December 22, 2022 7 min read

Water Exercise improves your balance, muscle strength, flexibility and coordination, which improves your ability to prevent trips and falls. Falls the a leading cause of injury deaths and Australia's largest contributor to injuries that require a stay in hospital. More than half of hospitalisations are due to broken bones (fractures).

There are four high-risk groups for falls:


Did you know that 30% of adults 65 years and over will experience at least one fall a year? Older adults are almost 12 times more likely to have a fall than a motor vehicle or pedestrian accident. Fall risk factors increase as we age due to the normal ageing process. These changes can include a person's general health, vision, the anxiety of falling, medication, and reduction in strength and muscle mass. All of this can contribute to the increased risk of falls.

The risk of mortality among fall-related injuries in elderly patients over 80 years is high (1.48 times higher 95% CI: 1.20–2.10),  studies reveal. 

Workplace Falls

Working from heights continues to be a high-risk activity and the leading cause of death and serious injury in Australia, according to the latest figures from Safe Work Australia. Ladders posing the highest risk are now restricted in some hospital settings like Buderim Private Hospital because of the number of ladder-related surgical patients. Tradies are a high-risk category for fall-related injuries. This, combined with other musculoskeletal challenges from workplace overuse like back, knee, and hip injuries, make this group high risk and need early preventative measures, particularly from the age of 30.

Workplace fall risks also increase with age, doubling the risk and compounding the industry risk with age-related health decline.

Bike Falls

According to Sports Injury Australia, there were 17,300 cycling injury hospitalisations in 2020–21. Balance and fall prevention is essential for young mountain bikers and road racers, with very high fall-related injuries being seen as young as 15.

Bike fall risk factors also increase with age, not only due to the normal ageing process of health, vision, the anxiety of falling, medication, and reduction in strength and muscle mass but also slower reaction times on the road or pre-existing joint destabilisation due to prevalent conditions like osteoarthritis in the knees.

Suffers of Persistent Dizziness

Dizziness is common in adults with many conditions and possible causes, including:

  • problems or conditions that affect the ears, like Meniere's disease
  • problems with the eyes
  • problems with the heart
  • migraine
  • stress or anxiety
  • blood sugar fluctuations or diabetes
  • a fall in blood pressure
  • problems with the blood flow to the brain
  • motion or travel sickness
  • vertigo
  • viruses and other illnesses
  • brain and nerve-related disorders


Falls are not inevitable, and many falls can be prevented. Some risk factors for falls, like muscle weakness, are relatively easy to change, and where falls do occur, the impact and severity of injuries can be drastically reduced.

The first step is to ensure that if you are feeling unsteady on your feet or even had a fall, even one that does not cause a severe injury, an appointment is made to discuss this with a doctor. Falls can be an early indication of an underlying health problem.

The second is to begin a balance improvement and fall prevention program.


Exercise is a fantastic way to reduce risks; the more we exercise, the more our strength and balance will improve. A systematic review shows that physical exercise is an effective treatment to improve static and dynamic balance and reduce the number of falls and fallers for older adults aged 65 or over.  Balance and postural exercises should be included in all training protocols for older adults to prevent the risk of falls, including the healthy population, not only as rehabilitation after stroke or fractures or for those affected by neurodegenerative disease.

There are four key areas in which exercise and training can help prevent falls:

Stabiliser muscles.  The stabiliser muscles keep you upright and allow you to change directions quickly. There are two essential stabilisers for fall prevention: the gluteus medius (located on the side of the hips) and the gluteus maximus (the largest muscle of the buttock). These muscles work both together and independently to enable us to stand upright and stabilise the back and pelvis as we move.

Core strength.  Core strength is vital to prevent falls, the core is the centre of all body movements. When we walk, our bodies constantly adapt to ever-changing ground levels. Core stability and strength help you react to any sudden changes or stability and prevent falls. Your bodies' core consists of several muscle groups:

  • The rectus abdominis (abs)
  • The obliques (on both the side and front of the abdomen)
  • The transverse abdominis muscles (under the obliques and attached to your spine)

Stabiliser and core muscles weaken over time. As we age, we naturally lose our muscle mass, a condition called sarcopenia. These muscles weaken even further from a sedentary lifestyle or when people follow an exercise program that neglects these areas and doesn't adequately build and maintain stabilisers and core muscles.

Balance.  As do reflexes and coordination, a sense of balance naturally wanes over time. This makes it easier to topple and more complex to catch yourself if you have a misstep or knock. Another less obvious cause of bad balance is the deterioration of the inner ear's vestibular system. The inner ear feeds essential information to the brain about motion your head position, and controls spatial orientation. Over time, it, too, becomes less effective as we age.

Gait Training.  Your gait is the mechanics of your walk. It's the cycle of repetition involving the coordinated efforts of your both feet, knees, and hips. Gait training is a series of movements or programs to help improve or restore function to this cycle. Perturbation-based balance training (PBT) is a form of reactive balance training aimed at strengthening reactive balance control after unexpected external perturbations. These perturbations elicit rapid postural responses, training reactive postural control. Perturbation training has also shown to reduce fall risk by 50% and to have retention over six months. Increasing the total training volume also likely increases the effectiveness.

Research from the NSW Department of Health indicates that exercise programs that include highly challenging balance training are the most effective in preventing falls. These programs include exercises conducted while standing in which participants aim to:

  1. Stand with their feet closer together or on one leg.
  2. Minimise the use of their hands to assist balance.
  3. Practice controlled movements of the body's centre of mass.

There are more significant effects of exercise on falls from programs that include a larger dose of exercise (more than 50 hours). It also indicates that training needs to be ongoing in order to have a lasting effect on fall rates.


Water therapy has been used to help treat rheumatic, orthopaedic, and neurological conditions for a long time. The aquatic environment is considered safe and efficient because the water movement challenges musculoskeletal and balance systems.

Aquatic exercise provides a low-impact and low-weight-bearing environment where individuals can exercise safely. The risk of falling is eliminated; therefore, an individual can concentrate on making physical improvements without fear.

Many relevant elements of physical fitness can be well-trained in an aquatic environment to help reduce the risk of falling. These include agility, balance, coordination, strength, flexibility, and speed.

Some factors that can create barriers on land can be eliminated or reduced when in water, such as pain, muscle weakness, balance deficits, obesity, arthritic diseases, and fear of falling.

The different physical properties of water (density, specific gravity, hydrostatic pressure, buoyancy, viscosity, and thermodynamics) can play an essential role in improving balance control and permitting balance training in safe conditions.

The buoyancy of water can be used as a support, providing safe conditions to exercise, avoiding falls, and reducing the fear of falling. The buoyance also reduces the load on the joints, therefore reducing any pain, and can allow arthritic joints to move more freely, strengthening the muscles.

The water properties of drag or turbulence can also be utilised in exercising to provide an environment that challenges stability and balance. In addition, floating allows individuals to perform exercises and movements that cannot be done on the ground.

Water buoyancy reduces gravity. An aquatic environment can be considered a microgravity environment. Research has documented modifications of static and dynamic postural control in prolonged microgravity. Performing exercise in a different gravity environment can lead patients to transform an automatic movement into a voluntary action, improving learning, which can then be transferred onto land to prevent a stumble from turning into a fall.

Researchers have found physical activity to be the most promising fall prevention strategy, both as a single intervention and as a part of a multi-factorial approach. Research shows that physical exercises reduce falls risk by 12% and the number of falls by 19%. These interventions can also increase the time before a person falls for the first time. Strength training is the only reliable intervention that improves wasting muscles (sarcopenia) by increasing muscle mass, strength, and power, but it has not been shown in isolation to reduce falls. A physical activity program should be specific for individuals and include exercise that challenges balance at a moderate to a high extent with a two times a week program over 6+ months.


An Aquabike is excellent for strengthening the two essential stabilisers for fall prevention, the gluteus medius and the gluteus maximus, and suitable for everyone from children aged 9 to seniors in their 80s. It is a favourite among tradies and is available for home pools and group classes. An Aqua Bike isn’t just a fabulous piece of equipment for the glutes and legs it also supports core strength and destabilising moves can be programmed i.e. hand in the air to develop the core and assist in fall prevention.

An Aquatic Treadmill can assist with gait biomechanics and a great tool for prolonging walking movements in older adults.

A floating fit mat like the Hydrorider FOW is also a fun way for younger participants, mountain bikers, and surfers to build further core strength and stabilisers without the risk of injury.

A Water Circuit class with targeted balance programming or pertubation training can also be beneficial to older adults and others in the high-risk category to help improve balance and prevent falls.


Participating in an aquatic exercise program with specialised equipment can reduce the risk of falls and prevent injuries, particularly as you age if you suffer from dizziness in the workplace or while riding a bike on land. Changing our own behaviour is important to improving balance and an aquatic exercise program is a fantastic way to improve our own safety and health, reduce the risk of falls, and maintain our independence. Exercise programs such as water cycling or water circuit group exercise classes are beneficial physical activities. Equipment is also available for home pools if attending a centre is challenging.

If you'd like to know more about improving your balance, water specialists can support you through one-on-one sessions or in a group class setting. To find your closest expert, click here.

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