Balance and falls
Everything in the library studied for it, medical and holistic together. Within each kind, what was shown to help comes first, strongest evidence first. What was tested and not shown to help stays on the list.
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Supplements
Fractures, falls and bone density
Not shown to lower fractures, hip fractures or falls in adults mostly not deficient or at high risk. Calcium with vitamin D had little to no effect.
The numbers and sources
- Effect
- Across 81 RCTs (53,537 participants), vitamin D had no effect on total fracture (RR 1.00, 95% CI 0.93 to 1.07), hip fracture (RR 1.11, 95% CI 0.97 to 1.26) or falls (RR 0.97, 95% CI 0.93 to 1.02). Results were similar for doses above 800 IU a day, and bone density differences ranged from -0.16% to 0.76% over 1 to 5 years [1]. A 2026 review of 69 trials (153,902 participants) found vitamin D alone did not change the risk of any fracture (RR 1.00, 95% CI 0.95 to 1.06, 36 trials, 92,045 participants, high certainty). Calcium with vitamin D gave RR 0.91 (95% CI 0.84 to 0.99, 15 trials), which the authors rated as little to no effect by absolute risk thresholds. Other fracture and fall outcomes showed little to no effect [2]. In VITAL, 2,000 IU a day for a median 5.3 years did not change total fractures (HR 0.98, 95% CI 0.89 to 1.08), nonvertebral fractures (HR 0.97) or hip fractures (HR 1.01, 95% CI 0.70 to 1.47) [3]. In the Finnish Vitamin D Trial, fractures were more frequent on 1,600 IU a day than placebo (HR 1.52, 95% CI 1.06 to 2.18) and did not differ on 3,200 IU a day (HR 1.07, 95% CI 0.72 to 1.58) over a mean 4.1 years [4]. Fall risk was 55% and fall-injury risk 11% in all three arms over 5 years [5].
- Population
- Adults in 81 trials [1]; adults not on osteoporosis drugs in 69 trials, 87% community dwelling and 73% not at high risk of fractures or falls [2]; 25,871 US men 50 and older and women 55 and older not selected for deficiency, low bone mass or osteoporosis [3]; 2,495 men 60 and older and women 65 and older in Finland, mean baseline 25-hydroxyvitamin D 75 nmol/L [4][5].
- Sources
- [1], [2], [3], [4], [5]
- Caveats
- Most participants were not selected for deficiency or high fracture risk, and evidence for high-risk people and residential care was limited [2]. The higher fracture count at 1,600 IU in the Finnish trial did not appear at 3,200 IU [4]. The bone density figures come from one review [1]. Trials that gave calcium with vitamin D were counted in [1] only where the groups differed by vitamin D alone.
Practices
Falls in older adults
Shown to reduce the rate of falls in older adults by about 19% to 43% in pooled trials, and the number of people who fall by about 20%.
Compared with control interventions not thought to reduce falls [1]; other treatments [2]; control groups the source abstract does not describe [3]
The numbers and sources
- Effect
- In a Cochrane review, tai chi reduced the rate of falls by 19% (rate ratio 0.81, 95% CI 0.67 to 0.99, 7 trials, 2,655 participants, low certainty) and the number of people who fell by 20% (risk ratio 0.80, 95% CI 0.70 to 0.91, 8 trials, high certainty) [1]. Another meta-analysis found falls cut over the short term (incidence rate ratio 0.57, 95% CI 0.46 to 0.70) and less over the long term (0.87), with fewer injurious falls (0.50 short term). Time to first fall did not change (hazard ratio 0.98, 95% CI 0.69 to 1.37) [2]. A third found fewer fallers (risk ratio 0.80) and a lower fall rate (0.69, 95% CI 0.60 to 0.80), larger with more frequent practice [3].
- Population
- Community-dwelling adults aged 60 and over, mean age 76, 77% women [1]. Older and at-risk adults in 10 trials [2]. 3,824 older adults in 18 trials [3].
- Sources
- [1], [2], [3]
- Caveats
- Most trials had unclear or high risk of bias in at least one item [1]. Funnel plot asymmetry suggested publication bias [3]. The reviews share many trials.
Balance and mobility in older adults
Shown to improve balance by a small to moderate amount in adults aged 60 and over, in two meta-analyses. Whether this prevents falls was not tested.
Compared with control groups the source abstract does not describe [13]; inactive controls such as a waiting list or education booklets [7]
The numbers and sources
- Effect
- Yoga improved balance performance (g = 0.40, 95% CI 0.15 to 0.65, 6 trials) and physical mobility (g = 0.50, 95% CI 0.06 to 0.95, 3 trials) [13]. In older adults without a specific condition, balance improved against inactive controls (effect size 0.7) [7].
- Population
- 307 people aged 60 and over in 6 trials [13]. Older adults in 22 trials [7].
- Sources
- [13], [7]
- Caveats
- The reviewers state that whether balance gains translate into fewer falls is unknown [13].
Falls, against other exercise
One trial of 670 adults at high risk of falling found a tai chi balance program cut falls 58% against stretching and 31% against a multimodal exercise program.
Compared with stretching exercises [4]; multimodal exercise combining balance, aerobic, strength and flexibility work [4]
The numbers and sources
- Effect
- Over 6 months, there were 152 falls in 85 people with tai chi, 218 falls in 112 people with multimodal exercise and 363 falls in 127 people with stretching. The incidence rate ratio was 0.42 (95% CI 0.31 to 0.56) for tai chi against stretching and 0.69 (95% CI 0.52 to 0.94) against multimodal exercise [4].
- Population
- 670 community-dwelling adults aged 70 and over who had fallen in the past year or had impaired mobility, mean age 77.7, 65% women, in Oregon [4].
- Sources
- [4]
- Caveats
- One single-blind trial of a program tailored for balance, not classic tai chi forms [4].
Daily life
Falls
Limited evidence: one meta-analysis linked 7,000 steps a day to 28% fewer falls than 2,000, at very low certainty.
Compared with 2,000 steps a day [4]
The numbers and sources
- Effect
- Against 2,000 steps a day, 7,000 steps was linked to a 28% lower risk of falls (HR 0.72, 95% CI 0.65 to 0.81), with an inflection at about 5,000 to 7,000 steps [4].
- Population
- 4 cohort studies [4].
- Sources
- [4]
- Caveats
- The review rated certainty very low [4]. People with poor balance or past falls walk less, which is reverse causation.
Falls in older adults
Mixed results: programs combining balance and strength exercises probably cut falls by about a third, while the effect of strength training alone was uncertain.
Compared with control interventions not thought to reduce falls [16]
The numbers and sources
- Effect
- Programs with several exercise types, most often balance and functional exercises plus resistance exercises, probably reduced the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88) and the number of people falling by 22% (RR 0.78). Balance and functional exercises reduced the rate of falls by 24%. The review was uncertain of the effect of programs that were mainly resistance training [16].
- Population
- 23,407 people 60 and older living in the community, average age 76, in 108 trials [16].
- Sources
- [16]
- Caveats
- Evidence for mixed programs was rated moderate in certainty, and for resistance training alone too uncertain to judge [16].