Simple Exercise Programme Found to Reduce Falls and Injuries in Older Adults: Study
USA: A randomised trial involving nearly 12,000 older adults found that personalised exercise recommendations integrated into primary care reduced documented falls and fall-related injuries.
Falls are a leading cause of injury, disability, and loss of independence among older adults. Although balance and strengthening exercises can reduce fall risk, they are often overlooked during routine consultations. A study published in JAMA Network Open on October 16, 2026, suggests that prescribing simple, personalised exercises through routine primary care may help prevent falls and related injuries.
The eSTEPS cluster-randomised trial included 11,945 adults aged 65 years or older across 22 primary care practices in the United States. Participants were considered at increased risk if they had experienced previous falls, fall-related injuries, or fear of falling associated with walking or balance difficulties.
Primary care practices were randomly assigned to usual care or an intervention called Electronic Strategies for Tailored Exercise to Prevent Falls (eSTEPS).
In intervention practices, electronic medical records alerted clinicians to patients at increased fall risk and provided personalised exercise recommendations. Patients received instructions for home exercises targeting balance and lower-limb strength, with physiotherapy referral when appropriate.
The programme emphasised simple exercises requiring minimal equipment, with sessions lasting approximately ten minutes and difficulty adjusted to individual ability.
During 12–23 months of follow-up, documented falls occurred at a rate of 19.3 per 100 patient-years in the intervention group compared with 21.2 in usual care, representing a 9% relative reduction (rate ratio 0.91; 95% CI 0.88–0.95).
Fall-related injuries were also lower, at 15.7 versus 16.7 per 100 patient-years.
Interestingly, only 22.1% of patients in intervention practices received exercise prescriptions, highlighting the challenge of implementing preventive care consistently.
Key Points for Exercise Prescription in Older Adults
The following practical recommendations combine the eSTEPS approach with established geriatric fall-prevention exercise principles.
| Exercise component | Practical prescription |
| Balance training | Supported single-leg standing, tandem standing and controlled weight shifting |
| Muscle strengthening | Chair sit-to-stand, supported heel raises, knee extensions and hip strengthening |
| Functional training | Practise stepping, turning, reaching and safe walking |
| Frequency | Balance and functional training at least 3 days weekly; strengthening at least 2 days weekly |
| Duration | Begin with approximately 10 minutes per session and gradually increase |
| Progression | Increase repetitions or difficulty according to strength, balance and confidence |
| Safety | Use stable support; arrange supervised physiotherapy for patients with significant instability or recurrent falls |
Walking is beneficial for general health but should not replace structured balance and strengthening exercises when preventing falls.
Before prescribing exercise, physicians should assess gait, balance, muscle strength, postural hypotension, visual impairment and medications that may cause dizziness or sedation.
The trial has limitations. Falls were identified primarily through electronic medical records, potentially missing events not reported to healthcare providers. The study was conducted within one US healthcare system, and the intervention depended on electronic decision-support infrastructure. It also did not establish a significant reduction in mortality.
Nevertheless, the findings are relevant to Indian clinical practice, where older patients frequently have multiple chronic illnesses and limited access to structured rehabilitation.
A brief fall-risk assessment during outpatient visits, followed by a personalised home exercise prescription, may provide an inexpensive and practical preventive intervention.
The clinical message is straightforward: fall prevention should begin before the first serious injury. Asking older patients about previous falls, assessing balance and prescribing appropriate strengthening exercises can become a routine part of geriatric care, alongside blood pressure monitoring and medication review.
Original Research Reference
Latham NK, Hommel E, Kiesman M, et al. Clinical Decision Support for Fall Prevention in Primary Care: The eSTEPS Cluster Randomized Clinical Trial. JAMA Network Open. 2026;9(10). Published online October 16, 2026. DOI: https://doi.org/10.1001/jamanetworkopen.2026.39240
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