How We Move and Why We Fall

Fall Avoidance Dependent on Exquisitely Sophisticated Neural Control System

Brian E. Maki, PhD, PEng
Professor, Department of Surgery and
Institute of Medical Science,
University of Toronto and Senior Scientist,
Sunnybrook and Women's College Health Sciences Centre

It is well known that aging brings an elevated risk of falls and serious injuries, as well as other adverse medical and psychosocial outcomes. In recent years, exercise has been widely promoted as a potential means of reducing the risk of falling in older adults. There is no doubt that exercise and physical fitness is associated with a myriad of health benefits, and that older adults are able to improve strength, flexibility, aerobic capacity and other fitness measures as a result of exercise programs.1-4 Even the very frail and very old have shown that they can improve their functional fitness through exercise.5 But what is the evidence to support the view that exercise and fitness could actually help to prevent falls and their consequences?

Certainly, there is evidence supporting an association between strength and falling risk. Severe compromise in the strength of the ankle dorsiflexors has been documented in nursing home residents with a history of falling.6 Other studies of less impaired individuals have also found evidence of associations between leg muscle weakness and an increase in the risk of falling.