Balance Training and Fall Prevention: What the Research Says

The short answer

Yes, balance training helps prevent falls. The strongest evidence comes from a Cochrane review of 108 randomized trials: exercise programs built mainly on balance and functional movement reduced the rate of falls in adults over 60 by about 24%, rated high-certainty evidence. The programs that work are done standing, get progressively harder and are kept up for months.

Why falls matter

Falls are one of the biggest threats to independence as we age. The CDC reports that more than one in four adults aged 65 and older falls each year, and about 37% of those who fall are hurt badly enough to need medical treatment or limit their activity for at least a day (CDC).

The CDC is equally clear that falls are not a normal part of aging, and that strength and balance exercise is one of the main ways to reduce them (CDC fact sheet).

What the research shows

The big review: 108 trials, 23,000+ people

In 2019, Cochrane, the gold standard for summarizing medical evidence, pooled 108 randomized trials of exercise in adults over 60 living at home. Participants averaged 76 years old (Sherrington et al., 2019). Not all exercise worked equally well:

The takeaway: balance work is the active ingredient. Strength training helps most when it's combined with balance, and walking on its own isn't enough. Most of the effective exercises were done standing.

Programs you can do at home

The Otago Exercise Programme was designed for exactly that: a home routine of leg strengthening, balance exercises and walking, introduced by a trained instructor. Across seven trials of adults averaging 82, it reduced fall rates by about 32% (Thomas et al., Age and Ageing 2010).

Confidence counts too

Fear of falling makes people move less, which weakens balance further. A 2024 meta-analysis of 16 trials found the Otago program significantly reduced fear of falling, with bigger effects when programs ran longer than 16 weeks and more than twice a week (Han et al., BMC Sports Science, Medicine and Rehabilitation 2024).

What the effective programs have in common

• Standing exercises that challenge balance, not just seated stretches.

• Progression: exercises get harder as you improve.

• Consistency: several sessions a week, kept up for months.

• Guidance: programs led by a physical therapist or trained instructor tended to work better.

Where a SlackBoard fits

A SlackBoard is a way to do the standing, progressive balance work the research points to, at home and in a few minutes a day. The two-line SlackBoard Plus gives a stable starting point, and switching to one line adds challenge as you improve, which is the progression that effective programs build in.

It isn't a fall-prevention program on its own. Use it alongside strength work and walking, and if you've fallen before or have a health condition, ask your doctor or a physical therapist to help you set up a routine.

Next read: Balance Exercises for Older Adults You Can Do at Home.

FAQ

Q: Does balance training really prevent falls?

A: Yes. A Cochrane review of 108 trials found balance and functional exercise programs reduce the rate of falls in older adults by about 24%, with high-certainty evidence.

Q: What type of exercise is best for preventing falls?

A: Standing balance and functional exercises, ideally combined with leg strengthening. Walking alone hasn't been shown to reduce falls.

Q: How often should older adults do balance exercises?

A: Several times a week, kept up for months. Programs lasting longer than 16 weeks and running more than twice a week showed stronger effects on fear of falling.

Q: What is the Otago Exercise Programme?

A: A home-based program of leg strengthening, balance exercises and walking. In trials it reduced fall rates by about a third.

Q: Is it ever too late to start?

A: No. Participants in these trials averaged 76 to 82 years old.

Sources

• Sherrington C, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019; CD012424. Abstract

• Thomas S, Mackintosh S, Halbert J. Does the "Otago exercise programme" reduce mortality and falls in older adults? Age and Ageing 2010;39(6):681–687. Summary

• Han J, et al. Effect of Otago exercise on fear of falling in older adults. BMC Sports Sci Med Rehabil 2024;16. DOAJ

• CDC. Older Adult Falls Reported by State. CDC Stacks

• CDC. Older Adult Falls fact sheet. CDC Stacks