Poor balance and falls pose substantial risks to health and well-being. Thalidomide survivors with arm defects have an additional risk being unable to protect themselves in a fall. Generic exercise information to improve strength and balance is increasingly available to the elderly. However, disability can carry a lifetime risk. Identifying and correcting underlying musculoskeletal issues, correction of gait abnormalities together with establishing an appropriate exercise routine that is affordable, convenient and fun should improve outcomes at any stage of adult life. This can be challenging, not least in those who have never previously exercised and who are now middle aged or older. The Thalidomide Trust piloted focused support for a middle-aged thalidomide survivor with bilateral radial club hands and increasing balance issues who had never previously exercised. This met with great success improving his strength, balance, gait and posture together with ensuring an established exercise routine to maintain the improvement.