Fall-Prevention Exercises for Older Adults and How to Start Safely

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Quick take: A large Cochrane review found that exercise lowers the rate of falls in community-dwelling older adults by about a quarter. The programs that worked best were built around balance and functional movement, often combined with strength work. This guide explains what that looks like in plain terms: how to set up a safe space, which movements the National Institute on Aging (NIA) lists, how often to do them, and when to get a professional involved first.

Medical note: This article is general education, not a diagnosis or a personal exercise prescription. If you have fallen, feel unsteady, have a heart, bone, nerve, or joint condition, or take medicines that cause dizziness, talk with a doctor or physical therapist before starting. In the US, call 911 if you are badly hurt or cannot get up after a fall. The shopping links are nonmedical household items.

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What the evidence says about exercise and falls

The NIA says more than one in four people age 65 or older fall each year, and that many falls can be prevented. Exercise is one of the steps it lists, along with managing medicines, checking vision, and making the home safer.

The strongest summary evidence comes from a 2019 Cochrane review by Sherrington and colleagues. It pooled 108 randomized trials with 23,407 people living in the community. On average, participants were 76 years old and 77% were women. The review reported that exercise reduced the rate of falls by 23% and the number of people who fell at least once by 15%, both with high-certainty evidence.

Bar chart of Cochrane review results: all exercise 23 percent fewer falls, balance and functional exercise 24 percent, multiple types 34 percent, Tai Chi 19 percent

The type of exercise mattered. Balance and functional exercise lowered the rate of falls by 24% (high certainty). Programs that combined several types, most often balance and functional work plus resistance exercise, probably lowered it by 34% (moderate certainty). Tai Chi may reduce falls by 19% (low certainty for the rate of falls, though the number of people who fell dropped by 20% with high certainty). The review could not tell whether programs that were mainly resistance training, walking, or dance reduce falls, because the evidence was too uncertain.

Interpretation: The review's search ended in May 2018, and the figures are averages across many different programs. They suggest balance work is worth doing, not that any routine will prevent your next fall. Reported side effects were mostly minor muscle or joint complaints.

Who should check with a clinician first

The NHS advises seeing a GP if you are worried about your balance or mobility, or if you have had a fall. A falls service may check for muscle weakness, weak bones, or eyesight problems, offer strength and balance training, review your medicines, and look at home safety. The NIA also asks older adults to tell their doctor about any fall, even without pain.

The NIA lists several risk factors that exercise alone does not address: medicines that cause dizziness or confusion, blood pressure that drops when you stand, foot pain, poor vision or hearing, and conditions such as diabetes, heart disease, or nerve problems. If any of these apply to you, a professional can help you choose movements that fit.

Set up a safer space

NIA's safety advice for balance exercises is simple. Go slowly, keep a sturdy chair, person, or wall nearby to hold, and wear comfortable, stable footwear or go barefoot so you have grip. If you feel unsteady, take action to steady yourself. For strength work, it adds: do not hold your breath, and avoid locking arm and leg joints.

Checklist of four safety steps before a balance session: hold onto support, wear nonskid footwear, move slowly without locking joints, and stop for dizziness or chest pain

For daily life, the NIA recommends nonskid, rubber-soled, low-heeled shoes and advises against walking on stairs or floors in socks. The NHS adds non-slip bath mats, safety rails on steps, and keeping loose rugs and wires out of walkways.

Balance movements the NIA lists

The NIA's examples of balance exercises are tai chi, yoga, standing on one foot, the heel-to-toe walk, the balance walk, walking backward or sideways, practicing standing up from a sitting position, and using a wobble board. The set-ups below are common teaching conventions, not NIA numbers, so adjust them with a therapist.

  • Standing on one foot: Stand beside a counter with a hand near it. Lift one foot slightly, hold as long as it feels steady, then switch. Start with a few seconds.
  • Heel-to-toe walk: Place one foot directly in front of the other so heel touches toes. Walk a short, clear path next to a wall.
  • Sideways and backward steps: Take small, slow steps along a counter, looking at a fixed point ahead. Only go backward where the path behind you is clear.
  • Sit-to-stand: Rise from a sturdy chair and sit back down slowly.

Tai chi deserves a mention because the Cochrane review found a lower number of people who fell. The NIA describes it as a slow, precise "moving meditation."

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Strength movements that support balance

The NIA says muscle-strengthening activity helps with everyday tasks like getting up from a chair or climbing stairs and helps prevent falls and fall-related injuries. It suggests training at least two days a week, working major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms), and not working the same group two days in a row. It describes one set of eight to 12 repetitions as effective, with two or three sets possibly more so, taken to the point where another repetition would be hard.

Examples it gives include resistance bands, hand-held weights, squats, leg raises, and carrying groceries. Beginners can start with body weight and no bands or weights until the movement feels comfortable.

Interpretation: Because the Cochrane review could not confirm benefit from resistance training alone, strength work is best treated as a partner to balance practice, not a replacement. For product background, see our guide on Resistance Bands and Balance Exercises for Seniors.

Putting a week together

The NIA recommends getting all three types of activity: aerobic, muscle-strengthening, and balance. It suggests about three balance sessions a week and building gradually to at least 150 minutes of moderate aerobic activity, such as brisk walking. The NHS falls page says to be active every day and do strength and balance activities at least twice a week.

Weekly activity targets: balance about three days, strength two or more days, aerobic 150 minutes, from NIA and NHS guidance

One practical idea is to attach a few minutes of balance practice to something you already do, such as brushing your teeth beside the counter. Increase difficulty only when the current version feels steady.

Other steps that work alongside exercise

The NIA also recommends having your eyes and hearing checked, asking a doctor or pharmacist about medicine side effects, getting enough sleep, limiting alcohol, and standing up slowly. Getting up too quickly can cause a blood pressure drop that makes you feel wobbly.

When to get help

  • Call 911 (US) or 999 (UK): You may have injured your head, back, neck, or hip after a fall, or you cannot get up. The NHS gives the same advice for those situations.
  • Stop exercising and get advice: You feel dizzy, have chest pain or pressure, or feel nauseated.
  • Schedule a visit: You have fallen, almost fallen, feel less steady than before, or have started avoiding activities because you fear falling.

If you do fall and are not hurt, the NIA says to stay calm, rest for a moment, roll to your side, crawl to a sturdy chair, and rise slowly.

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Frequently asked questions

Can exercise really prevent falls?

It lowers them on average. The Cochrane review found about a 23% lower rate of falls across all exercise types. It does not guarantee any one person will not fall.

How often should I do balance exercises?

The NIA suggests about three sessions a week. The NHS says strength and balance activities at least twice a week.

Is walking enough?

Walking is useful for fitness, and the NIA counts brisk walking toward the 150-minute aerobic goal. But the Cochrane review could not confirm that walking programs on their own reduce falls, which is why balance work is added.

I am afraid of falling. Should I avoid exercise?

The NIA says fear of falling can lead people to avoid walking and social activities, and that staying active actually helps prevent falls. A physical therapist can help you start in a supported way.

Related Guides

Sources

Reviewed against the linked sources on October 30, 2026. This article is an editorial summary and interpretation, not a clinical guideline. Related reading on this site: Resistance Bands and Balance Exercises for Seniors: NIA and CDC Guidance.

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