Exercise to reduce falls in Community-Dwelling people after stroke: A systematic review with meta-analysis

Objective: To determine the effect of falls-prevention exercise compared with nothing, sham or another exercise intervention on reducing falls after stroke. To also determine the effect of falls-prevention exercise on balance, mobility and quality of life. Data sources: Searches were conducted from inception to December 2025 on MEDLINE, EMBASE, Scopus and PEDro databases according to predefined search terms with details provided in supplementary materials. Review methods: Randomised trials were included if the intervention targeted falls and the primary outcome was the rate of falls or the number of people experiencing one or more falls. Other outcomes of interest were balance, mobility and quality of life. Methodological quality was rated with the PEDro scale. Two researchers independently extracted data, which was synthesised by meta-analysis. Results: Three trials (n = 677) were included in the review. Exercise trended towards a lower rate of falls compared to no/sham intervention (IRR 0.84, 95% CI 0.62 to 1.15, p = 0.29) with uncertainty in the estimate (confidence interval includes the possibility of no effect). Exercise did not reduce the number of individuals experiencing one or more falls (RR 0.98, 95% CI 0.81 to 1.18, p = 0.84). There was a trend towards improved balance (MD 0.49 steps in the Step Test, 95% CI −0.11 to 1.08, p = 0.11) and exercise did improve mobility a small amount (MD 0.04 m/s preferred walking speed, 95% CI 0.01 to 0.07, p < 0.01). No trials compared two exercise interventions. Conclusion: There is a suggestion that exercise can reduce the rate of falls after stroke but does not affect the number of individuals falling. Registration: PROSPERO CRD42024520272. © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).