Falls-Prevention Exercises That Work: A UK Evidence Guide

Why do falls matter so much if you have osteoporosis?

Because the fracture usually comes from the fall, not the bone weakness alone. Osteoporosis makes bones more fragile, but a fragile bone in a body that never falls rarely breaks. Most hip and wrist fractures in older people happen when someone slips, trips or falls — the Royal Osteoporosis Society is clear that "slips, trips and falls can lead to broken bones (fractures)." Royal Osteoporosis Society, Exercise to help your balance, 2024

Falls are common as we age. NICE notes that around a third of people aged 65 and over, and around a half of people aged 80 and over, fall at least once a year. NICE, Falls: assessment and prevention in older people and in people 50 and over at higher risk (NG249), 2025 Put those two facts together and the message is simple: if you have osteoporosis, reducing your chance of falling is one of the most powerful things you can do to avoid a fracture — and it sits right alongside the bone-loading work in our guide to the best exercises for bone health.

Which exercises actually reduce falls?

The best evidence points firmly to combined strength and balance training. The landmark Cochrane review of exercise for preventing falls — 108 trials in older people living in the community — found that:

• Balance and functional exercises reduce the rate of falls by about 24% (rate ratio 0.76), rated as high-certainty evidence.
• Programmes using several types of exercise together — usually balance and functional work plus resistance (strength) training — probably reduce the rate of falls by about 34% (rate ratio 0.66), rated as moderate-certainty evidence.
• Tai Chi may reduce the rate of falls by about 19% (rate ratio 0.81), though this is low-certainty evidence. Sherrington C, Fairhall N, Wallbank G, et al., Exercise for preventing falls in older people living in the community, Cochrane Database of Systematic Reviews, 2019

The honest reading of this is that balance and strength are the active ingredients, and combining them works best. General walking or gentle stretching on their own have not been shown to prevent falls — the exercise has to genuinely challenge your balance and load your muscles. This is also why building strength matters for the bone itself; see our guide to resistance training for bone density.

What does an evidence-based falls-prevention programme look like?

In the UK it usually means a structured strength-and-balance programme, prescribed for you as an individual. NICE recommends that strength and balance training be offered to older people at risk — particularly those with a history of recurrent falls or problems with gait and balance — and that it be individually prescribed and monitored by an appropriately trained professional. NICE, Falls: assessment and prevention in older people and in people 50 and over at higher risk (NG249), 2025

Two well-established examples appear again and again in this evidence:

• The Otago Exercise Programme — a home-based set of individually prescribed leg-strengthening and balance exercises, plus a walking plan, designed for older adults and widely used within NHS falls services.
• Tai Chi — a gentle, flowing practice that steadily trains balance, weight-shifting and lower-limb strength, and which the Cochrane evidence shows can reduce falls.

Both share the same core ingredients the research keeps highlighting: they challenge balance and build lower-body strength, and they are done regularly over time rather than as a one-off. If you have already broken a bone, our guide to hip fracture prevention covers how these programmes fit into recovery.

Practical balance and strength exercises to try

You can start gently at home, as long as you feel safe and steady. The NHS advises being active every day and doing activities that improve strength and balance at least twice a week. NHS, Falls – Prevention, 2025 Simple, evidence-aligned starting points include:

• Sit-to-stands — rising from a sturdy chair without using your hands, then sitting back down slowly. Builds the leg strength that catches you when you stumble.
• Heel-to-toe standing and walking — standing with one foot directly in front of the other, or walking heel-to-toe along a hallway, holding a worktop for support at first.
• Standing on one leg — near a kitchen counter you can grab, holding for a few seconds and building up.
• Sideways and backwards steps — training the movements a real trip demands.
• Strength work across the main muscle groups — build in muscle-strengthening moves for the legs, arms, back and stomach; our guide to resistance training for bone density explains how to progress safely.

Beyond exercise: home hazards, vision and medication checks

Exercise is the biggest single lever, but the NHS and NICE recommend tackling several risk factors together. For anyone with recurrent falls or unsteadiness, NICE advises a comprehensive falls assessment that looks at all the contributing causes, not just fitness. NICE, Falls: assessment and prevention in older people and in people 50 and over at higher risk (NG249), 2025 The everyday version of that, drawn from NHS guidance, is: NHS, Falls – Prevention, 2025

• Clear the trip hazards at home — remove clutter, loose wires and unsecured rugs, and consider grab rails on steps and in the bathroom.
• Have your eyes tested regularly — poor or changing vision is a major falls risk, and the NHS suggests getting your ears and hearing checked too, as inner-ear problems affect balance.
• Review your medicines — some medicines, or combinations of them, can cause dizziness or drowsiness. Ask a GP or pharmacist if you think yours might be affecting your balance.

None of these replace the exercise — they multiply its benefit by removing the situations where a stumble turns into a fall.

How does bone screening fit into falls prevention?

Falls prevention stops the fall; bone screening tells you how much is riding on it. Two people can fall the same way — one walks away, the other fractures — and the difference is often their bone strength. Knowing where your bones stand lets you and your clinician judge how urgent your falls-prevention work is, and whether treatment is also needed.

That is where a REMS (Radiofrequency Echographic Multi Spectrometry) scan helps. It is radiation-free, so it can be repeated safely to track whether your bones are strengthening as you build muscle and balance — something a plan aimed at preventing fractures genuinely benefits from.

You can book a radiation-free bone health assessment or read more about our bone health assessment to find out exactly where your bone strength stands before you build your falls-prevention plan.

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This article is part of our bone health series. For the exercises that build bone as well as balance, see our guides to the best exercises for bone health and resistance training for bone density.