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Mobility and balance

In older adults living in the community, exercise programmes built mainly on balance and functional exercises reduce falls, with high-certainty evidence from a Cochrane review of randomised trials, and exercise may also modestly improve balance measures and reduce fear of falling. Regular stretching increases joint range of motion in healthy adults, and strength training appears to give similar gains, but this evidence is low certainty and no trials have tested flexibility exercise alone for falls. Tai chi for falls is covered in the qigong-and-tai-chi topic.

  • Longevity
  • Recovery
  • Strength

Evidence retrieved up to

What the research shows

As part of a healthy lifestyle, exercise programmes built mainly on balance and functional exercises may help reduce the risk of falls in older adults living in the community, lowering both the rate of falls and the number of people who fall.

High certaintyFurther research is very unlikely to change this.
No known concerns at usual amountsBenefit

Who this is about

older adults (60 years and over) living in the community

Practical note

Graded high, following the Cochrane review's own GRADE rating: 39 randomised trials (7,920 participants) of balance and functional exercise reduced the rate of falls by about a quarter. Programmes combining balance with resistance exercise were rated moderate certainty; no trials tested flexibility exercise alone against control. Tai chi for falls is covered in the qigong-and-tai-chi topic.

Safety note

Adverse events in the trials were mostly non-serious and musculoskeletal, though few trials monitored them closely. Older adults at higher risk of falls or with complex health conditions may need supervised or supported programmes.

Sources

In older adults, exercise programmes involving gait, balance, coordination and functional tasks, strengthening, or multiple exercise types may modestly improve clinical balance measures at the end of the programme.

Low certaintyFurther research is likely to change this.
No known concerns at usual amountsBenefit

Who this is about

older adults (60 years and over)

Practical note

Graded low: 94 randomised trials, but each outcome drew on only a few trials, most were at unclear risk of selection bias and high risk of performance bias, and most measured balance only at the end of the programme. In the review, the more effective programmes ran three times a week for three months and involved dynamic exercise in standing.

Safety note

The review judged these programmes probably safe, but most trials did not monitor or report adverse events.

Sources

In older adults living in the community, exercise programmes such as balance training, strength training, tai chi and yoga may produce a small to moderate reduction in fear of falling immediately after the programme.

Low certaintyFurther research is likely to change this.
No known concerns at usual amountsBenefit

Who this is about

older adults (mostly 65 years and over) living in the community

Practical note

Graded low, matching the Cochrane review's GRADE rating for the immediate post-programme outcome (24 studies, 1,692 participants): outcomes were self-reported without blinding. Evidence for longer-term effects was very low certainty.

Sources

In adults, supervised strength training and stretching produced similar gains in joint range of motion in randomised trials comparing the two.

Low certaintyFurther research is likely to change this.
No known concerns at usual amountsBenefit

Who this is about

adults in supervised exercise trials

Practical note

Graded low: 11 randomised trials with 452 participants, and the authors note the studies were highly heterogeneous in design, protocols and populations, so the finding is imprecise and indirect for any one group.

Sources

In healthy adults, regular stretch training increases joint range of motion compared with no stretching, with static and proprioceptive neuromuscular facilitation stretching producing larger gains than ballistic or dynamic stretching.

Low certaintyFurther research is likely to change this.
No known concerns at usual amountsBenefit

Who this is about

healthy adults

Practical note

Graded low: a 2024 meta-analysis of 77 studies found a moderate overall effect with consistent direction, but heterogeneity was high (I2 about 75%), participants were not blinded, and few studies involved older adults, so the effect in older people is less direct. Volume, intensity and frequency of stretching did not significantly moderate the gains in that analysis.

Sources