Walking alone has not been shown to be effective for fall prevention. Balance exercises and strength training together reduce falls in older adults most strongly, with up to 34% reduction. For knee osteoarthritis, low-intensity training is sufficient; high intensity adds nothing and produces more adverse events. Walking retains its value, particularly in more intensive forms for fitness and blood sugar.
Walking is good for your health, but as a sole activity it lacks sufficient evidence for preventing falls in older adults. A large Cochrane analysis1 shows that exercise in general reduces the number of fall incidents by 23%, and the proportion of people who fall at least once by 15%. However, walking as a standalone intervention was not identified in that review as proven effective for fall prevention. The evidence for that is uncertain.
The interventions with the strongest evidence for fall prevention are balance and functional exercises, including Tai Chi. These reduce the number of falls by 24% (high certainty). Those who also add strength training on top of that are likely looking at around 34% fewer falls, although that combined outcome is based on evidence of slightly lower certainty. Strength training therefore offers a clear added benefit, but as a supplement to balance exercises, not necessarily as heavy lifting.
For people with knee osteoarthritis, there is an important nuance regarding the intensity of strength training. A large RCT2 found that high-intensity strength training offered no additional benefit over low-intensity training for knee pain or knee load after 18 months. In addition, there were considerably more adverse events in the high-intensity group (53 adverse events) compared with the low-intensity group (30) and the control group (4). For osteoarthritis, gentler strength training is preferable to heavy lifting.
If you want to make walking more intensive, interval walking training (alternating fast and slow) has shown demonstrated improvements in fitness, muscle strength, and blood sugar regulation in people with type 2 diabetes3. How this plays out in the long term and in other populations has not yet been sufficiently studied. It is not a replacement for targeted balance exercises, but it does add an extra dimension to walking.
For people with Parkinson's disease, most forms of physical training show positive effects on motor symptoms and quality of life compared with doing nothing4. Which specific form within that is the best choice cannot be stated with certainty based on the available evidence. The message here is: moving helps, and it is better than remaining passive.
All claims are based on one Cochrane review (PMID 30703272), one RCT on knee osteoarthritis (PMID 33591346), one review on interval walking training in diabetes (PMID 38507778), and one review on Parkinson's disease (PMID 35014064). The Cochrane review is the most robust source for fall prevention. The remaining studies support specific sub-questions.