• Wing S Kwok, Saman Khalatbari-Soltani, Xenia Dolja-Gore, Julie Byles, Juliana S Oliveira, and Catherine Sherrington.
• Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia. Electronic address: venisa.kwok@sydney.edu.au.
• Am J Prev Med. 2025 Jan 30.

IntroductionThe relationship between physical activity behaviour and subsequent falls in adults from mid-life to older age is unclear. Falls and fall-related injuries could lessen physical activity participation. This study examined patterns and bidirectional associations between physical activity and falls from mid-life to older age.MethodsIn the Australian Longitudinal Study on Women's Health, women born 1946-51 (n=11,759, mean age: 56 years at baseline in 2004) self-reported weekly physical activity amounts (0, 1 to <150, 150 to <300, ≥300 minutes/week) and non-injurious and injurious falls every three years between 2004 survey and 2019 survey. Bidirectional prospective three-year associations between physical activity and falls were examined using generalised estimating equations to estimate Odds Ratios (OR) and 95% CI, adjusting for directed acyclic graph-informed covariates (analyses conducted in 2023).ResultsParticipation in any amount of physical activity was associated with a reduced risk of injurious falls (OR1-<150min:0.87, 95%CI 0.80-0.96; OR150-<300min:0.87, 95%CI 0.79-0.96; OR≥300min:0.85, 95%CI 0.78-0.93) in the next three years, compared to women with no physical activity. Women who reported non-injurious falls had lower odds of undertaking ≥300 minutes/week of physical activity three years later (OR:0.84, 95%CI 0.77-0.92), compared to women without falls. Women who reported injurious falls had lower odds of subsequently undertaking various amounts of physical activity (OR:0.83, 95%CI 0.75-0.91 for 1-<150;0.82, 95%CI 0.74-0.90 for 150-<300;0.83, 95%CI 0.76-0.90 for ≥300 minutes/week).ConclusionThe prospective bidirectional association between physical activity and falls supports addressing falls by promoting activity and highlighting the impact of injurious falls on reduced physical activity participation.Copyright © 2025. Published by Elsevier Inc.

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