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Association of Long-term Exercise Training With Risk of Falls, Fractures, Hospitalizations, and Mortality in Older Adults: A Systematic Review and Meta-analysis
Open accessAbstract
Importance: Long-term exercise benefits on prevalent adverse events in older populations, such as falls, fractures, or hospitalizations, are not yet established or known. Objective: To systematically review and investigate the association of long-term exercise interventions (≥1 year) with the risk of falls, injurious falls, multiple falls, fractures, hospitalization, and mortality in older adults. Data Sources: PubMed, Cochrane Central Register of Controlled Trials, SportDiscus, PsychInfo, and Ageline were searched through March 2018. Study Selection: Exercise randomized clinical trials (RCTs) with intervention length of 1 year or longer, performed among participants 60 years or older. Data Extraction and Synthesis: Two raters independently screened articles, abstracted the data, and assessed the risk of bias. Data were combined with risk ratios (RRs) using DerSimonian and Laird's random-effects model (Mantel-Haenszel method). Main Outcomes and Measures: Six binary outcomes for the risk of falls, injurious falls, multiple falls (≥2 falls), fractures, hospitalization, and mortality. Results: Forty-six studies (22 709 participants) were included in the review and 40 (21 868 participants) in the meta-analyses (mean [SD] age, 73.1 [7.1] years; 15 054 [66.3%] of participants were women). The most used exercise was a multicomponent training (eg, aerobic plus strength plus balance); mean frequency was 3 times per week, about 50 minutes per session, at a moderate intensity. Comparator groups were often active controls. Exercise significantly decreased the risk of falls (n = 20 RCTs; 4420 participants; RR, 0.88; 95% CI, 0.79-0.98) and injurious falls (9 RTCs; 4481 participants; RR, 0.74; 95% CI, 0.62-0.88), and tended to reduce the risk of fractures (19 RTCs; 8410 participants; RR, 0.84; 95% CI, 0.71-1.00; P = .05). Exercise did not significantly diminish the risk of multiple falls (13 RTCs; 3060 participants), hospitalization (12 RTCs; 5639 participants), and mortality (29 RTCs; 11 441 participants). Sensitivity analyses provided similar findings, except the fixed-effect meta-analysis for the risk of fracture, which showed a significant effect favoring exercisers (RR, 0.84; 95% CI, 0.70-1.00; P = .047). Meta-regressions on mortality and falls suggest that 2 to 3 times per week would be the optimal exercise frequency. Conclusions and Relevance: Long-term exercise is associated with a reduction in falls, injurious falls, and probably fractures in older adults, including people with cardiometabolic and neurological diseases.
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“Long-term (> one year) physical exercise interventions [284,285] have been shown to reduce the risk of falls and improve muscle strength, balance, physical function, and cognition [285] without increasing the risk of health-related dropouts, mortality, or fractures compared to usual care [284,285].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [284]
In the citing paper
“Long-term (> one year) physical exercise interventions [284,285] have been shown to reduce the risk of falls and improve muscle strength, balance, physical function, and cognition [285] without increasing the risk of health-related dropouts, mortality, or fractures compared to usual care [284,285].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [284]
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Detecting subtle mobility changes among older adults: the Quantitative Timed Up and Go test
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“back pain, last week (mm) 39 (19-60) 29 (17-42) .”
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Risk of hospitalised falls and hip fractures in working age adults receiving mental health care
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“…disorders, we know these patients often engage in weight-loss activities such as exercise [57], which can be preventive against risk of falls [58]; alternatively, since excessive exercise in eating disorders may accelerate weight loss, reduce BMD and lead to complications associated with…”
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Fall risk assessment through a synergistic multi-source DNN learning model
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The Role of Prevention in Healthy Aging
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Senolytics: The Modern Snake Oil?
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Self-reported hearing measures can predict risk of falling and balance problems
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Comprehensive Geriatric Assessment
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Evidence Based Strategies for Preventing Falls in Community-Dwelling Older Adults
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Bone-friendly lifestyle and the role of calcium or vitamin D supplementation
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Understanding Osteoporosis: Pathophysiology, Risk Factors, Diagnosis, and Management
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“Long-term exercise reduces the fall risk by enhancing the sense of balance [18]; because most hip fractures are caused by falls, a reduction in fall risk equates to a reduction in hip fracture risk [19].”
BackgroundBraz, R. R. S., Campos, S. L., Wanderley, D., Antonino, G. B., Batista, P. K. A., Guerino, M. R., Rodrigues, F. T. M., Alves, K. F. P., Duarte, J., Silva, D. D. A., et al. (2022) · Biology · doi:10.3390/biology11020266 · Cited by 5
“Data from a meta-analysis [18] show that long term effects of exercise reduce the risk of falls (RR 0.88; 95% CI, 0.79–0.98; 4420 participants, 20 randomized controlled trials; moderate heterogeneity) and fall injuries (RR 0.74; 95% CI, 0.62–0.88; 8410 participants, nine RCTs; moderate but not…”
BackgroundInfluentialRikkonen, T., Hantunen, S., Kröger, H., Lamberg-Allardt, C. J. E., Manson, J. E., Nurmi, T., Tuppurainen, M. T., Voutilainen, A., Tuomainen, T., & Virtanen, J. K. (2026) · Journal of the American Geriatrics Society · doi:10.1111/jgs.70295 · Cited by 4
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Reducing Falls in Older Women with Urinary Incontinence
Reaves, S. N., Arya, L. A., Newman, D. K., Wyman, J. F., Klusaritz, H. A., Walsh, W., Brown, R. T., & Andy, U. U. (2023) · Advances in Geriatric Medicine and Research · doi:10.20900/agmr20230011 · Cited by 3
Exercise for Preventing Falls in People with Dementia: Time to Work Together
Maltais, M. L. (2023) · Journal of Alzheimer s Disease · doi:10.3233/jad-230227 · Cited by 3
Self-citation
Metadata
- Authors
- de Souto Barreto, P., Rolland, Y., Vellas, B., & Maltais, M.
- Affiliations
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
- Université Toulouse III - Paul Sabatier (FR)
- Centre Hospitalier Universitaire de Toulouse (FR)
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2019-03-01
- Volume
- 179
- Issue
- 3
- Pages
- 394
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC6439708
- OpenAlex
- W2906707737
- Cited by
- 186
- References
- 80
- Citations by year
- 2026: 11 · 2025: 23 · 2024: 24 · 2023: 27 · 2022: 32 · 2021: 31 · 2020: 20 · 2019: 17
- FWCI
- 3.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- long-term exercise training, older adults, falls, injurious falls, fracture, hospitalization, mortality, multicomponent exercise, resistance training, balance training, aerobic exercise, exercise safety, fall risk reduction, exercise frequency, exercise duration, exercise dose-response, exercise adherence facilitators
- MeSH terms
- Accidental Falls, Aged, Hospitalization, Humans, Mortality, Exercise, Randomized Controlled Trials as Topic, Fractures, Bone
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