Optimal type and dose of exercise to improve fall behavior in older adults: A systematic evaluation and network meta-analysis.

BACKGROUND: This meta-analysis aims to evaluate the effects of exercise interventions on fall rates and fall risk in older adults and identify the most effective exercise types and doses for fall prevention. METHODS: Systematic searches of PubMed, Web of Science, SPORTDiscus, PsychINFO, Embase, and Scopus databases were conducted from the beginning of database construction through November 2024. Studies were included if they were randomized controlled trials (RCTs) of exercise interventions for older adults. Paired, network, and dose-response meta-analyses were conducted using random-effects models for outcomes of falls behavior in older adults. RESULTS: A total of 21 RCTs involving 3387 participants were included in this study. The results indicated that the ranking of intervention effectiveness in reducing fall-related behaviors among older adults, based on SUCRA values, was as follows: Falls Management Exercise Programme (FaME) (68.56 %) > Otago Exercise Program (OEP) (57.58 %) > aquatic exercise (43.96 %) > Tai Chi (41.52 %) > balance training (0.58 %). In addition, a reverse U-shaped dose-response relationship was observed between total exercise dose and fall-related outcomes in older adults, with the optimal response occurring at approximately 420 MET·min/week. Notably, the optimal dose varied across different exercise modalities. CONCLUSIONS: The study identified the relative effectiveness of different exercise interventions in improving fall-related outcomes among older adults. Falls Management Exercise Programme (FaME) was found to be the most effective adjunctive intervention, followed by Otago Exercise Program (OEP), aquatic exercise, Tai Chi, and balance training. Providing the most effective exercise strategies may enhance fall prevention in older adults, even when the exercise dose falls below the thresholds recommended by the WHO guidelines.