Exercise for improving balance in older people.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized trials
PubMed 22071817 · doi:10.1002/14651858.CD004963.pub3
What was done
This Cochrane systematic review and meta-analysis evaluated randomized controlled trials (searched to February 2011) assessing the effects of exercise interventions on clinical balance measures in older adults aged 60 and over, living in the community or institutional care. Two authors independently assessed risk of bias and extracted outcome data across eight categories of exercise: gait/balance/coordination, strengthening, 3D exercise (e.g., Tai Chi, yoga, dance), walking, cycling, computerized balance training, vibration platforms, and multi-component exercise.
What was found
The review included 94 studies with 9,917 participants (mostly women living at home). Statistically significant immediate post-intervention improvements occurred in several categories: - Gait, balance, coordination: Timed Up & Go (TUG) (mean difference [MD] -0.82 s; 95% CI -1.56 to -0.08 s, 4 studies, n=114), walking speed (standardised mean difference [SMD] 0.43; 95% CI 0.11 to 0.75, 4 studies, n=156), and Berg Balance Scale (BBS) (MD 3.48 points; 95% CI 2.01 to 4.95, 4 studies, n=145). - Strengthening: TUG (MD -4.30 s; 95% CI -7.60 to -1.00 s, 3 studies, n=71), single-leg stance eyes closed (MD 1.64 s; 95% CI 0.97 to 2.31 s, 3 studies, n=120), and walking speed (SMD 0.25; 95% CI 0.05 to 0.46, 8 studies, n=375). - 3D exercise: TUG (MD -1.30 s; 95% CI -2.40 to -0.20 s, 1 study, n=44), single-leg stance eyes open (MD 9.60 s; 95% CI 6.64 to 12.56 s, 1 study, n=47), single-leg stance eyes closed (MD 2.21 s; 95% CI 0.69 to 3.73 s, 1 study, n=48), and BBS (MD 1.06 points; 95% CI 0.37 to 1.76, 2 studies, n=150). - Multiple exercise types: TUG (MD -1.63 s; 95% CI -2.28 to -0.98 s, 12 studies, n=635), single-leg stance eyes open (MD 5.03 s; 95% CI 1.19 to 8.87 s, 9 studies, n=545), and BBS (MD 1.84 points; 95% CI 0.71 to 2.97, 2 studies, n=80). Single-leg stance eyes closed (MD 1.60 s; 95% CI -0.01 to 3.20 s, 2 studies, n=176) and walking speed (SMD 0.04; 95% CI -0.10 to 0.17, 15 studies, n=818) did not reach statistical significance. - Walking, cycling, computerized balance training, and vibration platforms had insufficient or absent primary outcome data. The most effective programmes typically ran 3 times weekly for 3 months and used dynamic standing exercise.
Why it matters
The review provides synthesized evidence that targeted exercise programmes—particularly multi-component routines, strength training, dynamic balance tasks, and 3D exercises—can improve clinical balance outcomes in older adults immediately post-intervention. It also highlights modalities where evidence remains inadequate to support balance claims.
Limits
For most individual balance outcomes, evidence derived from only a few small trials. Most trials had an unclear risk of selection bias due to inadequate reporting of randomization, high risk of performance bias from lack of participant blinding, lack of follow-up beyond the end of the intervention, and poor monitoring or reporting of adverse events.
Cited by
- supports Balance training practices like standing on one leg, yoga, or tai chi can significantly improve balance within one to two months.