Balance, mobility and function

Balance, mobility and physical function describe the ability to stay upright, move joints through their range and carry out everyday physical tasks. All three decline with age, and their most serious consequence is falling: at least one-third of people over 65 living in the community fall each year [1], and in the US an estimated 38,742 deaths resulted from fall-related injuries in 2021 [2]. In the first three months after a hip fracture, mortality (the death rate) is 5.75 times that of people of the same age in women and 7.95 times in men [3]. Fall prevention covers the measures used to reduce falls and their injuries.

Simple tests of physical function predict survival. In a meta-analysis (a study that pools the results of earlier studies) of adults living in the community rather than in care, the slowest quarter of walking speed had 2.87 times the mortality of the fastest quarter [4], and in 1,702 adults aged 51 to 75, being unable to stand on one leg for 10 seconds was linked to 84% higher mortality [5]. Functional fitness describes these tests, including grip strength, gait (walking) speed, chair rises and the sitting-rising test, and why they are markers of health rather than proven targets.

Exercise that challenges balance is the best-studied way to reduce falls. Across randomised trials (in which participants are assigned to groups by chance) in adults aged 60 and over, balance and functional exercises reduced the rate of falls by 24%, and programmes combining balance with strength training probably reduced it by 34% [1]. Balance training covers how balance works, how it changes with age and what the trials found; tai chi is a structured form of balance exercise.

Flexibility and mobility has the least outcome evidence in the section. A single Brazilian study linked low flexibility to 87% higher mortality in men [6], but no fall-prevention trial has tested flexibility training alone [1], and stretching did not reduce sports injuries in randomised trials [7]. Related topics include resistance training, sarcopenia (age-related loss of muscle strength and mass) and exercise and longevity.