Balance and preventing falls

Which exercises reduce the risk of falls?

Exercises that challenge your balance are the best-supported way to reduce falls, and strength work is a useful addition.

Exercise programmes reduce the rate of falls in older people by 23% and the number of people who fall by 15%¹. Programmes built around balance and functional exercises, such as standing up from a chair and stepping in different directions, reduce the rate of falls by 24%. Programmes that combine balance and functional exercises with resistance exercises probably reduce it by 34%¹.

Strength training is important for older adults generally, but on its own it isn't effective for preventing falls. Balance work comes first, and strength is added to it².

A strong guideline recommendation says older adults should be offered programmes with balance-challenging and functional exercises, tailored to the person, getting harder over at least 12 weeks and continuing longer for greater effect. It applies to all older adults, whatever their age or assessed risk of falling⁴.

The WHO recommends that adults aged 65 and over do varied activity that emphasises balance and strength, at moderate or greater intensity, on at least 3 days a week, to improve how well they can do everyday things and prevent falls³. That is a minimum to aim for. Doing more is fine, and doing less still helps. Adults of any age should also aim for muscle-strengthening activities at moderate or greater intensity, working all major muscle groups, on at least 2 days a week. Any strength activity is better than none.

Tai Chi may reduce the number of people who fall by about 20%; how much it reduces the number of falls is less certain¹. For programmes that are mainly resistance training, dance or walking, the effect on falls is uncertain¹. Guidance says general activity alone, such as walking, is unlikely to prevent falls⁴. Older adults should still be as active as their abilities allow; the balance exercises go on top.

How does exercise reduce falls in older adults?

Exercise appears to reduce falls by training the muscle coordination and balance control you need to stay upright while you move².

Falls tend to happen during movement, such as walking or moving from standing to sitting, and rarely during quiet standing⁵. Slips and trips are described as leading to most falls among older adults living in the community⁶. That may be why exercises that copy everyday movements are likely to give more benefit². General exercise may help less because it doesn't practise the quick actions that stop a fall, such as taking a step to catch yourself or grabbing something nearby⁵. Balance training is thought to work partly by helping you anticipate a stumble so you need less recovery, and partly by changing how you respond when one catches you out⁶.

Strength matters too. Low muscle strength and power, and poor balance, are linked with a higher risk of a first fall, repeat falls and falls that cause injury⁷. Programmes that include functional balance and muscle strength training are the most effective, and the exercise should get progressively more challenging, be ongoing and be enough in amount⁸.

It isn't simply a matter of being more active. More active people have fewer falls, but encouraging older people to be more active doesn't appear to prevent them. Specific exercise for balance and strength needs to be done regularly over a sustained period². Turning up counts: programmes where people completed at least 75% of sessions were linked with bigger reductions in falls⁹.

When to check with a health professional

If you're starting exercise after a long break, it's always a good idea to see your doctor first.

For an injury or a health condition, see a health professional, such as your doctor or a physio. If you have had a fall or are worried about your balance, it's sensible to talk to a doctor or physio.

People at higher risk of falls may need more support to exercise safely, and some people need other measures alongside exercise. This applies to people with complex medical conditions, a recent hospital stay, or risk factors that exercise doesn't improve. Ask a doctor or physio what suits you⁸. Problems from exercise programmes like these are mostly minor and mainly to do with muscles or joints¹.

If a joint or muscle starts to hurt, stop or ease off, and see a doctor or other health professional if it persists or gets worse. If you feel dizzy, stop and rest; if it keeps happening, see a doctor.

Call your local emergency number for chest pain or pressure (or pain spreading to the arm, neck, jaw or back, especially with sweating or feeling sick), severe breathlessness, fainting or collapse, signs of a stroke, a serious injury, or someone who isn't safe.