the other leg.

[…] Walk and turn

• Walk at your usual pace in a figure of 8 shape (around 2 chairs if this is easier for you)
• Try to maintain an upright posture as you walk 

Repeat …..…. times.

[…] Stair practice

• Hold on to the handrail for this exercise but try not pull too much with your arms
• Go up the stairs and down again
• Use your strongest leg to lead on the way up and your weakest leg to lead on the way down (if taking one step at a time.)
• Make sure your foot is placed fully on each step
• Check your foot position by looking down with the eyes only, do not lean forwards

Repeat …..…. times.

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

ST2865
Version 1