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Exercise to reduce the risk of falls

All clients should be assessed by a physiotherapist (and any medical cause(s) for fall(s) excluded) prior to commencing exercise intervention. If muscle weakness, poor balance or co-ordination and/or fear of falling is identified on assessment, a programme of strength and balance exercises is recommended. There are a number of different options for learning these exercises depending on the level of support or supervision required to carry out the exercise effectively, and the choice of the individual taking part.

It is important to remember that exercise must be continued for life to maintain the benefits.

Types of exercise interventions

Depending on the client’s level of motivation and physical and cognitive function, the various exercise opportunities available are:

  • One to one strength and balance training with physiotherapist/assistant
  • Physiotherapy led strength and balance class run at falls clinic
  • Otago home exercise programme with rehabilitation assistant/physiotherapy assistant
  • Community exercise class run by postural stability instructor
  • Exercise groups in the community (including chronic disease exercise groups)
  • Leisure card scheme at local leisure centre for general exercise
  • Walking groups.

How do I choose the most appropriate intervention for my client?

Once a cause of falls has been established (and any medical cause has been excluded), the segmentation chart should always be used to determine the most appropriate exercise intervention for the client. Please refer to the Assessment section of the website if the client has not been assessed. The type of exercise intervention indicated is dependent on the presence and severity of any strength, balance and cognitive impairment.

Segmentation matrix

SLIPS Segmentation No/mild balance impairment
Low/no/mild falls risk score on PPA
Moderate balance impairment
Ability to stand unsupported for 30 seconds
Moderate/marked falls risk score on PPA but balance is adequate for safe independent exercise
Severe balance impairment
Inability to stand unsupported for 30 seconds
Marked falls risk score on PPA but balance is inadequate for safe independent exercise
Able to participate independently
(Good cognition/ motivation)
Leisure card for general exercise.
Walking groups.
Advice on exercise.
Otago home exercise programme.
Community exercise groups.
One-to-one strength and balance training with physiotherapist/assistant.
  1A 2A 3A
Unable to participate independently (Poor cognition/motivation/extreme fear of falling) Exercise groups in community including chronic disease exercise groups. Strength and balance class.
Exercise in care homes/day centres.
One-to-one strength and balance training with physiotherapist/assistant.
  1B 2B 3B

Falls referral pathway

Please ensure that the falls pathway is followed to ensure that clients receive the most effective falls management. The following care pathway should be used.

Any questions?

If any aspect of the assessment and referral pathway is unclear, please contact us.