Protocol
Mobility and fall-prevention protocols
A network meta-analysis A study that pools the numbers from several trials into one combined estimate. of 21 randomized trials in 3,387 older adults ranked Falls Management Exercise and the Otago program highest for reducing falls, with a reverse U-shaped dose response peaking near 420 MET-minutes per week.
These are exercise programs that build balance and strength in older adults. A review of 21 studies in 3,387 older adults found that structured fall-prevention exercise and the Otago program cut falls the most. A separate review of 21 studies found that Tai Chi improved balance and fall risk compared with no exercise. People in exercise studies know which group they are in, which limits how sure the results can be. The reviews did not look at broken bones or deaths.
A network meta-analysis of 21 randomized trials in 3,387 older adults ranked Falls Management Exercise and the Otago program highest for reducing falls, with a reverse U-shaped dose response peaking near 420 MET-minutes per week. A separate meta-analysis of 21 trials found Tai Chi improved balance and fall-risk measures against non-exercise controls.
Why this gradeThe reasoning, and what the grade does not cover.
Grade B on falls and fall risk in older adults. A network meta-analysis of 21 randomized trials in 3,387 older adults ranked structured fall-prevention exercise and the Otago program highest for reducing falls (Cheng et al., 2026; PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 41110662), and a meta-analysis of 21 trials found Tai Chi improved balance and fall-risk measures against non-exercise controls (Dong et al., 2026; PMID 41567791).
WHY NOT Afalls are a hard outcome, but a grade change requires blinded trials, and exercise trials cannot blind the people taking part.
WHAT THIS GRADE DOES NOT COVERfracture or mortality outcomes, which the cited reviews did not grade, and any single program over another beyond the ranking those reviews report.
A grade describes the human evidence for a named use. It is not advice, and it is not a judgment on any individual prescription. How the letters are decided →
The evidence, in fullTwo papers, each linked to its PubMed record.
Cheng et al. (Aging Research Reviews, 2026; PMID 41110662): network meta-analysis of 21 randomized trials, 3,387 older adults; the Falls Management Exercise program ranked highest, then Otago, aquatic exercise, Tai Chi and balance training, with benefit peaking near 420 MET-minutes a week. Dong et al. (Frontiers in Public Health, 2026; PMID 41567791): meta-analysis of 21 randomized trials in healthy older adults; Tai Chi improved balance and fall-risk measures against non-exercise controls; fall counts were not pooled. Grade B.
The 30-second sit-to-stand test and timed-up-and-go (TUG) at baseline and every 8 weeks: both are validated predictors of fall risk. Balance confidence using the Activities-Specific Balance Confidence (ABC) scale monthly. In populations with prior falls, record fall frequency over 6-month blocks compared to baseline history.
Evidence notes: meta-analysis, randomized trial
Endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score. graded: Falls in older adults (hard)
Last reviewed: October 2026
Educational use only · Not medical advice · EBL grades published human evidence and does not recommend treatment. Stopping a prescription is a decision for your physician.
As studiedDose, form, population and duration for every use.
A grade describes the intervention that was tested. Where the product on the shelf differs from it, this says so.
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How EBL searched for the trials (1 search)
The search that was run, what it returned, and what was left out and why, so the absence of evidence can be checked as well as its presence.
(exercise[tiab] OR "tai chi"[tiab] OR "balance training"[tiab]) AND (falls[tiab] OR "fall rate"[tiab] OR "rate of falls"[tiab]) AND (older[tiab] OR elderly[tiab]) AND meta-analysis[pt]Grades move when new trials publish. A free monthly email lists every grade EBL moved, with the reason and the trial behind it: the sign-up is on the Evidence Log →