Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

Lower limb muscle strengthening exercises can reduce the risk of falls in older adults.

Ishigaki EY, Ramos LG, Carvalho ES, et al. Effectiveness of muscle strengthening and description of protocols for preventing falls in the elderly: A systematic review Braz J Phys Ther. 2014;18(2):111-118.

Review question

Do lower limb muscle strengthening exercises help to reduce the risk of falls in the elderly?


Falls are a serious health and safety concern for the elderly, and lead to an estimated 424,000 deaths around the world each year. Recent research suggests that balance training exercises and lower limb muscle strengthening exercises can reduce the risk of falls, and improve mobility and functioning in everyday activities. It is difficult to find specific guidelines that provide detailed instructions for balance and lower limb muscle strengthening exercises aimed at preventing falls.

How the review was done

The researchers did a systematic review of 12 randomized and controlled clinical trials published between 2002 and 2012.

A total of 3795 elderly adults were included in the studies (3260 from the community, 96 from hospitals, and 439 from aged-care facilities).  Participants were placed in exercise or control groups.

Key features of the studies were:

  • Studies lasted on average 6 months and exercise sessions occurred on average two and a half times per week
  • Participants self-reported their falls. 75% of the studies used a monthly calendar to record any falls, and 25% reported any falls directly to a nurse or study researchers
  • Two different types of lower limb muscle strengthening exercises were studied: 4 studies focused on muscle load training exercises (e.g using ankle weights); 8 studies focused on functional exercises (e.g. repeating sit-to-stand movements, or climbing up-and-down steps)
  • Studies compared the number of falls of participants in the exercise groups to people in the control groups


What the researchers found

All four of the studies assessing muscle load training exercises reported decreases in the number of falls, ranging from 25% to 75% fewer falls compared to the control groups. As well, 6 out of the 8 studies assessing functional exercises reported a reduction in falls while two did not.

Many of the studies combined muscle load training exercises with functional exercises, balance training, activities of daily living exercises, gait training and muscle stretching, so it is unknown what the independent effect of muscle load exercises and/or functional exercises have on falls prevention. It may be that strategies that impact multiple components associated with falls prevention are needed to reduce the risk of falls. Future studies describing how often a muscle load activity should be repeated in a week, and how long each exercise session should be done are recommended.


Lower limb muscle strengthening exercises can reduce the number of falls in the elderly.



Clinical trials
Studies where people are assigned to one of the treatments but not purely by chance.
Control group
A group that receives either no treatment or a standard treatment.
Controlled clinical trials
A research design that differs from experimental studies in that participants are not randomly assigned to groups, but the investigator still controls the intervention(s) (e.g. test, or treatment) received by at least one of the groups. This means a researcher can't draw conclusions about 'cause and effect'. This design is frequently used when it is not feasible, or not ethical, to conduct a randomized controlled trial.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Peripheral Arterial Disease and Exercise

    Health Link B.C.
    Being physically active can help in the management and prevention of Peripheral Arterial Disease (PAD). Supervised, facility-based specialized exercise programs may potentially help relieve leg pain and improve walking ability in people with PAD. Unsupervised, structured home-based exercise programs are also an option. Consult with your health care provider prior to initiating any type of exercise program.
  • Fitness: Using a Pedometer or Step Counter

    Health Link B.C.
    Walking can help boost your level of physical activity. Tracking your daily step count using a pedometer or step counter allows you to identify your activity level so you can then set goals to be more active.
  • Patient education: Pelvic floor muscle exercises (Beyond the Basics)

    UpToDate - patient information
    Pelvic floor muscles work to support the organs in the pelvis, such as the bladder and rectum. When these muscles are weakened—naturally through age, an injury, or some other contributing factor—it can result in urinary and fecal incontinence and pelvic organ prolapse. Pelvic floor exercises (i.e. Kegel exercises) can help to enhance the strength of these muscles and improve symptoms.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

Register for free access to all Professional content