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Comparing the effects of different exercises on falls in older adults: A network meta-analysis of randomized
Lu Zhou1, Haiyan Huang1, Caixia Wang1
1School of Nursing, Sun Yat-Sen University, Guangzhou, 510080, China.
Background:
Falls are a common geriatric syndrome in older adults and are associated with functional decline, disability, hospitalization, and increased mortality. Exercise has been shown to improve fall-related outcomes, but the comparative effectiveness across different exercise modalities remains to be clarified.
Objective:
This study aimed to assess the comparative effectiveness of different exercise interventions on the number of fallers, recurrent fallers, fall-related injuries, and fall-related fractures in older adults.
Design:
Network meta-analysis of randomized controlled trials.
Methods:
Systematic searches were conducted in five databases, including PubMed, Web of Science, Embase, the Cochrane Library, and CINAHL Plus with Full Text, from database inception to October 21, 2025, and were updated to April 18, 2026. Risk of bias was assessed using the Cochrane Risk of Bias tool 2.0 for randomized controlled trials. A frequentist network meta-analysis was performed using Stata 17 and R 4.2.1. Heterogeneity was assessed using τ2, Q statistics, and I2, and interventions were ranked according to the surface under the cumulative ranking curve.
Results:
A total of 45 randomized controlled trials involving 16,240 older adults were included, evaluating five types of exercise interventions. Compared with usual care, multicomponent exercise (OR = 0.78, 95% CI: 0.67 to 0.91) and mind-body exercise (OR = 0.62, 95% CI: 0.46 to 0.85) were associated with fewer fallers among older adults (Q = 89.27, P < 0.05, I2 = 55.2%, τ2 = 0.08), while mind-body exercise (OR = 0.57, 95% CI: 0.38 to 0.85) was also associated with fewer recurrent fallers (Q = 32.95, P = 0.02, I2 = 45.4%, τ2 = 0.06). In addition, mind-body exercise (OR = 0.68, 95% CI: 0.47 to 0.99) and balance training (OR = 0.76, 95% CI: 0.61 to 0.96) may reduce the risk of fall-related injuries (Q = 4.03, P = 0.67, I2 = 0%, τ2 = 0). No statistically significant differences were observed between exercise interventions and usual care for fall-related fractures. Sensitivity analyses indicated that the results were stable.
Conclusion:
Multicomponent exercise, mind-body exercise, and balance training may reduce fall-related outcomes in older adults and may inform clinical decision-making regarding exercise interventions. However, these findings should be interpreted with caution because the certainty of evidence ranged from moderate to very low across outcomes. Further high-quality randomized controlled trials are needed to confirm these findings.
