approximately 30% of individuals over 65 yr of age fall at least once a year ( tinetti , 2003 ) . falling is a major public health and medical problem that can cause serious injuries including fracture , brain injury , and even death . as aging progresses , muscle mass , muscle strength , and joint range decrease and strides narrow as walking speed declines . stimulus response time and nerve conduction velocity decrease owing to changes in the nervous system , which leads to reduced balance ability . this decline in physical function reduces lower extremity strength , balance , and flexibility , thereby causing frequent falling during walking ( huh et al . , 2010 ; jeoung , 2014 ; kressing et al . , in korea , 21.441.6% of elderly patients receiving home care and 30.3% of elderly patients in nursing homes who have experienced falls ( gu et al . , 2006 ) , in who over 65 yr elderly , falling were higher prevalence than other elderly disease ( kim and lee , 2006 ) . of community - dwelling elderly persons , 43% reported being fearful of falling , while 44% reported activity restrictions ( robertson et al . , 2002 ) . almost half of older adults transitioning to frailty had a fear of falling ( kressing et al . , 2001 ) . fear of falling is not only the immediate result of falls but also a risk factor for falls which creates a vicious cycle between falls and fear of falling . various complex health problems arise in 50% of the elderly who have experienced falls ; 10% of them require medical treatment and 5% experience fracture . since 50% of the elderly individuals who are admitted to the hospital for fall - related injuries die within 1 yr , falling is a major cause of morbidity and mortality in the elderly ( tinetti and powell . , 1993 ) . since falling induces pain , restricts activities , and disables independent living , fear of falling and the restriction of social activities due to falling greatly reduce well - being and quality of life . as such , falling not only leads to physical damage in the elderly but can create serious problems for social well - being ; therefore , studies on fall prevention and intervention are required . recent research implicates fear of falling as a contributor to physical dependence among elderly persons ( tinetti and powell . , 1993 ) , while other studies supported the close association among exercise , physical performance , and fear of falling ( li et al . , 2005 ) . the risk of falling can reportedly be reduced for those who exercise regularly , but few studies have examined its correlation with physical fitness . the purpose of this study was to examine the correlation between physical fitness and falling fears in the elderly . a total of 173 elderly women who were 6585 yr old were recruited from a welfare center in inchon city . all potential participants underwent a comprehensive explanation of the proposed study , its benefits and inherent risks , and the expected time commitment . medical information ( health status and medications ) was obtained from participants using a questionnaire . the subjects were excluded if they were not able to walk without a cane or other assistive device or had known conditions and musculoskeletal problems limiting their safe participation in this study . the physical fitness test for seniors was developed by roberta & jessie and included a 6-min walk test , grip strength , 30-sec arm curl test , 30-sec chair stand test , back scratch and chair sit and reach test , 8-foot up and go , unipedal stance , and body mass index . this study approached fear of falling in two ways : ( 1 ) direct questioning focused on perceptive fear of falling ; and ( 2 ) the korean version of the fall efficacy scale - international ( kfes - i ) to measure the confidence of avoiding falling during daily activities using the level of concern about falling . the kfes - i has 16 items , each of which is scored from one to four for a total score of 1664 . according to the cut point suggested by delbaere et al . ( 2004 ) , we considered patients with a score 23 as having a higher level of concern over falling . statistical analysis was performed using spss for windows version 21 ( ibm spss inc . , a correlation analysis was conducted to examine the correlation between fall efficacy and physical fitness factors , and the correlated physical fitness factors were divided into quartiles to analyze the differences between groups . to investigate the differences in fall efficacy between physical fitness items , one - way analysis of variance ( anova ) was performed . a total of 173 elderly women who were 6585 yr old were recruited from a welfare center in inchon city . all potential participants underwent a comprehensive explanation of the proposed study , its benefits and inherent risks , and the expected time commitment . medical information ( health status and medications ) was obtained from participants using a questionnaire . the subjects were excluded if they were not able to walk without a cane or other assistive device or had known conditions and musculoskeletal problems limiting their safe participation in this study . the physical fitness test for seniors was developed by roberta & jessie and included a 6-min walk test , grip strength , 30-sec arm curl test , 30-sec chair stand test , back scratch and chair sit and reach test , 8-foot up and go , unipedal stance , and body mass index . this study approached fear of falling in two ways : ( 1 ) direct questioning focused on perceptive fear of falling ; and ( 2 ) the korean version of the fall efficacy scale - international ( kfes - i ) to measure the confidence of avoiding falling during daily activities using the level of concern about falling . the kfes - i has 16 items , each of which is scored from one to four for a total score of 1664 . according to the cut point suggested by delbaere et al . ( 2004 ) , we considered patients with a score 23 as having a higher level of concern over falling . statistical analysis was performed using spss for windows version 21 ( ibm spss inc . , a correlation analysis was conducted to examine the correlation between fall efficacy and physical fitness factors , and the correlated physical fitness factors were divided into quartiles to analyze the differences between groups . to investigate the differences in fall efficacy between physical fitness items , one - way analysis of variance ( anova ) there was a significant correlation between 6-min walk , 30-s chair stand test , 30-s arm curl test , chair sit and reach test , back scratch test , and 8-foot up and go test scores , unipedal stance , grip strength , and fall efficacy ( p<0.05 ) ( table 2 ) . the mean fall efficacy was 25.499.4 , higher than the fall efficacy risk score ( < 23 ) . analysis of fall efficacy after the division of each physical fitness item into quartiles showed that fall efficacy was lower as physical fitness increased . moreover , the group with the highest level of physical fitness ( > 75% ) had the lowest risk of fall efficacy compared to the group with the lowest level of physical fitness ( < 25% ) . the group with high physical fitness ( > 75% ) according to the 6-min walk , 30-s chair stand test , 30-s arm curl test , and 8-foot up and go test scores and grip strength had lower fall efficacy points than the cut point suggested by delbaere et al . risk of falling in the elderly includes not only the result of falling itself but also the high chance of injury accompanying falls . analysis of the correlation between physical performance and fear of falling in this study showed that they have a strong correlation and that fear of falling decreases as physical fitness level increases . studies have reported a strong correlation between muscle strength and balance with falling ( howland et al . , 1993 ; lawrence et al . , that is , balance ability and falling are decided by how the body copes with a sudden postural disturbance in which an individual maintains a correlation between the instant reaction and the balance ability of the upper and lower body ( higuchi et al . , 2004 ; jeoung , 2014 ; walker et al , 1991 ) . for this reason , muscle strength declines and the incidence of falling becomes more frequent as aging progresses . the results of this study also verified that muscle strength , cardiovascular endurance , and agility are highly associated with a fear of falling as shown in previous studies . therefore , a regular exercise program that can enhance muscle strength , muscle endurance , cardiovascular endurance , and agility should be emphasized .
the fear of falling is a common psychological consequence of falling , especially for elderly individuals . 
 fear of falling can lead to activity restriction and medical problems . 
 the primary purpose of this study was to examine the correlation between fall efficacy and physical fitness factors in elderly women . 
 we assessed physical fitness factors and investigated the korean version of the fall efficacy scale - international ( kfes - i ) in 173 participants . 
 we investigated the correlation between physical fitness factors and fall efficacy . 
 when the subjects were divided into four groups according to physical fitness level , subjects with high 6-m walk , 30-s chair stand test , 30-s arm curl test , chair sit and reach test , 8-foot up and go test scores and high grip strength had low fall efficacy . 
 physical fitness factors were strongly associated with decreased fall fear , suggesting that physical fitness improvements play an important role in preventing or reducing the fear of falling .