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New Year 2020 and Balance Intensity 20:20

I hope you are enjoying your start to 2020! This is the perfect year to highlight the balance training principle of 20:20. This post will help you start 2020 with a better understanding of 20:20. The balance principle of 20:20 states individuals need to be 20% steady AND 20% unsteady when training balance. During the exercise time, for at least 20% of the time, individuals should feel secure, still, and in control. During the same exercise, however, they should also experience unsteadiness at least 20% of the time. Unsteadiness is defined as interruptions to balance, including swaying, reaching, stepping, grabbing, etc.

In respect to intensity, balance exercises are unique in that steadiness will fluctuate during a given exercise, despite the conditions remaining the same. Unlike speed on a treadmill or weights on a bar, steadiness is not a constant when performing balance exercises. Individuals will fluctuate in and out of periods of steadiness while training balance. Below is a guide for establishing proper balance training intensity:

  1. Exercise is too easy – To keep exercises from being too easy, it is important to feel “unsteady” at least 20% of exercise time. Unsteadiness is defined as the presence of postural reactions (ankle, hip, stepping, etc.), slow movements (interrupted reaches, pauses in head turns, etc.), and/or use of supports (gait belt help, grabbing, touching, etc.). If balance exercises are too easy, the individual is able to complete over 80% of the exercise time without signs of unsteadiness. Exercises that are too easy limit positive training improvements.
  2. Exercise is too hard – To keep exercises from being too hard, individuals also need to feel “steady” at least 20% of the time. Steadiness is defined as the ability to maintain a posture, or perform an exercise, without obvious postural reactions, slow movements, or need for supports. If individuals are noted unsteady over 80% of exercise time, the balance exercise is too hard. Exercises that are too hard, lead to feelings of vulnerability, uncertainty, and frustration.
  3. Exercise is just right – For exercise intensity to be “just right,” individuals should be able to work through periods of steadiness and unsteadiness. The presence of postural reactions, slow movements, and/or need for supports should range from 20% to 80% of the exercise time. Signs of unsteadiness while exercising are good, just not more than 80% of the exercise time. Balance exercises are a mix of steadiness and unsteadiness. Too much, or too little, of one or the other, results in a sub-optimal training. It is important to feel challenged, but not frustrated or unsafe. Exercises shouldn’t be too easy or too hard. Exercises need to be "just right" with a ratio of 20% steadiness and 20% unsteadiness. 

To help achieve the 20:20 balance intensity ratio, exercises need to be continually monitored and adjusted. Balance challenges will need to be increased,  if exercises are too easy; or decreased, if too hard. To help get more out of your balance training in 2020, follow the 20:20 balance principle described above and help keep 2020 fall free!

Resources: For more on balance training check out the Haas Balance Book: 100+ Exercises for PTs and OTs. For more on fall-prevention visit