Background: Falls are a major public health concern among older adults, often resulting in injury, functional decline, and reduced quality of life. While handgrip strength (HGS), fall efficacy, and balance confidence have individually been associated with fall risk, their combined predictive value is still underexplored, particularly in physically active older adults. This study aimed to investigate the relationship between HGS, fall efficacy, and balance confidence and their association with fall risk in community-dwelling older adults engaged in regular exercise programs; A cross-sectional study was conducted with 280 participants aged 55 and over from community exercise programs near Lisbon, Portugal. Fall risk was assessed through self-reported falls in the past 12 months. HGS was measured with a dynamometer, fall efficacy using the Falls Efficacy Scale-International (FES-I), and balance confidence using the Activities-specific Balance Confidence (ABC) Scale. Statistical analyses included Spearman correlations and binary logistic regression. Results: Falls were reported by 26.4% of participants. Fall efficacy and balance confidence were significantly associated with fall history, while HGS was not. Fall efficacy was significantly associated with increased fall risk, as indicated by the odds ratio (OR = 3.37, p < 0.001), while balance confidence was negatively associated (OR = 0.95, p < 0.001). HGS was positively correlated with balance and confidence but not with fall incidence. Conclusions: Psychological factors, particularly fall efficacy and balance confidence, play a critical role in fall risk among physically active older adults. However, this study included physically active middle-aged and older adults living in the community, which should be considered when interpreting the generalizability of the results. These findings support the integration of simple, validated psychological assessments into fall prevention strategies in community settings.

Background/Objectives: Falls are a leading cause of morbidity and mortality in older adults, even among those who are physically active. This study examined the associations between skeletal muscle mass, muscle strength, and muscle power and fall risk in physically active, community-dwelling older adults. Methods: A cross-sectional analysis was conducted with 280 participants (71.9 ± 5.3 years; 75% women) enrolled in the Stay Up–Falls Prevention Project. Assessments included skeletal muscle mass (anthropometric prediction equation), handgrip strength, lower limb strength and power (Five Times Sit-to-Stand test, 5×STS), and fall history over the past 12 months. Muscle power was calculated from 5×STS performance using the equation proposed by Alcazar and colleagues. Logistic regression models and receiver operating characteristic (ROC) curve analyses were performed. Results: Overall, 26.4% of participants reported at least one fall in the previous year, with a higher prevalence among women (28.9%) than men (18.8%). Fallers showed significantly lower handgrip strength (23.1 vs. 25.4 kg, p = 0.022) and poorer lower limb strength (9.2 vs. 8.7 s, p = 0.007) compared with non-fallers. However, no significant differences were found for skeletal muscle mass or sit-to-stand–derived power. In multivariable models adjusted for age, sex, body mass index, comorbidities, and medications, lower limb strength remained the only independent variable associated with fall status (OR = 1.78, 95% CI: 1.11–2.85, p = 0.016). ROC analysis confirmed fair discriminative capacity for 5×STS performance (AUC = 0.616, p = 0.003), with an optimal cut-off of 8.62 s (sensitivity = 78.4%, specificity = 33.0%). Handgrip strength, muscle mass, and power did not show independent associations with fall status. Conclusions: These findings indicate that the 5×STS test provides a simple, cost-effective, and functional indicator for fall-risk stratification in physically active older adults. Clinicians should consider the 5×STS as a sensitive functional indicator that contributes to fall risk stratification, ideally combined with complementary assessments (e.g., balance, gait, cognition) to improve risk stratification and guide preventive interventions in ageing populations.

Background/Objectives: Falls are a leading cause of morbidity and mortality in older adults, even among those who are physically active. This study examined the associations of skeletal muscle mass, muscle strength, and muscle power with fall risk in community-dwelling, physically active older adults. Methods: A cross-sectional analysis was conducted with 280 participants (71.9 ± 5.3 years; 75% women) enrolled in the Stay Up–Falls Prevention Project. Assessments included skeletal muscle mass (anthropometric prediction equation), handgrip strength, lower-limb strength and power (Five Times Sit-to-Stand test, 5xSTS), and fall history over the past 12 months. Muscle power was calculated from 5xSTS performance using the equation proposed by Alcazar and colleagues. Logistic regression models and receiver operating characteristic (ROC) curve analyses were performed. Results: Overall, 26.4% of participants reported at least one fall in the previous year, with a higher prevalence among women (28.9%) than men (18.8%). Fallers showed significantly lower handgrip strength (23.1 vs. 25.4 kg, p = 0.022) and poorer lower-limb strength (9.2 vs. 8.7 s, p = 0.007) compared with non-fallers. However, no significant differences were found for skeletal muscle mass or sit-to-stand–derived power. In multivariable models adjusted for age, sex, body mass index, comorbidities, and medications, lower-limb strength remained the only independent predictor of falls (OR = 1.78, 95% CI: 1.11–2.85, p = 0.016). ROC analysis confirmed fair discriminative capacity for 5xSTS performance (AUC = 0.616, p = 0.003), with an optimal cut-off of 8.62 s (sensitivity = 78.4%, specificity = 33.0%). Handgrip strength, muscle mass, and power did not show independent predictive value. Conclusions: These findings indicate that the 5xSTS test provides a simple, cost-effective, and clinically relevant measure for fall-risk screening in active older adults. Clinicians should consider the 5xSTS as a sensitive first-line screening tool, ideally combined with complementary assessments (e.g., balance, gait, cognition) to improve risk stratification and guide preventive interventions in ageing populations.