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Programme frequency, type, time and duration do not explain the effects of balance exercise in older adults: a systematic review with a meta-regression analysis
  1. Melanie K Farlie1,2,
  2. Lauren Robins1,2,
  3. Romi Haas1,2,
  4. Jennifer L Keating1,
  5. Elizabeth Molloy3,
  6. Terry P Haines1,2
  1. 1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
  2. 2 Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
  3. 3 Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Melanie K Farlie, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199, Australia; melanie.farlie{at}


Objective The objective of this systematic review was to examine the effects of different balance exercise interventions compared with non-balance exercise controls on balance task performance in older adults.

Design Systematic review.

Data sources Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Scopus and Cochrane Database of Systematic Reviews were searched until July 2017.

Eligibility criteria for selecting studies Systematic reviews and meta-analyses of randomised trials of balance exercise interventions for older adults were identified for extraction of eligible randomised trials. Eligibility criteria for inclusion of randomised trials in meta-analyses were comparison of a balance exercise intervention with a control group that did not perform balance exercises, report of at least one end-intervention balance outcome measurement that was consistent with the five subgroups of balance exercise identified, and full-text article available in English.

Results Ninety-five trials were included in meta-analyses and 80 in meta-regressions. For four balance exercise types (control centre of mass, multidimensional, mobility and reaching), significant effects for balance exercise interventions were found in meta-analyses (standardised mean difference (SMD) 0.31–0.50), however with considerable heterogeneity in observed effects (I2: 50.4%–80.6%). Risk of bias assessments (Physiotherapy Evidence Database score and funnel plots) did not explain heterogeneity. One significant relationship identified in the meta-regressions of SMD and balance exercise frequency, time and duration explained 2.1% of variance for the control centre of mass subgroup.

Conclusion Limitations to this study included the variability in design of balance interventions, incomplete reporting of data and statistical heterogeneity. The design of balance exercise programmes provides inadequate explanation of the observed benefits of these interventions.

  • effectiveness
  • elderly people
  • exercise
  • exercise rehabilitation

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  • Contributors All authors contributed to the conception and design of the work. MKF, LR and RH contributed to acquisition of data. All authors contributed to analysis and interpretation of data, drafting and revision of the manuscript, and gave final approval of the version to be published.

  • Funding MKF is supported by the Monash University Maxwell King PhD Scholarship. TPH is supported by a National Health and Medical Research Council Career Development Fellowship.

  • Competing interests Employment or affiliation: TPH is Director of Hospital Falls Prevention Solutions. This company provides the Safe Recovery Training Program for the purposes of preventing falls in the hospital setting. Speaker forum: TPH received payment for speaking at the Australian New Zealand Falls Prevention Conference through the Australian New Zealand Falls Prevention Society. Consultancy: TPH provides statistical analysis consultancy for DorsaVi in the field of back pain research. Expert testimony: TPH has provided expert witness testimony in the area of falls in the hospital setting through MinterEllison Lawyers. Publications: TPH has authored trials included in this study but was not involved in the evaluation of those trials for the purpose of this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data available in the online supplementary files.