How can Clinical Pilates Reduce Falls in Old Age?

"Clinical Pilates and Physiotherapy isn't just about injuries. One of the most important things we can do is keep the body running as we get older."

Reducing Falls for the Elderly

“How do I keep my father from falling?” 

“I’m worried about leaving my Grandmother alone with the stairs”

“I don’t want to use a walker.  I want to go shopping by myself.”


These are thoughts that we’ll all have at some point in our lives.  After all, falls are dangerous, and when older adults are involved, it can be the final push that stops them from doing what they love.


The Centre for Disease Control and Prevention reports that falls are a leading cause of injury and death in individuals 65 years of age and older. (1)  As medicine gets better, we’re living longer, but our joints and muscles still wear out at the same pace! We need to start looking after ourselves!


This is backed up by our experience in the Physiotherapy world, which has shown that people who reduce their fall risk live longer, more independent, and happier lives.  Conversely, when someone over 60 does break a bone, it can take months or even years to fully recover back to their previous quality of life.  This means that it’s extremely important to reduce falls for the elderly before they happen.


Sorry: No amount of injections, massages, surgeries, or other ‘quick fixes’ are going to change this reality.


Although it’s impossible to completely avoid all falls for older people, we can take preventive measures to vastly improve their injury tolerance, balance, and responsiveness to make a big difference to Quality of Life.  


International-Quality Physiotherapists teaching Clinical Pilates is the answer to your problem.  It’s not a quick fix – it’s the one that works.


The Magnitude of such Deadly Falls - and My Own Personal Experience!

At 65, you're not elderly, but falls still hurt a lot!

According to the World Health Organization, it is estimated that approximately 28-35% of individuals aged 65 and above have a significant fall each year. As age increases, there is an increase in the fall rates, rising to 32-42% for people over 70 years. (3)  


Imagine having a 30% chance of a significant fall every year!


It’s hard to believe it until it happens in your own family.  At 65, my mother was strong, fit,and exercising every day. You could hardly call her elderly at all.  Despite that, one unlucky staircase later, and she had to spend several months in a cast, followed up by 1 year of rehab physiotherapy – something that a younger person would have recovered from in a much shorter time.  


It can happen to any of us, and we were lucky that her excellent fitness regimen before the fall meant that she was able to make a full recovery with Clinical Pilates after it happened.  Needless to say, this personal experience made us all that much more focused on the issue!

What Factors Cause Older People to Fall?

Falls in older adults are multifactorial. This means that it’s not just one reason causing the issue, but many small factors adding up to a big difference.  It’s not just weak knees, or bad balance – it’s many things, and this is why many other fitness programmes, surgerys, and injections fail – they only address one factor, and leave all of the other factors in place.

  • Weakness
  • Ageing balance system
  • Lack of flexibility
  • Lower Bone Density
  • Poorer eyesight and situational awareness
  • Slow reaction time.
  • Pain
  • Poor walking technique (Gait)
  • Many Others…

Everyone’s body is unique, and so everyone needs to be working on a slightly different programme to maximise their quality of life.  We need to address every factor that we can, and we need to address them in harmony. Think: “Flexibility without Strength is just as dangerous as Strength without Flexibility.”

Here are some of the most common issues that we need to address with Clinical Pilates before a fall ever happens:

  • The first line of defense: Building strong primary leg muscles to support the knee and ankle joints.  This makes us safer when we do hit a bad stair or bump in the road.
  • The second line of defense: Retraining the vestibular system (balance system) to keep it responsive and accurate.  When we’re toddlers, we first have to learn to balance on two legs. It’s a skill that we had to learn and calibrate before we could walk.  As we get older, our balance mechanisms start to deteriorate (the inner ear gets more viscous), and we need to recalibrate and train it to get it back to peak responsiveness.
  • The third line of defense: building a better range of motion (think ‘strong flexibility’ as opposed to ‘uncontrolled flexibility’).  This better range of motion makes us more responsive if a slip or trip does happen.
  • The last line of defense: a stronger core, arms, and wrists so that if we do fall, we can absorb the impact and protect our vulnerable joints and bones.


And of course, reducing falls for the elderly is all about building confidence and acceptance in our society.  It’s never embarrassing to work towards a fit, older self.

How does Clinical Pilates Specifically Help Reduce Fall Incidents in Older People?

Several experimental studies (4,5), analyses (6) and systematic review studies (7-9) have demonstrated the benefits of Clinical Pilates for falls prevention.


Clinical Pilates focuses on controlled and conscious movements to improve overall flexibility, muscle tone, fitness, posture and balance. These movements are based on 6 core principles: precision, breathing, concentration, control, centralization and fluidity.  


Most importantly, Clinical Pilates is tailored to each person so they work on exactly what their body needs.  This is the key in the system’s success.


We do Clinical Pilates using small equipment such as a mat, rollers, elastics and balls.  We also use large Studio equipment such as the Cadillac (aka Trapeze Table), Reformer, Ladder Barrel, and Wunda Chair.  This lets us do highly targeted exercises that you can’t do with other forms of fitness and physiotherapy.

1 - Clinical Pilates Increases the Level of Muscle Strength

Clinical pilates increases the strength of your lower limbs, abdominal and dorsal muscles (your back muscles). (10)


With aging, there is a corresponding decline in muscle mass and strength. Sarcopenia is a natural syndrome which is characterized by progressive loss of skeletal muscle mass. This natural loss of muscle mass occurs in the older population which further increases the probability of fall incidents.


Clinical pilates can help to fix these issues by building muscle mass and strength, without the risk of damaging joints (a common risk in yoga, jogging, cycling, or weight lifting). Using apparatus such as the Reformer, Trapeze Table and Combo chair, we challenge and strengthen your lower limbs, trunk flexors and extensors (your abs and core), eventually increasing your level of muscle strength.


This makes for a stronger body that is more resilient to falls, slips, and unexpected forces.  It’s our first line of defense as we age.

2 - Clinical Pilates Increases your Level of Flexibility

We often associate flexibility workouts with warm-up and cool-down exercises. But when it comes to quality of life, we forget that flexibility is one of the important elements of our health. Clinical pilates stretches your whole body and helps you increase your level of flexibility in a safe and balanced way (remember: building flexibility without control just makes you weaker!). (11)


Clinical pilates utilizes dynamic stretches to safely increase your range of motion. A better range of motion, when combined with more muscle strength, helps you to react more quickly to slips and falls.

3 - Regulates Your Balance System

Loss of balance is one of the most common reasons for falls in elderly people. This is because as we age, the fluid in our inner ear starts to get more viscous, our eyesight gets worse, and our hearing is not as sharp.  These elements all make up important parts of our vestibular system, and as they degrade, we become less-responsive to fast changes in balance.  


If we just let ourselves degrade slowly over time, we will eventually have worse overall balance.  But the good news is that just as you learned balance as a toddler, you can re-learn it as an adult and improve your responsiveness.


Using clinical pilates we stimulate both the static and dynamic balance systems, by working on your visual, vestibular and proprioceptive processes. (12,13)  This is all about create new challenges for your balance system in a controlled environment, improving your response speed, and helping your brain to recalibrate with your inner ear and eyes.


The second part is rebuilding your static balance power.  Your body’s balance largely depends on the deep muscles of the trunk i.e. the core muscles. The more activated the core muscles, the better an older adult can maintain his or her balance. Clinical pilates helps in activating the deep core muscles using conscious and controlled body movements.

4 - Clinical Pilates improves your Gait and Sway

Gait and balance dysfunction are prominent risk factors for falls in the older population. It is estimated that 20-40% of people aged over 65 are affected by gait disorders, with the stat increasing to 40-50% in adults over 85 years of age. (14)  To put this in simple terms, as we age, we stop walking efficiently, and start to put unnecessary stress and wear on our joints!


Impaired gait is highly associated with an increase in stride or step variability, which is a hallmark predictor of falling. If we can walk more efficiently, we are less likely to slip or trip on an uneven surface.


Clinical Pilates helps in reducing falls for the elderly by improving balance and gait, where other modes of fitness fail to provide results.  We do this through targeted exercises with a single, clear goal – improving your walking efficiency. Imagine going back to school to learn to walk!  (Don’t worry, it’s not embarrassing – it’s surprisingly fun).


For example, Tandem walking, a simple but effective clinical pilates exercise can be used to improve gait parameters in older adults by working on stride-length and balance in a safe and effective environment.  We also improve the strength of your gluteus medius muscles (the forgotten ‘side of your bum’ muscle), which can help to reduce hip sway. 

5 - Reduces the Fear of Falls - Improving your Quality of Life!

At the end of the day, we’re specialist physios because we want you to get out there and live your life to the fullest.  We get great joy out of seeing people leave our studio with a renewed sense of physical purpose, and more spring in their step.


Fear of falling is almost as bad as the fall itself.  If you’re living in fear, you’re not doing all of the great things that you love to do.  And if you’re not doing the things you love to do, your body gets weaker and increases your risk of falling.


As you can see above, Clinical pilates is an exceptional modality for improving specific strength and balance. It emphasizes the motor control of the pelvic floor and deep trunk muscles, i.e. the transversus abdominis and multifidus.  


It is effective in bone formation in women with osteopenia (the first stage of weakening bones) (17-19), enhancing function and improving emotional and social well being (21-22) in the elderly population.


But most importantly, it improves confidence and gets you back out there enjoying your life, and that’s what really matters.  (16)

3 Best Exercises for Reducing Falls in Older People

With so many proven benefits, we’re confident in reducing the number of falls in elderly individuals through Clinical Pilates exercises. 


Nothing beats seeing a professional, and getting a safe, personalized, and targeted programme.  But to get you started, here are three great ways to start improving your (or your parent’s) life.

1 - Shoulder Bridge

Shoulder Bridge Starting Position. Lie on your back with your knees bent and your arms by your sides.
Step 2, slowly lift the back off the ground to start the shoulder bridge. This is great for your hamstrings.

In older people, the stiffness in the spine increases with age, restricting free body movements. It seems like the whole upper body is rigid and not able to move freely. The shoulder bridge is the perfect exercise to keep the spine mobile, agile and ultimately young.




Lie down in a neutral position. With your knees bent, start tilting your pelvis. This will help you close the gap between the mat and your lumbar spine.


Now, lift your back, vertebrae by vertebrae until a diagonal line is created, all the way from your knees to the shoulder. Make sure the knees are parallel and are not wandering or shaky.


Hold this position for 5 seconds and then lower your spine vertebrae by vertebrae, slowly on to the mat again. Repeat this exercise for 10 to 15 repetitions.




Shoulder Bridge is an excellent exercise to individually work on your spine and increase its mobility. Moreover, by contracting your trunk muscles and lifting the pelvic floor, you also activate the core as well.

2 - Standing Side Kicks

As we age, we tend to lose muscle mass and strength. For balancing the body, it is important to maintain your lower body strength.


Your hips are the largest weight-bearing joints in your body. Therefore, they are also prone to a great amount of physical abuse. Standing side kicks are effective in regaining the lost strength of your lower body.




Before beginning with standing side kicks, properly warm your body for 5 to 10 minutes.


To begin with, stand on your feet, with feet hip-width apart. Place your hands on the hips and contract your glutes and abdominal muscles.


Now transfer your weight on your right leg and lift your left leg towards the side until you reach the edge of your flexibility. Hold this position for a count of two and slowly lower it back to the ground.


Do it for 15 repetitions before moving onto your right leg. If you are finding it difficult to balance on one leg, hold onto a chair or a wall for stability.




With standing sidekicks, you work on the muscles that support the hips, which includes the glutes, quadriceps, abductors, adductors, iliopsoas, and hamstrings.


By performing this exercise you keep these lower body muscles strong and healthy and provide additional stability to the hips.

3 - Tandem walking

Impaired gait patterns are highly associated with the risk of falls in the elderly population. Tandem walking is an excellent exercise to improve spatial coordination and leg strength in older people.




Stand up straight with your abdominal muscles contracted and your chin tucked in.


Now place your one foot in front of the other in such a way that the heel of the forward foot touches the toes of the rear foot.


In the same manner, move forward as if you are walking on a tightrope. Walk for about 10 feet. Repeat it five times with performing the exercise once or twice a day.


Make sure the flooring is firm without any obstructions.




Tandem walking is the best exercise for maintaining body balance that can be performed anywhere. It improves your coordination and also strengthens your core and lower body muscles.

Join us in the movement for reducing falls in old age

Clinical Pilates is an outstanding tool for reducing falls for the elderly.  Start in your 40’s or 50’s if you can, but it’s never too late to get moving.

If you are suffering from any chronic health conditions, do consult your healthcare provider (and us) before beginning any exercise program.

An of course, do join us to learn the power of Clinical Pilates and we’ll show you the best exercises for your body.

“Body in Common is an Australian-Style Physiotherapy Studio in Bangsar, Malaysia. We provide Physiotherapy and Clinical Pilates services in our studio, as well as online Telehealth services. Feel free to get in touch and look after yourself.”

See Some Examples on our Youtube Channel

Backed by Evidence. References.

  1. Falls are leading cause of injury and death in older Americans. (2016, September 22). Retrieved from
  2. United Nations (UN) (2004). World Population Prospects: The 2004 Revision. New York, USA.
  3. Falls Prevention in Older Age. (2015, October 3). Retrieved from
  4. L Donath, R Roth, C Hurlimann, L Zahner, O Faude (2016) Pilates vs. Balance Training in Healthy Community- Dwelling Seniors: A 3-arm, Randomized Controlled. Int J Sports Med 37(3): 202-210.
  5. J Bertoli, GM Biduski, C De la Rocha Freitas (2017) Six weeks of Mat Pilates training are enough to improve functional capacity in elderly women. J Bodyw Mov Ther 21(4): 1003-1008.
  6. GC Miyamoto, LOP Costa, CMN Cabral (2013) Efficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: A systematic review with meta-analysis. Braz J Phys Ther 17(6): 517-532.
  7. WHO-World Health Organization (2007) Global Report on Falls Prevention in Older Age. Community Health (Bristol) 53.
  8. IFO Barros, MB Pereira, TH Weiller, ETR Anversa (2015) Internações hospitalares por quedas em idosos brasileiros e os custos correspondentes no âmbito do Sistema Único de Saúde. Rev Kairós Gerontol 18(4): 63-80.
  9. PB Engers, AJ Rombaldi, EG Portella, MC da Silva (2016) Efeitos da prática do método Pilates em idosos: Uma revisão sistemática. Rev Bras Reumatol 56(4): 352-365.
  10. LC De Oliveira, RG De Oliveira, DAA Pires Oliveira (2015) Effects of Pilates on muscle strength, postural balance and quality of life of older adults: A randomized, controlled, clinical trial. J Phys Ther Sci 27(3): 871-876.
  11. S De Azevedo, J Simas, Z Machado, V Jonck (2014) The effect of Pilates method on elderly flexibility. Fisioter em Mov 27(2): 181-188.
  12. IPC Coriolano, VR Pérez, MM Nascimento, HJ Appell (2012) The Pilates Method to Improve Body Balance in the Elderly. Arch Exerc Heal Dis 3(3): 188-193.
  13. MS Tomruk, MZ Uz, B Kara, E Idiman (2016) Effects of Pilates exercises on sensory interaction, postural control and fatigue in patients with multiple sclerosis. Mult Scler Relat Disord 7: 70-73.
  14. RW Pata, K Lord, J Lamb (2014) The effect of Pilates based exercise on mobility, postural stability, and balance in order to decrease fall risk in older adults. J Bodyw Mov Ther 18(3): 361-367.
  15. M.E. Tinetti, D. Richman, L. Powell, Falls efficacy as a measure of fear of falling,J. Gerontol. 45 (1990) 239–243.
  16. D Cruz Díaz, A Martínez Amat, MJ Torre Cruz, RA Casuso, N Mendoza, et al. (2015) Effects of a six-week Pilates intervention on balance and fear of falling in women aged over 65 with chronic low-back pain: A randomized controlled trial. Maturitas 82(4): 371-376.
  17. Betz, S., 2005. Modifying Pilates for clients with osteoporosis. IDEA Fit. J. 46e55.
  18. Kim, C.S., Kim, J.Y., Kim, H.J., 2014. The effects of a single bout pilates exercise onmRNA expression of bone metabolic cytokines in osteopenia women. J. Exerc.Nutr. Biochem. 18 (1), 69e78.
  19. Sinaki, M., Mikkelsen, B.A., 1984. Postmenpausal spinal osteoporosis: flexion versus extension exercises. Arch. Phys. Med. Rehabil. 65 (10), 593e596.
  20. de Siqueira Rodrigues, B.G., Cader, S.A., Torres, O.B., de Oliveira, E.M., Dantas, E.H., 2010. Pilates method in personal autonomy, static balance and quality of life ofelderly females. J. Bodyw. Mov. Ther. 14 (2), 195e202.
  21. Mokhtari, M., Nezakatalhossaini, M., Esfarjani, F., 2013. The effect of 12-week Pilates exercises on depression and balance associated with falling in the elderly.Procediae Soc. Behav. Sci. 70, 1714e1723.
  22. Roh, S.Y., 2016. The effect of 12-week Pilates exercises on wellness in the elderly. J. Exerc. Rehabil. 12 (2), 119e123.
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