Key numbers
23%
Lower rate of falls, all exercise types
15%
Fewer people with one or more falls, all exercise types
24%
Lower rate of falls, balance and functional exercises
What the trials found overall
Sherrington and colleagues (2019) pooled randomized trials of exercise in community-dwelling older adults. Compared with control groups, exercise of all types reduced the rate of falls by 23% (rate ratio 0.77, 95% CI 0.71 to 0.83; 12,981 participants, 59 studies, high-certainty evidence).
The rate of falls counts falls per person over time. A separate outcome is how many people fell at all: exercise reduced the number of people having one or more falls by 15% (risk ratio 0.85, 95% CI 0.81 to 0.89; 13,518 participants, 63 studies, high-certainty evidence).
Which types of exercise showed a benefit
Different forms of exercise had different effects on falls. Balance and functional exercises reduced the rate of falls by 24% (rate ratio 0.76, 95% CI 0.70 to 0.81; 7920 participants, 39 studies, high-certainty evidence), a separate figure from the 23% across all exercise types.
Tai Chi reduced the number of people who fell by 20% (risk ratio 0.80; 2677 participants, 8 studies, high-certainty evidence). Programs combining multiple types of exercise probably reduced the number of people having one or more falls by 22% (risk ratio 0.78; 1623 participants, 17 studies), with moderate-certainty evidence.
For programs that were mainly resistance training, dance or walking, the effects on falls were uncertain. The trials tested whole programs, not any single Systematic exercise or test.
Other outcomes the review reported
Exercise may reduce the number of people having falls that need medical attention (risk ratio 0.61; 1019 participants, 5 studies, low-certainty evidence). Its effect on falls needing hospital admission is unclear, and it may make little difference to health-related quality of life.
Results did not differ according to whether trials chose people at higher risk of falling. Adverse events were reported to some degree in 27 trials with 6019 participants, but monitored closely in both groups in only one; where reported, they were mostly non-serious.
Why falls matter and how guidelines frame prevention
At least one-third of community-dwelling people over 65 years of age fall each year. Falls harm functional independence and quality of life, and they are associated with higher illness, death and health costs, which is an association rather than proof of cause.
The 2022 World Falls Guidelines (Montero-Odasso and colleagues) were written for health and other professionals because earlier guidelines were inconsistent. They recommend opportunistic case finding for falls risk in community-dwelling older adults and advising all older adults on falls prevention and physical activity. In that approach exercise is one part, and assessment depends on each person's risk profile; a Systematic balance test is not a substitute for that full assessment.
The evidence
Each cited source is labeled according to how it supports the particular claim on this page. Direct test evidence, underlying-capacity findings and population reference values are distinguished from Systematic-defined protocols and standards. Historical development notes are retained internally rather than presented as public evidence. A study of an underlying capacity is never presented as validation of the Systematic test itself.
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Underlying-capacity evidence New source
Sherrington et al. (2019). Exercise for preventing falls in older people living in the community. The Cochrane database of systematic reviews.
What it found. Exercise reduced the rate of falls by 23% and the number of people having one or more falls by 15%; balance and functional exercises reduced the rate by 24%.
What it does not show. The trials tested whole programs, so they do not establish the effect of any single Systematic exercise or test.
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Underlying-capacity evidence New source
Montero-Odasso et al. (2022). World guidelines for falls prevention and management for older adults: a global initiative. Age and ageing.
What it found. Falls are common in older adults and harm independence and quality of life; the guidelines recommend case finding for falls risk and advice on falls prevention and physical activity.
What it does not show. A Systematic balance test is not a substitute for the guidelines' full falls-risk assessment.
The Systematic Healthspan Assessment is a physical baseline. It is not a diagnosis, and it does not estimate a biological age, a disease risk or a lifespan.