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Objectively measuring balance
exercise intensity

About the Balance Intensity Scale

A research team from the Department of Physiotherapy at Monash University has developed a world first interval rating of balance exercise intensity, the Balance Intensity Scale (BIS). The BIS is a clinical measurement of balance exercise intensity used to rate exercises performed by adults. The BIS has a component that is rated by clinicians and a component that is rated by the exerciser.

The aim of the current education and research strategy is to promote awareness of the scale, provide clinicians and researchers with training on how to use and apply the scale, promote  exerciser friendly information on how to use the scale and support ongoing research into the applications and properties of the scale.

Balance intensity

Balance intensity is defined as “the degree of
challenge to the balance control system relative
to the capacity of the individual to
maintain balance”[Ref1](p.314).

High balance intensity

High balance intensity is defined by the American College of Sports Medicine as “the highest level of balance-enhancing exercises that can be tolerated without inducing a fall
or near fall”[Ref2](p589).

How to use the scale

The Balance Intensity Scale (BIS) is designed to be used as part of routine clinical care when prescribing balance exercises.  The BIS measures how difficult balance tasks are for exercisers and can be used for initial assessment, reassessment and on discharge from therapy.

Therapist ratings (BIS-T)

To use the scale, the exercise to be rated is first determined, then the exercise is performed. For each of the 11 balance exercise responses that are observed tick ‘yes’ and for any balance exercise response not observed tick ‘no’. If you are unsure if you have observed a response, then tick ‘no’.

To answer Item 12 – “Did the person fall during the task?” the World Health Organisation definition of a fall is used: “A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level””[Ref1].

Some clinical evaluation may be needed to determine the intent and whether resting at a lower level was deliberate or inadvertent.

After completing the checklist items, score the overall exercise intensity on the Global Rating of Perceived Effort 5-point scale

Exerciser ratings (BIS-E)

After completing a balance exercise, exercisers rate the balance intensity on the exerciser global rating scale of balance effort by selecting the appropriate number on the 5-point scale from “1-no effort at all” to “5-maximal effort".

We are continuing to work on the Balance Intensity Scale to further develop training materials and research to investigate the reliability and validity of the Balance Intensity Scale.

Access the full scale

Download pdf

Access the exerciser version

Download pdf

Want to know more?

We are continuing to work on the Balance Intensity Scale to further develop training materials and research to investigate the reliability and validity of the Balance Intensity Scale.

If you would like to know more about how to use the Balance Intensity Scale, how to teach others how to use the Balance Intensity Scale, or want to be part of research using the Balance Intensity Scale, please sign up for our Balance Intensity Scale Updates below.


Farlie, M. K., Keating, J. L., Molloy, E., Bowles, K.-A., Neave, B., Yamin, J., . . . Haines, T. P. (2019). The Balance Intensity Scales for Therapists and Exercisers Measure Balance Exercise Intensity in Older Adults: Initial Validation Using Rasch Analysis. Physical Therapy, 99(10), 1394-1404.

Farlie, M. K., Molloy, E., Keating, J. L., & Haines, T. P. (2016). Clinical Markers of the Intensity of Balance Challenge: Observational Study of Older Adult Responses to Balance Tasks. Physical Therapy, 96(3), 313-323. doi:10.2522/ptj.20140524 [Ref 1]

Farlie, M. K., Robins, L., Haas, R., Keating, J. L., Molloy, E., & Haines, T. P. (2019). Programme frequency, type, time and duration do not explain the effects of balance exercise in older adults: a systematic review with a meta-regression analysis. British Journal of Sports Medicine, 53(16), 996-1002. doi:10.1136/bjsports-2016-096874

Farlie, M., Robins, L., Keating, J., Molloy, E., & Haines, T. (2013). Intensity of challenge to the balance system is not reported in the prescription of balance exercises in randomised trials: a systematic review. Journal of Physiotherapy, 59(4), 227-235. doi:10.1016/S1836-9553(13)70199-1

American College Sports Medicine. (2014). ACSM's Resource Manual of Guidelines for Exercise Testing and Prescription (7th ed.). Philadelphia: Wolters Kluwer Lippincott Williams and Wilkins. [Ref 2]

Contact us

Dr Melanie K. Farlie

Department of Physiotherapy
Researcher profile
+61 9904 4524

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