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Exercise for improving balance in older people

  1. Tracey E Howe1,*,
  2. Lynn Rochester2,
  3. Alison Jackson3,
  4. Pauline MH Banks4,
  5. Valerie A Blair5

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 26 JUL 2007

DOI: 10.1002/14651858.CD004963.pub2

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Howe TE, Rochester L, Jackson A, Banks PMH, Blair VA. Exercise for improving balance in older people. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD004963. DOI: 10.1002/14651858.CD004963.pub2.

Author Information

  1. 1

    Glasgow Caledonian University, HealthQWest, Glasgow, Scotland, UK

  2. 2

    Northumbria University, School of Health, Community and Education Studies, Newcastle upon Tyne, UK

  3. 3

    University of Glasgow, Department of Psychological Medicine, Glasgow, UK

  4. 4

    HealthQWest, School of Health Studies, Hamilton, Lanarkshire, UK

  5. 5

    Bell College, School of Health Studies, Hamilton, Lanarkshire, UK

*Tracey E Howe, HealthQWest, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland, G4 0BA, UK. tracey.howe@gcal.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Characteristics of included studies [ordered by study ID]
Boshuizen 2005
MethodsRCT.
Method of randomisation not known.
Assessors blinded.
Losses: 23 of 72 from 3 arms.
ParticipantsN = 33 completers in two arms
Age: mean (SD) 80.0 (6.7) exercise group, 77.2 (6.5) control group.
Sex: high guidance group - all female, medium guidance group - 2 male, control group 2 male.
Setting: Netherlands.
Inclusion: difficulty getting up from chair.
Exclusion: maximum knee extensor torque over 87.5 Nm, self reported disease adversely affected by exercise.
InterventionsExercise group (STRENGTH) (n = 16): strengthening exercises of lower limbs with theraband and increasing resistance in sitting and standing.
Control group (n = 17): usual activity.
Duration and intensity: 10 weeks of 2 x 1hour supervised classes per week and 1 self supervised home session.
Supervisor: physical therapist for exercise groups.
Supervision: group exercise classes for exercise groups and self home exercises.
Setting: community.
Outcomes20 metre walk test (s).
TUG (s).
Tandem stance (s).
NotesTrial had 3 arms but NSD between 2 interventions therefore data taken from 'High guidance' group
Compliance in exercise group 73%
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Brouwer 2003
MethodsRCT.
Method of randomisation not known.
Blinding not known.
Losses: 4 of 38.
ParticipantsN= 38
Age: mean (SD) 77.1 (5.1) - exercise group, 78.0 (5.5) - control group.
Sex: 5 male, 12 female - exercise group, 4 male, 13 female - control group.
Setting: Canada.
Inclusion: fear of falling.
Exclusion: co-morbidities (neuropathy, vestibular deficits, mobility arthritis, neurological conditions).
InterventionsExercise group (GBFT): low resistance exercises against gravity, theraband for legs and trunk, reaching, weight shifting, marching on spot, and home exercise programme.
Control group: discussion about concerns relating to falling, education about environment.
Duration and intensity: 1 hour per week x 8 weeks both groups. Exercise group additional 40 minutes x 2 week home exercise programme.
Supervisor: physiotherapist.
Supervision: group.
Setting: gym.
OutcomesForce platform - LOS AP and ML (cm).
Walking speed (middle 10 of 20 metres) (m/s).
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Buchner 1997a
MethodsRCT.
Random permuted blocks.
Assessors blinded.
Losses: 5 of 105.
Intention to treat analysis.
ParticipantsN = 105, Factorial design 51 allocated to relevant arms.
Age: mean 75 range 68 - 85.
Sex: 51% female.
Setting: USA.
Inclusion: 68 - 85 years unable to do 8 step tandem gait with no errors, below 50th centile for knee extensor strength for height and weight.
Exclusion: cardiovascular, pulmonary, vestibular and bone disease, dependency terminal illness, unable to speak English, positive cardiac stress test, body weight greater than 180% of ideal.
InterventionsStrength group (STRENGTH): free weights and gym equipment
Control group: usual activities.
Duration and intensity: intervention groups - 1 hour x 3 days a week (24 - 26 weeks).
Supervisor: not stated.
Supervision: group.
Setting: gym/ clinic.
OutcomesAbility to walk on wide and narrow beams.
Balance in parallel, semi tandem and tandem stance (s).
Single legged stance (s)
Gait speed (m/min).
Tilt board AP and OMNI directional (s).
NotesTrial had 4 arms. Part of FICSIT study see Buchner 1993
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Buchner 1997b
MethodsRCT.
Method of randomisation not known.
Assessors blinded.
Losses: 4 of 106.
Intention to treat analysis.
ParticipantsN = 106.
Age: mean 75 control, 75 cycle, 74 walk, 75 aerobic.
Sex: females - 50% control, 54% cycle, 54% walk, 54% aerobic.
Setting: USA.
Inclusion: sedentary, 68 - 85 years, mild balance deficit.
Exclusion: regular exercise, cardiovascular, pulmonary, vestibular and bone disease, dependency terminal illness, unable to speak English, positive cardiac stress test, body weight greater than 180% of ideal.
InterventionsControl group: usual activity
Cycling group (CYCLING): static cycle
Walking group (WALKING): outdoors
Dance movement group (3D): to music
Duration and intensity: intervention groups - 1 hour x 3 per week for 3 months.
Supervisor: not stated.
Supervision: group.
Setting: gym/clinic.
OutcomesOMNI tilt board (s).
Walking on wide beam (m/s).
Walking on narrow beam (m/s).
Force plate - eyes open, eyes closed (area mm2/s: average radius mm).
AP tilt board (s)
Gait speed (m/min)
NotesPart of FICSIT study see Buchner 1993
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Cress 1999
MethodsRCT.
Method of randomisation not known.
Blinding not known.
Losses: 7 of 56.
Intention to treat analysis.
ParticipantsN = 56
Age: mean (SD) 76 (4).
Sex: not stated.
Setting: USA.
Inclusion: 70 years and above, good health, living in retirement community or apartment.
Exclusion: unstable cardiovascular or metabolic disease, recent unhealed fractures, other disorders, life expectancy less than 1 year, excessive alcohol, non English speaking.
InterventionsExercise group (STRENGTH): combined endurance and resistance.
Control group: none exercising.
Duration and intensity: 1 hour x 3 per week for 6 months.
Supervisor: not stated.
Supervision: group.
Setting: community.
OutcomesUsual walking speed (m/s).
Time on 9 m beam (s).
FRT (cm).
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Crilly 1989
MethodsRCT.
Randomised by random tables.
Blinding not known.
Losses: 14 of 50
ParticipantsN = 50
Age: mean 82, range 71 - 92.
Sex: female.
Setting: Canada.
Inclusion: over 70 years, ability to ambulate independently, good eyesight and hearing, understand instruction, ability to participate in exercise programmes.
Exclusion: no specific criteria.
InterventionsExercise group (GBFT): exercise aimed at improving breathing, single and double limb balance, co-ordination, flexibility, strength and relaxation.
Control group: usual activity.
Duration and intensity: exercise group - 15 - 35 minutes x 3 week for 3 months.
Supervisor: physiotherapist.
Supervision: group.
Setting: institutional.
OutcomesPostural sway during quiet standing on force plate - eyes open, eyes closed - RMS ML and AP (mm)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Islam 2004
MethodsRCT.
Method of randomisation not known.
Blinding not known.
Losses: 4 prior to testing
ParticipantsN = 43
Age: 69 - 89 years
Sex: 20 male, 19 female.
Setting: Japan
Inclusion: healthy
Exclusion: taking medication, signs or symptoms of diagnosed disease.
InterventionsExercise group (GBFT): balance exercises designed to challenge the visual (e.g. opened /closed eyes), vestibular (e.g. move head), somatosensory (e.g. stand on foam) and muscular (e.g. standing on one leg, bending body in different directions) systems. Exercises were initially performed while standing on the floor (first 4 weeks) and then progressed to standing.
Control group: usual activity.
Duration and intensity: 2 sessions per week for 60 minutes for 12 weeks.
Supervisor: fitness instructor
Supervision: individual
Setting: gym
OutcomesMaximum excursion of LOS (forward, backward, right, left)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Jessup 2003
MethodsRCT.
Method of randomisation - parallel design, random number table designed by Burns and Grove.
Assessors blinded to randomisation but aware of which group participants were allocated to.
Losses: 2 of 18.
ParticipantsN = 18
Age: mean (SD) 69.2 (3.5).
Sex: female.
Setting: USA
Inclusion: healthy women not taking hormone or osteoporosis medication, or done so in the last 12 months, no regular exercise in the last 12 months.
Exclusion: medical history or physical examination revealing cardiac or pulmonary, endocrine, neuromuscular or orthopaedic conditions or dextra results indicating contra indication, visual acuity test less than 20/50, mini mental test less than 20, inability to retain Romberg stance for 20 seconds without losing balance, alcohol or drug abuse, smokers, psychiatric conditions.
InterventionsExercise group (MULTIPLE): Strength exercises began with 8 to 10 repetitions at 50% of pretest 1RM score on progressed to 75%. Load-bearing walking, stair-climbing and balance -training exercises, wearing weighted vests after 2 weeks. Balance-training exercises, in walking.
Control group: usual activities of daily living.
Duration and intensity: 3 sessions (60 - 90 mins) per week for 32 weeks
Supervisor: research assistant and co investigator
Supervision: group
Setting: gym
OutcomesBody sway (cm)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?YesA - Adequate




Johansson 1991
MethodsRCT.
Method of randomisation not known.
Assessors blinded to experimental design and pre test scores.
Losses: 1 of 34.
ParticipantsN = 34
Age: 70 years old
Sex: female
Setting: Sweden
Inclusion: healthy volunteers aged 70 years.
Exclusion: neurological disease, amputation, severe pain in legs.
InterventionsExercise group (MULTIPLE): walking different directions at different speeds, combined with movement of the arms, neck and trunk. Exercise to music including weight transfer exercises while sitting and standing and rising from and sitting down in a chair, were performed.
Control group: usual activity
Duration and intensity: exercise group - 1 hour, twice a week, for 5 weeks.
Supervisor: physiotherapist
Supervision: group
Setting: gym
OutcomesSingle legged stance - eyes open, eyes closed (s)
Walking along a beam (m)
Walking for 30 metres (s)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Krebs 1998
MethodsRCT.
Method of randomisation: not known.
Assessors blinded.
Losses: 12 of 132
ParticipantsN = 132
Age: mean 74.3 years
Sex: 31 male, 89 female.
Setting: USA
Inclusion: Community dwelling, 60 years plus, reported one or more functional limitations on SF36 physical function scale, no medical history contraindicating exercise, no current rehab.
Exclusion:
InterventionsExercise group (STRENGTH): strong for life programme, 35 minute video of 11 exercises, resistance elastic bands, functional movement patterns simulate to PNF, arms and legs, therapists supervised 2 home visits then telephone contact.
Control group: usual activity
Duration and intensity: 6 months
Supervisor: therapist
Supervision: self and therapist (therapists supervised 2 home visits then telephone contact).
Setting: home
OutcomesGait velocity (cm/s).
NotesCompliance 78%
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Lichtenstein 1989
MethodsQuasi RCT.
Method of randomisation: Random Number table to recruit participants from sample then group randomised by apartment building n = 2 by coin toss.
Assessors blinded.
Losses: 7 of 50
ParticipantsN = 50
Age: mean 76.7
Sex: Female
Setting: USA
Inclusion: Women, 65 years or older, single (never married, divorced, separated, widowed) and living alone
Exclusion: History of Parkinson or Stroke, had any loss of limb, were unable to walk independently or with use of cane
InterventionsExercise group (GBFT): stretching, "static balance" (e.g. standing on one leg), "active balance" (e.g. using tandem heel/toe gait, walking along a line), "response exercises" (e.g. performing maneuvers in response to changing colour signals), walking and cool-down and relaxation.
Control group: usual activity
Duration and intensity: sessions were 1 hr, 3 x week for 16 weeks.
Supervisor: investigator
Supervision: group
Setting: community
OutcomesSingle legged stance - eyes open, eyes closed on force platform
Average XY area per second (square inches/s
Average radial area per second (square inches/s)
Average velocity (inches/s)
NotesCompliance median 85% range 0-142%
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?YesA - Adequate




Lord 1995
MethodsRCT.
Method of randomisation. Participants were drawn from a health insurance membership database in Northern Sydney. They were randomised in matched blocks n = 20.
Assessors blinded.
Losses: 46 of 197.
ParticipantsN = 197.
Age: 60 - 85 years mean (SD) 71.6 (5.4)
Sex: females
Setting: Australia
Inclusion: 60 years plus in community dwelling.
Exclusion: not living at dwelling of time of study, little English.
InterventionsExercise group (MULTIPLE): improving strength, flexibility, co-ordination, and balance, the individualised exercise regimes were based on participant's falls risk profile.
Control group: no information assumed usual activity
Duration and intensity: sessions 1 hr 2 x week for 12 months
Supervisor: accredited fitness instructor
Supervision: group
Setting: community
OutcomesPostural sway eyes open and eyes closed on floor and foam (cm) (Lord sway meter)
Maximal balance range (cm)
Co-ordinated stability test (errors)
NotesCompliance: mean 73.2% across the groups
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Lord 2003
MethodsCluster RCT.
Randomisation was stratified by accommodation status (self care of intermediate care) and cluster size. There were 20 clusters 7 self care and 3 intermediate care exercise clusters 20 clusters 7 self care and 3 intermediate care control clusters.
Blinded person organising randomisation not involved in rest of trial
Losses: 43 out of 551
ParticipantsN = 551, factorial design 280 allocated to relevant arms
Age: range 62-95 mean (sd) 79.5 (6.4) years
Sex: 77 male, 474 female
Setting: Australia
Inclusion: living in retirement village,
Exclusion: mini mental score <20, mental condition involving neuromuscular, skeletal, or cardiovascular system, in hospital or not present at the time of recruitment, already attending exercise class of equivalent intensity
InterventionsExercise group (MULTIPLE): warm-up period, conditioning period including aerobic exercises, specific strengthening exercises, and activities for balance, hand-eye and foot-eye coordination, and flexibility.
Control group 1: Took part in a flexibility and relaxation program.
Control group 2: No input assumed usual activity
Duration and intensity: exercise group and control group 1: sessions 1 hour twice a week for 12 months.
Supervisor: exercise group: trained instructor, control group 1 - yoga instructor.
Supervision: group
Setting: community
OutcomesPostural sway on floor and foam eyes open and eyes closed (mm) (Lord sway meter)
Co-ordinated stability test (errors).
Maximum balance range (cm)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?YesA - Adequate




Lord 2005
MethodsRCT.
Randomised in matched blocks using concealed allocation, drawing lots.
Assessors blinded.
Losses: 144 of 620
Intention to treat analysis.
ParticipantsN = 620
Age: 75 - 98, mean (SD) 80.4 (4.5).
Sex: females 409, males 211.
Setting: Australia
Inclusion: 75 years plus, community living
Exclusion: minimal English language skills, blind, Parkinson, short portable mini mental test less than 7, and not considered risk of falling.
InterventionsExercise group (MULTIPLE): based on falls risk profile, individualised exercises aimed at improving strength, and balance and or vision if a problem, peripheral warm up, conditioning, strength, flexibility, coordination and balance.
Minimal intervention group: instruction sheets for home exercise.
Control group: usual activity
Duration and intensity: sessions 1hr x 2 week for 12 months (only data for initial 6 months reported)
Supervisor: trained supervisor
Supervision: group
Setting: community
OutcomesPostural sway on floor and foam eyes open and eyes closed (mm) (Lord sway meter)
Co-ordinated stability test (errors)
NotesThree arms to this study: we have reported the enhanced intervention group
only data on balance outcomes for initial 6 months reported.
Compliance with exercise: median 21 of 78.
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?YesA - Adequate




MacRae 1994
MethodsRCT.
Quasi-randomised by senior centre.
Assessors blinded.
Losses: 21 of 80.
ParticipantsN = 80
Age: exercise group - mean 72.4, control group - mean 70.
Sex: females
Setting: USA
Inclusion: medical clearance, 60 years plus attending a senior centre.
Exclusion: physicians advice.
InterventionsExercise group (GBFT): stand up/step up routine designed to improve strength and balance with warm up and cool down.
Control group: attention control group
Duration and intensity: exercise group - 1 hour sessions 3 days a week for 12 months, control group - one hour weekly for 12 months.
Supervisor: exercise instructor
Supervision: group
Setting: gym
OutcomesOne legged stance (s)
Self paced gait velocity (m/s)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?YesA - Adequate




McGarry 2001
MethodsRCT
Method of randomisation not known.
Blinding not known.
Loss: not stated
ParticipantsN=22
Age: mean 74.77 (range 60-87) years
Sex: 16 female, 6 males
Setting: USA
Inclusion: not stated
Exclusion: not stated
InterventionsExercise group (GBFT): "Get off your Rocker" balance class, including single leg stance, Swiss ball, tandem walking.
Control group: usual activity.
Duration and intensity: 3 sessions per week for 6 weeks.
Supervisor: physical therapist
Supervision: group
Setting: ?gym
OutcomesBBS (score)
FRT (cm)
TUG (s)
NotesAbstract only
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearD - Not used




McMurdo 1993
MethodsRCT
Randomised homes by sealed envelopes based on computer generated numbers, participants allocated in blocks of 4 by gender and age (70-79 and 80+)
Assessors blinded.
Losses: 8 of 49.
ParticipantsN = 49
Age: mean 81 (range 64 - 91) years.
Sex: 33 females, 8 males.
Setting: UK
Inclusion: in residential care
Exclusion: residents with severe communication difficulties.
InterventionsExercise group (GEN ACTIVITY): All exercises were performed seated. Warm-up, exercises designed to put joints in upper and lower limbs through their full range of movements. As the study progressed participants were encouraged to sustain muscle contractions for longer and increase number of repetitions.
Control group: attended reminiscence sessions
Duration and intensity: exercise group - 45 minutes twice weekly for six months, control group - for 45 mins twice weekly for 6 months.
Supervisor: not stated.
Supervision: group
Setting: residential home
OutcomesPostural sway - eyes open and eyes closed.
NotesCompliance mean 91% exercise sessions
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Nelson 2004
MethodsRCT.
Stratified block randomisation by gender and age (70 - 79, 80 plus)
Assessors blinded.
Losses: 4 of 72.
ParticipantsN = 72
Age: over 70 years
Sex: 27 female
Setting: USA
Inclusion: > 70 exercising no more than 1 day/week community dwelling must have 2 functional limitations and score 10 or less on EPESE.
Exclusion: Unstable cardiovascular disease, psychiatric disorders, neurological or muscular diseases, terminal illness, cognitive impairment.
InterventionsExercise group (MULTIPLE): balance and strength using free weights working at 7/8 on a 10 point Borg Scale, tandem walks, running etc, plus 120 minutes physical activity per week .
Control group: attention via nutritional education booklet.
Duration and intensity: exercise programme - 3 times a week for 6 months plus 120 minutes physical activity per week.
Supervisor: exercise physiologist
Supervision: exercise group - individual self paced, 6 home visits in the 1st month and then monthly, attention control - 2 home visits in 1st month and then monthly.
Setting: home.
OutcomesTandem walk (over 20 feet) (s).
One legged stance (max 30 s).
Maximum gait speed (over 2 m).
NotesCompliance mean 82%.
Adverse events 1 fell in exercise group and 1 food poisoning in control group.
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Okumiya 1996
MethodsRCT.
Method of randomisation not known.
Assessors blinded.
Losses: 6 of 42
ParticipantsN = 42
Age: 75 - 87 years, mean 79
Sex: 18 males, 24 females.
Setting: Japan.
Inclusion: 75 years and over.
Exclusion: evidence of coronary artery disease or severe obstructive airways.
InterventionsExercise group (GEN ACTIVITY): warm up, light aerobic exercise, exercises aimed at improving neuromotor co-ordination, and muscle-strengthening exercises, cool down.
Control group: usual activity.
Duration and intensity: exercise group - 60 minute session twice a week for 24 weeks.
Supervisor: one physical educator, one medical doctor, and 5 nurses.
Supervision: group
Setting: community
OutcomesTUG (s)
Functional Reach Test (cm)
NotesCompliance mean 86% (59-100%)
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Paillard 2004
MethodsRCT.
Method of randomisation not known.
Blinded not known.
Losses: not stated.
ParticipantsN = 21
Age: 63 - 72 years
Sex: males
Setting: France
Inclusion: active in physical exercise 3 hours per week, good condition for their age.
Exclusion: medical contra indications.
InterventionsExercise group (WALKING): individual walking programme determined by lactate levels during VO2 max test
Control group: usual activities
Duration and intensity: 45 - 60 minutes x 5 times a week x 12 weeks.
Supervisor: not stated.
Supervision: self.
Setting: home.
OutcomesForce platform - dynamic test, lateral and AP.
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Ramsbottom 2004
MethodsRCT.
Randomised by random number tables.
Assessors not blinded.
Losses: 8 of 22.
Intention to treat analysis.
ParticipantsN = 22
Age: over 70 years.
Sex: 7 males, 15 females.
Setting: UK.
Inclusion: Normal, sedentary over 70 years, community dwelling.
Exclusion: risk of taking PRE, physically active.
InterventionsExercise group (MULTIPLE): free weights to strengthen and develop power in shoulder, hip adductors/abductors/flexors/extensors, knee flexor/extensors, increasing in repetitions, functional mobility, stretching and balance exercises.
Control group: usual activities.
Duration and intensity: 2 x a week for 24 weeks.
Supervisor: keep fit association registered teacher.
Supervision: group.
Setting: community.
OutcomesPostural sway on BPM
TUG (s)
FRT (cm)
NotesAdherence - mean (SD) 43 (3) classes (max 48)
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?YesA - Adequate




Reinsch 1992
MethodsRCT.
Randomised by senior centre (n = 16).
Blinding not known.
Losses: 46 of 230.
Intention to treat analysis.
ParticipantsN = 230.
Age: 60 years plus.
Sex: 185 female, 45 male.
Setting: USA.
Inclusion: 60 years and over, attending senior centres (n = 16).
Exclusion: none reported.
InterventionsExercise group (GBFT): stand up and step ups functional exercises.
Control group: discussion.
Duration and intensity: both groups 1 hour, 3 times per week for 12 months.
Supervisor: college students.
Supervision: group
Setting: community in senior centres.
OutcomesSingle legged stance (s).
NotesTrial had 4 arms: others included CBT only, exercise plus CBT.
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Rooks 1997a
MethodsRCT.
Randomised by unbalanced 3 group block randomisation (due to expected higher attrition rate in control group every 13th volunteer was allocated to control group).
Blinded not known.
Losses: 38 of 131.
Intention to treat analysis.
ParticipantsN = 131.
Age: 65 - 95 years.
Sex: % female = 59 resistance group, 52 walking group, 82 control group.
Setting: USA
Inclusion: 65 years plus, climb a flight of stairs, participate in regular activities outside home a minimum 2 x week, transport to community centre.
Exclusion: use of medication comprising safety or ability to complete study, uncontrolled or unstable chronic conditions.
InterventionsResistance training group (STRENGTH): stair climbing with resistance, seated knee extension, standing, standing knee extension.
Walking group (WALKING): walking own pace on level ground.
Control group: on a waiting list for exercise programme.
Duration and intensity: resistance training group and walking group - 1 hour, 3 times per week for 10 months.
Supervisor: research assistant.
Supervision: group (5-6).
Setting: community.
OutcomesTandem stance (s).
Single legged stance - eyes open and eyes closed (s).
Timed forward tandem walk (10 feet).
Notes% Compliance resistance training group - 85 (47 - 100), walking group - 82 (29 - 97)
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Rubenstein 2000
MethodsRCT.
Randomly generated sequence of cards in sealed envelopes.
Assessors blinded.
Losses: 4 - 7 of 59.
ParticipantsN = 59.
Age: mean (SD) 74.4 (43.4) - control group, 76.4 (4.9) - exercise group.
Sex: male.
Setting: USA.
Inclusion: 70 years plus, lower extremity weakness, impaired gait, impaired balance, one fall in previous 6 months.
Exclusion: regular exercises, severe cardiac or pulmonary disease, terminal illness, severe joint pain, dementia, medical unresponsive depression, progressive neurological disease.
InterventionsExercise group (MULTIPLE): PRE, hip, knee and ankle, endurance training bike, treadmill, indoor walking and balance training.
Control group: usual activities.
Duration and intensity: exercise group - 90 minutes, 3 times per week x 12 weeks.
Supervisor: exercise physiology students.
Supervision: group.
Setting: clinic.
OutcomesSingle legged stance (s) (for max 15 s)
NotesSD 43.4 years for control group age, might be a typo in original paper
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?YesA - Adequate




Sauvage 1992
MethodsRCT.
Method of randomisation not known.
Assessors blinded.
Losses: 2 of 14.
ParticipantsN = 14
Age: mean (SD) exercise group - 73.38 (4.04), control group - 73.83 (4.74).
Sex: male.
Setting: USA.
Inclusion: Recruited from Veterans Nursing Home. Aged over 60 years, independently mobile, gait and balance difficulties (Tinetti score greater than 30), lower extremity weakness.
Exclusion: moderate to severe dementia, asymmetrical focal neurolic deficits, lower extremity amputation, leg length discrepancies, significant systemic disease.
InterventionsExercise group (MULTIPLE): PRE and aerobic conditioning (>70% exercise stress tested maximal HR) using gym equipment and ergometers.
Control group: usual activity.
Duration and intensity: 45 - 75 minutes, 3 times per week x 12 weeks.
Supervisor: not stated
Supervision: group (3 -4).
Setting: Institutional.
OutcomesAverage gait velocity (cm/s) over 20 feet. (right and left).
COP movement during quiet stance - eyes open, eyes closed (mm).
NotesCompliance 95% for exercise group
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Schoenfelder 2004
MethodsRCT.
Method of randomisation not known (matched pairs by risk assessment for falls).
Assessors blinded.
Losses: 37 of 81.
ParticipantsN = 81
Age: 64 - 100 years, mean 84.1.
Sex: 62 female, 19 male.
Setting: USA.
Inclusion: Recruited from nursing homes, 65 years and over, independent ambulators, English speakers, scored 20 plus on MMSE.
Exclusion: unstable physical conditions.
InterventionsExercise group (MULTIPLE): strength and endurance training plus 10 minutes walking.
Control group: attention placebo.
Duration and intensity: exercise group - 15 -20 minutes, 3 times per week x 3 months. Control group - 30 minutes weekly x 3 months.
Supervisor: student nurses.
Supervision: individual.
Setting: institutional.
OutcomesParallel stance (max 10s) (s).
Semi tandem stance (max 10s) (s).
Tandem stance (max 10s) (s).
Walking speed over 6 metres (m/s).
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Shigematsu 2002
MethodsRCT.
Randomised by centre.
Blinding not known.
Losses: none reported.
ParticipantsN = 38
Age: 72 - 87 years (mean 78.6 exercise group, 79.8 control group)
Sex: female
Setting: Japan.
Inclusion: over 70 years, living independently, no cardiovascular problems, not exercising regularly, must be attending silver club.
Exclusion:
InterventionsExercise group (3D): aerobic dance to music
Control group - not stated (assumed usual activity).
Duration and intensity: 1 hour 3 times per week x 3 months.
Supervisor: exercise specialist.
Supervision: group.
Setting: community.
OutcomesSingle legged stance - eyes open, eyes closed (s).
Functional reach test (cm).
NotesCompliance with exercise 78.8%
Measures reported in Shigematsu 2000 - Age scale for assessing functional fitness in older Japanese ambulatory women. Ageing Clin Ex Res 12, 256-263.
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?YesA - Adequate




Shimada 2004
MethodsRCT.
Randomised by random number tables.
Assessors not blind.
Losses: 6 of 32
ParticipantsN = 32
Age: 66 -98 years
Sex: 25 female, 7 male.
Setting: Japan.
Inclusion: ambulatory residents or attending a geriatric health facility, high risk for falls, decreased balance, gait and muscle strength
Exclusion: unable to walk for 3 mins at 0.5 km/hr, health problems or dementia
InterventionsExercise group (WALKING):- gait training on a bilateral separated treadmill
Control group: usual care
Duration and intensity: 1-3 times per week for 6 months
Supervisor: physiotherapist.
Supervision: individual.
Setting: institutional.
OutcomesSingle legged stance (s).
FRT (cm).
Walking speed over 10 m (m/s)
NotesData not reported appropriately for walking speed.
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearD - Not used




Sihvonen 2004
MethodsRCT.
Randomised in blocks by drawing lots.
Blinding not known.
Losses:1 of 28.
ParticipantsN = 28
Age: mean (SD) 80.7 (6.1) - exercise group, 82.9 (4.2) control group.
Sex: female.
Setting: Finland.
Inclusion: resident at two care homes, 70 years and over, able to stand and walk without walking aid.
Exclusion: health problems.
InterventionsExercise group (GBFT): dynamic exercise on force platform and training device with visual feedback on movement on COP.
Control group - usual activity.
Duration and intensity: 20 - 30 minutes session, 3 times per week for 4 weeks.
Supervisor: not stated.
Supervision: individual.
Setting: institutional.
OutcomesAP and ML velocities of sway and velocity moment in 6 standing balance tests.
Performance time and distance in 3 dynamic balance tests.
BBS (points).
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Suzuki 2004
MethodsRCT
Randomisation by random number tables
Assessors blinded.
Losses: 8 of 52
Intention to treat analysis
ParticipantsN=52
Sex: female
Age: mean (SD) 77.31 (3.4) exercise, 78.64 (4.39) control
Setting: Japan
Inclusion: 73-90 years, participants in longitudinal study on aging.
Exclusion: marked decline in ADL, hemiplegia, missing baseline data.
InterventionsExercise group (MULTIPLE): exercise centred falls prevention programme with home based exercise aimed at enhancing muscle strength, balance and gait. Included resistance exercise and Tai Chi.
Control group: usual activity and a pamphlet and advice on falls prevention.
Duration and intensity: 1 exercise session every 2 weeks for 6 months (10 hours).
Supervisor: not stated.
Supervision: group and self.
Setting: community
OutcomesSingle legged stance (s), eyes open (max 1 min), eyes closed (max 30 sec) (s)
Walking speed (over 11 m) (m/s).
Tandem walk (over 2.5m) (steps)
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Wolf 1997
MethodsRCT.
Method of randomisation not known.
Blinding not known.
Losses not stated.
ParticipantsN = 72.
Age: mean (SD) 77.7 (6.5) balance group, 75.2 (4.9) education group, 77.7 (5.2) Tai Chi group.
Sex: 60 females, 12 males.
Setting: USA.
Inclusion: over 70 years, free from progressive debilitating processes, able to walk across a room independently, residing in independent living centre.
Exclusion:
InterventionsBalance group (GBFT): force platform standing moving target via cursor excursions eyes open and closed.
Control group - discussion of topics and socialisation.
Tai Chi group (3D): Tai Chi quan - 10 forms.
Duration and intensity: 1 hour every week x 15 weeks.
Supervisor: instructor.
Supervision: group.
Setting: gym.
OutcomesChattex balance system to measure: quiet standing eyes open, eyes closed
NotesPart of Atlanta FICSIT site study.
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear




Wolf 2001
MethodsRCT.
Randomised by sealed envelopes post stratification, selected by blind folded person.
Assessors blinded.
Losses: 45 of 94.
Intention to treat analysis.
ParticipantsN = 94.
Age: mean (SD) exercise group - 84.5 (6.1), control group - 83.6(5.1).
Sex: 56 female, 21 male.
Setting: Netherlands.
Inclusion: 75 years and over, minimal loss of visual acuity, no acute illness, no physical therapy in previous month, minimum of 17 on MMSE, BBS < 52, impaired balance during function.
Exclusion:
InterventionsExercise group (GBFT): exercise in sitting, standing and walking, in a variety of situations to test balance.
Control group - reading and board games.
Duration and intensity: 30 minutes 2-3 times per week x 4-6 weeks (10 sessions).
Supervisor: therapist and trainers.
Supervision: individual.
Setting: gym or home.
OutcomesBBS (points) out of 56.
Notes
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?YesA - Adequate




Wolfson 1996
MethodsRCT.
Randomised by blocked allocation schedule stratified by gender using the Moses - Oakford algorithm.
Assessors blinded.
Losses: unclear.
ParticipantsN = 110.
Age: mean (SD) 79 (5).
Sex: 58% male.
Setting: USA.
Inclusion: 75 years and over, community dwelling, free of clinically detectable disease affecting balance.
Exclusion: inability to walk 8 metres without assistance, other diseased affecting mobility, dementia.
InterventionsBalance group (GBFT): PRObalancemaster with COP feedback, standing and sitting including gym ball eyes open and eyes closed with and without perturbations and gait on foam and narrow beams.
Strength group (STRENGTH): stretching and PRE with sand bags for hip and knee.
Balance and strength group (MULTIPLE): PRObalancemaster with COP feedback, standing and sitting including gym ball eyes open and eyes closed with and without perturbations and gait on foam and narrow beams and stretching and PRE with sand bags for hip and knee.
Educational control group: usual activities, sessions on fall prevention and stress management.
Duration and intensity: balance only and strength only groups 45 mins x 3 times per week x 3 months. Balance and strength group - 45 mins (strength) plus 45 mins (balance) x 3 times per week x 3 months. Educational control group - 5 x 90 minute education sessions. All groups - 6 months Tai Chi maintenance.
Supervisor: not stated.
Supervision: balance training - individual, strength training - group.
Setting: gym.
OutcomesLoss of Balance during sensory organisation test.
Functional base of support.
Single legged stance time (s).
Usual gait velocity (m/s).
NotesPart of FICSIT trials.
Compliance - mean (SD) balance 74 % (26), strength 82 % (21), balance and strength 82 % (16), control near perfect.
All subjects including those in control group participated in 6 month Tai Chi following the 3 month intervention phase.
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?YesA - Adequate




Zhang 2006
MethodsRCT.
Randomised by tossing a coin after pairing by sex, falls and exercise habits.
Blinding not known.
Losses: 2 of 49.
ParticipantsN = 49.
Age: mean (SD) 70.2 (3.6) Tai Chi, 70.6 (4.9) control.
Sex: 25 male, 24 female.
Setting: Japan.
Inclusion: Community dwelling, scoring 20 -25 seconds on one legged stance time.
Exclusion:
InterventionsExercise group (3D): Tai Chi simplified form of 24 forms plus 11 easy forms at home.
Control group - usual activities.
Duration and intensity: 1 hour, 7 times per week for 8 weeks.
Supervisor: Tai Chi instructor.
Supervision: group and self.
Setting: community in park and home.
OutcomesOne legged stance eyes open (max 60 s).
Walking speed (10 metres).
NotesSubjects from earlier study by Zhang et al 2003
Compliance - 91.7% practiced 4 plus hours per week.
Risk of bias
ItemAuthors' judgementDescription
Allocation concealment?UnclearB - Unclear
 ABBREVIATIONS AND ACRONYMS:
1RM - One repetition maximum score
3D - 3D exercise including tai chi, qi gong, dance, yoga
ADL - Activities of Daily Living.
AP - Anterior - Posterior
BBS - Berg Balance Scale
BPM - Balance Performance Monitor
cm - centimetres
CoM: Body's centre of mass
COP - Centre of Pressure.
COPD - Chronic Obstructive Pulmonary Disease
EPESE - Established Populations for the Epidemiologic Studies of the Elderly short physical performance battery
Ex - Exercise
FRT - Function Reach Test
GBFT - Gait, balance, functional tasks
GEN ACTIVITY - general physical activity
HR - Heart Rate
Hr - hour
Km- kilometres
LOS - Locus Of Support
min - minute
ML - medio-lateral
mm - millimetres
MMSE - Mini Mental Status Examination.
m/s - metres per second
NSD - no significant difference
PNF - proprioceptive neuromuscular facilitation
PRE - Progressive Resistance Exercise.
RCT - Randomised Controlled Trial
RMS - root mean squared
s - seconds
SD - Standard Deviation
SLS - Single Legged Stance
SMD - standardised mean difference
STRENGTH - strength training including resistance or power training
TUG - Timed up and go test
WMD - weighted mean difference


 
Characteristics of excluded studies [ordered by study ID]
StudyReason for exclusion
Alexander 2001aRCT but no specific balance outcomes
Alexander 2001bRCT no suitable outcome measures
Allen 1999Description of study no data reported
Anonymous 2002Summary of Day 2002
Au-Yeung 2002Control group received some exercise
Ballard 2004Control group received some exercise
Barnett 2003Control group had home exercise
Barrett 2002Control group received some exercise
Bean 2004Comparison of different exercise types , no control group
Binder 2002Control group had home exercise
Bonnefoy 2003Trial of energy supplements all participants received supplement or placebo
Brown 2000Control group received some exercise
Bruyere 2005Intervention not exercise
Buchner 1993Description of methodology no data
Campbell 1999No suitable balance outcome measures
Cornillon 2002Not appropriate outcome measures
Day 2002No control group
De Vreede 2004Comparison of exercise types, no control group
Devereux 2005osteoporotic participants
DeVito 2003No measures
Dyer 2004Multifactorial falls programme
Earles 2001No control group
Fiatarone 1993FICSIT study multi-nutrient supplementation no data presented
Gill 2002No specific balance outcome measures
Gras 2004No control group
Greendale 2000Comparison of weighted vests
Hauer 200361% of participants had hip fracture or lower extremity fracture
Helbostad 2004aNo specific balance outcome measures
Helbostad 2004bNo control group
Hinman 2002No control group
Hornbrook 1993Description of study
Hu 1994No exercise intervention
Jones 1992No appropriate outcome measures of balance
Judge 1993aControl group received flexibility training
Judge 1993bNo specific balance outcome measures
Judge 1994No specific balance outcome measures
King 2002Control group had home exercise
Kovacs 2004No specific balance outcome measures
Kutner 1997No specific balance outcome measures
LaStayo 2003Participants had received cardiopulmonary rehabilitation for prior medical conditions.
Latham 2001Control group had PT
Lazowski 1999Control group had exercise
Li 2002No specific balance outcome measures
Li 2005aIntervention under investigation cobblestone mat
Li 2005bControl group had stretching
Lindemann 2004Control group had exercise programme
Liu-Ambrose 2004all participants had low bone mass
Marigold 2005Participants were chronic stroke patients
McMurdo 1994No measures
McMurdo 2000Primary outcome falls no primary outcome measure for balance
Means 1996No specific balance outcome measures
Means 2005No specific balance outcome measures
Messier 2000Participants had osteoarthritis
Morgan 2004No measures
Mulrow 1994No measures
Nitz 2004Control group had exercise
Ourania 2003Not randomised
Paillard 2005Investigating effects of electrical stimulation
Prasansuk 2004Participants had balance disorders
Ramsey 2003Participants were visually impaired
Robbins 2001Commentary on Robertson 2001
Rooks 1997bNo control group
Ryushi 2000Age range from 41 years to 53 years.
Shaughnessy 1998Commentary on Campbell 1997
Shimada 2003Control groups received exercise
Signorile 2002No specific balance outcome measures
Simmons 1996Water versus land based exercise
Simons 2006No appropriate outcome measures of balance
Skelton 1999Description of FAME programme no data reported
Sohng 2003Control group had video programme
Steadman 2003Control group had PT
Steinberg 2000No specific balance outcome measures
Szturm 1994Participants with chronic peripheral vestibular disfunction
Timonen 2002Control group had home exercise
Tinetti 1994No specific balance outcome measures
Udani 1998Commentary on Wolf 1996
Verfaillie 1997No control group
Williams 2002Control group had exercise
Wolf 1996No specific balance outcome measures
Wolf 2003No specific balance outcome measures
Yates 2001Multifactorial intervention


 
Comparison 1. Gait, balance, co-ordination, functional tasks exercise versus control
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 AP stability during stance (quiet and dynamic) eyes open: lower values indicate better balance ability3Std. Mean Difference (IV, Random, 95% CI)Subtotals only
    1.1 Immediately post intervention
3116Std. Mean Difference (IV, Random, 95% CI)-0.71 [-1.33, -0.09]
    1.2 Follow-up @ 6 weeks post intervention
130Std. Mean Difference (IV, Random, 95% CI)-0.63 [-1.37, 0.10]
    1.3 Follow-up @ 4 months post intervention
135Std. Mean Difference (IV, Random, 95% CI)-0.96 [-1.67, -0.26]
 2 Mediolateral stability during stance (quiet and dynamic) eyes open: lower values indicate better balance3Std. Mean Difference (IV, Random, 95% CI)Subtotals only
    2.1 Immediately post intervention
3116Std. Mean Difference (IV, Random, 95% CI)-0.39 [-0.98, 0.20]
    2.2 Follow-up @ 6 weeks post intervention
130Std. Mean Difference (IV, Random, 95% CI)-0.68 [-1.42, 0.06]
    2.3 Follow-up @ 4 months post intervention
135Std. Mean Difference (IV, Random, 95% CI)1.09 [0.37, 1.81]
 3 AP stability during quiet stance eyes closed: lower values indicate better balance ability2Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    3.1 Immediately post intervention
282Std. Mean Difference (IV, Fixed, 95% CI)-0.32 [-0.77, 0.12]
    3.2 Follow up @ 4months post intervention
135Std. Mean Difference (IV, Fixed, 95% CI)-0.13 [-0.79, 0.54]
 4 Mediolateral stability during quiet stance eyes closed: lower values indicate better balance ability2Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    4.1 Immediately post intervention
282Std. Mean Difference (IV, Fixed, 95% CI)-0.17 [-0.60, 0.27]
    4.2 Follow up @ 4 months post intervention
135Std. Mean Difference (IV, Fixed, 95% CI)-0.15 [-0.82, 0.51]
 5 Functional base of support during dynamic test (distance): higher values indicate greater balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    5.1 Immediately post intervention
135Mean Difference (IV, Fixed, 95% CI)0.12 [0.05, 0.19]
    5.2 Follow-up @ 6 months post intervention
133Mean Difference (IV, Fixed, 95% CI)0.08 [0.01, 0.15]
 6 Loss of balance during sensory organisation test (errors): less errors indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    6.1 Immediately post intervention
153Mean Difference (IV, Fixed, 95% CI)-1.1 [-2.24, 0.04]
    6.2 Follow-up @ 6 months post intervention
147Mean Difference (IV, Fixed, 95% CI)-1.1 [-2.16, -0.04]
 7 Maxium excursion of limits of stability (LOS) test: higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    7.1 Forward
129Mean Difference (IV, Fixed, 95% CI)20.10 [8.66, 31.54]
    7.2 Backward
129Mean Difference (IV, Fixed, 95% CI)8.90 [-1.77, 19.57]
    7.3 Right
129Mean Difference (IV, Fixed, 95% CI)19.0 [9.02, 28.98]
    7.4 Left
129Mean Difference (IV, Fixed, 95% CI)12.80 [4.10, 21.50]
 8 Single leg stance eyes open (force platform measures): lower values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    8.1 Average XY area per second (square inches per second)
142Mean Difference (IV, Fixed, 95% CI)0.02 [-0.57, 0.61]
    8.2 Average radial area per second (square inches per second)
142Mean Difference (IV, Fixed, 95% CI)-0.05 [-0.26, 0.16]
    8.3 Average velocity (inches per second)
142Mean Difference (IV, Fixed, 95% CI)0.12 [-0.62, 0.86]
 9 Single leg stance eyes closed (force platform measures): lower values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    9.1 Average XY area per second (square inches per second)
139Mean Difference (IV, Fixed, 95% CI)-0.41 [-1.85, 1.03]
    9.2 Average radial area per second (square inches per second)
139Mean Difference (IV, Fixed, 95% CI)-0.93 [-2.05, 0.19]
    9.3 Average velocity (inches per second)
139Mean Difference (IV, Fixed, 95% CI)-0.55 [-2.04, 0.94]
 10 Single leg stance time eyes open (s): higher values indicate better balance ability4Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    10.1 Immediately post intervention
4164Std. Mean Difference (IV, Fixed, 95% CI)0.33 [0.02, 0.64]
    10.2 Follow up @ 6 months post intervention
137Std. Mean Difference (IV, Fixed, 95% CI)0.32 [-0.33, 0.97]
 11 Single leg stance time eyes closed (s): higher values indicate better balance ability133Mean Difference (IV, Fixed, 95% CI)Not estimable
 12 Functional Reach Test: higher values indicate better balance ability122Mean Difference (IV, Fixed, 95% CI)0.60 [-1.71, 2.91]
 13 Timed up and go test (s): lower values indicate better balance ability122Mean Difference (IV, Fixed, 95% CI)-1.5 [-3.49, 0.49]
 14 Self paced gait speed: higher values indicate better balance ability4Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    14.1 Immediately post intervention
4176Std. Mean Difference (IV, Fixed, 95% CI)0.23 [-0.07, 0.53]
    14.2 Follow-up @ 6 months post intervention
145Std. Mean Difference (IV, Fixed, 95% CI)0.31 [-0.28, 0.90]
    14.3 Follow-up @ 6 weeks post intervention
130Std. Mean Difference (IV, Fixed, 95% CI)0.30 [-0.42, 1.03]
 15 Walking on a beam (m): higher values indicate better balance ability133Mean Difference (IV, Fixed, 95% CI)Not estimable
 16 Berg Balance Scale (score out of 56) higher values indicate better balance ability3Mean Difference (IV, Fixed, 95% CI)Subtotals only
    16.1 Immediately post intervention
3126Mean Difference (IV, Fixed, 95% CI)2.72 [0.94, 4.50]
    16.2 Follow up @ 4 weeks post intervention
177Mean Difference (IV, Fixed, 95% CI)3.60 [-1.96, 9.16]
    16.3 Follow up @ 1 year post intervention
149Mean Difference (IV, Fixed, 95% CI)0.67 [-7.29, 8.63]
 
Comparison 2. Strengthening exercise versus control
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Functional base of support during dynamic test (distance): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    1.1 Immediately post intervention
134Mean Difference (IV, Fixed, 95% CI)-0.01 [-0.09, 0.07]
    1.2 Follow-up @ 6 months post intervention
127Mean Difference (IV, Fixed, 95% CI)Not estimable
 2 Loss of balance during sensory organisation test (errors): less errors indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    2.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)-0.40 [-1.66, 0.86]
    2.2 Follow-up @ 6 months post intervention
142Mean Difference (IV, Fixed, 95% CI)-0.10 [-1.63, 1.43]
 3 Tilt board (s) post-pre change scores: higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    3.1 Omnidirectional tilt board (s)
151Mean Difference (IV, Fixed, 95% CI)-4.0 [-7.89, -0.11]
    3.2 AP tilt board (s)
151Mean Difference (IV, Fixed, 95% CI)-1.0 [-4.32, 2.32]
 4 Single leg stance time eyes open (s): higher values indicate better balance ability3170Std. Mean Difference (IV, Fixed, 95% CI)0.39 [0.08, 0.70]
 5 Single leg stance time eyes closed (s): higher values indicate better balance ability2Std. Mean Difference (IV, Random, 95% CI)Subtotals only
    5.1 Immediately post intervention
2119Std. Mean Difference (IV, Random, 95% CI)0.51 [-0.31, 1.32]
    5.2 Follow up @ 6 months post intervention
131Std. Mean Difference (IV, Random, 95% CI)-0.09 [-0.80, 0.63]
 6 Tandem walk over 10 feet (s): higher values indicate better balance ability181Mean Difference (IV, Fixed, 95% CI)-2.0 [-4.40, 0.40]
 7 Tandem stance (s): higher values indicate better balance ability3165Std. Mean Difference (IV, Random, 95% CI)0.24 [-0.34, 0.82]
 8 Functional Reach Test (FRT) (cm) pre-post change scores: lower values indicate better balance ability149Mean Difference (IV, Fixed, 95% CI)-4.33 [-6.00, -0.66]
 9 Timed up and go test (TUG) (s): lower values indicate better balance ability133Mean Difference (IV, Fixed, 95% CI)-3.5 [-9.70, 2.70]
 10 Gait speed: higher values indicate better balance ability5Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    10.1 Immediately post intervention
5304Std. Mean Difference (IV, Fixed, 95% CI)0.25 [0.02, 0.48]
    10.2 Follow-up @ 6 months post intervention
142Std. Mean Difference (IV, Fixed, 95% CI)0.24 [-0.37, 0.85]
 11 Balance beam: post-pre change scores (s): higher values indicate better balance ability2Mean Difference (IV, Fixed, 95% CI)Subtotals only
    11.1 Wide beam
2100Mean Difference (IV, Fixed, 95% CI)-0.14 [-0.55, 0.26]
    11.2 Narrow beam
151Mean Difference (IV, Fixed, 95% CI)0.5 [-0.14, 1.14]
 
Comparison 3. 3D (Tai Chi, Gi Gong, dance, yoga) versus control
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 AP stability during stance (quiet and dynamic) eyes open: lower values indicate better balance ability2Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    1.1 Immediately post intervention
287Std. Mean Difference (IV, Fixed, 95% CI)-0.24 [-0.66, 0.19]
    1.2 Follow-up @ 3 months post intervention
148Std. Mean Difference (IV, Fixed, 95% CI)0.17 [-0.40, 0.75]
    1.3 Follow-up @ 4 months post intervention
135Std. Mean Difference (IV, Fixed, 95% CI)-0.15 [-0.82, 0.52]
 2 Mediolateral stability during stance (quiet and dynamic) eyes open: lower values indicate better balance1Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    2.1 Immediately post intervention
138Std. Mean Difference (IV, Fixed, 95% CI)0.30 [-0.34, 0.94]
    2.3 Follow-up @ 4 months post intervention
138Std. Mean Difference (IV, Fixed, 95% CI)0.30 [-0.34, 0.94]
 3 AP stability during quiet stance eyes closed: lower values indicate better balance ability1Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    3.1 Immediately post intervention
138Std. Mean Difference (IV, Fixed, 95% CI)0.21 [-0.43, 0.84]
    3.2 Follow up @ 4months post intervention
138Std. Mean Difference (IV, Fixed, 95% CI)0.35 [-0.29, 0.99]
 4 Mediolateral stability during quiet stance eyes closed: lower values indicate better balance ability1Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    4.1 Immediately post intervention
138Std. Mean Difference (IV, Fixed, 95% CI)0.00 [-0.63, 0.64]
    4.2 Follow up @ 4 months post intervention
138Std. Mean Difference (IV, Fixed, 95% CI)0.06 [-0.57, 0.70]
 5 Area during narrow stance eyes open post-pre change scores (mm2/s): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    5.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)-2.0 [-21.89, 17.89]
    5.2 Follow-up @ 3 months post intervention
148Mean Difference (IV, Fixed, 95% CI)3.0 [-17.47, 23.47]
 6 Angular radius narrow stance eyes open post-pre change scores (mm): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    6.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)-0.10 [-1.14, 0.94]
    6.2 Follow-up @ 3 months post intervention
148Mean Difference (IV, Fixed, 95% CI)Not estimable
 7 Area during narrow stance eyes closed post-pre change scores (mm2/s): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    7.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)29.00 [-28.94, 86.94]
    7.2 Follow-up @ 3 months post intervention
148Mean Difference (IV, Fixed, 95% CI)39.0 [-19.01, 97.01]
 8 Angular radius narrow stance eyes closed post-pre change scores (mm): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    8.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)0.4 [-1.23, 2.03]
    8.2 Follow-up @ 3 months post intervention
148Mean Difference (IV, Fixed, 95% CI)0.40 [-1.28, 2.08]
 9 Omnidirectional tilt board post-pre change scores (s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    9.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)-1.00 [-7.08, 1.08]
    9.2 Follow-up @ 3 months post intervention
148Mean Difference (IV, Fixed, 95% CI)-3.0 [-7.54, 1.54]
 10 Single leg stance time eyes open (s): higher values indicate better balance ability285Std. Mean Difference (IV, Random, 95% CI)1.13 [-0.17, 2.44]
 11 Single leg stance time eyes closed (s): higher values indicate better balance ability138Mean Difference (IV, Fixed, 95% CI)-1.20 [-3.80, 1.40]
 12 Functional Reach Test (cm): higher values indicate better balance ability138Mean Difference (IV, Fixed, 95% CI)2.80 [-1.05, 6.65]
 13 Gait speed: higher values indicate better balance ability2Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    13.1 Immediately post intervention
299Std. Mean Difference (IV, Fixed, 95% CI)0.05 [-0.34, 0.45]
    13.2 Follow-up @ 3 months post intervention
148Std. Mean Difference (IV, Fixed, 95% CI)0.10 [-0.48, 0.68]
 14 Wide balance beam post-pre change scores (m/s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    14.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)-0.1 [-0.16, -0.04]
    14.2 Follow-up @3 months post intervention
148Mean Difference (IV, Fixed, 95% CI)-0.07 [-0.17, 0.03]
 15 Narrow balance beam post-pre change scores (m/s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    15.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)0.8 [-0.01, 1.61]
    15.2 Follow-up @3 months post intervention
148Mean Difference (IV, Fixed, 95% CI)0.70 [-0.08, 1.48]
 
Comparison 4. General physical activity versus control
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Postural sway double stance (post-pre change scores): lower values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    1.1 Eyes open
141Mean Difference (IV, Fixed, 95% CI)-6.70 [-17.59, 4.19]
    1.2 Eyes closed
141Mean Difference (IV, Fixed, 95% CI)-5.70 [-26.82, 15.42]
 2 Functional Reach Test (cm): higher values indicate better balance ability142Mean Difference (IV, Fixed, 95% CI)11.8 [7.75, 15.85]
 3 Timed up and go test (s): lower values indicate better balance ability142Mean Difference (IV, Fixed, 95% CI)-3.9 [-5.83, -1.97]
 
Comparison 5. General physical activity (walking) versus control
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Area during narrow stance eyes open post-pre change scores (mm2/s): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    1.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)-4.0 [-24.10, 16.10]
    1.2 Follow-up @ 3 months post intervention
151Mean Difference (IV, Fixed, 95% CI)1.0 [-19.26, 21.26]
 2 Angular radius narrow stance eyes open post-pre change scores (mm): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    2.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)-0.5 [-1.54, 0.54]
    2.2 Follow-up @ 3 months post intervention
151Mean Difference (IV, Fixed, 95% CI)-0.4 [-1.47, 0.67]
 3 Area during narrow stance eyes closed post-pre change scores (mm2/s): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    3.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)102.0 [28.58, 175.42]
    3.2 Follow-up @ 3 months post intervention
151Mean Difference (IV, Fixed, 95% CI)118.00 [46.83, 189.17]
 4 Angular radius narrow stance eyes closed post-pre change scores (mm): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    4.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)1.4 [-0.26, 3.06]
    4.2 Follow-up @ 3 months post intervention
151Mean Difference (IV, Fixed, 95% CI)1.6 [-0.05, 3.25]
 6 Dynamic balance lateral axis (degrees): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    6.1 Average position (degrees)
121Mean Difference (IV, Fixed, 95% CI)-0.20 [-0.46, 0.06]
    6.2 Amplitude (degrees)
121Mean Difference (IV, Fixed, 95% CI)-2.50 [-4.01, -0.99]
 7 Omnidirectional tilt board post-pre change scores (s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    7.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)-1.00 [-7.08, 1.08]
    7.2 Follow-up @ 3 months post intervention
151Mean Difference (IV, Fixed, 95% CI)-1.00 [-7.12, 1.12]
 8 AP tilt board post-pre change score (s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    8.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)1.0 [-1.20, 3.20]
    8.2 Follow-up @ 3 months post intervention
151Mean Difference (IV, Fixed, 95% CI)-1.0 [-3.75, 1.75]
 9 Single leg stance time eyes open (s): Higher values indicate better balance ability295Std. Mean Difference (IV, Fixed, 95% CI)0.15 [-0.26, 0.57]
 10 Single leg stance time eyes closed (s): higher values indicate better balance ability169Mean Difference (IV, Fixed, 95% CI)0.40 [-0.89, 1.69]
 11 Tandem walk over 10 feet (s): lower values indicate better balance ability169Mean Difference (IV, Fixed, 95% CI)-2.30 [-4.05, -0.55]
 12 Tandem stance (s): higher values indicate better balance ability169Mean Difference (IV, Fixed, 95% CI)12.90 [3.91, 21.89]
 13 Functional Reach Test (cm): higher values indicate better balance ability126Mean Difference (IV, Fixed, 95% CI)10.92 [5.03, 16.81]
 14 Self paced gait velocity (m/min): higher values indicate better balance ability2Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    14.1 Immediately post intervention
273Std. Mean Difference (IV, Fixed, 95% CI)0.21 [-0.26, 0.67]
    14.2 Follow-up @ 3 months post intervention
151Std. Mean Difference (IV, Fixed, 95% CI)0.44 [-0.12, 1.00]
 15 Wide balance beam post-pre change scores (m/s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    15.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)0.06 [-0.01, 0.13]
    15.2 Follow-up @3 months post intervention
151Mean Difference (IV, Fixed, 95% CI)0.08 [-0.01, 0.17]
 16 Narrow balance beam post-pre change scores (m/s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    16.1 Immediately post intervention
152Mean Difference (IV, Fixed, 95% CI)0.5 [-0.07, 1.07]
    16.2 Follow-up @3 months post intervention
151Mean Difference (IV, Fixed, 95% CI)0.3 [-0.37, 0.97]
 
Comparison 6. General physical activity (cycling) versus control
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Area during narrow stance eyes open post-pre change scores (mm2/s): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    1.1 Immediately post intervention
151Mean Difference (IV, Fixed, 95% CI)-15.0 [-32.22, 2.22]
    1.2 Follow-up @ 3 months post intervention
149Mean Difference (IV, Fixed, 95% CI)-12.0 [-33.05, 9.05]
 2 Angular radius narrow stance eyes open post-pre change scores (mm): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    2.1 Immediately post intervention
151Mean Difference (IV, Fixed, 95% CI)-0.8 [-2.12, 0.52]
    2.2 Follow-up @ 3 months post intervention
149Mean Difference (IV, Fixed, 95% CI)-0.80 [0.00, 0.40]
 3 Area narrow stance eyes closed post-pre change scores (mm2/s): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    3.1 Immediately post intervention
151Mean Difference (IV, Fixed, 95% CI)38.0 [-19.93, 95.93]
    3.2 Follow-up @ 3 months post intervention
149Mean Difference (IV, Fixed, 95% CI)55.00 [-1.38, 111.38]
 4 Angular radius narrow stance eyes closed post-pre change scores (mm): lower values indicate better balance1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    4.1 Immediately post intervention
151Mean Difference (IV, Fixed, 95% CI)1.0 [-0.87, 2.87]
    4.2 Follow-up @ 3 months post intervention
149Mean Difference (IV, Fixed, 95% CI)1.30 [-0.66, 3.26]
 5 AP tilt board post-pre change score (s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    5.1 Immediately post intervention
151Mean Difference (IV, Fixed, 95% CI)Not estimable
    5.2 Follow-up @ 3 months post intervention
149Mean Difference (IV, Fixed, 95% CI)-2.0 [-5.09, 1.09]
 6 Omnidirectional tilt board post-pre change scores (s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    6.1 Immediately post intervention
151Mean Difference (IV, Fixed, 95% CI)-1.0 [-4.87, 2.87]
    6.2 Follow-up @ 3 months post intervention
149Mean Difference (IV, Fixed, 95% CI)-5.0 [-10.13, 0.13]
 7 Self paced gait velocity post-pre change scores (m/min): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    7.1 Immediately post intervention
151Mean Difference (IV, Fixed, 95% CI)3.00 [-3.77, 9.77]
    7.2 Follow-up @ 3 months post intervention
149Mean Difference (IV, Fixed, 95% CI)3.0 [-1.20, 7.20]
 8 Wide balance beam post-pre change scores (m/s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    8.1 Immediately post intervention
151Mean Difference (IV, Fixed, 95% CI)Not estimable
    8.2 Follow-up @3 months post intervention
149Mean Difference (IV, Fixed, 95% CI)0.07 [-0.02, 0.16]
 9 Narrow balance beam post-pre change scores (m/s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    9.1 Immediately post intervention
151Mean Difference (IV, Fixed, 95% CI)0.1 [-0.62, 0.82]
    9.2 Follow-up @3 months post intervention
149Mean Difference (IV, Fixed, 95% CI)0.3 [-0.47, 1.07]
 
Comparison 7. Multiple exercise types versus control
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 Functional base of support (distance) during dynamic test: higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    1.1 Immediately post intervention
132Mean Difference (IV, Fixed, 95% CI)0.09 [0.03, 0.15]
    1.2 Follow-up @ 6 months post intervention
126Mean Difference (IV, Fixed, 95% CI)0.09 [0.02, 0.16]
 2 Maximal balance range (cm) during dynamic test: higher values indicate better balance ability2595Mean Difference (IV, Random, 95% CI)0.76 [-1.29, 2.81]
 3 Total distance travelled by COP during quiet stance (mm): lower values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    3.1 Eyes open
114Mean Difference (IV, Fixed, 95% CI)97.15 [18.59, 175.71]
    3.2 Eyes closed
114Mean Difference (IV, Fixed, 95% CI)212.52 [114.79, 310.25]
 4 Sway (mm) during dynamic test: higher values indicate better balance ability3Std. Mean Difference (IV, Random, 95% CI)Subtotals only
    4.1 Floor, eyes open (immediately post intervention)
3893Std. Mean Difference (IV, Random, 95% CI)-0.08 [-0.41, 0.24]
    4.2 Floor, eyes closed (immediately post intervention)
3893Std. Mean Difference (IV, Random, 95% CI)-0.10 [-0.24, 0.04]
    4.3 Foam, eyes open (immediately post intervention)
3893Std. Mean Difference (IV, Random, 95% CI)-0.18 [-0.59, 0.23]
    4.4 Foam, eyes closed (immediately post intervention)
3893Std. Mean Difference (IV, Random, 95% CI)-0.10 [-0.31, 0.11]
 5 Body sway (cm): lower values indicate better balance ability235Std. Mean Difference (IV, Fixed, 95% CI)-0.87 [-1.60, -0.13]
 6 Loss of balance during sensory organisation test (errors): less errors indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    6.1 Immediately post intervention
153Mean Difference (IV, Fixed, 95% CI)-0.60 [-1.86, 0.66]
    6.2 Follow-up @ 6 months post intervention
143Mean Difference (IV, Fixed, 95% CI)-0.20 [-1.59, 1.19]
 7 Co-ordinated stability (errors): less errors indicate better balance ability3829Mean Difference (IV, Fixed, 95% CI)-0.76 [-1.97, 0.44]
 8 Single leg stance time eyes open (s): higher values indicate better balance ability4Mean Difference (IV, Fixed, 95% CI)Subtotals only
    8.1 Immediately post intervention
4202Mean Difference (IV, Fixed, 95% CI)1.30 [-0.85, 3.44]
    8.2 Follow up @ 6 months post intervention
133Mean Difference (IV, Fixed, 95% CI)2.80 [-4.73, 10.33]
 9 Single leg stance time eyes closed (s): higher values indicate better balance ability139Mean Difference (IV, Fixed, 95% CI)2.03 [-0.29, 4.35]
 10 Semitandem stance time (s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    10.1 Immediately post intervention
167Mean Difference (IV, Fixed, 95% CI)1.0 [-0.52, 2.52]
    10.2 Follow-up @ 3 months post intervention
158Mean Difference (IV, Fixed, 95% CI)1.40 [-0.63, 3.43]
 11 Parallel stance time (s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    11.1 Immediately post intervention
167Mean Difference (IV, Fixed, 95% CI)0.80 [-0.47, 2.07]
    11.2 Follow-up @ 3 months post intervention
158Mean Difference (IV, Fixed, 95% CI)-0.30 [-1.66, 1.06]
 12 Tandem stance time (s): higher values indicate better balance ability1Mean Difference (IV, Fixed, 95% CI)Subtotals only
    12.1 Immediately post intervention
167Mean Difference (IV, Fixed, 95% CI)1.90 [0.06, 3.74]
    12.2 Follow-up @ 3 months post intervention
158Mean Difference (IV, Fixed, 95% CI)1.20 [-0.64, 3.04]
 13 Tandem walk (number of steps): higher values indicate better balance ability139Mean Difference (IV, Fixed, 95% CI)3.39 [1.75, 5.03]
 14 Tandem walk (s): lower values indicate better balance ability170Mean Difference (IV, Fixed, 95% CI)-8.10 [-13.71, -2.49]
 15 Functional Reach Test (cm): higher values indicate better balance ability260Mean Difference (IV, Fixed, 95% CI)5.80 [3.37, 8.23]
 16 Gait speed: higher values indicate better balance ability6Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    16.1 Immediately post intervention
6264Std. Mean Difference (IV, Fixed, 95% CI)-0.14 [-0.38, 0.11]
    16.2 Follow-up @ 6 months post intervention
150Std. Mean Difference (IV, Fixed, 95% CI)0.37 [-0.19, 0.93]
    16.3 Follow-up @ 3 months post intervention
158Std. Mean Difference (IV, Fixed, 95% CI)-0.11 [-0.63, 0.40]
 
Comparison 8. Sensitivity analyses for effect of clustering
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 (01.10) Single leg stance time eyes open (s): higher values indicate better balance ability4Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    1.1 Immediately post intervention
4164Std. Mean Difference (IV, Fixed, 95% CI)0.33 [0.02, 0.64]
 2 (01.14) Self paced gait speed: higher values indicate better balance ability4Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only
    2.1 Immediately post intervention
4176Std. Mean Difference (IV, Fixed, 95% CI)0.23 [-0.07, 0.53]
 
Table 1. Glossary of terms
Glossary
1RM - one repetition maximum score
3D - 3D exercise including tai chi, qi gong, dance, yoga
ADL - Activities of Daily Living
AP - Anterior - Posterior
BBS - Berg Balance Scale
BPM - Balance Performance Monitor
cm - centimetres
CoM: body's centre of mass
COP - centre of pressure
COPD - Chronic Obstructive Pulmonary Disease
EPESE - Established Populations for the Epidemiologic Studies of the Elderly short physical performance battery
Ex - Exercise
FRT - Function Reach Test
GBFT - Gait, balance, functional tasks
GEN ACTIVITY - general physical activity
HR - Heart Rate
Hr - hour
Km- kilometres
LOS - Locus Of Support
min - minute
ML - medio-lateral
mm - millimetres
MMSE - Mini Mental Status Examination
m/s - metres per second
NSD - no significant difference
PNF - proprioceptive neuromuscular facilitation
PRE - Progressive Resistance Exercise
RCT - randomised controlled trial
RMS - root mean squared
s - seconds
SD - Standard Deviation
SLS - Single Legged Stance
SMD - standardised mean difference
STRENGTH - strength training including resistance or power training
TUG - Timed up and go test
WMD - weighted mean difference
 
Table 2. Methodological quality assessment items and possible scores
Items and scores
M-A (D1b). Was the assigned treatment adequately concealed prior to allocation?
2 = method did not allow disclosure of assignment.
1 = small but possible chance of disclosure of assignment or unclear.
0 = quasi-randomised or open list/tables.

Cochrane code: Clearly Yes = A; Not sure = B; Clearly No = C
M-B (D8). Were the outcomes of patients/participants who withdrew described and included in the analysis (intention to treat)?
2 = withdrawals well described and accounted for in analysis.
1 = withdrawals described and analysis not possible.
0 = no mention, inadequate mention, or obvious differences and no adjustment.
M-C (D4). Were the outcome assessors blinded to treatment status?
2 = effective action taken to blind assessors.
1 = small or moderate chance of unblinding of assessors.
0 = not mentioned or not possible.
M-D (D2). Were the treatment and control group comparable at entry?
2 = good comparability of groups, or confounding adjusted for in analysis.
1 = confounding small; mentioned but not adjusted for.
0 = large potential for confounding, or not discussed.
M-E (D6). Were the participants blind to assignment status after allocation?
2 = effective action taken to blind participants.
1 = small or moderate chance of unblinding of participants.
0 = not possible, or not mentioned (unless double-blind), or possible but not done.
M-F (D5). Were the treatment providers blind to assignment status?
2 = effective action taken to blind treatment providers.
1 = small or moderate chance of unblinding of treatment providers.
0 = not possible, or not mentioned (unless double-blind), or possible but not done.
M-G. Were care programmes, other than the trial options, identical?
2 = care programmes clearly identical.
1 = clear but trivial differences.
0 = not mentioned or clear and important differences in care programmes.
M-H (D3). Were the inclusion and exclusion criteria clearly defined?
2 = clearly defined.
1 = inadequately defined.
0 = not defined.
M-I. Were the interventions clearly defined?
2 = clearly defined interventions are applied with a standardised protocol.
1 = clearly defined interventions are applied but the application protocol is not standardised.
0 = intervention and/or application protocol are poorly or not defined.
M-J. Were the outcome measures used clearly defined?
2 = clearly defined.
1 = inadequately defined.
0 = not defined.
M-K. Were tests used in outcome assessment clinically useful?
2 = optimal.
1 = adequate.
0 = not defined, not adequate.
M-L. Was the surveillance active, and of clinically appropriate duration (i.e. at least 3 months)?
2 = active surveillance and appropriate duration (3 months follow up or more).
1 = active surveillance, but inadequate duration (less than 3 months follow up).
0 = surveillance not active or not defined.
D7. Were point estimates and measures of variability presented for the primary outcome measures?
2 = yes
1 = point estimates, but no measures of variability presented
0 = vague descriptions
MAC-1. Was the compliance rate in each group likely to cause bias?
2 = compliance well described and accounted for in analysis
1 = compliance well described but differences between groups not accounted for in analysis
0 = compliance unclear
MAC-2. Was there a description of adverse effects of the intervention(s)?
2 = well described
1 = poorly described
0 = not described
 
Table 3. Methodological quality assessment scores M-A (D1b) to M-G
Study IDM-A (D1b)M-B (D8)M-C (D4)M-D (D2)M-E (D6)M-F (D5)M-G
Boshuizen 20051222000
Brouwer 20031102000
Buchner 1997a1212000
Buchner 1997b1222000
Cress 19991002000
Crilly 19891202000
Islam 20042202000
Jessup 20031222000
Johansson 19911122000
Krebs 19981112002
Lichtenstein 19892101200
Lord 19952222002
Lord 20031100000
Lord 20051122000
MacRae 19942000202
McGarry 20011000000
McMurdo 19932222000
Nelson 20041122000
Okumiya 19961122000
Paillard 20042000001
Ramsbottom 20042201002
Reinsch 19921101101
Rooks 1997a1002100
Rubenstein 20001012012
Sauvage 19921022002
Schoenfelder 20041011200
Shigematsu 20021002202
Shimada 20041102002
Sihvonen 20041102002
Suzuki 20041222002
Wolf 19971002002
Wolf 20012212002
Wolfson 19962122022
Zhang 20060002002
 
Table 4. Methodological quality assessment scores M-H (D3) to MAC-2
Study IDM-H (D3)M-IM-JM-KM-LD7MAC-1MAC-2
Boshuizen 200512221210
Brouwer 200322221210
Buchner 1997a22222221
Buchner 1997b22222220
Cress 199922220200
Crilly 198920211200
Islam 200422212222
Jessup 200322212200
Johansson 199122211210
Krebs 199822210220
Lichtenstein 198922212212
Lord 199522212221
Lord 200301212211
Lord 200522212220
MacRae 199412212220
McGarry 200100120000
McMurdo 199322212010
Nelson 200422220212
Okumiya 199611212210
Paillard 200422210200
Ramsbottom 200422222210
Reinsch 199212210210
Rooks 1997a22220202
Rubenstein 200022220200
Sauvage 199222221220
Schoenfelder 200422222210
Shigematsu 200222221220
Shimada 200412220221
Sihvonen 200422211220
Suzuki 200411212122
Wolf 199722222200
Wolf 200122212200
Wolfson 199622222222
Zhang 200612220220
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