Celebrated across the UK on 24 September 2025 National Fitness Day is an annual campaign by ukactive that highlights the role physical activity plays across the UK, helping to raise awareness of its importance in assisting us to lead healthier lifestyles. It is a day dedicated to celebrating physical activity, fitness, and wellbeing. This is an important truth for all ages but all too often exercise and fitness is considered to be the preserve of the young or middle-aged and not a critical element in the care and support of older persons. Nothing could be further from the truth.
National Fitness Day is an invitation – not to chase step-counts for their own sake – but to stand up for dignity, independence and joy in later life. For those of us who live, work, or receive support in Scotland’s care homes and homecare, movement is essentially about human rights: the right to participate, to choose, to keep agency over our bodies and our days.
The UK Chief Medical Officers are unambiguous: older adults should build strength and balance at least twice a week, alongside regular aerobic activity. This isn’t gym-speak; it’s about getting out of a chair safely, turning in a narrow hallway, stepping onto a bus, and having the confidence to go to the garden gate.
The World Health Organisation echoes this: for people with lower mobility, activities that challenge balance three or more days a week are recommended to prevent falls. In other words, the type of movement matters as much as the minutes.
In Scotland, the numbers are stark. In the year to the end of March 2024, according to Public Health Scotland there were 56,294 emergency hospital admissions for unintentional injuries in Scotland. Of these, for those aged 65 and over, there were 28,389 admissions. Among the 65+ group, just over 86% of the unintentional injury admissions were the result of a fall. Behind every statistic is a person, often a carer, and almost always a loss of confidence that narrows life.
Scotland has recognised this for years. Our National Falls and Fracture Prevention Strategy set a whole-system vision; resources like NHS Inform and Public Health Scotland’s Up and about: Taking positive steps to avoid trips and falls make prevention practical and person-friendly.
The evidence is consistent.
In community settings, structured programmes that prioritise balance, functional tasks and lower-limb strength reduce the rate of falls by ~24–34%. That’s a meaningful difference in everyday lives. Specific activities like Tai Chi, when practiced regularly, shows additional benefits for balance and fall risk. The UK NICE’s 2025 Falls guideline (NG249) places exercise at the heart of multifactorial prevention, alongside review of medicines, vision, feet/footwear and home hazards.
The picture is more nuanced in residential care. A 2023 systematic review found exercise can prevent falls among residents who are willing and able to take part – but benefits fade if programmes stop. The implication is clear: make movement part of everyday life, not a short-term project.
I’ve seen first-hand what the benefits coordinated exercise programs for care home residence can lead to. Scotland’s own CAPA (Care About Physical Activity) programme showed how care staff, not just physiotherapists, can weave movement into ordinary moments – standing for teeth-brushing, purposeful walking to the dining room, gardening, dancing before lunch. The evaluation reported positive impacts on independence, quality of life and activity levels.
If our goal is fewer falls, as it should be – we need to get those who can, to get off the couch and out of their seats and to exercise. It may be necessary for those who are deconditioned, fearful, or recovering, to start with seated exercises but all the evidence shows that we then need to progress to standing, weight-bearing and balance-challenging work. The gains we need come from progressive, balance-challenging and strength-building activities, ideally 2–3 times/week, sustained over months and then maintained.
A rights-based approach means attending to all the factors that shape risk and confidence: regular medication review (especially psychotropics), vision and hearing checks, footwear and podiatry, and bone health. Exercise is powerful; it’s even more powerful when wrapped in this support.
We cannot continue to ignore the substantial global evidence which shows that activity and exercise bring real benefits even in very late life.
One recent study published earlier this year is “Effect of soft surface stepping exercise on physical activity among community-dwelling elderly: A Prospective Randomized Controlled Trial” undertaken in Thailand by Kaewjoho and others.
The research project took elderly, community-dwelling individuals with an average age ~70-71 years. Two groups undertook stepping exercises: one group practising on a soft surface, the other on a firm surface. Exercises were whole-body stepping movements, 50 minutes per session, 3 days per week, for 6 weeks. There was a follow-up one month after end of intervention.
The study showed that both groups improved in functional mobility, walking speed, and lower extremity muscle strength after 4, 6 weeks and at a one-month post-intervention. The soft-surface stepping group showed greater improvements in dynamic balance and in specific lower limb muscle strengths compared to the firm surface group at 6 weeks.
Taken as a whole the study showed that even relatively “gentle” interventions (stepping, balance work) over a short time (6 weeks) can yield measurable gains in strength, balance, mobility among older adults who are mobile. Use of soft surfaces might add extra benefit for balance.
I come across countless research items which consistently advocate the importance of mobilised exercise for individuals and yet our whole system response not least to falls prevention seems to be sporadic and spasmodic.
What we need is a real urgent priority on what is potentially a massive support to all the talk of preventative care and support. To achieve this, we need leaders and commissioners to make strength and balance a measured quality marker in contracts; and we also need to sustain activity beyond 12 weeks, so that benefits persist. And it’s stating the obvious that we need such a commitment to be funded and adequately resourced as a core part of commissioning care and support.
Providers need to be enabled and supported to treat movement like they do continence or nutrition – core care, discussed at handover, recorded, progressed, celebrated and there is so much from CAPA learning to draw upon.
Families and friends need to start asking “what helps you feel steady?” then to help make it happen – shoes that fit, a decluttered hallway, a weekly Tai Chi class.
And our political leaders and policy makers need to keep Scotland’s falls and fracture strategy live and funded and to align all this work with Public Health Scotland’s framework for physical activity.
On National Fitness Day exercise and movement need to be celebrated as the opportunity for all regardless of age. Every safe rise from a chair, every steady step to the window, every dance in a corridor is a small act of freedom. Movement is not an optional extra at the end of life; it is one of the ways we live it.
I leave you with the words of ‘Middle-aged Fanclub’ and the poem
Every day, a walk.
Every day, a walk.
Some days you feel like you’re fighting back,
others, like death warmed up.
Almost all, you’re glad to be alive.
Whether breathless
or jelly legged,
alone with your thoughts
or in company and chattering away
about anything and everything,
swaddled like a newborn against the biting cold
in your big coat
that she zips up for you, because you cannot,
dazed by the noise or the light,
or the breeze,
bruised but not battered,
tweaked but not torn,
smiling, but not quite as happy as you’d like to be
and always, always tired.
Every day, a walk.
https://middleagefanclub.co.uk/2023/01/18/poetry-blog-every-day-a-walk/
Donald Macaskill
