This session will consider the evidence for exercise as an important factor within a multifactorial fall prevention programme and exercise alone as both a preventative and a rehabilitative tool. It will also consider the need for balance specificity, tailoring, adequate duration and intensity, sufficient progression, education and telephone support. Epidemiological evidence suggests that, compared with a sedentary lifestyle, spending over three hours targeted exercise each week can halve the risk of osteoporosis, falls-related injuries and hip fracture 1. But the relationship between physical activity and falls is actually U-shaped, where those who are most sedentary and those who are most active (increased exposure to potential risk) are at increased risk 1. Robust RCTs of tailored, targeted exercise training over one year reduce the risk of falls and fractures in community dwelling older adults exercising in their own home (Otago Home Exercise Programme)2. Group exercise programmes for fallers have the added benefit of social inclusion, improving self-efficacy and reducing fear of falls when people have the chance to share experiences and solutions. Falls Management Exercise (FaME), delivered once a week for 9 months with a home exercise programme twice a week, halved the risk of falls compared to that in controls and reduced the likelihood of death or admission to institutional care 3. To date, FaME is the only programme to integrate retraining the ability to get down to and up from the floor and to include floor coping skills such as crawling and rolling to ensure avoidance of a long-lie after a fall. Targeted training can also improve balance and strength, and reduce pain and the incidence of fractures in elderly women with established osteoporosis. Although consensus and guidelines still favour a multi-factorial approach 4, a recent review 5, showed that exercise offers many other benefits wider than just preventing falls, so perhaps is the best “single” intervention that we could offer on a population basis. The science behind delivering effective falls prevention exercise involves ensuring tailoring and progression of exercise, highly challenging balance, a dose of at least 50 hours and avoidance of a walking programme 5. Our next challenge is to increase uptake and adherence to strength and balance training. When should we advise people to start strength and balance re-training? Studies suggest that certain activities, such as Tai Chi, if started when people have only mild deficits of strength and balance, can reduce the chance of falls. Most research, however, suggests that starting strength and balance training appears most effective when the participants are just at that critical threshold where daily home tasks are at the limits of the person’s stability. Small gains in balance and strength benefit by enabling the person to cope more safely with the activities of daily living.