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Balance and Fall Prevention Part IV - Building Functional Strength, Power, and Endurance

By David Drinks

This week, we are on to part 4 of our series on improving your balance and preventing falls. If you missed any of the previous three articles, then check them out here to make sure you get caught up:

In the first three parts of this series, we have talked about the importance of balance in preventing falls; the physiology of how we balance; and last week we started discussing how to train your body for better balance.

In part III, we focused on the first two aspects of developing a comprehensive balance training program:

  1. Finding ways to challenge your proprioceptive system by removing or reducing the use of the visual and vestibular systems.

  2. The importance of beginning your balance training on the ground in various kneeling positions to challenge your stability at a more fundamental level first before practicing balance on your feet.

This week, I will add the next step to your comprehensive program by discussing the importance of functional strength, power, endurance, and mobility!

Now, I could spend a long time going into each of these categories of physical fitness and how important they are to your balance and preventing falls. However, I will keep it simple and focus on the whole rather than the sum of the parts.

Basically, you need to be able to move well and have enough physical capacity to not get fatigued while you are moving. If you lack functional strength, power, endurance, or mobility, then you are going to be more at risk for falling.

This is an especially important consideration as you age since there is a natural decline in strength, power, endurance, and mobility as you get older.

And while this decline in physical fitness is natural, it should not be taken lying down! In fact, the rate of loss and the degree to which you lose these qualities of physical fitness is almost entirely up to you.

Train your body with a routine designed to maintain functional strength, power, endurance, and mobility, and you will see these qualities stick around for most of your life…you may even increase a lot of them, depending on where you are starting from.

However, failing to train your body for any one of these qualities of physical fitness means that you will lose it faster than you should, which can lead to big problems down the road.


Let’s spend just a minute highlighting the mobility that most people lose as they age and how that relates to balance and fall risk.

Most people lose ankle, hip, and thoracic spine (upper back) mobility as they age. Each one of these joints can play a large role in your balance and fall risk.

Folks without sufficient ankle mobility tend to be more at risk for falling. Much of this is due to them not being able to clear their toes as they walk, and so they end up catching their toe on something and tripping.

Likewise, with hip mobility. If you lack mobility at the hip joint, you are more prone to dragging your feet, not clearing a step with your foot when climbing stairs/stepping on a curb, or otherwise getting into poor positions when moving because you cannot move the hip well enough.

Finally, the thoracic spine (the upper back) tends to become stiff, and a common forward flexed pattern (referred to as thoracic kyphosis) can occur as you get older. This is the dreaded "Hunchback of Notre Dame" posture that everyone wants to avoid.

Not only does this bent-over posture not look great, but it also sets you up for potential falls because it more easily takes your center of mass outside of your base of support. When you start with the shoulders rolled forward and head out in front of you, it becomes much easier to lose balance and fall forward when you trip or drag your foot on the ground.

All of these common mobility restrictions that creep up on people as they age can be ameliorated by regular mobility training.

Not just any old stretching will do, though. You want to be sure you are working on mobilizing the ankles, hips, and thoracic spine and doing it correctly.

If you want to get started in the right direction with your mobility, you can check out some of the drills we demonstrated in our hip mobility series.

Strength & Power

Decreased muscle mass, muscular strength, and muscular power are typically observed in aging. In particular, the loss of lower body strength has been indicated as one of the most important risk factors for falling.

That means that preserving muscle mass, muscular strength, and muscular power is one of the most important parts of our comprehensive balance training program.

This loss in muscle mass (known as sarcopenia) is not as noticeable throughout middle age, but there tends to be about a 3% loss in muscle mass per decade around the time people reach the age of 40.

That number jumps to as much as 1% of muscle mass being lost per year for those age 65 and older.

This general loss in muscle mass also leads to a loss in strength (up to 1.5% per year after age 65), and perhaps more importantly, a loss in power (up to 3.5% per year after age 65).

Understanding this gives us a big key in our plan to train the body to avoid falling. We need both strength and power training to maintain these important components of muscular fitness as we age.

Strength refers to the amount of total force a muscle can generate. Power, on the other hand, refers to the ability of a muscle to exert a great amount of force over a short period of time. Power, therefore, refers to rapid muscle force production.

Quite often, falls result from a trip or loss of balance, with a subsequent inability to quickly get the legs back underneath you. This rapid, reactive movement of the body is lost most rapidly as you age, but it is a big deal when it comes to maintaining balance and avoiding a fall.

The good news for you is that maintaining muscle mass, and consequently your ability to display strength and power, is possible!

A study by Wrobleski, et al. in 2011, titled, "Chronic Exercise Preserves Lean Muscle Mass in Masters Athletes," demonstrated that master’s athletes, who train their bodies well into old age, can maintain their muscle mass.

This preservation of muscle is demonstrated in the following photo from their study. The top picture shows a cross-section of the thigh of a 40-year-old triathlete; the middle picture shows a 74-year-old sedentary man; the bottom picture shows a 70-year-old triathlete:

The darker tissue is the amount of lean muscle in the thigh, while the lighter tissue is the adipose (or, fat) tissue in the thigh.

You can see the incredible amount of lean muscle mass preserved in a 70-year-old who trained 4-5 days per week. Contrast that with the sedentary 74-year-old in the middle, and you get the idea.

Preserving your lean muscle mass is not only possible, but necessary to maintain your movement, metabolism, and function as you age!

In addition to helping you maintain your muscle mass, proper functional strength AND power training can ensure that you maintain these muscular qualities as you age.

Preserving muscle mass, strength, and power plays a crucial role in balance and fall prevention. This type of training should be a priority in any balance and fall prevention program.


Lastly, both muscular endurance and cardio endurance play key roles in ensuring that you can maintain balance and avoid falling. If fatigue sets in due to a lack of endurance, there is a much greater chance of you losing your balance and falling.

General fatigue can result in falling for several reasons:

  • Fatigue can cause you to misstep and not be able to steady yourself.

  • Fatigue can cause you to drag your feet more and catch them on the ground or another object.

  • Fatigue can limit your ability to raise your leg enough when climbing stairs or climbing up on a curb, resulting in you catching your foot and falling.

Developing the necessary endurance and resilience to do an activity without muscular and cardio fatigue is the fix.

You should build enough endurance through regular training that you have more than enough stamina to go about any daily activities without fatiguing.


So, to add to what we talked about in part III last week, your comprehensive balance routine is not complete until you are doing something to work on targeted mobility, strength, power, and endurance.

To do this, make sure that you are performing functional exercises, and not simply sitting on machines to get your muscular fitness.

Performing functional strength exercises that utilize your whole body instead of machine-based strength training is key to maximizing the quality of your training.

Sure, you can strength train with machines, but it is much less effective and efficient than doing exercises on your feet which force you to balance and use the whole body together.

This type of functional training - performing exercises like squats, deadlifts, lunges, step-ups, and more - has the dual effect of training your muscular strength while also making it necessary to balance!

So, functional training for all these physical fitness qualities is step 2 to developing your comprehensive balance and fall prevention program!

Next week, we’ll wrap the whole series up by talking about a few things you should probably avoid if you want to maximize your balance training.

Until then, stay strong and balanced!


Want to learn more about training your body to Move Better, Feel Better, and Live Better? Our exercise programs at The Med Gym are custom-made to get you exactly what you need.

Our expert coaches will assess your fitness and balance, and design an exercise routine specific to your goals. We can help you get on the right track with your movement and fitness!

Contact us here to talk about how we can help you develop an exercise routine that improves your balance and so much more!

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