OBJECTIVE: To investigate the impact of Alexander technique lessons on balance and mobility in older adults with visual impairments. DESIGN: Randomized assessor blinded controlled trial with intervention and usual care control groups. SETTING: Participants' homes. SUBJECTS: A total of 120 community-dwellers aged 50+ with visual impairments. INTERVENTION: Twelve weeks of Alexander lessons and usual care. MAIN OUTCOME MEASURES: Short Physical Performance Battery items were primary outcomes at 3 months and secondary outcomes at 12 months. Additional secondary outcomes were postural sway, maximal balance range and falls over 12 months. RESULTS: Between-group differences in primary outcomes were not significant. The intervention group reduced postural sway on a firm surface with eyes open at 3 months after adjusting for baseline values (-29.59 mm, 95%CI -49.52 to -9.67, p < 0.01). Planned sub-group analyses indicated a greater intervention effect among past multiple-fallers (2+) than non-multiple fallers for gait speed (p = 0.02) and step length (p < 0.01) at 3 months and chair stand at 12 months (p < 0.01). There was a non-significant reduction in falls rate (IRR 0.64, 95%CI 0.34 to 1.15, p = 0.13) and injurious falls (IRR 0.61, 95% CI 0.28 to 1.30, p = 0.20) in the intervention group compared to the control group. CONCLUSION: The intervention did not have a significant impact on the primary outcomes but benefits for the intervention group in postural sway, trends towards fewer falls and injurious falls and improved mobility among past multiple-fallers suggest further investigation of the Alexander Technique is warranted.

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