®Do it along with a timer
Choose your level and start
Stand beside a stable surface such as a kitchen worktop; if possible, have someone nearby. For the standing exercises, the timer counts 10 seconds for each foot; for the walking exercises, press Next when you have finished the steps.
Support level
Heel-to-toe stand
Place one foot directly in front of the other, with your heel touching the toes of the back foot, and stand like that. Then swap your feet.
Standing on one leg
Lift one foot slightly off the floor and stand on the other foot. Then change to the other foot.
Heel-to-toe walk
Along a straight line, walk 20 steps, touching your heel to the toes of the front foot with each step; turn around and repeat.
Sideways walking
Put your hands on your hips. Take 10 side steps to the right, then 10 side steps to the left. Move along without knocking your feet together, placing your feet firmly on the floor.
Toe walking
Lift your heels and walk 10 steps on your toes; turn around and repeat.
Sit-to-stand from a chair
Sit on a sturdy chair that is not too low. Lean forwards, stand up, then sit down slowly. Use your hands for support at first; as it gets easier, stop using them.
Ready
Stand beside a stable surface and press Start.
Your sessions are stored only on this device; they are not sent anywhere.
Three levels
- Level 1Holding onto a stable surface with both hands.
- Level 2Holding on lightly with one hand.
- Level 3Without holding on; the stable surface is still within reach.
In the Otago programme, support is adjusted to each person’s balance and confidence. The three levels here are a simplified adaptation of this principle; a physiotherapist can set the progression that is right for you. The UK’s 2025 falls guideline (NICE) also recommends programmes that combine balance, coordination and muscle strength and become gradually more challenging.
Safety
- Hold onto a stable surface such as a worktop or a heavy table, not something that can move, such as a chair.
- Work on a non-slip floor in flat shoes; if possible, have someone nearby.
- The exercises should challenge you but not put you at risk of falling.
- Do not hold your breath.
- Stop if you feel dizzy or have chest pain or shortness of breath.
Frequently asked questions
Does balance exercise really reduce falls?
Yes. In a Cochrane review covering 108 randomised controlled trials and 23,407 people, exercise reduced the rate of falls in older people living in the community by 23% and the number of people who fell by 15% (high-certainty evidence). Balance and functional exercises reduced the rate of falls by 24% and the number of people who fell by 13%; in programmes that mostly combined balance and strengthening, the reductions were 34% and 22% (moderate-certainty evidence). In an analysis of 7 trials of the Otago programme on which this page is based (1,503 people, average age 81.6), falls were reduced by 32%.
Why should I hold onto a worktop rather than a chair?
Do not hold onto anything that could slide or tip over, such as a chair. Work beside a stable surface such as a kitchen worktop or a heavy table. As you move up the levels, hold on less, but always keep the stable surface within reach.
How soon will I notice a difference?
The World Falls Guidelines recommend, to prevent falls, a balance and functional exercise programme done at least 3 times a week for at least 12 weeks, tailored to the person and progressed gradually; continuing for longer brings more benefit. This page counts the weeks in which you reach the target of 3 sessions a week.
Isn’t walking enough?
Walking is very valuable for the heart and general health. However, the Cochrane review did not find enough evidence to determine the effect of walking programmes alone on falls; in preventing falls, exercises that challenge balance and strengthen the legs stand out. Tai chi is also an option: in the same review it reduced the rate of falls by 19% (low-certainty evidence).
Which level should I start at?
If you are not sure, start at level 1, holding on with both hands. When you can do an exercise comfortably and safely over a few sessions, move up to the next level. The exercises should challenge you a little, but not put you at risk of falling. To measure your risk of falling, you can try the 4-stage balance test.
When should I stop exercising?
If you have dizziness, chest pain or shortness of breath while exercising, stop and see your doctor. If you have had a break from the programme because of illness, talk to the physiotherapist guiding you before starting again.
To measure your balance, you can try the 4-stage balance test and the 10-second balance test; for your leg strength, the home strength circuit; and for more detail, see the falls prevention guide.
Sources
- Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019;(1):CD012424. Haber: MDedge.
- Thomas S, Mackintosh S, Halbert J. Does the ‘Otago exercise programme’ reduce mortality and falls in older adults? A systematic review and meta-analysis. Age Ageing. 2010;39(6):681–687.
- Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. 2022;51(9):afac205. Summary: RoSPA.
- Royal Orthopaedic Hospital NHS Foundation Trust. Otago strength and balance exercises.
- National Institute for Health and Care Excellence. Falls: assessment and prevention in older people and in people 50 and over at higher risk. NICE guideline NG249, 29 April 2025.