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Balance is a skill you don’t think about until you really need it — like when you lose your footing and have to perform an exotic improv dance to keep from hitting the ground. But don’t wait until your sense of balance fails before you give it proper attention. As we age, balance can sharply decline, often with little warning. An exercise program called BEEP can help.

How you keep your balance

While keeping proper balance may seem simple, it involves a complex system with many moveable parts. Whenever you move, your eyes and brain process information about your surroundings. Your feet detect changes in the terrain. Your arms swing to keep you stable, and your lower-body muscles and joints generate rapid power so you can move forward, stop, and change directions.

Unfortunately, this system works less effectively over time. The sensation of our bodies moving through space is not as crisp, and information travels more slowly between the body and brain. Muscles become weaker, and joints lose flexibility.

Any breakdown in your balance system increases your risk of falls, which can cause hip fractures, broken bones, and head injuries.

“Doing more balance exercises and activities can keep your sense of balance in good shape, but you also want to focus on multifaceted movements that work on all the elements of your balance system,” says Dr. Brad Manor, associate director of the Mobility and Falls Translational Research Center with Harvard-affiliated Hebrew SeniorLife.

There are many kinds of balance exercises. Science has not tapped any specific ones as the best; however, some have stood out in many balance-related studies.

For instance, a 2016 study in the journal Gerontology and Geriatric Medicine found that a specific Balance-Enhancing Exercise Program (called BEEP for short) improved balance skills among adults ages 60 to 80. Study participants did better on both solid and uneven surfaces, and increased their walking speed and overall confidence.

Focus on three exercises to improve balance

The BEEP program focused on three exercises: squats, heel and calf raises, and one-legged standing. “These types of exercises increase both the physical and cognition skills needed for better balance,” says Dr. Manor. “Plus, they mimic movements of everyday life.”

He recommends adding these to your regular workouts or doing them daily on their own.

Squats. Stand with your feet shoulder-width apart. Bend your knees and imagine you are sitting down on a stool. Lower down until your thighs are parallel to the ground, or as far as is comfortable. Keep your weight on your heels. Extend your arms forward or place your hands on a chair, counter, or table for stability. Pause for a second or two, then rise back to the starting position. Do this up to 10 times.

Heel and calf raises. Stand with your arms crossed over your chest and lift your heels, so you rise up on your toes. Hold this position for up to 10 seconds, or as long as possible, and then lower your heels. Do this five to 10 times. If you need support, hold on to a door frame, a table, or another sturdy object. You also can place your hands flat on a wall.

One-legged standing. Stand tall and place your hands on your hips or hold on to a table or chair for stability. Then raise one leg, so your foot is about six to 12 inches above the floor. Keep your gaze straight ahead. Hold for 20 to 30 seconds. Repeat on the other leg. Go back and forth three to five times.

You also can perform these exercises with your eyes closed to work on coordination and concentration. Another option is to “distract” yourself by doing unrelated cognitive tasks — count backward, name words that begin with the same letter, or make a mental supermarket list.

“Balance is definitely a use-it-or-lose-it skill,” says Dr. Manor. “But if you work on your balance continuously, you are almost guaranteed to see improvements.”

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Metastatic prostate cancer can progress in different ways. In some men the disease advances rapidly, while other men have slower-growing cancer and a better prognosis. Researchers are developing various tools for predicting how fast prostate cancer might progress. Among the most promising are assays that count circulating tumor cells (CTCs) in blood samples.

Prostate cancer spreads by shedding CTCs into the bloodstream, so higher counts in blood generally reflect worse disease. Sometimes referred to as a liquid biopsy, the CTC assay can help doctors decide if patients should get standard or more aggressive treatment. Just one CTC assay is currently on the market for prostate cancer. Called CellSearch, its use is so far limited to men with late-stage metastatic cancer for whom hormonal therapies are no longer effective.

Using CTC data

Hormonal therapies block testosterone, a hormone that drives prostate tumors to grow. Research shows that high CTC counts predict poorer survival and faster disease progression among patients with metastatic prostate cancer who become resistant to this form of treatment. But new research shows CTC counts are also predictive for early-stage metastatic prostate cancer that still responds to hormonal therapy.

Why is that important? Because the earlier doctors can predict a cancer’s trajectory, the better their ability to select patients who could benefit from more powerful (and potentially more aggressive) drug combinations or a clinical trial. Conversely, men who are older or frail might be treated less aggressively if doctors had better insights into their prognosis.

How the study was done

The investigators collected blood samples from 503 newly-diagnosed patients with hormonally-sensitive metastatic prostate cancer who had enrolled in a clinical trial with experimental hormonal therapies. The team collected baseline samples at trial registration, and then another set of samples after the treatments were no longer working. CTC counts were divided in three categories:

• more than 5 CTCs per 7.5 milliliters (mLs) of blood
• between 1 and 4 CTCs per 7.5 mLs of blood
• zero CTCs per 7.5 mLs of blood.

What the research showed

Results showed that men with higher baseline CTC counts fared worse regardless of which cancer drugs they were taking. Median survival for men with 5 or more CTCs per sample was 27.9 months compared to 56.2 months in men with 1 to 4 CTCs. There weren’t enough patient deaths among those with 0 CTCs to calculate a survival rate.

Similarly, higher CTC counts predicted faster onset of resistance to hormonal therapy: 11.3 months for men in the highest CTC category, compared to 20.7 months and 59 months for men with 1 to 4 and zero CTCs respectively. Importantly, higher CTC counts correlated with measures of prostate cancer severity, including PSA levels, numbers of metastases in bone, and other indicators.

Observations and comments

“This research emphasizes the continued emergence of CTCs in helping to determine outcomes and potentially treatment options for men with metastatic prostate cancer,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases.

“Still to be determined is how this type of testing compares with more traditional evaluations of disease advancement, such as x-rays, bone scans, and other types of imaging. Ready access to cancer cells in blood that, in turn, eliminate the need for more invasive biopsy procedures of metastatic deposits will be a welcome addition — especially if future studies show that CTCs inform more precise treatment choices.”

Dr. David Einstein, a medical oncologist specializing in genitourinary cancers at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School, agreed with that assessment. “But the Holy Grail is finding predictive biomarkers [like CTCs] that tell you if patients will or will not benefit from particular treatments,” he added. “Answering these types of questions requires randomized clinical trials.”

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD