Can a better care plan help prevent falls? What new research tells us

Exercise works. Making it part of everyday care is another challenge.

We have good evidence that appropriately designed exercise can help prevent falls in older adults living in the community. A major Cochrane review found that programmes involving balance and functional exercise reduced the rate of falls compared with control groups.1

The challenge is getting that evidence into a care plan that a person can understand, follow and review. Someone may receive sound advice during an appointment yet leave without a clear sense of which exercises are appropriate, how often to practise or when their programme needs to change.

A new trial published on 16 October 2026 examined whether a better connection between clinical decisions and exercise advice could help.2

A large trial looked at what happens when exercise advice is built into care

The eSTEPS trial involved 11,945 adults aged 65 and over who had screened positive for falls risk at 22 primary care practices in the United States.

Some practices used a clinical decision-support tool within their electronic health records. It helped clinicians provide tailored strength and balance exercise recommendations, patient information and optional physiotherapy referrals. Other practices continued with usual care.

During follow-up, the rate of people with at least one medically recorded fall was 19.3 per 100 patient-years in the intervention practices, compared with 21.2 per 100 patient-years in usual care. That is a modest difference of 1.9 per 100 patient-years, or approximately 9% in relative terms. Recorded fall-related injuries were also slightly lower.2

A patient-year is a way of expressing follow-up time. For example, 100 people each followed for one year contribute 100 patient-years. The study's measure counts people with a recorded event relative to the time they were followed; it is not a count of every fall that occurred.

Evidence in context

The study relied substantially on falls recorded in medical records, so events that never reached the health system could be missed. The main fall and injury differences were statistically significant in adjusted analyses; unadjusted analyses did not show the same differences for those outcomes. Only 22.1% of intervention participants had an exercise prescription recorded, and the researchers did not measure whether people completed the recommended exercise. The results therefore support the overall care process, not a claim that one particular exercise, app or software feature prevented falls.2

The finding is encouraging because the intervention worked through ordinary appointments rather than requiring everyone to enter a separate research exercise class. It is also a reminder that advice is more useful when a person receives a plan and knows how it will be reviewed.

The exercise still needs to be right for the person

Another research review, published this month, compared different exercise approaches for older adults with frailty or sarcopenia, a condition involving reduced muscle strength and muscle quantity or quality.

Across 61 randomised trials involving 3,706 participants, programmes combining resistance exercise with other training appeared useful for functional mobility. Particular resistance-training approaches produced favourable results for selected strength measures. But the evidence for many comparisons was uncertain, and the findings did not identify one form of exercise that is best for everyone.3

This makes practical sense. Someone who struggles to rise from a chair may need to develop lower-limb strength and practise the movement. Another person may have enough strength but find turning, uneven ground or unexpected changes of direction difficult. Their programme may need to challenge balance, stepping and movement control instead.

A separate umbrella review, bringing together 28 existing research reviews, found the strongest and most consistent clinical support for interventions that included exercise. Nutrition alone showed less consistent effects on walking and functional performance, although nutritional support may be relevant for some people who are undernourished or living with sarcopenia.4

The important message is that exercise, nutrition and other care needs should be considered together when relevant. They are not interchangeable treatments.

Walking safely can involve thinking and adapting

Researchers are also examining how attention, prediction and movement work together as we age.

A recent review of exercise for people with both physical frailty and cognitive difficulties suggested that programmes combining movement and cognitive challenge may be helpful. The studies were relatively small and varied, so the evidence does not yet identify a single best approach.5

An experimental study published in October found that some older participants adjusted their expectations more slowly when the likelihood of needing to step changed. This helps researchers investigate movement preparation, but it does not prove that a particular training programme prevents falls.6

In everyday life, movement often happens while we are making decisions: finding our way through a busy place, turning to answer someone or choosing where to place a foot. Whether these situations need specific training depends on the individual's assessment and safety.

What does a useful falls-prevention conversation look like?

A fall is not the only reason to ask for advice. Near-falls, new unsteadiness, a change in walking confidence or avoiding familiar activities can all be worth discussing.

It helps to describe what has changed and when it happens. Does the difficulty occur on stairs, when turning, after standing up or while walking outdoors? Have you reduced your activity to avoid feeling unsteady? What would you like to be able to do more comfortably or confidently?

A clinician can use those details, along with an appropriate assessment, to consider which factors need attention. That may involve balance and functional exercise, strengthening, medical review, changes to the environment or other support. A plan should also explain how progress will be checked and when it needs adjusting.

At Clinics GRP, this is the purpose of connecting balance and falls care, therapeutic exercise and an individual clinical review. Research guides the options; the person's circumstances and goals determine the starting point.

The aim is to make progress useful outside an appointment, whether that means managing steps at home, walking to a familiar destination or continuing an activity that matters to the person. Improvements in clinical tests are important, but they should be considered alongside the person's experience of daily life.

If unsteadiness or falls are becoming a concern, contact the Clinics GRP intake team to discuss the appropriate starting point. Sudden severe symptoms, a serious injury or a medical emergency require urgent medical attention; call 000 in an emergency.