As individuals age, maintaining balance becomes increasingly important to prevent falls and sustain independence. This systematic review and Bayesian network meta-analysis, published in Ageing Research Reviews, investigates the impact of different exercise modalities on balance performance in older adults.
Background
Age-related decline in balance can lead to increased fall risk, making it essential to identify effective exercise modalities tailored to various balance domains. The study aimed to compare the overall and domain-specific effects of different exercise types based on factors such as fall risk, setting, and dosage.
Methods
The researchers conducted a comprehensive search across five databases, identifying randomized controlled trials involving adults aged 60 years and older, without disease-specific recruitment criteria. A total of 423 trials, encompassing 33,901 participants and 2,546 effect sizes, were included in the analysis. Bayesian network meta-analysis was employed to estimate Hedges’ g and 95% credible intervals (CrIs).
Results
The findings revealed that 18 out of 19 exercise modalities significantly improved overall balance compared to control groups, with stretching showing no clear benefits. The modalities with the largest effects included:
- Perturbation training: Hedges’ g of 0.66 (95% CrI 0.49-0.82)
- Sensory training: Hedges’ g of 0.55 (95% CrI 0.42-0.68)
- Dance: Hedges’ g of 0.54 (95% CrI 0.45-0.64)
- Agility stepping: Hedges’ g of 0.53 (95% CrI 0.39-0.67)
Specific modalities were found to be particularly effective for different balance types. For instance, Tai Chi, perturbation training, Pilates, and agility stepping or aquatic exercise showed the largest estimates for global, static, dynamic, and proactive balance, respectively. Balance-specific training, aquatic exercise, and conventional resistance training indicated tentative signals for reactive balance improvement.
Interestingly, perturbation training demonstrated larger effects in groups at increased risk of falls and in supervised settings, while sensory training had the most significant impact in home-based environments. The study also noted that dose-response relationships were nonlinear and exploratory.
Conclusions
The analysis concludes that exercise is beneficial for balance improvement, but the choice of modality should be informed by the specific balance domain targeted. The most favorable estimates were observed for:
- Perturbation training for overall and static balance under supervision
- Sensory training for home-based settings
- Tai Chi for global balance
- Pilates for dynamic balance
- Agility stepping or aquatic exercise for proactive balance
However, the authors caution that these estimates do not establish superiority among modalities. It is essential to consider task-specific challenges, safety, and feasibility when determining exercise dosage, as metabolic equivalents (METs) reflect metabolic cost rather than balance-specific challenges.
What this study does not show
This study does not establish the superiority of any exercise modality over others for improving balance performance in older adults.
Evidence scorecard
- Analytic validity: established
- Clinical validity: established
- Clinical utility: established
The evidence is based on a human meta-analysis of randomized controlled trials.