Slightly Fewer Falls Among Older Adults Who Did Exercise Programs

CATEGORY: MOBILITY, BONES & JOINTS

Structured exercise programs were linked to 15% fewer falls and 16% fewer falls causing injury among adults 65 and older, in a review of 37 randomized trials involving 16,117 people, conducted for the US Preventive Services Task Force and published in JAMA.¹ The task force is an independent panel of experts that reviews evidence on preventive care. The trials randomly assigned people to a program or to usual care, so the results carry more weight than studies that simply observe habits.

38,742 US Fall Injury Deaths in 2021

Falls are the most common cause of injury-related illness and death in older adults. In 2018, 27.5% of US adults 65 and older living at home reported at least one fall in the past year, and about one in ten reported a fall-related injury; in 2021, fall injuries were responsible for 38,742 deaths in the US.²

Two or Three Sessions Weekly for About a Year

Researchers systematically gathered randomized trials of fall-prevention programs in adults 65 and older who live in the community—at home rather than in nursing facilities. Most trials enrolled people at increased risk of falling, such as those with a previous fall or with balance and mobility problems. Nearly all of the exercise programs included gait, balance, and functional training—practicing steadiness and everyday movements—and about two-thirds added strength training; a typical program ran two to three sessions a week for around a year. Falls were counted as they happened during each trial, and results were pooled across trials.

8% Lower Chance of Falling at Least Once

People assigned to exercise programs had 15% fewer falls overall, a 16% lower rate of falls causing injury, and an 8% lower chance of experiencing at least one fall, compared with usual care. An effect on fall-related fractures specifically was not statistically clear in either direction. A person’s individual chance of having an injurious fall, as distinct from the rate of such falls, also showed no clear reduction with exercise.¹ Reported harms were rare and minor, mostly muscle soreness. A second strategy the review examined—individual risk assessments followed by tailored referrals, such as medication reviews and home-hazard fixes—was linked to 16% fewer falls but showed no significant reduction in injuries or fractures. Based on this evidence, the task force issued a recommendation that clinicians offer exercise interventions to older adults at increased risk of falls.²

Best Established in People at Elevated Fall Risk

The trials tested structured programs practiced regularly over months, not one-off classes, and the benefit is best established in people at elevated risk of falling, since that is who most trials enrolled. The review also cannot say which exact exercise mix works best—programs varied—though balance and gait training were the common thread.¹

Cochrane’s 108 Trials Found 23% Fewer Falls

A larger Cochrane review pooling 108 randomized trials with 23,407 older adults living at home found exercise linked to 23% fewer falls and 15% fewer people falling at all, with balance and everyday-movement training the common ingredient.³ In nursing homes, a separate review found 32% fewer falls while programs ran, with no lasting benefit afterward.⁴

Key Takeaways

• Across 37 randomized trials with 16,117 adults 65 and older, exercise programs—usually balance, gait, and strength training, two to three sessions a week for about a year—were linked to 15% fewer falls and 16% fewer falls causing injury.¹
• The chance of having at least one fall was 8% lower with exercise; effects on fractures specifically were not statistically clear.
• Falls are the most common cause of injury-related death in older adults, responsible for 38,742 US deaths in 2021.²

References

1. Guirguis-Blake JM, Perdue LA, Coppola EL, Bean SI. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2024;332(1):58–69. link
2. US Preventive Services Task Force; Nicholson WK, Silverstein M, et al. Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2024;332(1):51–57. link
3. Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019;1(1):CD012424. link.
4. Dyer SM, Suen J, Kwok WS, et al. Exercise for falls prevention in aged care: systematic review and trial endpoint meta-analyses. Age and Ageing. 2023;52(12):afad217. link.