Seated balance exercises are one of the safest ways to start rebuilding balance after a stroke, because you work on trunk control and weight shifting without the risk of a fall from standing. Sitting upright, leaning, reaching and turning in a safe chair all train the muscles you need for standing and walking. This guide gives you eight simple exercises, how to set up safely and when to move on. Always check with your stroke team or physiotherapist before starting, because the right exercises depend on how your stroke has affected you.
Good sitting balance is the foundation for almost everything else: getting dressed, eating, reaching, standing up and walking. Many physiotherapists start here for that reason.
Why seated balance matters after a stroke
After a stroke, the muscles of the trunk can be weak or slow to react, especially on the affected side. You might lean to one side, feel unsteady when you reach, or find it hard to sit up straight for long. Practising seated balance helps you:
- Sit upright with less effort
- Shift your weight safely from side to side and forwards
- Reach for things without losing balance
- Prepare for standing, transfers and walking
The NHS says that stroke rehabilitation often includes physiotherapy and exercises to help with movement and balance, and the Stroke Association has more on physiotherapy after stroke.
Before you start: safety set-up
- Get the go-ahead. Ask your physiotherapist or GP if you have low or very high blood pressure, dizziness, heart problems, severe shoulder pain or any other concern.
- Choose a safe chair. Use a firm, stable chair with a flat seat and no wheels. A height where your feet rest flat and your knees are bent about 90 degrees is ideal. Place it against a wall, or in a corner, if you can, so it cannot slide.
- Have a helper if you need one. Ask a family member to sit or stand on your weaker side, so they can guide you. See our guide on safely helping a stroke survivor with home exercises.
- Use a table or mirror. A stable table in front of you gives something to rest your arms on. A mirror helps you check your posture.
- Wear supportive shoes or non-slip socks.
- Keep the area clear and make sure you can reach a phone.
- Pick your best time of day. Fatigue can make balance worse. Our guide to post-stroke fatigue can help you plan.
The eight exercises
Do each exercise slowly and with control. Start with 5 repetitions, then build up to 10 as it feels easier. Rest as much as you need between exercises.
1. Sit tall
Sit with your bottom well back in the chair, feet flat and hip-width apart. Imagine a string pulling the top of your head up. Keep your shoulders relaxed and level. Hold for 10 to 30 seconds, then relax. Use a mirror to check you are not leaning.
2. Side-to-side weight shift
Place your hands on your thighs or lightly on the table. Slowly shift your weight to the right, so the right side of your bottom takes more weight, then back to the middle, then to the left. Keep your trunk tall. Move a small amount at first.
3. Forward lean
Sit tall, then slowly lean forward from the hips, keeping your back straight, as if looking at something on the floor. Return to upright by squeezing your stomach muscles. This trains the muscles you need to stand up.
4. Reach forward
Rest the weaker hand on the table (or ask someone to support it) and reach the stronger hand to touch a target in front of you. Gradually place the target further away. Return to sitting tall.
5. Reach to the side
Place a cup or object on the table to your stronger side, then reach for it and bring it back. Next, place an item on your weaker side and reach toward it. This is harder, so have your helper close. Stop if you feel you might tip.
6. Trunk turn
Clasp your hands together in front of you, if you can, or rest them on your lap. Slowly turn your upper body to the right as far as is comfortable, look behind you, then return to the middle and turn to the left. Keep your hips facing forward.
7. Seated marching
Sit tall, holding the sides of the chair if you need to. Lift one foot off the floor a few centimetres, then put it down and lift the other. If lifting the weaker leg is hard, ask your physiotherapist for guidance.
8. Sit-to-stand practice (with supervision)
Only practise this if your physiotherapist has said it is safe, and with someone beside you. Shuffle forward, feet flat, lean forward "nose over toes" and stand up, then sit down slowly. Use a table or stable support for balance.
How often?
| Stage | Suggested approach |
|---|---|
| Starting out | 2 to 3 exercises, once or twice a day, 5 repeats each |
| Getting comfortable | 4 to 6 exercises, 2 to 3 times a day, up to 10 repeats |
| Ready to progress | Add reaching further, sitting on a firmer seat with no back support (with help), or adding gentle ball passing |
| Moving towards standing | Add supervised sit-to-stand and standing weight shifts, as your physiotherapist advises |
This is a general guide. Your own physiotherapist will tell you what fits your recovery. Quality matters more than quantity. Stop before you become very tired. Our article on how often a stroke patient should do physiotherapy at home explains how to build up a routine.
How to know you are making progress
- You can sit upright for longer without leaning or needing your hands
- You can reach further before you feel unsteady
- You can weight-shift to the weaker side with less worry
- Dressing, eating and transfers feel easier
Keep a simple record, such as how far you can reach or how long you can sit without support. Progress can be slow, and that is normal. Our article on neuroplasticity after a stroke explains why repetition matters.
When to stop
Stop and rest if you have:
- Dizziness, light-headedness or feeling faint
- Chest pain, a racing heartbeat or breathlessness
- New or worsening pain, especially in the shoulder
- Sudden severe headache, blurred vision or confusion
⚠️ Call 999 if you notice signs of a new stroke
Face drooping, arm or leg weakness, slurred speech, sudden loss of vision, or a sudden severe headache. Do not wait for it to pass. See the NHS stroke guide.
Speak to your GP or physiotherapist if you often feel dizzy when sitting up, or if balance seems to be getting worse instead of better.
How a physiotherapist helps
A neurological physiotherapist can assess your sitting balance, find which side or direction is hardest and pick the right exercises. They also check your shoulder and posture, teach family members how to help and plan the move to standing balance and walking. Our guide to regaining hand function after a stroke is a useful companion because many reaching exercises double as hand practice.
Want a physiotherapist to design a safe balance programme at home? Book a stroke rehabilitation home assessment. The cost is £90 for 60 minutes, and no GP referral is needed.
This guide is general information, not personal medical advice. Always follow the instructions from your stroke team and physiotherapist.
Frequently Asked Questions
They are one of the safest ways to start, because you are already seated. But you should still check with your stroke team or physiotherapist first, use a stable chair and have someone nearby if you feel unsteady.
Many people start with a few exercises once or twice a day and build up slowly. Short, regular practice usually works better than one long session, because tiredness is common after a stroke.
Seated balance builds the trunk strength and weight-shifting skills that standing and walking need. Most people then progress to supervised standing exercises with their physiotherapist.
Stop, sit still and breathe slowly. Have a drink of water and rest. Tell your GP or physiotherapist, particularly if it happens often. Call 999 if dizziness comes with new weakness, slurred speech or a facial droop.
You may need more support, such as a chair with a back and arms, or someone sitting beside you. Ask your physiotherapist to assess your sitting balance first and to give you a programme that suits your level.