Effects of eccentric overload training on lower-limb muscle strength, gait performance, balance, and explosive power in older adults: A systematic review and meta-analysis

Objective: To evaluate the efficacy of eccentric overload training (EOT) in enhancing lower-limb muscle strength, gait performance, balance, and explosive power among older adults. Methods: We systematically searched seven databases (PubMed, Web of Science, Embase, Ovid, Cochrane Library, EBSCO, CINAHL) through March 2026 for randomised controlled trials (RCTs). The primary outcome was lower-limb strength; secondary outcomes included gait, balance, explosive power, and adverse events. Methodological quality and evidence certainty were evaluated using RoB 2.0 and GRADEpro, respectively. Results: Fifteen RCTs (n = 438) were included. EOT may enhance lower-limb strength (SMD = 0.50, 95% CI [0.12, 0.87]) and explosive power (SMD = 0.39, 95% CI [0.07, 0.71]) in the elderly population. A post-hoc subgroup analysis by comparator type indicated that EOT significantly improved lower-limb strength relative to inactive controls, while showing at least a non-inferiority trend compared with conventional resistance training in improving both lower-limb strength and explosive power. Exploratory subgroup analyses revealed that flywheel devices demonstrated superior efficacy in improving lower-limb strength (SMD = 0.54, P = 0.04) and explosive power (SMD = 0.44, P = 0.03), while physical health status did not significantly influence effect sizes. Regarding intervention frequency, high-frequency training (>2 sessions per week) was more effective for enhancing lower-limb strength, whereas low-frequency training (≤2 sessions per week) appeared more beneficial for improving explosive power. Furthermore, long-term training (≥8 weeks) yielded greater improvements in both lower-limb strength and explosive power. Conclusion(s): EOT shows promising potential for improving lower-limb strength (moderate certainty) and explosive power (high certainty) in older adults. Long-term training protocols result in greater efficacy, while the choice between high-frequency and low-frequency training should be tailored to specific clinical objectives. Future exercise prescriptions for the elderly population should prioritize both standardization and personalization. © 2026 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/