Every time we get up from a chair, turn to find something, or walk across a room, we rely on our balance. This ability is so automatic that it is easy to overlook. However, these normal movements depend on continuous input and coordination from the brain, muscles, joints, inner ear, and cardiovascular system. When connections begin to weaken, balance is often the first thing to falter.
Balance is important not only for preventing falls and maintaining independence. Studies have shown that it is closely linked to both heart and brain function, making it a strong indicator of overall health.1,2 These results highlight why it is important to protect your balance before it declines.
Imbalanced balance signals a higher risk of cardiovascular disease
The study, published in the Journal of the American Heart Association in September 2024 by researchers from Umeå, Sweden, set out to determine whether balance difficulties predict future cardiovascular disease (CVD) in older adults. Researchers followed 4,927 individuals, all of whom were 70 years old and had no history of heart attack, angina, or stroke at baseline.3
• How to measure balance — Participants took a balance test under two conditions: standing quietly with eyes open and eyes closed. Their sway was recorded in millimeters both side to side (side to side) and front to back (anterior to posterior). These measurements were analyzed along with other clinical data, including blood pressure, weight, and medication use.
• Lateral sway was a consistent predictor of CVD. Participants who swayed more from side to side during balance tests were more likely to be hospitalized for heart attack, stroke, or angina in subsequent years. For each millimeter increase in lateral sway during testing with eyes open, the risk of developing cardiovascular disease increased by approximately 1.4%. When tested with eyes closed, the risk increased by about 1.5% per millimeter.
• The more you shake, the greater the risk. The results showed that participants in the top quadrant of lateral sway had significantly higher rates of cardiovascular events compared to participants in the bottom quadrant. This means that even small increases in agitation make a meaningful difference in future health outcomes.
• Unsteady back and forth movements were also important. People who were tested with their eyes closed and who made faster, more irregular movements back and forth were also more likely to develop CVD. These patterns reflect instability that is not visible during routine medical visits.
• The scale tested outperformed some traditional risk indicators — In particular, shaking from side to side during the test with your eyes closed was ranked as one of the four strongest predictors of cardiovascular disease, along with being male and taking medications to prevent high blood pressure or blood clots. These four factors account for 61% of the risk across the population. The balance alone accounted for about 10% of that risk.
• The results were consistent and reliable. Results remained unchanged after removing participants with very short follow-up periods. Depending on the testing conditions, just 1 mm more wobble increased the risk of cardiovascular disease by up to 1.8%.
Balance disorders in older adults are closely related to cognitive decline
In addition to heart health, balance reflects how well the brain integrates sensory and motor signals. In older adults, balance problems are an early indicator of cognitive dysfunction, even before memory loss or disorientation appear. A January 2024 analysis published in the Journal of Prevention of Alzheimer’s Disease evaluated 143,788 community-dwelling Korean adults and found strong evidence linking balance difficulties with the future development of dementia.4
• Predicting future dementia with a balance test — At age 66, people with balance problems had significantly higher rates of new-onset dementia than those with normal balance. People who stood on one leg for less than 10 seconds were more than twice as likely to develop dementia as people who maintained the posture for more than 20 seconds.
• There is a higher risk of Alzheimer’s disease and vascular dementia. Participants with poor balance had an 83% higher risk of all-cause dementia compared to participants with normal balance. The risk of developing Alzheimer’s disease was 80 percent higher, and the risk of developing vascular dementia was almost three times higher.
• The shorter your balance time, the higher your risk of dementia. Even small declines in balance ability have been shown to have a persistent, graded relationship with dementia risk. People in the “cautious” category (standing on one leg for 10 to 19 seconds) had a 28% higher risk of dementia compared to those who could maintain balance for more than 20 seconds.
• White matter damage and cortical atrophy may explain the association. Imbalanced balance is associated with structural brain changes commonly seen in early cognitive decline, including white matter lesions and gray matter atrophy in areas involved in motor and memory functions. These changes impair both physical and cognitive processing, reducing adaptability to daily life.
• Microvascular disease contributes to cognitive and motor decline. Vascular-related damage to the prefrontal-subcortical circuitry (which controls movement and decision-making) explains why balance problems are accompanied by executive dysfunction, slow thinking, and an increased risk of dementia. These shared neural pathways suggest that the same biological perturbations that undermine stability also impair cognitive performance.
• Non-cognitive early indicators of dementia — Because the balance test is simple, non-invasive, and predictive, the authors suggest it as a valuable screening tool for identifying dementia risk in older adults, especially those who have not yet shown signs of cognitive impairment.
Gait and leg strength also predict dementia risk
The results of the January 2024 analysis support the August 2024 study published in the Journal of Gerontology.5 We find that poor balance, reduced walking speed, and lower limb weakness are strong predictors of future dementia. A study of more than 9,000 older adults followed for up to 15 years found that a simple physical test already used in routine geriatric assessments provides insight into cognitive vulnerability before symptoms appear.
• Balance disorders are expected to increase the risk of dementia by up to three times. Older adults who had difficulty maintaining a semi-aligned posture (with one foot slightly in front of the other and the heel next to the toes) had a two to three times greater risk of developing dementia than those who maintained stable balance.
• Slower walking speeds are a sign that your risk is significantly higher. Participants with slower walking speed at baseline were 52% to 73% more likely to develop dementia. The walking test, long known to predict frailty and mortality, has also proven to be a strong early indicator of cognitive decline.
• Lower extremity strength was also important. Poor performance on the chair stand test, an indicator of leg strength and neuromuscular coordination, was associated with a 56% higher risk of dementia. This is growing evidence that physical frailty and cognitive decline share overlapping biological pathways.
• Consistent risk across gender, age, and genetic risk — This association was consistent regardless of participants’ gender, age, and presence of the APOE ε4 gene, a major genetic risk factor for Alzheimer’s disease. These findings support the role of motor testing as a universal tool for early dementia screening.
To learn more about why balance is important as you age, read “Balance Function Serves as a Key Indicator for Healthy Aging.”
Evaluate your balance with a simple test
Adults, especially those over 50, should ideally have their balance tested and trained before problems begin. As reported by the Associated Press, the basic at-home test below provides powerful insight into your balance ability and overall health.6
• Standing on one leg – Greg W. Hartley, MD, professor of physical therapy at the University of Miami, recommends a simple balance test: standing on one leg for 10 seconds. If you can hold it without shaking, you are likely within a safe range. However, having difficulty with the test is a signal to seek medical evaluation.
For more information about what single-leg balance can tell you about your health, check out “One-leg balance reveals important clues about neuromuscular health.”
• Timed Walk Test Gauge — The “Timed up and go” test (TUG) is a quick check of functional balance. Get up from your chair, walk 3 meters (10 feet), turn around, walk backwards, and sit down. Ideally, this should be completed within 12 seconds. If it takes more than 15 seconds, your balance is impaired.
5 Daily Exercises to Improve Your Balance
Don’t wait until you lose your footing. Start improving your balance today to support your heart, brain, and overall health. We recommend starting with the five strategies below to help you transition smoothly into your daily life. If you’re just starting out, start with exercises 1 through 3 and gradually add other exercises as your confidence grows.
1. Walking from heel to toe as if walking a tightrope — Take 20 slow, deliberate steps in a straight line, with the heel of one foot directly in front of the toes of the other foot. Keep your arms relaxed and your eyes fixed in front of you. This improves the brain’s spatial processing abilities and improves coordination.
2. Try chair-supported squats — Stand with your feet hip-width apart. Hold the back of the chair and lower your body as if you were sitting. Start with 5 reps and gradually increase.
3. Use a stability ball — Sit or kneel on a stability ball for 30 seconds, increasing the time as your balance improves. This activates your deep core muscles and builds full-body stability.
4. Practice gentle tai chi or yoga — You do not need to attend class. Just a few minutes of slow, controlled breathing and movement at home is enough. These practices blend breathing, movement and balance to improve coordination and body awareness.
5. Strengthening ankle muscles — Weak ankles cause instability. Sit on a chair and write the alphabet in the air with your feet. Strengthen your ankles by tracing the alphabet with your feet while sitting or lifting your toes while standing.
Balance Frequently Asked Questions (FAQ)
cue: What does balance reveal about your overall health?
no way: Balance reflects the integrity of the nervous, muscular and cardiovascular systems. Studies show that poor balance increases the risk of heart disease, stroke, and cognitive decline.
cue: What does it mean if you stand still and then shake?
no way: Moving from side to side, especially when your eyes are closed, can be a sign that your brain and body are not working together smoothly. Even small increases in agitation can lead to a higher risk of heart problems and memory loss.
cue: Can imbalanced balance actually predict dementia?
no way: yes. Several large studies have shown that balance difficulties in midlife are associated with a significantly higher risk of developing Alzheimer’s disease or vascular dementia years later, even before memory problems begin.
cue: How can I test my balance at home?
no way: Try standing on one leg for 10 seconds or complete the “timed up and go” test. Having difficulty with either is a signal to focus on balance training and seek further evaluation.
cue: What’s the best way to improve your balance every day?
no way: Incorporate simple movements like heel-to-toe walking, chair squats, stability ball exercises, and ankle exercises into your daily routine. These small, consistent practices make a big difference over time.
