OBJECTIVES: To exam 1 ne whether fear of falling is a probable cause of reduced recreational physical activity levels in healthy older women.DESIGN: Cross-sectional analysis of baseline data from a longitudinal study.PARTICIPANTS: One thousand five hundred older, ambulatory women (aged 70-85), selected at random from the electoral roll.MEASUREMENTS: Self-reported recreational physical activity levels and fear of falling, demographic variables, anthropometric variables and measures of disability, and physical and cognitive function.RESULTS: The study subjects had low levels of physical and cognitive impairments; 24.1% of the group was obese (body mass index >30). Twenty-six percent of the women did not participate in recreational physical activity; 39% participated in sufficient activity to gain probable health benefits. Although the women who did not participate In recreational activities were most likely to report fear of falling (45.2%), it was common in the group as a whole (33.9%), including the most active women (27.0%). Independent risk factors for nonparticipation in physical activity were fear of falling (odds ratio (OR) = 0.70, 95% confidence interval (CI) = 0.54-0.90, P = .006), obesity (OR = 0.50, 95% CI = 0.38-0.66, P = .001), and slower times on the tuned up-and-go test (OR = 0.88, 95% CI = 0.84-0.92, P = .001). Fear of falling was also independently associated with lower recreational physical activity levels in women who were active (beta = -0.09, P = .003). Subgroup analysis suggested that fear of falls affected activity levels at a predisability stage in women with mildly impaired mobility.CONCLUSIONS: Fear of falling is common in healthy, high-functioning older women and is independently associated with reduced levels of participation in recreational physical activity, Fear of falling is an important psychological barrier that may need to be overcome in programs attempting to improve activity levels in older women.