Integrated Strength & Balance Exercises for the Older Adult

by: Josie Gardener & Joy Prouty

As one ages, many physiological changes take place. This is a natural part of the process, but many of the physical changes (biomarkers) that negatively affect personal wellness can be minimized with physical activity. One key biomarker is loss of muscle. As an individual ages, muscle is lost and has a profound impact on an older adult's well-being.

Exercise can have a definite positive impact on maintaining a high quality of life. Weight bearing, muscle strengthening and balance exercise help reduce the risk of falls and fractures, and improve bone density. It is of utmost importance that fitness professionals know how to appropriately counsel participants in regard to exercise order, as well as how to improve or maintain agility, strength, posture and balance capabilities.

When older adults begin an exercise program, slow progression and quality of movement is the number one predictor of success. Many trainers or group fitness instructors, well intentioned, will progress too fast and give exercises to participants where the risk outweighs any potential benefit. This is why I say, "Start low and go slow."

By selecting exercises that strengthen all muscles, ligaments and tendons surrounding the joints, instructors can help make clients more stable and able to react to a changing environment. These exercises should focus on the muscles needed to perform the activities of daily living (ADL).

Before you start consider this…Many older adults are fearful, and rightly so, that they can get hurt when starting a new exercise program. Clients must be progressed so that each move is performed safely. This means the participant needs to perfect the exercise and maintain body control while performing on a stable surface before progressing to an unstable surface. Transitioning to a more complex or challenging exercise should not be done until the client feels secure with moving to a new progression that may or may not utilize a new piece of equipment.

Reactive training, or having a capability to respond to changing, unpredictable demands of real life, is a very important component of fitness for this age group. The BOSU® Balance Trainer (BT), when used properly, is a great tool to train this key element of fitness.

Trainers and group instructors are always looking for new and exciting training methodologies to keep workouts fresh and results coming. While we do not want to "baby" this population, it is critical to use a proper progression or regression to assist the older adult in being simultaneously successful and safe.

The following exercises will strengthen important postural and stabilizing muscles which include the quadriceps, gluteus maximus, hamstrings and rectus abdominis/obliques (core).

While exercises may seem simple to instructors, the opposite might be true for the new participant. Do not lose sight of the age, and more importantly, the fitness level of the client or participant. Older adults tell us that young instructors have little understanding of how they feel, and unfortunately, fail to ask or understand the challenges that face an older population with a number of health issues. Constant communication is encouraged and fosters greater empathy and trust for the instructor.

Each exercise can be performed on the floor and then progressed to the BT. Be sure to have adequate padding or an alternative, especially if the client cannot easily move to the floor. In some cases, moving to the BT is easier for the older adult than moving to the floor. Be prepared to modify any exercise to fit the client's needs.

Following the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) Guidelines and Basic Recommendations for Adults Over 65 (2007):

  • Chose 8 to 10 strength exercises.
  • Perform 10 to 15 repetitions of each exercise per workout.
  • Do strength workout 2 to 3 times per week.
  • Allow 24 to 48 hours of rest between sessions.

Strength Exercises

1) Squat Lift (Legs/Gluteus Maximus)  
Integrated Strength & Balance Integrated Strength & Balance


  • Stand next to the BT. Place R foot on top of dome (center of BT) and L foot on the floor. Rest hands on hips or slightly extend to sides of the body for more balance.
  • Perform a partial squat and extend/straighten leg on the BT without locking knee. Lift L leg to side.
  • The goal is to perform 10 repetitions on each side. Note that the participant may need to work toward this goal slowly.
  • Key cues include: 1) squeeze glutes/buttocks to stabilize, 2) pull abdominals in and 3) up like an elevator.
  • A simpler modification is to lightly hold client's hands, use a weighted bar turned on its end, a wall or the BOSU® 3D System for support.


2) Standing Knee Lift (Hip Flexors/Core)  
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  • Stand on top of the BT.
  • Feet should be centered with body weight evenly distributed on each foot. At first, standing on top of the BT dome is challenging.
  • The goal is to hold position for 1 minute, then perform 20 alternating knee lifts when the body is stable and controlled. Progress slowly.
  • Key cues include: 1) pull abs in and up, as though putting on a tight pair of jeans, 2) contract qlutes, 3) knees can be slightly bent, 4) maintain proper posture (chest up, shoulders back and down, abs contracted, hips, knees and feet pointing forward, 4) find a focal point in front, rather than looking down.
  • A simpler modification is to lightly hold client's hands, use a
    weighted bar turned on its end, a wall or the BOSU® 3D System for support.


3) Opposition Arm and Leg Raise (Core/Back)  
Integrated Strength & Balance Integrated Strength & Balance
  • Kneel on top of the BT with toes in contact with the floor.
  • Place hands on the floor in quadruped position.
    Extend 1 leg behind body at hip level. Then, lift and extend opposite arm in front of shoulder with thumb up toward the ceiling.
  • Try to keep shoulders and hips even, maintaining a straight line from fingertips to toes.
  • Bring extended knee in toward chest and touch it with extended hand, maintaining neutral posture.
  • Hold each position for 2 counts. Repeat on other side.
  • The goal is to perform 5 repetitions on each side.
  • Key cues include: 1) contract abdominals and glutes, 2) lengthen torso as fingertips reach towards wall in front and toes push back towards wall in back, 3) if a water bottle was placed on the hips and back, it should not move, 4) extend leg and arm for 2 counts, touch hand to knee for 2 counts, extend leg and arm for 2 counts, and lower for 2 counts.
  • A simpler modification is to perform arms or legs only.
  • A harder modification is to lift toes off of the floor,


4) Bridging Knee Lift (Gluteus Maximus/Hamstrings)  
Integrated Strength & Balance Integrated Strength & Balance
  • Lie in supine position with knees bent, feet on top of the BT and arms resting on the floor.
  • Squeeze buttocks and extend hips off the floor.
  • Slowly extend R leg, then pull R knee in towards chest. Repeat on L side
  • Hold for 2-4 counts and lower back to starting position.
  • The goal is to perform 15 repetitions.
  • Key cues include: 1) squeeze buttocks to stabilize lifting motion, 2) keep hips lifted and level throughout exercise.
  • A simpler modification is to keep both feet on the BT.
  • A harder modification is to cross arms on chest.


About the Author:

Josie Gardiner, a former Reebok Master Trainer and member of the Reebok University Development Team, is the 2002 IDEA Group Exercise Fitness Instructor of the Year and 2005 ACE Instructor of the Year. Gardiner served on the Massachusetts Governor's Committee on Physical Fitness and Sports for ten years. With over 35 years presenting for the fitness industry, Gardiner is recognized for her creative dance style and expertise with the 50-plus market.

Joy Prouty, a former Radio City Music Hall Rockette, has been a fitness instructor and trainer for 40 years. Prouty operates Fitness Programming, Inc., where she develops fitness programs for individuals and corporations, and conducts fitness instructor education. As a former member of the Reebok University Training and Development Team, Prouty taught fitness programs to trainers and consumers around the world. Certified by ACSM as a Health Fitness Director, she also holds certifications from ACE and AFAA, and is a certified and licensed Wellcoach.

Gardiner and Prouty have 14 fitness DVDs and eight music CDs on the international market mostly focusing on 50-plus and de-conditioned individuals. Partnering with Dr. Carolyn Kaelin, Director of the Comprehensive Breast Health Center at the Brigham and Women's Hospital in Boston, and Francesca Coltrera, medical writer, Gardiner and Prouty co-authored The Breast Cancer Survivor's Fitness Plan published by McGraw-Hill and Harvard Medical. They also co-developed the Zumba Gold training program, and are members of the Beamfit Advisory Board, to cater to program development for the active older adult.