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Does balance training prevent falls in older adults? What the trials show

Large reviews find balance and functional exercise cuts falls in older adults by about a quarter. Evidence on fractures is weaker.

Published October 2026

Short answer

Balance and functional exercise probably reduces falls in older adults, by about a quarter in large reviews; evidence on fractures is weaker. Evidence grade B (Moderate). Cochrane review of 108 RCTs (23,407 people) plus a 2024 review; downgraded once for risk of bias, as most included trials were unclear or high risk on at least one item.

Key takeaways

  • Across 108 trials, exercise programmes cut the rate of falls by 23%, and balance and functional exercises by 24% [1].
  • Reactive balance training, which trains quick balance reactions, reduced falls in daily life across 29 trials, though more adverse events were reported with it [2].
  • A two-year trial of 409 older women found strength and balance training did not cut all falls, but it roughly halved injurious falls [3].

The short version

Balance training helps prevent falls in older adults. A large Cochrane review of 108 trials found balance and functional exercise cut the rate of falls by about a quarter [1]. The evidence on falls is the strongest; for fractures and injuries it is weaker [1][3].

What the studies show

The Cochrane review pooled 23,407 community-dwelling people aged 60 and over. Exercise of all types reduced falls by 23%, and balance and functional exercises by 24%; the authors rated the evidence as high certainty for falls [1]. Exercise may also reduce fall-related fractures and falls needing medical attention, but those findings are low certainty [1].

A 2022 meta-analysis of 29 trials found that reactive balance training, which trains quick balance reactions, made people less likely to fall in daily life (fall risk ratio 0.76) [2]. An earlier meta-analysis of eight trials found the same type of training cut falls, with the rate of falls about half that of controls [4].

In a cluster trial of 221 residents of aged-care homes, a programme of resistance and balance training cut falls by 55% over the trial period [5]. The confidence interval was wide, so the true effect could be smaller.

In a two-year trial of 409 women aged 70 to 80 who had fallen before, neither exercise nor vitamin D reduced falls overall. Injurious falls fell from 13.2 to 6.5 per 100 person-years with exercise, and exercisers were less likely to be injured [3].

For balance itself, a meta-analysis of eight trials found balance training after hip fracture surgery improved balance and gait compared with usual care [6].

The nuances

What works best seems to matter. A 2024 review concluded the most certain benefit came from supervised, long-duration balance and resistance programmes, and that the benefit appears greatest for people at higher risk of falling [7]. A 2021 meta-analysis concluded that integrated programmes run more than five times a week for over 32 weeks were more effective at reducing fall risk [8].

Some trials measured fall risk scores rather than actual falls. In a 12-week trial of 72 pre-frail adults, the exercise group improved balance, posture and fall-risk scores compared with controls [9]. That is encouraging, but it is not the same as showing fewer falls.

The review's authors included some of the researchers who ran trials it included, although none selected their own trials [1]. The Cochrane review also found most trials were unclear or high risk of bias on at least one item [1].

What this means for you

If you are an older adult worried about falls, the evidence favours regular, supervised exercise that works on balance and strength. Reactive balance training may suit people with balance problems, but it was linked to more adverse events in one review [2]. Talk with your doctor or a physiotherapist before starting a new programme, especially after a recent fall or surgery.

Go deeper

  • Balance Training — Balance and functional exercise probably reduces falls in older adults, by about a quarter in large reviews.

References

  1. Exercise for preventing falls in older people living in the community.. Cochrane Database Syst Rev, 2019.
  2. The Effect of Reactive Balance Training on Falls in Daily Life: An Updated Systematic Review and Meta-Analysis.. Phys Ther, 2022.
  3. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial.. JAMA Intern Med, 2015.
  4. Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials.. Phys Ther, 2015.
  5. Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program.. J Am Med Dir Assoc, 2018.
  6. Effect of Balance Training After Hip Fracture Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Studies.. J Gerontol A Biol Sci Med Sci, 2019.
  7. Falls prevention interventions for community-dwelling older adults: systematic review and meta-analysis of benefits, harms, and patient values and preferences.. Syst Rev, 2024.
  8. The Effect of Exercise Intervention on Reducing the Fall Risk in Older Adults: A Meta-Analysis of Randomized Controlled Trials.. Int J Environ Res Public Health, 2021.
  9. Multi-System Physical Exercise Intervention for Fall Prevention and Quality of Life in Pre-Frail Older Adults: A Randomized Controlled Trial.. Int J Environ Res Public Health, 2020.