The effect of FallProof exercise programs on balance, fear of falling and quality of life in older adults: a systematic review with meta- analysis
Authors
Mohammad Alghosi1, Hossein Khazanin2, Shabnam Faraji3, Hüseyin Şahin Uysal4, Hassan Daneshmandi2, Ali Shamsi Majelan2, Kimia Karimi1,2*, Mohammad Alimoradi5,6, Manuela Deodato7 and Giacomo Rossettini8,9
- Department of Physical Education, Technical and Vocational University (TVU), Tehran, Iran
- Department of Sports Injury and Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran
- Department of Sport Injuries and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran
- Department of Physical Education and Sports Education, Faculty of Sports Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
- Department of Sports Injuries and Corrective Exercises, Faculty of Sports Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
- HERC – Health, Exercise & Research Center, Mina Rashid, Dubai Maritime City, Dubai, United Arab Emirates
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- School of Physiotherapy, University of Verona, Verona, Italy
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odon, Spain
Phase
Published in BMC Geriatrics
The Project
Abstract
Background:
Population ageing is associated with an increased risk of falls. Balance impairments and fear of falling further exacerbate this risk. This systematic review and meta-analysis aimed to assess the effect of FallProof exercise program on balance, fear of falling, and quality of life in older adults.
Objective:
PubMed, Web of Science, Scopus, and Google Scholar were searched from inception to November 6, 2025. Eligible studies were randomized controlled trials (RCTs) investigating the effects of FallProof in older adults and reporting outcomes on balance, fear of falling, or quality of life. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the ROB-2 tool. Random-effects meta-analyses were conducted to estimate pooled effect size. Statistical heterogeneity (I²), small-study effects, and certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation, GRADE) were assessed. Analyses were performed using R version 4.1.
Results:
Eleven RCTs (n = 338; mean age 69.3 ± 5.9 years; age range 60.0-81.7 years; 26.3% female) were included. FallProof produced large and statistically significant improvements in static balance (SB; ES = 1.82, 95% CI 1.12–2.51; I² = 27%; GRADE: high), quality of life (ES = 1.33, 95% CI 0.64–2.02; I² = 56%; GRADE: low), and a large reduction in fear of falling (ES = − 2.40, 95% CI − 5.20 to − 1.28; I² = 84%; GRADE: low). Improvements in dynamic balance were not statistically significant (ES = 1.01, 95% CI − 1.12 to 2.51; I² = 91%; GRADE: very low), and evidence of publication bias was detected.
Conclusion:
FallProof exercise programs are associated with large improvements in static balance, fear of falling, and quality of life in older adults. However, high certainty of evidence was observed only for static balance, while evidence for fear of falling, quality of life, and dynamic balance remains limited due to small sample sizes, heterogeneity, and risk of bias. Overall, the findings are promising but preliminary. Larger, multicenter RCTs with long-term follow-up are required before FallProof can be routinely integrated into fall-prevention strategies.