A variable difficulty balance board for standing desk and fitness use is provided. The balance board facilitates the conditioning and rehabilitation of the nerves, bones, muscles, and joints of the body by limiting the range of motion and biomechanical forces around the longitudinal and lateral axes. The balance board comprises a deck, a fulcrum receiver, and a fulcrum insert. The fulcrum insert is press-fit into a fulcrum cavity of the fulcrum receiver. The fulcrum insert extends outward from the fulcrum receiver and provides an area where the balance board can pivot. The fulcrum insert may be replaced by the user such that it may occupy either a first orientation or a second orientation within the fulcrum cavity. The first orientation and the second orientation configures the fulcrum insert such that it provides a lateral or longitudinal axis of balance relative to the deck, respectively.