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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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Citations
Cites
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Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
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Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817
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Exercise and Physical Activity for Older Adults
Chodzko-Zajko, W. J., Proctor, D. N., Fiatarone Singh, M. A., Minson, C. T., Nigg, C. R., Salem, G. J., & Skinner, J. S. (2009) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e3181a0c95c · Cited by 5,153
Interventions for preventing falls in older people living in the community
Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L., & Lamb, S. E. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007146.pub3 · Cited by 3,966
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Pahor, M., Guralnik, J. M., Ambrosius, W. T., Blair, S., Bonds, D. E., Church, T. S., Espeland, M. A., Fielding, R. A., Gill, T. M., Groessl, E. J., et al. (2014) · JAMA · doi:10.1001/jama.2014.5616 · Cited by 1,427
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The clinician's guide to prevention and treatment of osteoporosis
LeBoff, M. S., Greenspan, S. L., Insogna, K. L., Lewiecki, E. M., Saag, K. G., Singer, A. J., & Siris, E. S. (2022) · Osteoporosis International · doi:10.1007/s00198-021-05900-y · Cited by 1,487
International exercise recommendations in older adults (ICFSR): Expert consensus guidelines
Izquierdo, M., Merchant, R. A., Morley, J. E., Anker, S. D., Aprahamian, I., Arai, H., Aubertin-Leheudre, M., Bernabei, R., Cadore, E. L., Cesari, M., et al. (2021) · The Journal of nutrition, health and aging · doi:10.1007/s12603-021-1665-8 · Cited by 1,247
“Systematic reviews have reported that long-term (>1 year) physical exercise interventions in older adults do not increase the risk of dropouts due to health issues, mortality, hospitalisation or fracture compared with a usual care group (127, 128).”
Self-citationAlgorithm for the management of patients at low, high and very high risk of osteoporotic fractures
Kanis, J. А., Harvey, N. C., McCloskey, E. V., Bruyère, O., Veronese, N., Lorentzon, M., Cooper, C. C., Rizzoli, R., Adib, G., Al‐Daghri, N. M., et al. (2019) · Osteoporosis International · doi:10.1007/s00198-019-05176-3 · Cited by 412
“Where indicated, the addition of fall prevention measures, including supervised exercise and/or rehabilitation, has been shown to be useful in reducing falls [46, 47] but the effects on fracture risk remain uncertain [47].”
BackgroundBernabei, R., Landi, F., Calvani, R., Cesari, M., Del Signore, S., Anker, S. D., Bejuit, R., Bordes, P., Cherubini, A., Cruz-Jentoft, A. J., et al. (2022) · BMJ · doi:10.1136/bmj-2021-068788 · Cited by 318
Self-citationRisk Assessment and Prevention of Falls in Older Community-Dwelling Adults
Colon-Emeric, C. S., McDermott, C. L., Lee, D. S., & Berry, S. D. (2024) · JAMA · doi:10.1001/jama.2024.1416 · Cited by 294
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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