Improve Balance With Otago Exercises

Improve balance and prevent falls

If you are having difficulty walking safely due to balance problems, you may benefit from the skilled services of a physical therapist (PT). Your therapist can work closely with you to help improve your mobility and balance so you can safely return to your normal level of activity.

Your PT will likely prescribe specific exercises that can improve posture and positioning, strength, and proprioception. One specific exercise program for balance that your PT may teach you is called Otago exercises.

Otago exercises are a specific set of exercises that can improve balance. The program was developed in New Zealand and has been proven to improve mobility and prevent falls due to balance problems.

The Otago exercise program is easy to learn and implement, and it includes components for mobility, proper posture, strength, and balance. It is quickly becoming a staple in the physical therapy exercise toolbox for people with balance and mobility impairments.

Photo of older people performing balance exercises.
xavierarnau / Getty Images


There are various components of the Otago exercise program for balance. These include:

The exercises may be simple for some people and more difficult for others. They are usually done three times each week for several weeks, and they can be used as a balance maintenance program to prevent falls.

Effectiveness of Otago Exercises

The Otago exercises have been proven to be an effective program to help improve balance, reduce the risk of falls, and improve overall mobility.

When it was first introduced in the early 1990s, four clinical trials were performed to assess the effectiveness of Otago exercises. In total, 1016 men and women participated in the research, and they ranged in age from 65 to 97 years.

The main takeaway results from the research into Otago exercises include:

  • Falls among people participating in the Otago were reduced by 30% to 66% when compared to controls who were not doing Otago exercises.
  • After one year, injuries due to falls were reduced by 28% in participants performing Otago exercises.
  • The Otago exercise program was most effective at reducing falls for people over the age of 80 years, but people who were younger still found some benefit.
  • Seventy percent of patients performing Otago exercises continued doing the program after one year.

Research concludes that the Otago exercise program is safe, effective, and can provide a long-term self care strategy for reducing falls and reducing injuries due to falls.

Getting Started With Otago Exercises

Before starting any exercise program for falls or mobility problems, you must see your physician. A visit to a physical therapist trained in the Otago exercise program may also be helpful. Your PT can assess your personal condition and provide instruction and guidance as you begin the exercise program.

Before exercising, it is recommended your warm up a bit. Move around your house, get your blood pumping, and find a safe place to exercise.

Improving balance with exercise may mean creating situations that challenge your balance. Therefore, you must remain safe while exercising. Be sure something stable, like the kitchen counter, a table, or a chair, is nearby to grab onto while exercising.

The exercises start with spinal movements and postural control, and they progress through seated and standing lower extremity strengthening and, finally, to functional balance exercises.

Be sure to stop any exercise that causes pain or creates an unsafe situation for you.


Cervical Rotation

To start neck rotation, stand up tall with proper posture. Be sure a stable object is nearby:

  1. Slowly turn your head to one side. Hold the end position for 3 seconds
  2. Slowly turn your head to the other side. Hold for 3 seconds.
  3. Repeat the sequence 5 times.

If standing is difficult or unsafe, sit in a comfortable chair with upright posture while performing the exercise.


Cervical Retraction

Cervical retraction neck exercise.
Do cervical retraction by bringing your head back and up, the way the nurse's hand is guiding the woman's chin in this photo. lisafx

To perform cervical retraction, stand up tall with proper posture. Be sure something stable is nearby to grab onto:

  1. Place one hand on your chin.
  2. Pull your head and neck straight back, being sure not to nod your chin up or down. Imagine a long straight neck as you guide your head backward.
  3. Hold this position for 3 seconds, and then release the stretch.
  4. Repeat 5 times.

If standing is not possible, sit in a comfortable chair with upright posture as you exercise.


Standing Lumbar Extension

Photo of the sanding back bend.
QxQ Images-Datacraft/Getty Images

To perform the standing lumbar extension exercise, stand with your feet shoulder-width apart:

  1. Place both hands on your low back just above your buttocks.
  2. Slowly bend backward.
  3. Hold the end position for 3 seconds.
  4. Come back up to full, upright posture.
  5. Repeat 5 times.

It is often helpful to perform this exercise while standing in front of a bed. That way you can have a safe place to quickly sit if you lose your balance.


Standing Lumbar Rotation

To perform standing lumbar rotation:

  1. Stand in front of a stable kitchen counter with your feet shoulder-width apart and your hands on your hips.
  2. Turn your body, torso, and shoulders to one side. Hold for 3 seconds.
  3. Rotate to the other direction. Hold for three seconds.
  4. Repeat 5 times.

Seated Leg Extension

Keeping your quadriceps muscles on the front of your upper thighs strong is important in maintaining good mobility and balance. To do this, perform the seated leg extension. Here's how:

  1. Sit in a chair with upright posture
  2. Straighten one knee as far as possible.
  3. Tighten your quadriceps muscle (front of thigh) when your knee is fully straight. Hold for 3 seconds.
  4. Slowly lower your leg back to the starting position.
  5. Repeat the seated leg extension exercise 10 times.

Standing Hip Abduction

Ben Goldstein

Standing hip abduction can strengthen your gluteus medius muscles near your hips. To perform this exercise:

  1. Stand next to something stable like a kitchen counter or table.
  2. Hold onto the table with one hand.
  3. Lift one leg to out to the side while keeping your knee straight.
  4. Hole the end position for three seconds, and then release back to starting position.
  5. Repeat 10 times.

Be sure to keep your posture upright as you lift your leg to the side.



sit to stand chair exercise

Ben Queenborough / Getty Images

The sit-to-stand exercise can help strengthen your hips, thighs, and lower legs. Functionally, the exercise can help improve your ability to stand up from a seated position.

To perform the sit-to-stand exercise:

  1. Sit upright in a supportive chair.
  2. Stand up.
  3. Slowly sit back down. Be sure to sit slowly; it should take you a couple of seconds to fully sit.
  4. Repeat 10 times.

It may be necessary to use your hands when doing the sit to stand. Progress from using two hands to help you rise, to then using one hand. As you continue exercising, you should be able to rise from sitting with no upper extremity support.


Standing Heel Raise

Large visible veins of calf muscles in a man's leg. - stock photo

Joaquin Corbalan/Getty Images


The standing heel raise improves strength of your calf muscles in your lower legs. This can make maintaining appropriate balance easier while standing and walking.

To perform the standing heel raise:

  1. Stand with upright posture and hold onto something stable like the kitchen counter or the back of a chair.
  2. Keeping both knees straight, rise up onto your toes, lifting your heels off the ground. Hold this position for 2 seconds.
  3. Slowly lower down.
  4. Repeat the heel raise 10 times.

This exercise can be made more challenging by holding onto a stable with only one hand or by performing this while not holding on.


Standing Toe Raise

The standing toe raise exercise improves strength of the anterior tibialis muscles of your lower legs. These muscles are active if you are standing and start to lean backwards; they'll contract to help keep you upright.

To perform the standing toe raise:

  1. Stand up tall and hold onto something stable.
  2. Keeping your knees straight, lift your toes and the balls of your feet off the floor. Hold this position for 2 seconds.
  3. Slowly lower your toes
  4. Repeat 10 times.

The standing toe raise can be made more challenging by only holding on to a stable object with one hand or not holding on at all.


Standing Mini Squats

Standing mini squats are a great strengthening exercise for your hips, thighs, and lower legs. To perform the exercise:

  1. Stand up tall and hold onto a stable object.
  2. Slowly bend your knees into a mini squat; be sure to not bend too far. Hold the squat position for 2 seconds.
  3. Return to the starting position.
  4. Repeat 10 times.

Figure 8 Walking

Figure 8 walking is an advanced dynamic balance exercise in the Otago program. To perform this, place two small objects on the floor about 6 feet apart.

  1. Walk around the objects in a figure 8 pattern. Be sure to keep your steps even, and keep your head and eyes forward while walking.
  2. Walk in the figure 8 pattern 10 times

Be sure something stable is nearby to grab on to in case you lose your balance.


Functional Exercise: Stair Climbing

ONOKY-Fabrice-LEROUGE/Brand X Pictures/Getty Images

Stair climbing is a functional exercise that can help you gain confidence when ascending or descending stairs.

Simply find a staircase with a railing, and walk up and down the stairs 10 times. Be sure to hold on to the railing for safety.


Functional Exercise: Backward Walking

Backward walking can be challenging, but it can be used to help improve balance and mobility. To safely perform the exercise, stand to the side of your kitchen counter. Make sure the floor is clear behind you:

  1. With one hand resting on the counter, simply walk backward along the kitchen counter.
  2. When you run out of space, turn around and walk backward in the other direction
  3. Repeat 10 laps.

If it is easy to walk backward along the kitchen counter, you can try to make it more challenging by not using any upper extremity support.


Tandem Stance and Walk

Young Gymnast Toes on Balance Beam
Tabitha Patrick / Getty Images

Tandem standing is simply standing with one foot in front of the other. The heel of the front foot should be touching the toe of the back foot. This position makes your base of support more narrow, challenging your balance.

To perform tandem standing:

  1. Stand upright next to your kitchen counter, hold on, and place one foot in front of the other. Be sure your toes and heel are just barely touching.
  2. Hold this position for 10 seconds.
  3. Switch feet.
  4. Repeat three times for each foot forward.

Tandem standing can be made more challenging by not holding on while remaining in the tandem stance position.

When tandem standing becomes easy, you can try tandem walking. Simply hold onto the kitchen counter, and walk forward with one heel just in front of your toes. Walk along the length of your kitchen counter, turn around, and tandem walk back.

Tandem walking can be made more challenging by performing the walking without any upper extremity support. If that becomes easy, try tandem walking forward and then in reverse in a toe-to-heel pattern.


Single Leg Stance

Ben Goldstein

Single leg standing is an advanced exercise in the Otago program. It improves your ability to stand on one foot, something that naturally occurs as you walk and climb stairs.

To perform the single leg stance exercise:

  1. Stand upright in front of a stable object, like a table or kitchen counter.
  2. Hold onto the table.
  3. Raise one leg off the floor. Hold this position for 10 to 15 seconds.
  4. Lower your leg.
  5. Repeat standing on one foot 3 times for each foot.

To make the single leg stance more challenging, perform the exercise while holding on with only one hand. Advanced exercisers can do it without holding on at all.

If you are able to stand on one foot for 15 seconds without holding on, you can try it with your eyes closed; removal of visual input challenges your muscles and nervous system even more.

Another way to increase the challenge is to stand on a small pillow or folded towel. Just be sure to remain safe while performing the exercise.

A Word From Verywell

Falling down can be a scary thing, and it can cause injury and create a situation where your confidence with mobility is shaken. Performing Otago exercises three times a week has been shown to help improve balance and mobility and prevent falls.

The Otago exercise program is a simple, effective, and fun way to improve your balance and hopefully prevent falls.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kocic M, Stojanovic Z, Nikolic D, et al. The effectiveness of group Otago exercise program on physical function in nursing home residents older than 65years: A randomized controlled trial. Arch Gerontol Geriatr. 2018;75:112-118. doi:10.1016/j.archger.2017.12.001

  2. Albornos-muñoz L, Moreno-casbas MT, Sánchez-pablo C, et al. Efficacy of the Otago Exercise Programme to reduce falls in community-dwelling adults aged 65-80 years old when delivered as group or individual training. J Adv Nurs. 2018;74(7):1700-1711. doi:10.1111/jan.13583

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.