Falls Prevention Exercise for Older Adults

A falls prevention exercise program for older adults is built around two things that decline with age and inactivity: lower limb strength and balance under challenge. Both respond to training. This article covers what gets assessed, what a program actually contains, and how often it needs to be done to be worth the effort.

Why balance and strength change

Muscle mass and power drop from around the fifth decade, and power fades faster than strength. Power is what you need when you trip on a lifted footpath slab and have to get a foot out quickly. The vestibular system, joint position sense and vision all change too, and the ankle strategies that keep you upright over small perturbations get slower.

Medications add to it. Sedatives, some blood pressure medications, and combinations of four or more medicines are associated with increased falls risk, which is why a pharmacist or GP medication review sits alongside exercise rather than after it.

Most people notice the change indirectly. Reaching for the handrail on stairs you used to take without thinking. Turning more slowly. Avoiding the bus because of the step up.

What gets assessed

An initial assessment takes about an hour and mixes history with objective tests.

History covers previous falls and near misses, where and when they happened, footwear at the time, dizziness on standing, continence, vision checks, medications, and any fear of falling. Fear matters because it changes behaviour. People who are afraid of falling often reduce activity, lose more strength, and end up at higher risk.

Objective tests commonly include:

• Timed up and go. Stand from a chair, walk three metres, turn, return, sit. The CDC's STEADI initiative flags 12 seconds or more as a marker of increased falls risk.
• 30-second chair stand. How many sit-to-stands you complete in 30 seconds, compared against published age and sex norms.
• Four-stage balance test. Feet together, semi-tandem, tandem, single leg, each held while timed.
• Gait speed over a marked four-metre course, walking at your usual pace.
• Berg Balance Scale where a fuller picture of balance under different tasks is useful.

We also look at ankle range, hip abductor strength, and how you get up from the floor, since floor transfer is a separate skill from standing balance and often the one that determines how long someone lies there after a fall.

What the program contains

Progressive resistance training for the legs and hips. Sit-to-stands, step-ups, calf raises, hip abduction and knee extension work, loaded properly and progressed as strength changes. Light bands used for months without progression don't build much.

Balance training that is genuinely challenging. Balance improves when the task pushes you toward your limits with something to hold onto nearby. That means narrowing the base of support, adding head turns, reaching outside your base, standing on a foam surface, and reducing hand support over time. Sitting exercises don't train standing balance.

Gait and task practice. Walking with direction changes, stepping over obstacles, stairs, carrying a bag on one side, and stopping and starting on cue. These reproduce the situations where falls happen rather than only the components.

Floor transfer practice, where appropriate. Getting down to and up from the floor with a chair for support, so it's a rehearsed movement rather than a first attempt in an emergency.

How much and how often

The World Health Organization's 2020 physical activity guidelines recommend adults aged 65 and over do varied multicomponent activity emphasising functional balance and strength training at moderate or greater intensity on three or more days a week, plus muscle-strengthening on at least two days.

Balance work responds to frequency more than session length. Ten to fifteen minutes most days at home, plus supervised sessions where load and difficulty get adjusted, tends to be more workable than one long weekly session. Gains reduce when training stops, so falls prevention programs are set up as something ongoing at a maintainable dose rather than a fixed six-week course.

We re-test the same measures at around 8 to 12 weeks so progression is based on numbers instead of impressions.

Everything around the exercise

A home visit lets us check the environment where most falls happen. Loose mats, poor lighting between the bedroom and bathroom, low chairs that are hard to rise from, clutter on stairs, and bathroom rail placement all get noted. Where changes need equipment or modification, that's a referral to an occupational therapist.

Footwear comes up often. Backless slippers, worn soles and very soft thick midsoles all reduce the information your feet give you about the ground.

We'll also suggest a GP review if you report dizziness on standing, unexplained falls, blackouts, new vision changes, or if you're on multiple medications.

When to get assessed

Sooner than most people do. Reasonable triggers include one fall in the past year, a near miss that shook you, needing hands on the armrests to stand from a chair, holding the rail on every stair, or a hospital admission followed by weeks of reduced activity.

Family members often notice before the person does, particularly furniture surfing around the house and declining invitations that involve walking or uneven ground.

Funding pathways include a GP chronic condition management plan, NDIS capacity building supports, DVA referral, or private health extras. Sessions run at our Five Dock clinic or at home across Canada Bay and the surrounding Inner West suburbs.

To get a baseline set of balance and strength measures and a program built from them, book a falls prevention assessment.