The Otago Program

What Is It?

The Otago Exercise Program (Otago) is an individually-tailored balance and strength fall prevention program that is delivered by a physical therapist over the course of 52 weeks. This program entails that physical therapists have a minimum of seven visits with a patient to assess, prescribe, and monitor progress as well as monthly phone calls when there is not a visit over the course of one year.  

Otago includes a series of 17 strength and balance exercises that reduces falls between 35% and 40% for frail older adults.  The program also includes a walking program.

Who Can Benefit From Otago?

Evidence shows that Otago is most effective in reducing falls among persons 80 years of age and older with a history of falls in the previous year. In clinical practice, the physical therapist should determine if others would also benefit from this program.

  • Otago is most effective for older adults who have fallen and who have moderate to severe decreased strength and balance due to multiple risk factors, such as arthritis, de-conditioning, and inactivity. Participants should be living in the community and able to walk in their own home with or without a walking aid.
  • Older adults who are less than 80 years of age and who are falling, as well as adults who are too frail to do standing exercises may require a more individualized physical therapy program.
  • Older adults with mild strength and balance deficits may need a more challenging program than those in Otago and may benefit from other evidence-based fall prevention programs such as Tai chi: Moving for Better Balance. 
  • Older adults who fall due to syncope, vertigo, severely impaired vision, some neurologic conditions, or who have significant cognitive impairment may not benefit from Otago. These older adults should be referred to their primary health care provider who can prescribe treatment or refer them to appropriate specialists.

What Is The Otago Exercise Program Like?

The program is designed to be delivered over 12 months and includes a minimum of seven home visits.  

The first visit is Day 1 of Otago when performance of the functional measures is assessed and the exercises are prescribed. Then the therapist will see the patient for 4 visits over an 8 week period (typically every other week). This is considered the initial bolus of Otago. Then the therapist will follow the patient via phone calls and a visit at 6 months, 9 months, and 12 months.  

Otago is not designed to be started on Day 1 of therapy. It is designed to start when the patient is ready to start. The therapist can see the patient more than the 4 visits over the 8 weeks if that is what the patient needs. The therapist can discharge the patient to another program if the patient meets their goals.  

How Do Patients Pay For Otago?

 Because Otago targets older adults with balance problems, services provided by Otago-trained physical therapists may be covered under Medicare Part A or B, Medicare Advantage, and/or third party insurers.

  • Physical therapists should work with their patient’s insurer to determine what, if any, co-pay may be required. If there is co-pay, the physical therapist should inform the patient and help determine if there are other avenues for funding their participation.
  • Adjustable ankle weights are required for Otago. Physical therapists will bring ankle weights for the first few sessions. The patients need to purchase their own set of weights to use when exercising on their own. 
  • The physical therapist should provide patients with low cost options for purchasing adjustable ankle weights. Visit the how do I get reimbursed page (click here) to learn more about how to get reimbursed for Otago. 

Contact Dr. Cathy Elrod for more information about how to make the Otago Exercise Program more affordable to you and your patients.  


The OTAGO Program at Your Orgnization

We are here to make setting up the Otago Exercise Program at your organization a very straight-forward process.  Through the grant, we have several resources available.  

If you do not have a trained leader at your organization, we may be able to make arrangements to provide them for you.   

Please contact  Victoria Powers who is tasked with guiding you and your organization through the implementation process for The Otago Exercise Program.


How Do I get Trained In The Otago Exercise Program?

Otago was designed for delivery by a physical therapist and/or a physical therapy assistant. An online training course is available that includes the research evidence and rationale for the program, and gives clear guidelines for delivery, including how to conduct and prescribe each exercise. 

Click here to learn more about becoming an Otago Leader