How's your balance? Here's what that could mean for heart and brain health

It's an ability and skill often taken for granted. It affects quality of life and has been linked to heart disease and stroke. As we age and our muscles weaken, balance becomes crucial to staying active and supporting a healthy heart and brain.

"Balance is important because it's one of the attributes that allows you do to physical activity," said Dr. Kelley Gabriel, a professor of epidemiology and associate dean at the University of Alabama at Birmingham School of Public Health. "Everything you do involves some level of balance – standing at the sink, mopping, walking the dog. It's embedded into almost every single activity."

According to federal physical activity guidelines, balance training should be part of the weekly exercise routine for older adults to help prevent falls, another frequent problem for stroke survivors. Such exercises include walking backward, standing on one leg or using a wobble board. Use caution and work with a coach or training partner if needed. Activities that strengthen the back, abdomen and legs also improve balance, the guidelines say.

Balance is a "multifaceted physiological process" that involves vision, the vestibular system in the inner ear and the nervous system, researchers wrote in a 2024 study in the Journal of the American Heart Association. The Swedish study included 4,927 participants without cardiovascular disease who were 70 years old. Their balance was measured at the start of the study using a balance board.

After five years of follow-up, researchers found that problems with lateral balance – the ability to remain stable while shifting weight from one side of the body to the other – were associated with a higher risk for heart attack and stroke.

Similarly, a 2023 study in the European Journal of Medical Research found that among nearly 130,000 adults age 60 and older in Korea, those with balance impairment may be at increased risk for coronary heart disease or stroke.

Two 2024 studies – one in the Journal of Prevention of Alzheimer's Disease and the other in the Journals of Gerontology Series A – also found an association between balance impairment and increased risk of dementia among older adults.

Dr. Pei-Shiun Chang, associate professor of community and health systems at the University of Indiana School of Nursing in Bloomington, said that while impaired balance may be an early indicator of brain and heart health, and vice versa, "you can never say if someone has issues with their balance that they also have some issues with their brain or heart. You need to dig more into their" medical history.

Gabriel agreed, saying that direct connections between balance and heart and brain health cannot be made because conditions such as cardiovascular disease and dementia develop over decades, and may arise because of other risk factors. "It becomes very challenging to measure the relationship between balance and things like cardiovascular disease and dementia given balance is so challenging to isolate from other aspects of physical activity," she said.

One relationship that is more certain, Gabriel said, is that the more active someone is, the better their balance is likely to be. And balance is a key factor in preventing falls, which is the leading cause of injury among adults 65 and older, according to the Centers for Disease Control and Prevention.

Clinicians should assess balance and risk for falling in people with cardiovascular diseases, according to a 2022 American Heart Association scientific statement that says patients with any loss of balance should be referred for physical therapy.

Balance exercises can help with the recovery process for those who have had a heart event or stroke. People should plan their exercise program with a health care professional, Chang said.

Start slowly with exercises that strengthen the foot and lower leg muscles, and work with a rehabilitation specialist or family member who can assist if needed. Gradually build up duration and intensity.

"Maybe start with a short walk in your neighborhood, and once you feel like you can tolerate that level, slowly increase intensity. Then move on to other exercises," Chang said.

She recommended toe stands, which is a balance exercise that requires someone to stand or move on the tips of their toes, as great balance training for older adults since it strengthens the calves and ankles.

In general, many lower-body strength training exercises can improve balance for people of all ages. Practicing yoga and Pilates can help with balance, strength and flexibility.

Chang also recommends qigong, a form of traditional Chinese mind-body exercise, as another practice that can improve balance, flexibility, muscle strength and overall health, especially for older adults. Qigong, which is similar to tai chi, combines slow and precise body movements with controlled breathing and mental focus.