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Feel more confident moving: a pair of well-gripped walking shoes on a stone garden step beside a wooden handrail, a folded towel and a water bottle, with a curved path edged with green plants in soft morning light

Move Better & Support Your Joints

Feel More Confident Moving

It is common to feel wary of moving after pain, an injury, surgery or a fall, and that worry can quietly shrink what you do each day. This page covers what studies and health agencies say about rebuilding confidence step by step, and when a symptom needs a clinician rather than more practice.

General information, not medical advice. Last updated October 31, 2026. Written by the AlternativeMed editorial team. Not medically reviewed.

Start here

  • Pick one small, ordinary movement you have been avoiding (a short walk, the stairs, bending to a low shelf) and do a gentle version of it on most days, adding a little at a time.
  • Keep doing your normal daily activities rather than resting for long periods. Both the NHS and the NIA advise staying active, and the NHS says not to stay in bed for long stretches with back pain.
  • If you have fallen, or you are worried about your balance, tell a doctor or physiotherapist. Strength and balance exercise is one of the best-studied ways to feel steadier.

Be careful with

  • Build up slowly. The NHS warns that doing too much exercise too quickly, or the wrong kind, can harm joints when you have osteoarthritis.
  • Stop and get advice if the pain gets steadily worse, if a joint locks or gives way, or if you notice any of the warning signs listed further down. Fear of movement is common, but it is not the only reason movement can feel wrong.
  • Mild soreness after new activity is common and usually settles. Sharp pain, new numbness or weakness, or pain that is worse at night or does not ease with rest is different and needs checking.
  • Do not use this page to decide you can stop or change any medicine, including osteoporosis, blood pressure or pain medicines. Talk to the prescriber first.

Get help when

  • Call emergency services (999 in the UK, 911 in the US, as the NHS and NIA name them) if you have fallen and may have injured your head, back, neck or hip, or cannot get up.
  • Back pain with pain, tingling, weakness or numbness in both legs, numbness around the genitals or anus, new bladder or bowel changes, chest pain, or pain that started after a serious accident needs emergency care, according to the NHS.
  • Get prompt medical advice for severe pain that starts suddenly or is getting worse quickly, for back pain with fever or feeling generally unwell, for pain that is worse at night or does not ease with rest, or for back pain with weight loss you cannot explain.
  • A joint that is hot, swollen and painful (especially with a fever), a joint that locks or gives way, or a suspected broken bone should be seen promptly rather than managed with practice at home.
  • See a doctor if you have had a fall (even without pain), if you are worried about your balance, or if your fear of moving is making you stop going out, doing chores or seeing people.

About Feel More Confident Moving

What this goal means

This goal is about confidence in your own movement: trusting your body enough to walk, climb stairs, bend, reach, exercise and go out without constant worry. It is different from improving a specific physical skill. Our neighbouring goals cover balance, flexibility, stiffness, range of motion, walking comfort, back care and posture; this page is about the fear, hesitation and avoidance that can sit on top of those.

The NHS says that if you have fallen or are worried about falling, exercises to improve strength, balance and flexibility will help make you stronger and feel more confident on your feet.

1

Common experiences

People describe holding their breath on stairs, gripping the rail, avoiding the street after dark, giving up a walk, a swim or a class, or doing a task only when someone else is nearby. Some feel fine day to day but tense up the moment something might hurt.

The NIA notes that many older adults fear falling even if they have not fallen before, and that this fear may lead them to avoid walking, shopping or social activities.

2

Contributing factors

Common contributors include a previous fall, pain that flares with certain movements, recovery from injury or surgery, muscle weakness, poor balance, foot problems, eyesight or hearing changes, some medicines, and a general loss of fitness after a period of rest. The NIA lists several of these as fall risk factors.

Fear itself becomes a factor. A review of low back pain trials found that people with strong fear-avoidance beliefs had more pain, more disability and less return to work in the first six months. In fall-related research, a 2022 review notes that fear of falling contributes to activity restriction.

2,3,4

Relevant conditions

Osteoarthritis, back pain, osteoporosis, recovery from a fracture or joint operation, and balance problems can all make movement feel risky. Fear of movement can also overlap with anxiety. This page does not diagnose any of these. If you recognise yourself in one of them, the linked condition pages explain what is known and when to see a clinician.

5,6,7,8

Realistic expectations

Confidence usually returns in steps, not overnight, and often follows doing the movement rather than preceding it. In trials, exercise reduced fear of falling by a small to moderate amount. A Cochrane review of 30 studies (2,878 people) found a reduction right after the programme (low certainty), and could not say whether it lasts beyond the end of the programme.

Feeling more confident does not mean pain or risk has gone. It means you are doing more of what matters to you, safely, and know what to do if something goes wrong.

9

Who this applies to

Adults of any age who feel hesitant to move after pain, injury, surgery, illness or a fall, or who have noticed they are doing less out of worry. Most of the fall-related research here is in people aged 65 and over; most of the pain-related research is in adults with persistent back pain, osteoarthritis or other musculoskeletal pain. Children, pregnant people and anyone with an unstable condition should take advice from their own clinician before changing activity.

1,10

Related conditions and symptoms

Falls and Balance Problems → Anxiety disorders →

A manageable starting plan

An educational starting point, not a personal prescription. Adjust it to your own situation and any advice from your clinician.

Your first actions

  • Choose one movement you want back and write it down.
  • Do the smallest repeatable version on most days for 2 weeks, then increase a little.
  • Add strength and balance work (a class, a physiotherapist's plan or a reliable video routine) on at least 2 days a week.
  • Check your home and footwear, and ask someone to know your plan if you live alone.

Optional additions

  • Try a beginner tai chi class.
  • Try a warm-water class if hips or knees make land exercise hard.
  • Join a group programme on confidence and falls if one runs near you.
  • Ask about pain education or CBT for pain if worry about pain is a large part of the picture.

What to track

  • What you did, how long, and how it felt afterward (the next day too).
  • A simple confidence score from 0 to 10 for the movement you chose.
  • Any falls, near-falls or new symptoms, and the date.
  • Your steps toward a goal, such as walking to the corner shop or climbing one flight.

When to reassess

After 4 to 6 weeks, look back at your notes. If confidence and activity are improving, keep going. If you are not improving, if pain or unsteadiness is getting worse, or if you have had a fall, speak to a GP or physiotherapist rather than pushing on alone.

When to seek professional support

  • Physiotherapist or MSK service for pain, stiffness, strength and balance.
  • GP for falls, new symptoms, medicines review and referral to a psychologist.
  • Occupational therapist for home safety and walking aids.
  • A friend, family member or class group for company and encouragement.

What helps

Ordered by how well the research supports each step. Evidence strength is shown on every card; precautions sit next to the advice.

Start here

Staying active in everyday life

Moderate certainty

Addresses: Keeps muscles and joints used to moving, and avoids the cycle of rest, weakness and more worry

Why it may help: The NHS advises staying active and continuing daily activities with back pain and says not to stay in bed for long periods. The WHO 2020 guidelines reaffirm that some physical activity is better than none, and include recommendations for adults living with chronic conditions or disability. A Cochrane overview of 21 reviews (381 studies, 37,143 people) found physical activity and exercise may improve pain severity and physical function for adults with chronic pain, mostly with small to moderate effects, and with few adverse events.

How to apply it: Keep doing the normal things in your day, even in lighter or shorter versions. Break long sitting with short bouts of movement.

Who it may suit: Most adults, including those with back pain, osteoarthritis or long-term pain.

Precautions: The Cochrane overview rated the evidence low in quality, mainly because of small studies. Speak to a GP first if you have not exercised for some time or have medical conditions.

7,11,10

Sit Less & Move More → Balance Activity & Rest →

Building up in small, planned steps (graded activity)

Low certainty

Addresses: Lets you do a little more each week without a big setback

Why it may help: Graded activity means starting at a level you can manage and increasing in agreed steps rather than by how you feel on the day. A 2010 systematic review of 15 trials (1,654 people) with persistent low back pain found graded activity was slightly more effective than minimal or no treatment for pain and disability in the short and intermediate term, but not more effective than other forms of exercise. The NHS warns that doing too much too quickly may harm joints in osteoarthritis.

How to apply it: Choose one activity. Start with an amount you can do on a bad day as well as a good day. Increase it by a small amount at a set interval, rather than only on good days. Write each step down.

Who it may suit: People who tend to stop completely after a flare, or who swing between overdoing it and resting.

Precautions: The trials were of low to moderate quality and the differences were small. A physiotherapist can help set safe steps after surgery, injury or with a medical condition.

12,6

Balance Activity & Rest →

Strength and balance exercise at least twice a week

Moderate certainty

Addresses: Makes everyday movement feel steadier and lowers worry about falling

Why it may help: The NHS recommends adults aged 65 and over do activities that improve strength, balance and flexibility on at least 2 days a week, and says these exercises help people who have fallen or are worried about falling feel more confident on their feet. A 2022 meta-analysis of 75 trials found exercise reduced fear of falling by a small to moderate amount (standardised mean difference -0.34, 95% CI -0.44 to -0.23). The Cochrane review of 30 studies found a similar small to moderate effect straight after the programme (low-certainty evidence) and no sign that exercise raised the risk of falling.

How to apply it: Look for a local strength and balance class, a physiotherapist-guided programme, or a reputable home routine. Start with a supported version (hands near a stable surface) and progress as it gets easy.

Who it may suit: Older adults, people who have fallen, and people who are afraid of falling.

Precautions: Studies mostly relied on self-reported fear and could not blind participants. Whether the benefit lasts after the programme ends is unclear. Ask a clinician before starting if you have heart, bone or joint conditions or recent surgery.

1,4,9

Falls and Balance Problems → Improve Your Balance →

Additional options

Tai chi and similar mind-body movement

Moderate certainty

Addresses: Slow, controlled movement can build both balance and trust in your body

Why it may help: A 2023 meta-analysis of 13 trials in older adults reported lower fear of falling with tai chi (standardised mean difference -0.54, with a confidence interval of -1.09 to 0.01, so the result sat right at the edge of statistical significance) and fewer falls (relative risk 0.48). In a 2018 trial of 670 adults aged 70 or older who had fallen or had impaired mobility, a tailored tai ji quan programme (two 60-minute classes a week for 24 weeks) cut the rate of falls more than stretching (incidence rate ratio 0.42). A 2022 review of 66 studies found that interventions with meditation, holistic exercises such as tai chi or Pilates, or body awareness were more effective at reducing fear of falling than those without.

How to apply it: Join a beginner class led by a qualified teacher, ideally one used to older adults or people with joint problems. Many classes can be done standing or seated.

Who it may suit: Older adults and people who prefer gentle, social movement.

Precautions: The fear-of-falling result in the meta-analysis was borderline and the studies were small. Sit or hold a support if you feel unsteady. Pregnant people, and people with recent surgery or unstable conditions, should check with their clinician.

13,14,15

Tai chi → Yoga →

Group programmes that tackle worry about falling directly

Low certainty

Addresses: Teaches practical coping steps and helps you do more of the activities you have been avoiding

Why it may help: A Matter of Balance is a community programme designed to improve fall-related efficacy (confidence to do activities without falling) and promote daily activities. A 2020 meta-analysis of 17 studies (3,860 people) found it reduced fear of falling (pooled effect -0.29, 95% CI -0.40 to -0.19) and improved fall-related efficacy (0.51, 95% CI 0.42 to 0.60). The authors noted that outcome measures were inconsistent between studies.

How to apply it: Ask your GP, local council, older-adult centre or falls service whether a confidence-and-falls group runs nearby.

Who it may suit: Older adults who restrict activities because of worry about falling.

Precautions: Not every area offers this exact programme. It does not replace a medical check after a fall.

16

Learning how pain works (pain education)

Low certainty

Addresses: Can reduce fear of movement when pain has lasted for months

Why it may help: Pain neuroscience education explains in plain terms how pain can persist and why it does not always mean damage. A 2019 meta-analysis of 12 trials (755 people) with chronic musculoskeletal pain found its effects on pain and disability were small, but the effect on kinesiophobia (fear of movement) in the short term was clinically relevant (-13.55 points on a 0 to 100 scale, 95% CI -25.89 to -1.21). Patients said that being able to tell their own story helped.

How to apply it: Ask a physiotherapist or pain service for education that fits your situation. It works best alongside gradual activity rather than alone.

Who it may suit: Adults with pain lasting longer than three months who fear that moving will cause damage.

Precautions: The confidence intervals were wide. It is not a substitute for assessing new, unexplained or worsening pain.

17

Warm-water exercise for sore hips and knees

Moderate certainty

Addresses: A supported, low-impact way to start moving when weight-bearing feels uncomfortable

Why it may help: A Cochrane review of 13 trials (1,190 people, average age 68) with hip or knee osteoarthritis found aquatic exercise gave a small short-term improvement in pain (standardised mean difference -0.31), disability (-0.32) and quality of life (-0.25).

How to apply it: Look for a warm-water class at a local pool, ideally one led by a trained instructor.

Who it may suit: People with knee or hip osteoarthritis who find land exercise uncomfortable.

Precautions: Effects were small and short term. Pool surfaces can be slippery, so wear secure footwear on the deck.

18

Still being studied

Getting professional help early if fear is part of the picture

Moderate certainty

Addresses: Treating fear and beliefs alongside the body may speed recovery from back pain

Why it may help: A 2014 systematic review of 17 trials found that, in people with low back pain lasting up to six months, high fear-avoidance beliefs went with more pain or disability and less return to work (GRADE high-quality evidence), and that interventions addressing these beliefs were more effective than purely biomedical approaches (moderate-quality evidence). In longer-lasting back pain the findings were less consistent.

How to apply it: Tell your GP or physiotherapist that worry about moving is part of the problem. In many areas the NHS allows self-referral to musculoskeletal services.

Who it may suit: People whose back pain is not settling and who are avoiding movement.

Precautions: Studies were varied and it is not clear which treatment approach works best. This is not a substitute for a medical check of back pain with warning signs.

3,7

Support Your Back During Everyday Activities →

Psychologist-led graded exposure to feared movements

Very low certainty

Addresses: Gradually facing movements you have avoided while learning that they are safe to do

Why it may help: Graded in vivo exposure is built on the fear-avoidance idea that pain can persist when someone avoids movements for fear of re-injury. In a randomised trial of 44 people with chronic low back pain, graded exposure produced greater improvements than graded activity in fear of pain and movement, fear-avoidance beliefs and pain-related anxiety, while differences in pain-related disability were only a trend. The 2010 systematic review (above) found limited, low-quality evidence for graded exposure compared with other approaches.

How to apply it: This is delivered by a trained psychologist or physiotherapist and should not be attempted alone for severe fear.

Who it may suit: People with strong, specific fears of certain movements who have not improved with general exercise.

Precautions: One small trial and limited reviews, so confidence in the results is very low.

19,12

Cognitive behavioural therapy (CBT) for persistent pain

Moderate certainty

Addresses: Small improvements in pain, disability and distress, which can make activity easier to take up

Why it may help: A 2020 Cochrane review of psychological therapies for chronic pain (59 studies, over 5,000 participants) found CBT had small or very small beneficial effects on pain, disability and distress, with mostly moderate-quality evidence. Evidence for behavioural therapy and acceptance and commitment therapy was low or very low in quality, so benefits are uncertain.

How to apply it: Ask a GP about psychological therapy for pain. The NHS lists CBT among treatments that may be recommended if back pain does not improve after a few weeks.

Who it may suit: Adults whose long-term pain is affecting mood, sleep and willingness to move.

Precautions: Effects were small. Not enough information on side effects. Therapy sits alongside, not instead of, a medical check.

20,7

Therapy for anxiety and stress →

Attending to confidence after a sporting injury

Low certainty

Addresses: Fear of re-injury may matter as much as healing for getting back to sport

Why it may help: In a study of 187 recreational and competitive athletes after ACL reconstruction, only 31% had returned to their pre-injury level of sport at 12 months. Psychological readiness to return, fear of re-injury and the athlete's own expectations before surgery and at 4 months were linked with returning. This was an observational study, so it shows association, not that treating fear causes return.

How to apply it: If you are returning after surgery, ask your rehabilitation team how they assess readiness and confidence as well as strength and movement.

Who it may suit: Athletes and active people recovering from a knee ligament injury or similar.

Precautions: Observational, one clinic, one injury. Follow your surgical team's rehabilitation plan.

21

Food & nutrition

Eating, drinking and feeling steady

We did not find trials showing that a particular food improves confidence in movement. The NHS does say that not eating and drinking enough can make you feel lightheaded or faint, which can make walking feel less safe, and suggests eating foods containing calcium and getting enough vitamin D for bone health. The NHS and NIA both advise limiting alcohol because it can affect balance and raise the risk of falls.

  • Regular meals and drinks through the day, especially before activity.
  • Foods that contain calcium, and enough vitamin D, as part of bone health (see the bone health page; amounts are for your clinician or national guidance).
  • Little or no alcohol, particularly before walking in unfamiliar places.
8,2

Remedies & supplements

Traditional use, laboratory findings and human trials are kept apart. "Natural" does not mean safe.

Heat pack or warm bath for stiffness

Low certainty

Studied form and route: Heat pack or hot-water bottle wrapped in a tea towel, or a warm bath

Intended outcome: Short-term relief of stiffness or muscle spasm, which can make it easier to start moving

Human evidence: The NHS suggests a heat pack or hot-water bottle wrapped in a tea towel to relieve joint stiffness or muscle spasms. We did not find a trial for this page, so this rests on agency self-care advice.

Traditional use: Warmth is a long-standing household approach to stiff joints.

Limits: Short-lived and not a treatment for fear or for the cause of pain.

Interactions and precautions: Always wrap the heat source to protect skin. Take extra care if you have reduced skin sensation, circulation problems, or cannot easily move away from the heat. Do not use heat on a hot, swollen joint.

7

Warm-water exercise

Moderate certainty

Studied form and route: Supervised or group exercise in a warm pool

Intended outcome: Small short-term improvements in pain, disability and quality of life with knee or hip osteoarthritis

Human evidence: A Cochrane review of 13 trials (1,190 people) found small short-term improvements.

Traditional use: Water exercise and bathing are traditional approaches to stiff joints.

Limits: Small, short-term effects. Not every area has a warm pool.

Interactions and precautions: Wear secure footwear on wet decks. Check with a clinician if you have heart conditions, open wounds or incontinence concerns.

18

Tai chi and yoga

Moderate certainty

Studied form and route: Slow, flowing or posture-based movement classes

Intended outcome: Better balance, fewer falls and lower fear of falling in older adults

Human evidence: Tai chi lowered falls in a 670-person trial and in a meta-analysis of 13 trials; the fear-of-falling result was borderline. Yoga was among the practices in the Cochrane review of exercise for fear of falling.

Traditional use: Both are traditional practices from China and India, taught for movement, breath and calm.

Limits: Class quality varies and many trials were small. We did not find a trial showing yoga lowers falls in people with fear of falling.

Interactions and precautions: Choose a teacher experienced with older adults or joint problems; modify or skip poses that strain a painful joint or an osteoporotic spine; if you have osteoporosis, ask your clinician or teacher which spine positions are suitable.

13,14,9

Tai chi → Yoga →

Therapies & care

Established care for fear of movement starts with finding out why movement hurts or feels unsafe. A GP or physiotherapist can check balance, strength, joints and bones, review medicines, and refer to a falls service, a musculoskeletal (MSK) service or a psychologist. This page describes options in general terms and does not recommend any medicine. Never stop or change a prescribed medicine without asking the prescriber.

Physiotherapy or a falls service

Moderate certainty

Assessment and supervised exercise The NHS says a falls service may check for muscle weakness, weak bones or eyesight problems, offer strength and balance training, check the home and review medicines. In many areas you can refer yourself to NHS musculoskeletal services for back or joint help.

Who it may suit: Anyone who has fallen, is worried about balance, or has persistent joint or back pain.

Precautions: Tell the therapist about surgery, fractures, osteoporosis, heart conditions and dizziness.

8,7

Falls and Balance Problems →

Cognitive behavioural therapy for persistent pain

Moderate certainty

Psychological therapy Teaches ways to cope with pain, worry and avoidance. A Cochrane review found small benefits for pain, disability and distress.

Who it may suit: People whose pain has lasted months and whose worry is limiting activity.

Precautions: Effects are small and side effects were not well reported. It works best alongside gradual activity.

20

Therapy for anxiety and stress →

Home safety check and care needs assessment

Low certainty

Environmental and practical support The NHS says anyone can ask their local council for a free care needs assessment, which can include changes to make a home safer, and notes that a falls service may check home safety.

Who it may suit: People worried about falling at home.

Precautions: Availability depends on local services.

8

Specialist help for strong fear or panic

Very low certainty

Psychological care If worry about moving feels overwhelming or comes with panic, talk to a GP. A psychologist can offer graded exposure or other talking therapies. We found only small studies of graded exposure for back pain.

Who it may suit: People with intense or specific fears who have not improved with general exercise.

Precautions: Do not try intense exposure alone.

19

Anxiety disorders →

What to avoid

Habits, products and claims that can get in the way. Never stop a prescribed medicine without talking to the professional who prescribed it.

Risks that apply to most people

Long periods of bed rest or complete avoidance after pain starts

Moderate certainty

Why: The NHS says not to stay in bed for long periods with back pain and to stay active. Cochrane reviewers noted that rest and inactivity were recommended for many years but exercise may help chronic pain.

Who it applies to: Anyone with new or recurring pain who is tempted to stop moving.

Try instead: Shorten the activity, slow it down or break it up, but keep moving. Add gentle strength and stretching as pain allows.

7,10

Doing too much too soon after a lay-off

Low certainty

Why: The NHS warns that doing too much exercise too quickly, or the wrong sort, may damage joints in osteoarthritis. In a Cochrane review of exercise for knee osteoarthritis, the reported adverse events were increased knee or low back pain related to the exercise, and none was serious.

Who it applies to: People returning after a long rest, a flare or an operation, and anyone tempted to catch up on good days.

Try instead: Increase in small steps on a plan you could also manage on a bad day. Check any programme after surgery with your rehabilitation team.

6,22

Personal triggers to check

Pushing through worsening pain or warning signs

Low certainty

Why: The NHS says to stop if back pain gets worse while exercising and to see a GP, and lists warning signs that need urgent or emergency care.

Who it applies to: Anyone using this page to rebuild activity.

Try instead: Pause, note what happened and get advice. Mild soreness that settles is usual; sharp, spreading or night pain is not.

7,10

Giving up outings, chores and social plans because of worry about falling

Low certainty

Why: The NIA says fear of falling may lead people to avoid walking, shopping or social activities, yet staying active helps prevent falls. A 2022 review says fear of falling contributes to activity restriction.

Who it applies to: Older adults, people who have fallen and people who have noticed they are going out less.

Try instead: Keep a short list of places you still go and add one small outing a week. Take a stick, a friend or a phone if that helps.

2,4

Falls and Balance Problems →

Products that need caution

Ill-fitting shoes, slippers and borrowed walking aids

Low certainty

Why: The NHS advises shoes or slippers that fit, do not slip off and have a good grip. The NIA says canes and walkers need to be the right size and used correctly, and suggests a physical or occupational therapist can advise.

Who it applies to: Anyone worried about slipping or tripping.

Try instead: Wear secure, non-slip footwear and ask a physiotherapist or occupational therapist to check any walking aid.

8,2

Walk More Comfortably →

Unsupported claims

"Any pain means something is being damaged"

Low certainty

Why: Pain and damage do not always go together. In the Cochrane overview of exercise for chronic pain, most adverse events were increased soreness or muscle pain that subsided after a few weeks. Even so, some pain is a sign to stop, so changes need judging case by case.

Who it applies to: Anyone whose fear is driven by past flares.

Try instead: Learn the difference between ordinary soreness and warning signs, and ask a physiotherapist to help you judge them.

10,7,22

"Wait until you feel confident before moving"

Low certainty

Why: Confidence often follows doing the movement. In a trial, graded exposure reduced fear of movement and pain-related anxiety, and exercise programmes reduced fear of falling by a small to moderate amount.

Who it applies to: Anyone waiting for the worry to disappear before trying.

Try instead: Start with the smallest step you can repeat, even if the worry is still there.

19,9

"Exercise or tai chi guarantees you will never fall"

Moderate certainty

Why: Exercise and tai chi reduced falls in trials, but they did not remove risk (for example, in the 670-person trial, falls still occurred in all groups).

Who it applies to: Anyone promised full protection by a class or product.

Try instead: Treat exercise as one part of the plan, alongside home safety, vision, hearing and medicine checks.

14,8

Common mistakes

Ignoring a fall because nothing hurt at the time

Low certainty

Why: The NIA says to tell your doctor if you have fallen since your last check-up, even if you did not feel pain, because a fall can point to a new medical problem or an issue with medicines or eyesight.

Who it applies to: Older adults and anyone who has fallen.

Try instead: Book a check and ask about a falls service or physiotherapy.

2,8

Evidence & safety

What the research shows

Health agencies agree that staying active, and doing strength and balance exercises, helps people feel more confident on their feet. Reviews of trials found that exercise gives a small to moderate reduction in fear of falling, though the certainty is low and long-term effects are unclear. For persistent back pain, graded activity gave small short-term benefits, and treatments that address fear-avoidance beliefs did better than purely physical ones in early back pain. Tai chi and similar practices look promising for falls and fear. We did not find trials of foods or supplements for confidence in movement.

Limits of the evidence

  • Most fear-of-falling studies relied on self-reported scores and could not blind participants.
  • Many pain and psychology trials were small, with wide uncertainty.
  • Long-term effects after programmes end are mostly unknown.
  • Fear of movement is measured differently in different studies, which makes comparison harder.
  • Most fall research is in people aged 65 and over; findings may not apply to younger adults.

Precautions and interactions

  • Check with a clinician before starting new exercise if you have heart disease, osteoporosis, recent surgery, fractures, dizziness or unstable joint conditions.
  • Increase in small steps. The NHS warns that too much too soon may damage joints in osteoarthritis.
  • Do not stop or change prescribed medicines because of anything on this page.
  • Joint supplements, braces and gadgets were not reviewed here; ask a pharmacist or clinician about any that interact with medicines.

Life-stage considerations

  • Older adults: balance problems, medicines and low blood pressure on standing can affect falls; a medicine review is part of falls care according to the NHS.
  • Pregnancy: ask your midwife or doctor before starting a new activity programme.
  • After surgery or fracture: follow your surgical or rehabilitation team's plan.
  • Osteoporosis: exercise is generally encouraged, but ask about which movements are safe; fracture risk and medicines are medical decisions. See the bone health page.

Warning signs

  • Fall with possible head, neck, back or hip injury, or unable to get up.
  • Back pain with weakness or numbness in both legs, numbness around the genitals or anus, new bladder or bowel changes, or chest pain.
  • Severe pain that starts suddenly or is getting worse quickly, or back pain with fever or feeling unwell.
  • Pain that is worse at night or does not ease with rest, or back pain with unexplained weight loss.
  • A hot, swollen, painful joint, or a joint that locks or gives way.
  • Panic, or fear so strong that you stop leaving the house.

Claim checks

Exercise reduces fear of falling in older adults

Moderate certainty

A 2014 Cochrane review (30 studies, 2,878 people) found a small to moderate reduction immediately after programmes (low-certainty evidence); a 2022 meta-analysis of 75 trials found a similar effect. Whether it lasts is unclear.

9,4

Tai chi stops falls

Moderate certainty

In a 670-person trial, tailored tai ji quan lowered falls more than stretching, and a 13-trial meta-analysis found fewer falls, but falls still happened and the effect on fear was borderline.

14,13

Resting until the pain is gone is the safest option

Moderate certainty

The NHS advises staying active and not staying in bed for long periods with back pain; a Cochrane overview found exercise may help chronic pain with few adverse events.

7,10

Supplements will make joints feel ready for movement

Not enough evidence

We did not review supplement trials for this page, and we found no source showing supplements build confidence in movement. See the linked joint supplement page for what research exists and the cautions.

Fear of movement is just in the mind and needs no checking

Moderate certainty

Fear is real and treatable, but new, severe or unusual pain, weakness, numbness or a fall can have physical causes. The NHS lists specific warning signs that need medical care.

7,8

Questions people ask

Is it normal to be afraid of moving after an injury or fall?

Yes. The NIA notes that many older adults fear falling, even if they have not fallen, and research on back pain and sports injury also finds fear of pain or re-injury is common. It is something to address, not something to be embarrassed about.

How long does it take to feel confident again?

There is no fixed time. In trials, fear of falling usually dropped by the end of an exercise programme (often some weeks long), but studies could not say how long the benefit lasted. Expect steps forward and the odd step back.

What is graded activity?

Starting at an amount you can manage and increasing it in small planned steps, rather than doing more only when you feel good. A systematic review of 15 trials found it slightly better than minimal treatment for persistent low back pain, but not better than other exercise.

What is the difference between soreness and harm?

Mild muscle soreness after new activity is common and usually fades. In the Cochrane overview, most reported side effects of exercise were increased soreness that subsided after a few weeks. Pain that is sharp, rapidly worsening, spreading, with numbness or weakness, or worse at night needs checking. The NHS says to stop if back pain worsens and see a GP.

How much exercise should adults aim for?

The NHS recommends adults 65 and over be active every day, do strength, balance and flexibility activities on at least 2 days a week, and reach 150 minutes of moderate activity a week, if able. Speak to a GP first if you have not exercised for some time or have medical conditions. Any amount is better than none, according to the WHO.

Can tai chi help?

Evidence suggests yes for balance and falls. A 670-person trial found it lowered falls more than stretching. The result on fear of falling in a meta-analysis was borderline, so expect benefit mainly through steadier movement.

What should you do after a fall?

The NHS and NIA advise staying calm and checking for injuries. Call emergency services if you may have hurt your head, back, neck or hip, or cannot get up. If you can get up, roll to your side, get onto hands and knees, and rise slowly using something stable. Tell a doctor about the fall afterwards, even if you were not hurt.

Is a physiotherapist needed?

Not always, but one can help if you have had a fall or surgery, have persistent pain, or are unsure what is safe. In many parts of the UK you can refer yourself to NHS musculoskeletal services, according to the NHS.

Is fear of movement the same as anxiety?

They can overlap but are not the same. Fear of a specific movement is common after pain or injury. If worry is widespread, brings panic, or keeps you indoors, speak to a GP; see the anxiety page for more.

Do supplements or braces help confidence?

We did not find evidence that supplements improve confidence in movement. Braces and aids can help some people, but should be fitted properly; a physiotherapist or occupational therapist can advise.

Is this safe with osteoporosis?

Exercise is generally encouraged for bone and falls health, but the type matters. Ask your clinician which movements are suitable, and never stop osteoporosis medicines without asking the prescriber. See the bone health page.

References

  1. NHS. Physical activity guidelines for older adults (last reviewed 15 August 2024). Read 2026-10-31. source
  2. National Institute on Aging. Falls and Fractures in Older Adults: Causes and Prevention. Read 2026-10-31. source
  3. Wertli MM, et al. Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014. PMID 24614254. source
  4. Feng C, et al. A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults. Phys Ther. 2022. PMID 34636923. source
  5. NHS. Osteoarthritis. Read 2026-10-31. source
  6. NHS. Osteoarthritis: Treatment and support. Read 2026-10-31. source
  7. NHS. Back pain. Read 2026-10-31. source
  8. NHS. Falls. Read 2026-10-31. source
  9. Kendrick D, et al. Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst Rev. 2014. PMID 25432016. source
  10. Geneen LJ, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017. PMID 28436583. source
  11. Bull FC, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020. PMID 33239350. source
  12. Macedo LG, et al. Graded activity and graded exposure for persistent nonspecific low back pain: a systematic review. Phys Ther. 2010. PMID 20395306. source
  13. Zhang W, et al. Effectiveness of Tai Chi exercise on fear of falling and balance in older adults: A meta-analysis. Geriatr Nurs. 2023. PMID 37011491. source
  14. Li F, et al. Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling: A Randomized Clinical Trial. JAMA Intern Med. 2018. PMID 30208396. source
  15. Kruisbrink M, et al. Disentangling interventions to reduce fear of falling in community-dwelling older people: a systematic review and meta-analysis of intervention components. Disabil Rehabil. 2022. PMID 34511009. source
  16. Yoshikawa A, et al. Systematic review and meta-analysis of fear of falling and fall-related efficacy in a widely disseminated community-based fall prevention program. Arch Gerontol Geriatr. 2020. PMID 32911232. source
  17. Watson JA, et al. Pain Neuroscience Education for Adults With Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis. J Pain. 2019. PMID 30831273. source
  18. Bartels EM, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2016. PMID 27007113. source
  19. Woods MP, Asmundson GJG. Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: a randomized controlled clinical trial. Pain. 2008. PMID 17716819. source
  20. Williams ACC, et al. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2020. PMID 32794606. source
  21. Ardern CL, et al. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2013. PMID 23733635. source
  22. Fransen M, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015. PMID 25569281. source

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