What Is the Otago Exercise Program?

Medically Reviewed by Stephanie S. Gardner, MD on June 11, 2024
4 min read

In people over the age of 65, falls are the leading cause of injuries. 

The Otago exercise program is a fall-prevention exercise program for the elderly. It was designed to prevent falls by strengthening muscles and improving balance in older adults. 

In this article, you'll learn about the Otago exercise program so you can determine if it might be beneficial for you. 

The Otago exercise program was developed in New Zealand by the New Zealand Falls Prevention Research Group in the late 1990s. The theory behind the Otago program is that if you improve your balance, muscle strength, flexibility, and reaction time, you can reduce your chance of falling. 

The program was developed after many years of work, identifying risk factors for falls and testing interventions. The Otago program can be used alone or with other fall prevention interventions. 

One out of three adults over age 65 suffer a fall each year. These falls are typically attributed to risk factors such as:

Adults with more risk factors are at a higher likelihood of experiencing a fall and fall-related injuries. This high fall rate results in poorer quality of life and increased costs. 

Multiple studies, though, have shown a 35% reduction in falls for frail adults who are at high risk of falls, thanks to the Otago program. Additionally, although the program was originally designed to be administered by physical therapists, studies have shown that innovative methods of delivering the program by non-physical therapists were also effective at reducing falls. 

Since using physical therapists to deliver the program can be cost-prohibitive, hybrid models that bring in a physical therapist as needed may be a cost-effective solution.

The Otago exercise program is intended to improve balance and leg strength in order to prevent falls. It's ideal for older adults who: 

  • Have had one or more falls
  • Are frail or have complex medical conditions
  • Can't participate in a tai chi or other exercise class because they lack muscle strength or coordination
  • Don't have access to transportation to participate in a community class

The Otago program of exercise for older adults consists of three components that increase in difficulty as you progress through the program. 

Leg muscle strengthening exercises. These strengthening exercises focus on the major lower limb muscles that are important for functional movements, walking, and recovering balance, including: 

  • Knee flexors
  • Knee extensors
  • Hip abductors
  • Ankle dorsiflexors
  • Plantar flexors 

Resistance can be added using ankle cuff weights. 

Balance retraining exercises. The balance training exercises are dynamic instead of static. Not only do they help maintain balance, but they also improve the recovery of balance. 

A walking program. Walking by itself will not help decrease falls. However, it should be included in the Otago program to increase physical stamina. You should try to walk for 30 minutes twice a week at your usual pace, if you can do so safely. If you need to, you can break up the walking into a larger number of shorter sessions, such as three 10-minute sessions. 

Exercises are prescribed individually based on your condition when you start. You'll be given a booklet with a list of all of the exercises and ankle weights to use with the leg exercises. The exercises take about 30 minutes to complete. You should do the exercises three times per week and go for a walk at least twice a week. 

The Otago program was designed and tested as a stand-alone program. However, it can be used in conjunction with other methods to help further reduce your chance of falling. 

Here are some other steps you can take to prevent falls: 

Stay active. Staying active through a program such as Otago can help increase your strength and help you stay flexible. Weight-bearing activities can help keep your bones stronger by slowing bone loss from osteoporosis.

Know your medicines. Talk to your doctor or pharmacist about any possible side effects from your medicines. Some medicines can make you sleepy or dizzy. If you notice side effects such as these, talk to your doctor about what you should do.

Don't drink alcohol to excess. Studies have shown that the rate of hip fractures in older people increases with increased alcohol. Even a small amount of alcohol can affect your balance and slow your reflexes.

Stand slowly. Standing up too quickly can cause your blood pressure to drop and make you feel dizzy. If you notice such symptoms, have your doctor check your blood pressure while you're lying down and while you're standing.

Have your vision and hearing tested. Whenever you get a new prescription for glasses, take some time to get used to them. Though you may not think it's a big deal, even small changes in your vision or hearing can cause you to fall.

Make sure you get enough sleep. Being tired can increase your likelihood of falling.

Watch where you're walking. Wet or icy surfaces can be very slippery. When conditions are icy, spread some sand or salt by your front or back door, or (better yet) have someone else do it.

Wear appropriate footwear. Make sure you wear shoes that: 

  • Have rubber soles that are not too thick or too thin
  • Are non-skid
  • Fully support your feet

Use an assistive device if you need it. Using a cane or walker can help prevent falls. Make sure your device is the right size for you and that any wheels turn smoothly.