Village-led balance and exercise program cut falls by 40% in rural older adults with heart disease
A 12-month cluster randomised trial in rural China tested whether a village doctor-led program of balance exercises and health education could reduce falls in older adults with cardiovascular disease. The intervention reduced the proportion experiencing at least one fall from 42.7% to 31.6%, and halved the rate of fall-related injuries.
Older adults with heart disease or high blood pressure face disproportionate fall risk, but few scalable fall-prevention programs have been tested in rural, resource-limited settings. This secondary analysis of a cluster randomised trial enrolled rural Chinese adults aged 60 and older with self-reported physician-diagnosed hypertension or heart disease across 128 villages.
Villages were randomly assigned 1:1 to receive either a 12-month intervention led by local village doctors (balance and functional exercise plus health education) or usual care. Over 12 months, the intervention reduced the odds of reporting at least one fall by 40% (31.6% vs 42.7%; OR 0.60, 95% CI 0.43–0.84) and the falls rate by 38% (0.9 vs 1.6 per person-year; RR 0.62, 95% CI 0.43–0.89). Fall-related injury was also reduced significantly, from 24.9% to 15.9% (OR 0.57, 95% CI 0.42–0.78). Beyond safety, the intervention improved performance on chair stand tests (a marker of leg strength) and dynamic balance, and boosted health-related quality of life scores. Timed Up and Go performance (a test combining sitting, walking and turning) did not improve significantly. Benefits were consistent across most subgroups, though men showed a larger effect than women. A key strength is the integration into existing rural primary care; a limitation is the open-label design, which may introduce bias because participants knew which arm they were in.
The trial enrolled participants between September and November 2023, with outcomes measured over a full year—long enough to capture real-world fall patterns. The effect sizes are meaningful: moving from 42.7% to 31.6% fall prevalence represents an absolute reduction of 11 percentage points. The falls rate reduction (0.62 relative risk) aligns with or exceeds many pharmaceutical interventions for fall risk. The mechanistic improvements in chair stand and balance performance suggest the program works partly by restoring lower-limb strength and postural control. Notably, the open-label design—where participants and providers knew who received the intervention—means some benefit could come from increased attention and motivation rather than the exercises alone. The greater effect in men is unexplained and warrants follow-up; prior literature suggests women often benefit more from balance training, so this reversal is intriguing. The program's deliverability through existing village doctors (rather than specialist physiotherapists) strengthens its real-world applicability in rural or under-resourced settings.
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