Can the Alexander Technique improve balance and mobility in older adults with visual impairments? A randomized controlled trial

Clinical Rehabilitation 2015;29:244–60

Gleeson M, Sherrington C, Lo S, Keay L.



In this trial involving people aged over 50 years with impaired vision, 120 participants were randomised to receive either 12 weekly individual Alexander Technique lessons in their home or usual care (i.e. no Alexander Technique). Outcome measures for the study were The Short Physical Performance Battery (SPPB), which consists of a sit-to-stand test, a four-metre walk and a standing balance test. In addition to physical performance, participants were assessed on falls rate and concerns about falling. Participants were assessed pre-intervention, and 3 months and 12 months post-intervention. The results are interesting as although there was no significant difference between the groups on the SPPB tests at 3 months or 12 months, there were some indications of a significant change in the Alexander Technique group. Analysis of the tests for quality of performance on the SPPB* showed a significant difference in number of steps walked and amount of postural sway in standing at 3 months suggesting that changes in confidence in standing and walking had taken place. Indications were that there was a greater effect for those with a higher falls rate and a trend towards a greater reduction in falls for the Alexander Technique group. There was no difference between groups on the concern about falling measure. The findings provide support for the fact that 12 lessons of Alexander Technique have an effect on physical functioning and falls risk in older adults with visual impairments. Further research exploring number of lessons and types of changes is indicated. Another paper is planned which will report data on social and emotional wellbeing in the study participants.


*number of steps in the walk rather than time taken, and amount of postural sway in standing balance rather than time held.



OBJECTIVE: To investigate the impact of Alexander Technique lessons on balance and mobility in older adults with visual impairments.

DESIGN: Randomized assessor blinded controlled trial with intervention and usual care control groups.

SETTING: Participants' homes.

SUBJECTS: A total of 120 community-dwellers aged 50+ with visual impairments.

INTERVENTION: Twelve weeks of Alexander lessons and usual care.

MAIN OUTCOME MEASURES: Short Physical Performance Battery items were primary outcomes at 3 months and secondary outcomes at 12 months. Additional secondary outcomes were postural sway, maximal balance range and falls over 12 months.

RESULTS: Between-group differences in primary outcomes were not significant. The intervention group reduced postural sway on a firm surface with eyes open at 3 months after adjusting for baseline values (-29.59 mm, 95%CI -49.52 to -9.67, P < 0.01). Planned sub-group analyses indicated a greater intervention effect among past multiple-fallers (2+) than non-multiple fallers for gait speed (P = 0.02) and step length (P < 0.01) at 3 months and chair stand at 12 months (P < 0.01). There was a non-significant reduction in falls rate (IRR = 0.64, 95%CI 0.34 to 1.15, P = 0.13) and injurious falls (IRR = 0.61, 95% CI 0.28 to 1.30, P = 0.20) in the intervention group compared to the control group.

CONCLUSION: The intervention did not have a significant impact on the primary outcomes but benefits for the intervention group in postural sway, trends towards fewer falls and injurious falls and improved mobility among past multiple-fallers suggest further investigation of the Alexander Technique is warranted.

Growing Old

I have suffered back pain for a long time and the last 15 years have been a merry-go-round of doctors, drugs and complementary therapies. At the end of my second Alexander session I started to ease into the process. I followed my teacher's instructions between sessions, and found I could focus on my body, its movements and its tensions. It now seems possible to be free of pain and my usual cocktail of painkillers is no longer necessary. I wouldn't hesitate to recommend the technique.

Karen Johnson
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