A year after he retired from a career in sales in 2016, Gary Metzler was diagnosed with early-onset Alzheimer's disease at age 64. One of his earliest symptoms was trouble with balance. He broke his ankle so badly after slipping on a dance floor that he required surgery.

To keep him physically active and improve his stability, his wife, Beth, took him to see Brian DeKuiper, a personal trainer in Minneapolis, whose practice focuses on older adults with neurologic challenges. The Metzlers live in Eden Prairie, MN, a suburb of Minneapolis.

During one of his sessions, Metzler spotted a basketball among the racks of exercise equipment. “His eyes just lit up,” says DeKuiper. “Soon we were tossing the basketball around at every session.” Metzler told DeKuiper how much he loved the game. As a kid in Thornwood, NY, he would shoot hoops for hours, practicing his skills—layups, jump shots, dribbling—and later he played on a community team. “He said, ‘I bet I can still throw a behind-the-back pass and hit you right in the chest,’” DeKuiper says.

They practiced that move, and eventually Metzler could do it, thanks in part to an overall exercise regimen that focused on hand-eye coordination, flexibility, strength—and balance. To fortify Metzler's steadiness, DeKuiper had him use a large exercise ball (also called a stability, Swiss, or physio ball); having to sit on an unstable surface (as opposed to a chair or bench) activates and strengthens the parts of the brain required for balance.

Balance is complex and involves three different sensory systems, says Fay B. Horak, PhD, professor of neurology at Oregon Health & Science University in Portland. The most important one, she says, is proprioception—the body's ability to sense movement and action and its location in space. The vestibular system, located in the inner ear, is responsible for providing the brain with information about head position and motion in relation to gravity. The other system used in balance is vision, which helps us anticipate obstacles and place our feet when walking.

Maintaining balance requires combining information from all three sensory systems, and their input may vary depending on the environment, Dr. Horak says. “If you're walking on a soft sand beach, for example, it's harder to use proprioception to know where the center mass of your body is, because the surface is unpredictable. You have to rely more on vision and vestibular function to stay upright and walking.”

Poor balance is a symptom of many neurologic diseases. People with Parkinson's disease tend to have trouble controlling reflexes related to posture. “When we lean backward, there's a reflexive response to catch ourselves and move forward,” says Jacob Sosnoff, PhD, a kinesiologist and rehabilitation scientist at the University of Kansas Medical Center in Kansas City. “For various reasons, that doesn't happen in Parkinson's.” People with Alzheimer's disease often are unsteady, and those with multiple sclerosis might lose feeling in their feet because of a lesion, and that can affect balance.

People with balance problems are more likely to fall and possibly avoid social engagement, says Dr. Sosnoff. “There are strong data supporting the notion that when people are less confident in their ability to walk and move around safely, they tend to have lower levels of community participation,” he says. They may not visit the local coffee shop, for example, or attend church services.

Less walking and social activity make people more sedentary, which is an overall health risk. “We don't want people giving up on daily activities—like collecting the mail at the end of the driveway—that allow them to maintain their independence,” says Dr. Sosnoff.

Fortunately, improving balance is possible. “Lots of studies have shown this,” says Dr. Horak. “It's probably because of redundancy and plasticity in the nervous system. If you damage one neural network, you can compensate by using a different one.” But like any kind of training, it takes consistency and dedication. “The more you work on your balance, the better you'll get,” she says.

After several years of training with DeKuiper and his staff (much of it done remotely during the pandemic and after DeKuiper moved to Columbia, TN), Gary Metzler has improved his ability to stand upright and move fluidly, which allows him to play basketball more often and more safely—even as his disease has progressed. “Sometimes he'll shoot hoops with one of our neighbors' kids,” says Beth, who watches from the porch of their house. “He loves doing it. And I'm so grateful for that.”

4 Stability Ball Exercises

A stability ball is an effective tool for engaging the three sensory systems—proprioception, vestibular, and vision—involved in balance. A 2020 study in the Journal of Exercise Rehabilitation found significant improvements in balance among stroke survivors who had followed a regimen that included stability ball exercises.

“The best part about stability ball exercises is how accessible they are for just about anyone,” says Bob Phillips, a personal trainer in Melville, NY, who uses the ball with many of his older clients. “You can easily do them at home.”

Before starting any physical activity, check with your neurologist or physical therapist. You can find balance balls on Amazon or at any sporting goods store for about $20. For those with neurologic conditions, a larger ball is recommended for greater stability.

Wear comfortable, loose-fitting clothes; have a pen or pencil and a small rubber ball handy as props; and, depending on your level of fitness, ask a friend to assist or spot you. Once you're ready, try these exercises—designed by Brian DeKuiper, a personal trainer in Columbia, TN—to improve balance.

Bounce.
Sit on the ball with feet shoulder-width apart and flat on the floor. Gently bounce up and down using small pelvic movements. This improves proprioception—a sense of where your body is in space—by reinforcing balance and postural control, says DeKuiper. To stimulate the vestibular system, hold (or have a partner hold) a pen or pencil at arm's length and look at the letters or logo along its side. “Stay focused on it while bouncing,” says DeKuiper. Bounce for 10 seconds to start, and gradually build up to 30 seconds. “It's activating your brain, especially when you include the vision part,” says DeKuiper. “It seems simple, but it's effective.”

Bounce and Toss
Once bouncing feels comfortable, up the challenge by throwing a small rubber ball to a partner a few feet away or throwing it in the air to yourself. Introducing a moving target further challenges the visual component of balance, says DeKuiper. Continue for one minute. “This could be a 10- to 20-minute training session in and of itself,” he adds.

Head Turn.
While seated on the ball, turn your head gently left to right and back as you try to keep an object—the pencil at arm's length or something on a wall in front of you—clearly in sight. Turning the head helps activate the inner ear canals, which contribute to better balance, says DeKuiper. Repeat two or three times at first; stop if you feel dizzy. Work up to doing this for 30 to 60 seconds.

Side-to-Side.
With your feet firmly on the floor and your butt pressed into the ball, use your hips and torso to slide the ball under you from left to right and back. The ball should move only slightly. The goal is to get the hips and torso moving. “Aim for a smooth motion,” says DeKuiper. Feel your hips open as you do this. Again, focus on an object—either the pen or a picture on the wall. “You're working both your vision and vestibular systems with this exercise,” he says. Start with 20 seconds at a time and build to three to 10 repetitions of 20 seconds each. “Moving and looking at objects while on the ball work together to trigger beneficial adaptations,” says Lawrence Indiviglia, a personal trainer in San Diego, who works with clients over 55.