Abstract
BACKGROUND: Falls are a leading cause of injury, disability, and loss of independence among community-dwelling older adults. Although exercise-based interventions are widely recommended for fall prevention, the comparative effectiveness of different exercise modalities remains insufficiently synthesized. METHODS: This systematic review was conducted in accordance with PRISMA 2020 guidelines. Randomized and controlled trials were identified through searches of PubMed, Scopus, Web of Science, and CINAHL, including studies involving adults aged ≥60 years who participated in balance-based, strength-based, multimodal, Tai Ji Quan, Otago Exercise Program, or perturbation-based reactive balance training interventions. Methodological quality was assessed using the Cochrane Risk of Bias 2 (ROB-2) tool. Due to substantial clinical and methodological heterogeneity across interventions and outcome measures, a narrative synthesis was undertaken. RESULTS: Twenty-seven trials met the inclusion criteria. Exercise interventions consistently reduced fall incidence across studies. Tai Ji Quan interventions were associated with approximately 31-58% reductions in falls, the Otago Exercise Program with 23-40% reductions, and multimodal strength-balance training with 20-45% reductions. Perturbation-based reactive balance training demonstrated particularly strong effects on laboratory-induced falls, with reductions ranging from 50-75%. Functional outcomes also improved across intervention types, including faster Timed Up and Go performance, increased gait speed, improvements of approximately 1.2-2.5 points in Short Physical Performance Battery scores, 15-35% gains in lower-limb strength, and enhanced reactive balance responses. Longer-duration interventions (12-24 months) generally demonstrated sustained reductions in fall risk. CONCLUSIONS: Evidence from randomized and controlled trials indicates that structured exercise interventions, particularly Tai Ji Quan, the Otago Exercise Program, multimodal strength-balance training, and perturbation-based reactive balance training, are effective in reducing falls and improving balance, mobility, and strength in community-dwelling older adults. These findings support the use of targeted, evidence-based exercise programs as central components of fall-prevention strategies in older populations.