Slightly Fewer Falls Among Older Adults Who Did Exercise Programs

CATEGORY: MOBILITY, BONES & JOINTS

Balance classes are a fixture at senior centers. The trials behind them show a real but modest return. A review for the US Preventive Services Task Force, published in JAMA, pooled 37 randomized trials covering 16,117 adults 65 and older. Structured exercise programs were linked to 15% fewer falls and 16% fewer falls causing injury.¹ The task force is an independent panel of experts that reviews evidence on preventive care. Each trial sorted people into a program or into usual care by lot. That is why these results carry more weight than watching who happens to exercise.

38,742 US Deaths From Fall Injuries 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. 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 a Week, for About a Year

The reviewers gathered randomized trials of fall-prevention programs in adults 65 and older living in the community, meaning at home rather than in a nursing facility. Most trials enrolled people already at raised risk, after a previous fall or with balance and mobility problems. Nearly all the programs included gait, balance, and functional training, which is practice at steadiness and everyday movement. About two-thirds added strength training. A typical program ran two or three sessions a week for around a year. Falls were counted as they happened inside each trial, then pooled across trials.

Fractures Stayed Unclear

People assigned to exercise had 15% fewer falls overall, a 16% lower rate of falls causing injury, and an 8% lower chance of falling at least once, compared with usual care. Fractures were a different story. 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, showed no clear reduction either.¹ Reported harms were rare and minor, mostly muscle soreness. The review examined a second strategy too. Individual risk assessment followed by tailored referrals, such as medication reviews and home-hazard fixes, was linked to 16% fewer falls. Injuries and fractures showed no significant reduction from it. On this evidence the task force issued a recommendation that clinicians offer exercise interventions to older adults at increased risk of falls.²

What was tested were programs practiced regularly over months, not one-off classes. The benefit is best established in the people most trials enrolled, those at elevated risk of falling. Which exercise mix works best the review cannot say, since programs varied, though balance and gait training ran through nearly all of them.¹ Larger pools sit a little higher. A Cochrane review of 108 randomized trials with 23,407 older adults living at home tied exercise to 23% fewer falls and 15% fewer people falling at all.³ In nursing homes, a separate review found 32% fewer falls while the programs ran, and no lasting benefit afterward.⁴

Key Takeaways

• Across 37 randomized trials with 16,117 adults 65 and older, exercise programs were linked to 15% fewer falls, 16% fewer falls causing injury, and an 8% lower chance of falling at least once. A typical program was balance, gait and strength training, two or three sessions a week for about a year.¹
• Effects on fractures specifically were not statistically clear. The evidence is strongest in people already at elevated risk of falling, who made up most of the trials, and falls remain the most common cause of injury-related death in older adults, with 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.