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Case study: Preventing falls in the over 65s

The challenge

Falls are common in the over 65s, with a third of this group suffering a fall at least once a year in the UK. They may not always result in the need for medical attention or a hospital stay, but falls can have a negative effect on confidence levels and result in people becoming isolated and withdrawn from their usual activities.


Older people have a higher risk of falls as they are more likely to have issues with their balance, have poor vision or a health condition such as heart disease or dementia which can result in dizziness or loss of consciousness. Having a fall at an older age is more likely to result in injury, with older women being at a greater risk of osteoporosis and fall-related hip fracture.

Reviewing the evidence

Previous research has reported that exercises that promote balance and muscle strength can help to prevent falls. Researchers from the NIHR-funded Cochrane Bone, Joint and Muscle Trauma Group reviewed the existing evidence to assess the effectiveness of exercise interventions for preventing falls for older people living in the community.

They reviewed the evidence from 108 trials with over 23,000 participants from 25 countries. Participants in these trials were, on average, 76 years of age and most were women.

Overall, when considering the effects of all types of exercise, the results were clear: where people took part in exercise programmes, falls were reduced by 23% and the number of people experiencing falls was reduced by 15%. The research also suggested that, as a result of exercise, fewer people obtained a fall-related fracture or needed medical attention.

Looking at the types of exercise, balance and functional exercises reduced the rate of falls by 24% and the number of people falling by 13%. The evidence suggests that by including resistance exercises, falls could be reduced by up to 34% and 22% respectively. There was also evidence to suggest that Tai Chi could reduce the rate of falls by 20%. The effect of exercise on falls resulting in hospital admission remains unclear as are the benefits of dance, or walking.

Exercise programmes were effective whether they were delivered on a one-to-one basis or in a group. Exercise was equally as effective if the sessions were provided by a health professional or by a trained non-health professional or if the participant was deemed to be at risk, such as having fallen previously, or not. Most exercise programmes lasted between 3 months and one year. The evidence suggests that there could be long-term benefits and highlight the importance of primary prevention.

One of the review authors, Associate Professor Anne Tiedemann from The University of Sydney, Institute for Musculoskeletal Health, commented

“This review provides compelling evidence of the importance of exercise for preventing falls in older age. Crucially, the review identifies the specific types of exercise that are most effective for preventing falls. What is now needed is a greater investment in implementation of effective exercise programs to maximise the public health impact of this research.”

Making a difference

Since its publication in 2019, the Chartered Society of Physiotherapy and Royal College of Occupational Therapists have both used the evidence found in this Cochrane Review to highlight the importance and effectiveness of exercise programmes in the community. The findings of the review have also informed the latest NICE and Public Health England guidance and informed the World Health Organization’s recently released global guidelines on physical activity and sedentary behaviour.