Does balance training help prevent falls in later life?

Balance training demonstrably helps prevent falls in later life, though the strength of the evidence varies by type of programme. The strongest support comes from a large network meta-analysis of 219 trials involving more than 167,000 participants (PMID 39593159). In that analysis, supervised balance and resistance training and group tai chi lasting more than 3 months performed best: they showed the greatest certainty for reducing the number of fallers, the number of falls, and falls resulting in injury among community-dwelling older adults aged 65 and over. Walking training alone did not achieve that level of certainty.

A meta-analysis of 10 RCTs (648 participants, PMID 34886293) confirms this picture and adds an important detail: integrated training that combines resistance, core strength, and balance exercises works best at a high frequency (more than 5 times per week) and a long duration (more than 32 weeks). The more intensive and prolonged the programme, the greater the risk reduction.

An RCT in 72 frail older adults (pre-frailty, PMID 32365613) showed that a combined programme of balance, strength, proprioception, and reaction-time training (3 times per week, 12 weeks) significantly reduced fall risk. The effects persisted up to 24 weeks. Proprioception is the body's own sense of position and balance; training it appears to be a useful component of a comprehensive programme.

The Otago Exercise Programme, a standardised home-based programme of leg and balance exercises, also shows positive results for muscle strength, balance, walking stability, and fear of falling in a systematic review of 34 studies (PMID 36339194). A smaller study in women over 60 (PMID 33915843, n=50) also found statistically significant improvements in balance after three months of Pilates, although that study is not broadly generalisable due to its small size and restriction to women.

A review of 8 small studies (PMID 31277132, 9 to 61 participants per study) shows that various forms of exercise, including specific balance training, Wii Fit, and wobble board, improve balance by 16 to 42 percent relative to baseline in healthy older adults over 65. Control groups that did nothing actually declined. The certainty of this specific evidence is limited by the small study sizes.

Regarding safety: the large network meta-analysis reports that most exercise interventions produce few serious adverse effects, although some uncertainty exists for certain combined programmes. People with pre-existing conditions are advised to consult a doctor beforehand about which form of training is most appropriate for them.