By Amara Williams
Who This Matters Most For
This guide is written for adults over 60 who want to lower their risk of falling, along with the family members and caregivers who support them. It is especially relevant if you have noticed unsteadiness on stairs, a change in your walking pattern, a fear of falling that has started to limit your activities, or if you have already had one fall in the past year.
This article is general educational information, not medical advice. It is not a substitute for an evaluation by a physician, physical therapist, or other qualified health professional. If you have had a recent fall, experience dizziness or fainting, have a vision or inner-ear condition, take multiple medications, or manage a chronic condition such as heart disease, diabetes, or a prior stroke, talk with your doctor before starting any new exercise program.
Why Falls Matter: The Numbers Behind the Concern
Falling is often treated as a minor, almost comic mishap. Among adults over 60, the data tell a different story. Falls are the leading cause of both fatal and nonfatal injuries in older Americans, and the trend has been moving in the wrong direction for years.
According to a 2023 CDC report published in the Morbidity and Mortality Weekly Report, 27.6 percent of adults 65 and older, roughly 14 million people, reported falling at least once in the previous year based on 2020 survey data. That same report found that 38,742 older adults died from a fall in 2021, a rate of 78.0 deaths per 100,000 people, and noted that age-adjusted fall death rates have climbed steadily for at least two decades.
Sources: CDC, Nonfatal and Fatal Falls Among Adults Aged 65+, MMWR (2023); CDC, Facts About Falls; CDC STEADI Clinician Fact Sheet. See References below.
A few more figures put the risk in context. About 88 percent of hip fracture emergency visits and hospitalizations are the result of a fall, and roughly 83 percent of hip fracture deaths trace back to one. Falls are also the most common cause of traumatic brain injury in this age group. Perhaps most telling is that falling once roughly doubles a person’s chance of falling again, which is exactly why prevention, rather than reaction after the fact, is the focus of this guide.
None of this is meant to alarm. It is meant to explain why so much clinical research has gone into finding out which types of exercise actually change these odds, and the answer is encouraging: specific, well-studied training can meaningfully reduce fall risk for most older adults.
What CDC’s STEADI Program Recommends
STEADI stands for Stopping Elderly Accidents, Deaths, and Injuries. It is a CDC initiative built for healthcare providers who work with older adults at risk of falling, and it rests on three steps: screen every patient 65 and older for fall risk, assess the specific factors contributing to that risk, and intervene with strategies matched to those factors.
The intervention side of STEADI leans heavily on exercise. The program’s clinician materials specifically point to activities such as Tai Chi that build leg strength and improve balance, alongside broader guidance to enroll in exercise programs that target strength and balance together. STEADI also recommends pairing exercise with other risk-reduction steps: an annual vision check, a medication review with a doctor or pharmacist to flag drugs that can affect balance or alertness, and a home safety walk-through, which CDC packages as a printable “Check for Safety” checklist.
The Three Pillars of an Effective Program
Practicing your center of gravity under progressively harder conditions: narrower stance, standing on one leg, shifting weight, or reacting to a small nudge, always near something sturdy to hold.
Building the muscle power in hips, knees, and ankles that lets you catch yourself, rise from a chair, and climb stairs without strain.
Practicing the walking patterns that trip people up in daily life: turning, stepping over obstacles, walking on uneven ground, or changing pace.
The Exercise Components Proven to Reduce Fall Risk
Research on fall prevention keeps landing on the same conclusion: no single exercise does the job on its own. Programs that combine balance, strength, and gait work outperform programs built around just one of those elements, and the strongest evidence comes from two well-studied approaches.
The Otago Exercise Program is a structured routine of standing balance exercises, progressive leg-strengthening moves such as knee extensions and hip abduction, and walking drills including backward, sideways, and zigzag walking. A 2025 systematic review and meta-analysis published in Frontiers in Public Health, which pooled 15 randomized controlled trials involving nearly 1,300 participants ages 60 to 92, found that Otago-style programs produced significant improvements in balance, gait, and lower-limb strength, with the largest benefits seen in older adults who already had some functional limitations.
Tai Chi has its own strong track record. A widely cited randomized controlled trial published in 2005 followed 256 physically inactive adults ages 70 to 92 through six months of Tai Chi versus a stretching control program. The Tai Chi group had a 55 percent lower risk of experiencing multiple falls, along with fewer total falls, fewer people who fell at all, and fewer injurious falls, compared with the stretching group.
The common thread is that both programs train balance, strength, and movement patterns together rather than in isolation, and both require several months of consistent practice before the benefits show up. There is no evidence that a single session, or even a few weeks of casual effort, produces a lasting change in fall risk.
Exercise Components at a Glance
How to Start Safely
Starting a fall-prevention routine is less about intensity and more about sequencing. The safest path usually looks like this: a conversation with your doctor, an honest look at your home environment, a slow ramp-up in exercise difficulty, and a program that keeps going for months rather than weeks.
Begin with a medical check-in, particularly if you have fallen in the past year, feel dizzy or lightheaded when you stand, take four or more medications, or manage a condition like Parkinson’s disease, diabetic neuropathy, or a prior stroke. Your physician may refer you to a physical therapist who specializes in balance and fall prevention, which is often the most direct route to a program tailored to your specific risk factors.
From there, most people do well starting with seated or supported exercises, using a sturdy chair or countertop, before attempting anything unsupported. Progress happens gradually: less hand support, a narrower stance, a slightly longer single-leg hold, or a few extra reps, added only when the current level feels comfortable and controlled. A typical goal cited in clinical programs is two to three sessions per week for balance and strength work, sustained for at least several months, since that is roughly the timeframe over which trials like the Otago and Tai Chi studies measured meaningful drops in fall rates.
Checklist: Starting a Fall-Prevention Routine Safely
- Schedule a check-in with your doctor before beginning, especially if you’ve fallen, feel dizzy, or take several medications
- Ask about a referral to a physical therapist for a personalized balance and gait assessment
- Have your vision checked; outdated prescriptions and cataracts are common, correctable fall risks
- Review all medications, prescription and over-the-counter, with your doctor or pharmacist for fall-related side effects
- Clear walking paths at home: remove loose rugs, tape down cords, add night lights in hallways and bathrooms
- Install grab bars near the toilet and shower, and use a non-slip mat in the tub
- Wear supportive, low-heeled shoes with good tread for exercise, not socks or loose slippers
- Practice balance exercises near a counter, sturdy chair, or wall, and never on a slick or uneven surface
- Have a family member, friend, or caregiver nearby (or within earshot) during early balance sessions
- Progress slowly: add difficulty only after a level feels fully steady and controlled
- Keep a simple log of sessions and any near-falls to share with your doctor or therapist
- Stop and check in with a professional if you notice new dizziness, pain, or unsteadiness
Putting It Together: A Sample Weekly Structure
Once a physician or physical therapist has cleared a plan, many programs settle into a simple weekly rhythm. The exact days and sets should come from your own evaluation, but the outline below reflects the general pattern used in studied programs like Otago, where balance and strength work happen several times a week and gait practice is woven into ordinary walking.
Notice that rest days are built in deliberately. Muscles and the nervous system adapt during recovery, not only during the exercise itself, and pushing through fatigue tends to raise the odds of a misstep rather than lower them. If a session ever feels unusually hard, or if new joint pain appears, it is reasonable to scale back and mention it at the next medical visit rather than pushing through.
Group classes deserve a mention here too. Community centers, senior centers, and many YMCA locations offer Tai Chi, Otago-based, or general balance classes designed specifically for older adults. Beyond the physical benefit, a group setting adds social contact and an extra layer of built-in supervision, both of which tend to support long-term consistency.
A Worked Example: Starting a Program the Right Way
Consider a composite example drawn from common clinical scenarios. Robert is 68 and had a minor stumble on his porch steps last spring. He did not fall all the way down, but it shook his confidence, and he noticed he had started avoiding uneven sidewalks. He mentioned this at his next annual physical.
His doctor asked about medications, checked his blood pressure while sitting and standing, and referred him to a physical therapist for a balance evaluation. The therapist found mild weakness in his hips and ankles and some hesitancy in his gait when turning, and put together a plan: supported balance drills twice a week in clinic, a home program of sit-to-stand and heel-to-toe walking exercises three times a week, and a follow-up vision exam, since Robert had not had one in three years.
Robert started every home session holding the back of a dining chair. After about six weeks, his therapist progressed him to fingertip support, and by month four he could hold a single-leg stance for several seconds without touching the chair at all. His wife stayed in the room for his first few unsupported attempts. By month five, his gait on uneven ground felt noticeably steadier, and he had returned to his regular walking route. His case reflects the general pattern seen in the research: gradual progression, professional guidance, and several months of consistency, not a quick fix.
Common Mistakes to Avoid
What Geriatric Physical Therapists Say
Clinicians who specialize in older-adult mobility tend to repeat a few consistent themes. First, fear of falling can become almost as limiting as a fall itself, since it often leads people to move less, which weakens the very muscles and reflexes that prevent falls in the first place. Restoring confidence through supervised, graded practice is often as important as the physical exercises.
Second, geriatric physical therapists generally emphasize that balance is trainable at any age. The nervous system continues to adapt to practice well into older adulthood, which is part of why structured programs like Otago and Tai Chi show measurable results even in participants in their 80s and 90s.
Third, therapists typically stress individualized progression over a fixed routine copied from a video or article. A program is adjusted based on a person’s specific weaknesses, whether that is hip strength, ankle mobility, vision, or reaction time, which is why an in-person or telehealth evaluation tends to produce better outcomes than a generic exercise list.
A Note on Safety and Scope
This article provides general educational information about fall-prevention exercise research. It is not medical advice and does not replace a personalized evaluation. If you have had a recent fall, experience dizziness, fainting, or vision problems, or take multiple medications, please talk with your physician before starting any new exercise program.
Always have another person nearby, or at least within calling distance, when practicing balance exercises, particularly in the early stages of a new routine.
Key Takeaways
- More than one in four adults over 60 falls each year, and falls are the leading cause of injury death in this age group.
- CDC’s STEADI program recommends healthcare providers screen for fall risk, assess contributing factors, and intervene with exercise, vision checks, medication review, and home safety changes.
- The strongest evidence points to programs that combine balance, lower-body strength, and gait training, rather than any single exercise type alone.
- Well-studied programs such as Otago and Tai Chi show meaningful reductions in falls, but typically require several months of consistent practice.
- Always check with a physician before starting, especially after a recent fall, with dizziness, or with multiple medications, and have support nearby during balance practice.
Frequently Asked Questions
How often should someone over 60 do fall-prevention exercises?
Most clinical programs use two to three sessions per week for balance and strength training, continued for at least several months. Consistency over time matters more than any single intense session.
Is walking alone enough to prevent falls?
Walking supports general fitness and endurance, but the research behind CDC’s STEADI recommendations points to programs that specifically train balance and strength together with gait, since walking on its own does not reliably challenge balance reflexes the way targeted balance drills do.
What is the Otago Exercise Program?
It is a structured routine of progressive balance exercises, leg-strengthening moves, and walking drills, originally developed in New Zealand and studied in numerous randomized controlled trials, including a 2025 meta-analysis that found significant improvements in balance, gait, and lower-limb strength.
Does Tai Chi really reduce falls?
A randomized controlled trial of 256 older adults found that those practicing Tai Chi for six months had a 55 percent lower risk of multiple falls compared with a stretching control group. CDC’s STEADI materials list Tai Chi among the activities that build leg strength and improve balance.
When should I see a doctor before starting?
See your doctor before starting if you’ve fallen in the past year, feel dizzy or lightheaded when standing, take multiple medications, or manage a chronic condition such as diabetes, Parkinson’s disease, or a history of stroke.
What home changes matter most for fall prevention?
CDC’s Check for Safety checklist highlights removing loose rugs, adding grab bars near the toilet and shower, improving lighting in hallways and stairwells, and taping down loose cords, alongside wearing supportive, non-slip footwear.
Can balance really improve after age 70 or 80?
Yes. Studies of programs like Otago and Tai Chi have included participants well into their 80s and 90s and still found measurable improvements in balance, gait, and strength, particularly among those who started with some degree of functional limitation.
Should I practice balance exercises alone?
It’s best to have another person nearby, or at least within calling distance, especially in the early weeks of a new routine or when progressing to a harder version of an exercise, and to always stay near a sturdy chair, counter, or wall.
References
- Kakara R, Bergen G, Burns E, Stevens M. Nonfatal and Fatal Falls Among Adults Aged ≥65 Years, United States, 2020-2021. MMWR, CDC (2023). cdc.gov/mmwr/volumes/72/wr/mm7235a1.htm
- Centers for Disease Control and Prevention. Facts About Falls. cdc.gov/falls/data-research/facts-stats
- Centers for Disease Control and Prevention. STEADI Clinician Fact Sheet. cdc.gov/steadi/media/pdfs/STEADI_ClinicianFactSheet-a_1.pdf
- Centers for Disease Control and Prevention. STEADI, Older Adult Fall Prevention. cdc.gov/steadi/index.html
- Centers for Disease Control and Prevention. Check for Safety: A Home Fall Prevention Checklist for Older Adults. cdc.gov/steadi/pdf/steadi-brochure-checkforsafety-508.pdf
- Frontiers in Public Health. The Otago Exercise Program’s Effect on Fall Prevention: A Systematic Review and Meta-Analysis (2025). frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1522952/full
- Li F, Harmer P, Fisher KJ, et al. Tai Chi and Fall Reductions in Older Adults: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci (2005). pubmed.ncbi.nlm.nih.gov/15814861
- U.S. Preventive Services Task Force. Falls Prevention in Community-Dwelling Older Adults: Interventions. uspreventiveservicestaskforce.org
