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A Fall Prevention Program

The right exercise program can reduce older adults' risk of falling and help prevent potentially catastrophic injuries.

Falls can be serious at any age, often causing ligamentous sprains or injury to bones and soft tissue. In addition, the inevitable decrease in overall physical activity during the recovery period can lead to other unfavorable consequences. The temporary inactivity may be a minor setback for young people, but for seniors it can result in losses in muscle mass, endurance and functional range of motion. Thus falls can be disastrous for the senior population, possibly leading to long-term immobility and loss of independence, as well as increasing overall mortality risk.

Many factors associated with an increased risk of falls—including lack of strength and balance, improper footwear, hazards in the home and vision disturbances—are considered preventable (Lemcke et al. 2004). To help prevent falls, the American Academy of Orthopedic Surgeons (www.aaos.org) recommends that seniors participate in a fall prevention program designed to improve strength, balance, agility and coordination. (Some recent research [Porter 2006] suggests that improved muscular power may also reduce the risk of falling by enabling older adults to move their limbs more quickly when they begin to lose their balance. Future studies should provide more information on the benefits and risks of specific types of power training.)

A Well-Rounded Fall Prevention Program

It is easy for anyone—even a strong, healthy young person—to trip over a throw rug, a toy on the floor or a curb when he or she is not paying close attention to the surroundings. The amount of damage caused by a fall can depend on one’s muscle mass, as well as the energy and angle of the impact. Muscle mass can act as a protective mechanism, or cushion, taking some of the impact during a fall. Since a decline in muscle mass often accompanies aging, older adults typically have less muscle tissue surrounding their joints. This is one reason that a fall prevention program is so important for this population.

A good sense of balance can help prevent a fall or reduce the severity of one that does occur—by enabling the person to diminish the speed of the fall, for example. Coordination and agility exercises taught in fall prevention programs serve to help clients adjust more readily to changing surface areas, slippery surfaces or unexpected obstacles in their path.

Below is a suggested fall prevention program that incorporates strength, balance, agility and coordination. These fall prevention exercises should be performed in addition to a client’s regular stretching and cardiovascular exercise routine.

Strength Exercises

1. chair squats (3 sets of 8–15 reps)

  • Sit on the edge of a chair or bench. Lean the trunk forward and reach the arms out in front of the torso.
  • Push through the heels and rise to a standing position.

2. heel raises (3 sets of 10–15 reps)

  • From a standing position, push through the toes of both feet and raise the heels off the floor while maintaining an upright torso.
  • Pause for 1 second before slowly lowering the heels to the floor.

3. bridge on stability ball (3 sets of 10–15 reps)

  • Lie supine on a mat with legs extended and heels placed on top of a stability ball. Arms are braced out to the sides of the body in a T position to assist with balance.
  • Tighten the buttocks and abdomen, and then push through the heels to raise the buttocks off the mat, creating a straight line from heels to shoulders.
  • Hold for 1–3 seconds, as tolerated, and then slowly lower back to the starting position.

4. stability ball squats (3 sets of 10–15 reps)

  • Stand 11/2–2 feet in front of a wall, feet about hip width apart. Place a stability ball between the small of the back and the wall.
  • While keeping the knees pointed straight ahead, lower into a squatting position until thighs are parallel to the floor.
  • Hold for 1–3 seconds, then push through the heels and return to the starting position.

Balance Exercises

The following exercises are all variations on the single-leg stance.

1. single-leg stance, level 1 (3 reps per side)

  • Stand next to a wall or countertop, using a hand to maintain balance.
  • Stand on one leg and hold for up to
    10 seconds.

2. single-leg stance, level 2 (3 reps per side)

  • Stand next to a wall or countertop, using a hand to maintain balance.
  • Keep the eyes closed while standing on one leg.

3. single-leg stance, level 3 (5–10 reps per side)

  • Stand next to a wall, facing the seat of a chair placed 1–2 feet in front of you.
  • Stand on one leg, then bend the waist and reach forward to tap the chair seat.
  • Return to the starting position and repeat without placing the lifted foot back down on the floor.

Exercises With an Elastic Band

Standing four-way hip kicks work for both strength and balance and target hip flexion, abduction, extension and adduction. For all of the following exercises, begin with resistance tubing secured around the base of a pole or exercise machine. Tie an ankle loop around the other side of the tubing and slip one foot into the loop.

1. hip flexion (3 sets of 12–15 reps on each leg)

  • Face away from the tubing attachment point and, while maintaining an upright posture, kick the secured leg forward against the resistance.
  • Bring the leg back to the starting position with a slow, controlled movement.

2. hip abduction (3 sets of 12–15 reps on each leg)

  • After performing the hip flexion exercise above, turn 90 degrees counterclockwise so that the free leg is next to the tubing attachment point and the secured leg is on the far side. Make sure the free leg is behind the tubing.
  • Kick the secured leg out to the side against the resistance of the tubing while keeping an upright posture.
  • Bring the leg back to the starting position with a slow, controlled movement.

3. hip extension (3 sets of 12–15 reps on each leg)

  • Turn 90 degrees counterclockwise again to face the tubing attachment point.
  • Keeping an upright posture, kick the secured leg straight back.
  • Bring the leg back to the starting position with a slow, controlled movement.

4. hip adduction (3 sets of 12–15 reps on each leg)

  • Turn 90 degrees counterclockwise one more time so that the secured leg is next to the tubing attachment.
  • Kick the secured leg across the front side of the body.
  • Return the leg to the starting position with a slow, controlled movement.

Exercises for Agility and Coordination

1. front leg swings (3 sets of 8–15 reps per side)

  • Begin by standing tall next to a wall, using the hand closer to the wall to assist with balance.
  • Swing the leg farther from the wall forward, with knee straight, then back behind the body while maintaining an upright posture.

2. side leg swings (3 sets of 8–15 reps per side)

  • Stand tall next to a wall, using the wall for balance.
  • Swing the leg farther from the wall out to the side while maintaining an upright posture.

3. heel-toe walking (3 times, 1–2 minutes each)

  • Take a step forward, positioning the heel of one foot in front of the toes of the opposite foot. Try to have the toes touch the heel of the shoe each time a step is taken.
  • Ambulate forward or backward using this heel-toe pattern.

4. crossover walking, or grapevine (1–3 reps, 2–3 minutes in each direction)

  • Stand with feet hip width apart. A wall or countertop may be used for upper-body support.
  • Cross the right foot in front of the left foot, then uncross the feet by abducting the left leg out to the side.
  • Repeat this crossover step, while moving continuously to the left, then reverse directions.
  • Reverse to a “back” crossover, crossing the right foot behind the left foot instead of in front of it.

Note: To increase the balance challenge, perform heel-toe walking and crossover walking on a slightly uneven surface, such as a floor mat.

A Healthy Future

The older-adult population will continue to grow steadily over the coming years. Using your knowledge and expertise to implement a fall prevention program that includes strength, balance, agility and coordination will not only keep your older-adult clients feeling good but also allow them to maintain their health and independence.

tips for fall prevention

You can further help your older-adult clients by making the following suggestions to them:

1. Remove throw rugs from the household.

2. Try a tai chi class.

3. Remove clutter from hallways, staircases and other areas of heavy traffic in the home.

4. Discuss any dizziness or vision changes—especially after a change in medication—with
a physician.

5. Get regular eye examinations.

6. Keep staircases and hallways well lit, and consider installing night-lights in these areas.

7. Use proper technique when lifting heavy objects.

8. Wear flat, rubber-soled,
nonslip shoes.

the importance of
weight-bearing exercise

Each year osteoporosis causes 1.5 million broken bones. According to Bohan & Thompson (2005), 50% of women and 25% of men will develop a fracture due to osteoporosis during their lifetime. Exercise, especially weight-bearing exercise, increases bone density and therefore reduces fracture risk in the event of a fall (Bohan & Thompson 2005). Some good weight-bearing exercises include walking, squats, push-ups, hiking and dancing. (Swimming and biking are non-weight-bearing exercises.)

Adding a fall prevention program to the mix will reduce the risk of falling in the first place.

View the Designing Fall Prevention Workshops CEC Course


American Academy of Orthopaedic Surgeons. 2000.
Prevent falls! http://orthoinfo.aaos.org/fact/thr_
report.cfm?Thread_ID=102&topcategory=Injury%20prevention. www.aaos.org; retrieved May 2006.
Bohan, S., & Thompson, G. 2005. 50 Simple Ways to Live a Longer Life. Naperville, IL: Sourcebooks.
Lemcke, D., et al. 2004. Current Care of Women: Diagnosis and Treatment. New York: McGraw-Hill.
Porter, M.M. 2006. Power training for older adults. Applied Physiology, Nutrition, and Metabolism, 31 (2), 87–94.


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