Exercise to prevent falls in older adults: an updated systematic review and meta-analysis
Open accessAbstract
Objective: Previous meta-analyses have found that exercise prevents falls in older people. This study aimed to test whether this effect is still present when new trials are added, and it explores whether characteristics of the trial design, sample or intervention are associated with greater fall prevention effects. Design: Update of a systematic review with random effects meta-analysis and meta-regression. Data sources: Cochrane Library, CINAHL, MEDLINE, EMBASE, PubMed, PEDro and SafetyLit were searched from January 2010 to January 2016. Study eligibility criteria: We included randomised controlled trials that compared fall rates in older people randomised to receive exercise as a single intervention with fall rates in those randomised to a control group. Results: 99 comparisons from 88 trials with 19 478 participants were available for meta-analysis. Overall, exercise reduced the rate of falls in community-dwelling older people by 21% (pooled rate ratio 0.79, 95% CI 0.73 to 0.85, p<0.001, I 2 47%, 69 comparisons) with greater effects seen from exercise programmes that challenged balance and involved more than 3 hours/week of exercise. These variables explained 76% of the between-trial heterogeneity and in combination led to a 39% reduction in falls (incident rate ratio 0.61, 95% CI 0.53 to 0.72, p<0.001). Exercise also had a fall prevention effect in community-dwelling people with Parkinson's disease (pooled rate ratio 0.47, 95% CI 0.30 to 0.73, p=0.001, I 2 65%, 6 comparisons) or cognitive impairment (pooled rate ratio 0.55, 95% CI 0.37 to 0.83, p=0.004, I 2 21%, 3 comparisons). There was no evidence of a fall prevention effect of exercise in residential care settings or among stroke survivors or people recently discharged from hospital. Summary/conclusions: Exercise as a single intervention can prevent falls in community-dwelling older people. Exercise programmes that challenge balance and are of a higher dose have larger effects. The impact of exercise as a single intervention in clinical groups and aged care facility residents requires further investigation, but promising results are evident for people with Parkinson's disease and cognitive impairment.
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Isolated balance training improves balance and is associated with reduced falls, fall-related injuries, and improved functional mobility.
“Similarly, while isolated balance training leads to improved balance [123,124], and is associated with reduced falls and fall-related injuries, as well as improved functional mobility [110,125,126]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [110]
The implementation of balance training exercises presents challenges due to the inherent risk of accidental falls.
“The implementation of balance training exercises, however, presents challenges due to the inherent risk of accidental falls [110].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [110]
The effects of programs primarily involving resistance exercise (without balance and functional exercises), dance programs, or gait retraining on falls remain uncertain.
“The effects of programs primarily involving resistance exercise (without balance and functional exercises) [123,149], dance programs [[477], [478], [479], [480]] or gait retraining [84,130,131] remain uncertain [110,123,126].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [110]
The efficacy of falls prevention programs is reduced when walking is included, and walking by itself has been shown to increase the risk of fractures in osteoporotic women compared to controls.
“The efficacy of programs is reduced when walking is included in falls prevention programs [110], and walking by itself has been shown to increase the risk of fractures in osteoporotic women compared to controls [311].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [110]
Isolated balance training is associated with reduced falls and fall-related injuries and improved functional mobility.
“Similarly, while isolated balance training leads to improved balance [123,124], and is associated with reduced falls and fall-related injuries, as well as improved functional mobility [110,125,126], as does Tai Chi in some studies [[127], [128], [129]], these do not address aerobic capacity or sarcopenia.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [110]
Implementation of balance training presents challenges due to inherent risk of accidental falls.
“The implementation of balance training exercises, however, presents challenges due to the inherent risk of accidental falls [110].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [110]
Effects of programs primarily involving resistance exercise (without balance and functional exercises), dance programs, or gait retraining on falls remain uncertain.
“The effects of programs primarily involving resistance exercise (without balance and functional exercises) [123,149], dance programs [[477], [478], [479], [480]] or gait retraining [84,130,131] remain uncertain [110,123,126].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [110]
Efficacy of falls prevention programs is reduced when walking is included.
“The efficacy of programs is reduced when walking is included in falls prevention programs [110]”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [110]
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Self-citation
- Authors
- Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., Cumming, R. G., Herbert, R. D., Close, J. C. T., & Lord, S. R.
- Affiliations
- The University of Sydney (AU)
- King's College Hospital (GB)
- UNSW Sydney (AU)
- Corresponding author
- Sherrington, Catherine
- ORCID
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2016-10-04
- Volume
- 51
- Issue
- 24
- Pages
- 1750-1758
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W2527685915
- Cited by
- 1,095
- References
- 25
- Citations by year
- 2026: 97 · 2025: 106 · 2024: 113 · 2023: 128 · 2022: 121 · 2021: 139 · 2020: 148 · 2019: 109 · 2018: 103 · 2017: 30 · 2016: 1
- FWCI
- 14.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- HighWire Press Open Archive (submittedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institute for Health and Care Research (CAT CL-2013-04-007)
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- physical activity, fall prevention, older adults, balance training, exercise dose, Parkinson's disease, cognitive impairment, community-dwelling older adults, residential care, stroke survivors, hospital discharge, trial characteristics, effect size heterogeneity, meta-regression, randomized controlled trials, aged care facilities, stroke rehabilitation, falls in older adults, exercise dose-response, fall risk reduction
- MeSH terms
- Accidental Falls, Aged, Postural Balance, Exercise Therapy, Humans, Parkinson Disease, Exercise, Randomized Controlled Trials as Topic, Cognitive Dysfunction
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