One fall changes how people move
After a fall, even one without injury, many people start to move differently. They walk more slowly, hold on to furniture, go out less on icy mornings and avoid the stairs when nobody is home. That caution is understandable, but it often leads to less activity, weaker legs and, in turn, a higher chance of falling again.
The good news is that exercise to reduce falls is one of the best tested interventions in older people's health. Balance is not a fixed trait. It is a skill, and like any skill it improves with the right practice.
How common are falls?
At least one in three people over 65 living in the community falls each year (Sherrington et al., 2019). Worldwide, falls are the second leading cause of deaths from unintentional injury after road injuries, and most of those deaths happen in people aged 60 and over (World Health Organization, fact sheet on falls). In winter, wet leaves, ice and darker afternoons add to the everyday risks at home.
Falls are rarely about one thing. Weaker legs, slower reactions, eyesight, some medicines, low blood pressure on standing, foot problems and hazards at home all add up. That is why NICE recommends that older people, and people aged 50 and over at higher risk, are asked about falls and offered an assessment and a tailored plan when needed (NICE, 2025).
What the evidence says about exercise to reduce falls
A Cochrane review of 108 randomised trials, with more than 23,000 people living in the community, found that exercise reduces the rate of falls by around 23%. Programmes built on balance and functional exercises had the clearest effect, and programmes that combined several types of exercise, usually balance plus strength, also worked well. Tai chi probably helps too (Sherrington et al., 2019).
Another large analysis looked at which features made the difference. Programmes that really challenged balance and added up to more than three hours a week, over time, produced the biggest reductions, close to 40% when both were present (Sherrington et al., 2017).
The World Guidelines on falls in older adults, written by experts from 39 countries, use these findings to recommend progressive balance, functional and strength exercise, at least three times a week, continued for at least 12 weeks and ideally kept going for life (Montero-Odasso et al., 2022).
What "challenging balance" means
Balance training works when it is a little difficult. Holding on firmly with both hands while standing still is safe, but it does not teach the body much. Effective training gradually reduces support and asks you to control your body as it moves:
- standing with feet closer together, then one in front of the other
- standing on one leg, first with fingertip support, then without
- shifting weight, reaching and turning
- stepping in different directions, over small obstacles, or changing speed
- doing these with the eyes moving, or while talking
Why strength belongs in the plan
Strong thighs and hips help you catch yourself when you trip and get up from the floor if you do fall. Exercises such as sit to stand, step-ups, heel raises and squats to a chair build the power you need for quick recovery steps. Our article on strength after 50 covers this in more detail.
A safe way to practise at home
Always practise next to a sturdy worktop or a heavy chair, in a clear space, wearing supportive shoes. Start with what feels steady and progress slowly:
- Feet together: stand for 30 seconds with feet together, hand resting on the worktop.
- Heel to toe: place one foot directly in front of the other and hold. Swap feet.
- One leg: stand on one leg for up to 10 seconds, fingertips on the worktop. Build to 30 seconds.
- Heel and toe raises: rise onto your toes, lower slowly, then lift your toes.
- Sit to stand: ten times, without using your hands if you can.
- Walking practice: walk heel to toe along the worktop, then turn around.
Aim for short sessions most days. When an exercise feels easy, reduce the hand support, close your eyes briefly (only with support nearby), or add a turn of the head.
Practise getting up from the floor
Knowing how to get up after a fall reduces fear and the time spent on the floor. A therapist can teach a safe method: roll onto your side, come to hands and knees, crawl to a sturdy chair, and use it to rise in stages.
When to ask for an assessment
Speak to your doctor or book an assessment if you:
- have fallen in the last year, or have had a near miss
- feel dizzy or light-headed when you stand up
- have started avoiding activities because you are afraid of falling
- notice your walking has become slower or less steady
- have a condition that affects movement, such as Parkinson's disease or after a stroke
Get same day medical help (NHS 111, or 999 in an emergency) if a fall came with fainting or loss of consciousness, chest pain, or sudden weakness on one side of the body. These need a doctor, not a booking.
A falls assessment looks at your balance, strength, walking, feet and confidence, and links with your doctor about medicines, eyesight or blood pressure where needed. The result is a programme set at the right level for you.
Frequently asked questions
Is walking enough to reduce falls? Walking is good for health, but on its own it has not been shown to reduce falls. Balance and strength work are the parts that make the difference.
Is it too late if I have already fallen? No. People who have fallen were included in many of the trials and benefited from exercise.
Do I need special equipment? No. A worktop, a chair and a little floor space are enough to start. Classes and supervised programmes help many people progress safely.
The bottom line
Falls are common, but they are not a normal part of ageing that you simply have to accept. Balance can be trained, strength can be rebuilt, and the evidence that the right exercise reduces falls is strong. The key is practice that is challenging, regular and kept going.
To get a plan to reduce falls matched to your current balance, create an account at bpr.clinic and book an assessment with our therapists. At the assessment we listen to your history, check how you stand, walk and get up, and give you a balance plan you can follow at home.
References
- 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:CD012424. https://doi.org/10.1002/14651858.CD012424.pub2
- Sherrington C, Michaleff ZA, Fairhall N, et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British Journal of Sports Medicine. 2017;51(24):1750-1758. https://doi.org/10.1136/bjsports-2016-096547
- Montero-Odasso M, van der Velde N, Martin FC, et al. World guidelines for falls prevention and management for older adults: a global initiative. Age and Ageing. 2022;51(9):afac205. https://doi.org/10.1093/ageing/afac205
- National Institute for Health and Care Excellence. Falls: assessment and prevention in older people and in people 50 and over at higher risk (NG249). 2025. https://www.nice.org.uk/guidance/ng249
- World Health Organization. Falls: fact sheet. https://www.who.int/news-room/fact-sheets/detail/falls
