Dear Doctors: I am an 85-year-old man with congestive heart failure. I have almost totally lost my balance. My treadmill quit working and my daughter, a physical therapist, thinks I do not need to replace it. She thinks it is dangerous for me. My only alternative is a walker. Can you address this issue?
Dear Reader: Your daughter is correct that in certain circumstances, exercising on a treadmill can pose dangers. This is true for someone with poor balance, for people living with certain heart conditions and for older adults who are frail or who are not physically fit. In the personal information you have shared, you appear to fit into those categories.
That said, there is also evidence that, when used with medical supervision and in addition to other types of equipment, walking on a treadmill can be helpful. We’ll return to that in a moment. But first, let’s look at why a home treadmill may no longer be an appropriate option for you.
A treadmill is a narrow, motorized walkway that moves continuously beneath the user’s feet. For someone with poor balance, walking on something that dictates your pace can lead to a fall. The danger of the resulting impact is compounded by the chance of becoming entangled in the still-moving mechanism. Falls are a major cause of injury and disability in older adults, particularly those who are frail.
It’s true that many treadmills include handrails; however, using those alters the mechanics of walking. This can adversely affect the alignment of the spine, exacerbate back pain and have an adverse effect on balance. The perpetually flat surface of a treadmill also removes an important factor in balance training, which is the small and constant changes we encounter when walking on natural terrain. Finally, for people living with congestive heart failure, exercising on a treadmill can worsen symptoms such as fatigue and shortness of breath.
That brings us to the topic of medical supervision. If you are determined to incorporate a treadmill into your exercise routine, first talk to your cardiologist. They will let you know if it is an option. If so, you would move forward with a physical therapist who specializes in cardiac rehabilitation. They would schedule regular sessions in which your treadmill use, along with your vital signs — including heart rate, blood pressure and breathing — would be carefully monitored. A harness to allow an upright posture during exercise may be incorporated into the therapy.
Studies have shown that regular sessions of medically supervised treadmill exercise can be helpful in building up the leg, hip and core strength needed for older adults to improve their balance. When the exercise program included the use of a walker or a cane, the study participants showed even greater improvement.
You are fortunate to have a physical therapist in the family — perhaps she’s willing to help you explore some of the options discussed here. You may be able to do the treadmill exercise you desire and also give her peace of mind.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send questions to askthedoctors@mednet.ucla.edu.