Tai chi, balance and falls prevention in older adults

The NHS says causes of falls include muscles getting weaker with age, conditions that affect mobility or balance such as arthritis, stroke or Parkinson's disease, low blood pressure, side effects of some medicines, and problems with eyesight or hearing and dementia. Because falls usually have several contributing causes, exercise is one part of a wider picture that also includes eyes, ears, medicines and home safety.

The NHS says that if you have fallen or are worried about falling, doing exercises to improve strength, balance and flexibility will help make you stronger and feel more confident on your feet.

The NHS physical activity guidelines for older adults say adults aged 65 and over should be physically active every day, even if it is just light activity, do activities that improve strength, balance and flexibility on at least 2 days a week, and aim for at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous activity, or a combination. The same page lists tai chi, yoga and pilates among examples of muscle-strengthening activities.

NICE guideline NG249 on falls takes a broader approach. It recommends that people who have fallen in the last year and have a gait or balance impairment are offered a falls prevention exercise programme, and that such programmes are delivered by appropriately trained professionals, are progressive and tailored to the person's needs, preferences, goals and abilities, focus on balance, coordination, strength and power, and include regular progress reviews. The guideline does not name tai chi, so it should be seen as one possible way of building these capacities rather than a prescribed treatment.

If tai chi appeals to you, it makes sense to ask whether a local class is suitable for people with your mobility and any health conditions.

The NHS advises speaking to a GP first if you have not exercised for some time, or if you have medical conditions or concerns, and making sure the activity and intensity suit your fitness. For strength to improve, the NHS says exercises should be done to the point where you need a short rest before repeating.

• Choose a class led by someone experienced in working with older adults.

• Tell the instructor about previous falls, dizziness, joint problems or medicines that affect balance.

• Wear shoes that fit well and have a good grip, as the NHS advises for falls prevention.

• Have something stable to hold when you practise new movements at home.

• Build up gradually and keep activity regular rather than occasional.

• Stop and seek advice if you become unwell, dizzy or in pain.

The NHS lists several other measures: eat well and stay hydrated, look after bone health with calcium and vitamin D, have regular eye tests and get ears and hearing checked, speak to a GP or pharmacist if you think medicines affect balance, use non-slip mats in the bath or shower, consider rails and walking aids, avoid clutter and loose rugs, and do not drink too much alcohol. It also suggests wearing a personal alarm or carrying a phone.

NICE recommends a home hazard assessment be considered for people who have fallen and have a gait or balance impairment. You can also ask your local council for a free care needs assessment, according to the NHS.

The NHS says to call 999 if you or someone else has fallen and may have injured the head, back, neck or hip, or cannot get up. Get help from NHS 111 if someone has fallen and may be in pain, injured or unwell. See a GP if you are worried about your balance or mobility or have had a fall.

A GP may check your balance by asking you to get up and move around and may refer you to a specialist falls service, which may check for muscle weakness, osteoporosis or eyesight problems, offer strength and balance training, check home safety and review medicines.

On the NHS, falls prevention is delivered through GP practices, specialist falls services and community strength and balance programmes, with self-referral possible in some areas. Charities such as Age UK and the Chartered Society of Physiotherapy also provide guidance, which the NHS signposts.

Some people choose private physiotherapy or paid tai chi classes. The key questions are whether the instructor is experienced with older adults, whether the class matches your ability and whether any underlying causes of falls have been assessed first.