SIGNIFICANCE: Researchers have typically explored the effect that exercise has on fall risks, not taking into account other activities such as engagement in leisure and recreational activities. In the current study, we adopt a holistic approach in examination of an individual’s activity level and its relationship with fall risk. This corresponds with occupational therapy’s philosophy of considering all aspects of an individual’s life.

INNOVATION: The study is unique in its attempt to identify the nature of physical activity that contributes to fall risk reduction. We examined the daily lives of older women without using any intervention to modify their daily routines. The Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire, pedometers, and exercise logs were used to quantify physical activity.

APPROACH: Our hypothesis for this study was that older women with a higher level of overall activity (OA) are at less risk for falls. The purpose of this study was to identify the largely unexplored relationship between overall physical activity and fall risk factors (bone density, lower extremity muscle strength, balance and gait, fear of falling, depression) in community-dwelling older women at risk of falling. Physical activity was measured in terms of self-reported OA, engagement in strengthening exercises, and walking.

METHOD: We assessed fall risks using a cross-sectional design. The setting took place in the biomechanics and exercise physiology laboratories of a university in western New York. Community-dwelling, older women aged 60 yr and older who had an indoor fall in the past year (N = 46) were recruited from a larger fall-prevention study.

We measured physical activity using (1) energy expended in terms of kilocalories per week (kcal/wk) in self-reported OA with the CHAMPS questionnaire, (2) doing/not doing lower extremity strengthening exercises, and (3) pedometer for measuring mean daily steps. Fall risk factors analyzed were bone mineral density measured with dual-energy, x-ray absorptiometry of hip; lower extremity muscle strength measured with strain gauges; balance and gait measured with posturography; balance confidence measured with the Activities-specific Balance Confidence (ABC) Scale; and depression measured with the Center for Epidemiologic Studies Depression Scale (CES–D).

In this study, self-reported OA, strengthening exercise, and walking were individually analyzed for each fall risk factor. The sample was divided at the 33rd and 66th percentile into three levels for energy expended in OA (low, medium, and high) and number of steps walked (minimum, moderate, and maximum). On the basis of engagement in regular physical exercise, the sample was split into two groups (exercise and no exercise). One-way analyses of variance (ANOVAs) and independent t tests were used for data analysis and interpretation.

RESULTS: OA showed that the high-activity group (approximately 5,200 kcal/wk) had significantly better gait speed, ankle strength, and quadriceps endurance. A trend also emerged in which the high-activity group scored the best for most fall risk factors, and the low-activity group (approximately 1,200 kcal/wk) scored the worst.

CONCLUSION: Low fall risks were associated with engaging in physical exercise 3 times per week; walking moderately (mean = 4,402 steps/day); and a high level of OA, including gardening, house chores, and swimming (approximately 2.5 to 5.0 METs). This study lends further credence to the focus of the occupational therapy practice framework on activity to promote health and function.