Winter in Massachusetts is officially in full force with temperatures below freezing! That means that our all-too-familiar foe, black ice, is ready to pop up everywhere from your driveway to the front steps of your local post office. It is more important now than ever to be aware of the risks associated with falls.
According to the CDC’s updated 2023 data, falls are the leading cause of injury and injury-related death among adults 65 and older in the United States. Each year, approximately 36 million falls occur in this age group, resulting in more than 32,000 deaths and 3 million emergency room visits. The economic burden exceeds $50 billion annually. But here’s the important message: falls are not an inevitable part of aging. Targeted physical therapy — including balance training, strength work, and gait retraining — can reduce fall risk by 23-34% in community-dwelling older adults. These exercises don’t have to be time-consuming and can be both effective and enjoyable.
Many people go to the gym to perform strength training by lifting heavy weights so that they can complete their daily tasks with less effort. Think of balance exercises in the same way. We should challenge our balance by putting ourselves in difficult or unusual positions so that we can maintain our balance during everyday scenarios! Here are just a few examples of balance exercises you can do at home with little to no equipment.
- Tandem balance: Stand at a sturdy surface and place one foot in front of the other so that the heel of your front foot is touching the toes of your back foot. Hold this position for up to 30 seconds, repeating 3 times in each position.
- Single leg balance: Stand at a sturdy surface and hold your balance on one foot. Hold this position for up to 30 seconds, repeating 3 times on each leg.
- Single leg balance with nose taps: Stand at a sturdy surface and hold your balance on one foot with your arms extended at shoulder height. While holding this position, alternate tapping your nose with the index finger of each hand. Repeat for up to 30 seconds, repeating 3 times on each leg.
- Tandem walking: In a clear and open space, walk forward 20 ft by placing the heel of your stepping foot right at the toes of your standing foot. Repeat for a total of 5 laps.
Once these exercises are easy, try repeating them with your eyes closed or while standing on a pillow or a couch cushion. By taking your vision out of the equation or putting yourself on an uneven surface, you can challenge your body and the balance centers of your brain even more. It is always safer to do these exercises (especially with your eyes closed) with a friend or family member present! Keep track of how long you can hold each position and even compete with your friends or family!
Current Evidence-Based Fall Prevention: What Works in 2025
A landmark 2019 Cochrane review analyzing over 150 studies found that exercise programs are the single most effective intervention for fall prevention in community-dwelling older adults, outperforming vitamin D supplementation, home safety modifications, and medication review alone. The most effective exercise approaches combine balance training, resistance training, and walking — rather than any single modality. Programs like the Otago Exercise Programme and STAND TALL (a digital balance training program) have been validated in multiple studies and can be delivered in both clinic and home settings.
Boston-Specific Winter Safety Tips: Living in Massachusetts means navigating specific winter hazards. Black ice (frozen rain or melting snow that refreezes) is particularly dangerous because it is nearly invisible. Key recommendations: (1) Wear footwear with rubber outsoles and deep tread — avoid smooth-soled dress shoes or worn sneakers on icy surfaces; (2) Walk like a penguin on icy patches — take short shuffling steps with feet slightly wider apart and lean slightly forward; (3) When possible, take paths that have been treated with salt or sand; (4) Use handrails whenever available; (5) If carrying items, empty your hands when possible before walking on potential ice; (6) Increase your fall risk assessment awareness by talking to your PT about a formal balance assessment if you have had a near-miss fall or significant balance concern.
Strength Training for Fall Prevention: Lower extremity strength — particularly hip abductors, quadriceps, and ankle plantarflexors — is strongly correlated with balance and fall risk. A 2024 systematic review confirmed that progressive resistance training two to three times per week significantly reduces fall incidence over 12 months. For older adults who have not exercised recently, starting with seated or supported exercises and progressing gradually is essential. Physical therapists can provide a structured, safe progressive program that builds from basic exercises to more challenging balance activities over weeks to months.
-Mike Kantorski, PT, DPT, CSCS
