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Falls: 5 Essential Strength Exercises to Help Prevent Them

More than 14 million US adults aged 65 and older report a fall every year. More than 25 percent of older adults fall each year, and falls are the leading cause of injury-related death in people 65 and older. These figures come from a 2024 review in JAMA by researchers at Duke University.

The same review also shows that falls are not random events. They have identifiable causes, and many of those causes can be changed. Strength training is one of the most practical ways to start.

Why Older Adults Fall

According to the Duke review, falls result from age-related physiologic changes combined with multiple intrinsic and extrinsic risk factors. Intrinsic factors come from within the body. Extrinsic factors come from the environment or from outside influences.

The major modifiable risk factors are:

• Gait and balance disorders
• Orthostatic hypotension
• Sensory impairment
• Medications
• Environmental hazards

"Modifiable" is the key word. These are risk factors that can be addressed, so a fall is not simply a fact of getting older.

Who Should Take Fall Prevention Seriously

Guidelines recommend fall prevention interventions for anyone who meets one of three criteria:

• They reported a fall in the prior year.
• They have concerns about falling.
• Their gait speed is below 0.8 to 1 meter per second.

If any of these describes you or a family member, prevention is not something to put off.

What the Research Recommends

The Duke review states that functional exercises to improve leg strength and balance are recommended for fall prevention in average-risk to high-risk populations. That covers a wide range of people, not only those who have already fallen.

For people at high risk, multifactorial risk reduction may also reduce fall rates. This means a systematic clinical assessment for modifiable risk factors, followed by addressing what that assessment finds. Exercise is one piece of that approach.

Why Strength Matters

Leg strength sits at the center of the recommended exercise approach. The legs do the work in nearly every movement that matters for staying upright and independent: standing from a chair, walking, climbing stairs, stepping over an obstacle, and getting up from the floor.

Functional exercises train those same movement patterns. The goal is not to look athletic. The goal is to build the strength to perform daily tasks safely.

5 Essential Strength Exercises

These exercises are training suggestions built around the leg-strength focus of the research. They are not protocols taken from the review.

1. Sit-to-stand. Stand up from a sturdy chair and sit back down with control. It mirrors one of the most common movements in daily life. Begin with your hands on your thighs if needed, then progress to crossing your arms.

2. Squat. Lower your hips back and down as if sitting into a chair, then stand. Use a chair behind you as a target. Add a light dumbbell or kettlebell held at the chest as you get stronger.

3. Step-up. Step onto a low, stable platform, stand fully, and step down with control. It trains single-leg strength and mimics stair climbing. Hold a rail or wall at first.

4. Hip hinge (deadlift pattern). Push your hips back with a flat back, lower a light weight toward the shins, and stand tall. It strengthens the hips, hamstrings, and back, and it is the pattern used to pick things up safely.

5. Calf raise. Rise onto the balls of your feet and lower slowly. Hold a counter for support. The calves help with walking and push-off.

How to Start

Begin with a couple of sessions per week. Choose a weight or variation you can perform with good form, and increase the challenge gradually as the movements become easier. Consistency matters more than intensity in the early weeks.

Anyone with a health condition, a recent fall, or concerns about exercise safety should talk with their physician before starting. A qualified trainer can tailor the exercises and progressions to the individual.

Medications and Other Risk Factors

Exercise is not the only lever. Medications appear on the list of modifiable risk factors. A meta-analysis of randomized trials of programs to stop fall-associated medications did not find a significant reduction in falls. Deprescribing is still a component of many successful multifactorial interventions.

The takeaway is to have medications reviewed as part of a broader assessment. Never stop a medication without your doctor's guidance.

The Bottom Line

Falls are common, serious, and in many cases modifiable. The Duke review points to functional exercises that improve leg strength and balance, and to systematic assessment of risk factors for those at high risk. Building leg strength with simple, functional movements is a practical step that almost anyone can start.