A Cochrane review [Abstract] 1 included 94 studies with a total of 9 917 subjects. Most participants were women living in their own home. There were eight categories of exercise programmes. Some trials tested more than one type of exercise.The primary measures of balance are listed below. The exercises for which there was some evidence of a statistically significant effect at the end of the exercise programme are shown with statistics.
1. Gait, balance, co-ordination and functional tasks (19 studies of which 10 provided primary outcome data): Timed Up & Go test (MD -0.82 s; 95% CI -1.56 to -0.08 s; 4 studies, n=114); walking speed (SMD 0.43; 95% CI 0.11 to 0.75; 4 studies, n=156), and the Berg Balance Scale (MD 3.48 points; 95% CI 2.01 to 4.95 points; 4 studies, n=145).
2. Strengthening exercise (including resistance or power training) (21 studies of which 11 provided primary outcome data): Timed Up & Go Test (MD -4.30 s; 95% CI -7.60 to -1.00 s; 3 studies, n=71); standing on one leg for as long as possible with 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).
3. 3D (3 dimensional) exercise (including Tai Chi, qi gong, dance, yoga) (15 studies of which 7 provided primary outcome data): Timed Up & Go Test (MD -1.30 s; 95% CI -2.40 to -0.20 s; 1 study, n=44); standing on one leg for as long as possible with eyes open (MD 9.60 s; 95% CI 6.64 to 12.56 s; 1 study, n=47), and with eyes closed (MD 2.21 s; 95% CI 0.69 to 3.73 s; 1 study, n=48); and the Berg Balance Scale (MD 1.06 points; 95% CI 0.37 to 1.76 points; 2 studies, n=150).
4. General physical activity (walking) (7 studies of which 5 provided primary outcome data).
5. General physical activity (cycling) (one study which provided data for walking speed).
6. Computerised balance training using visual feedback (2 studies, neither of which provided primary outcome data).
7. Vibration platform used as intervention (3 studies of which one provided primary outcome data).
8. Multiple exercise types (combinations of the above) (43 studies of which 29 provided data for one or more primary outcomes): Timed Up & Go Test (MD -1.63 s; 95% CI -2.28 to -0.98 s; 12 studies, n=635); standing on one leg for as long as possible with eyes open (MD 5.03 s; 95% CI 1.19 to 8.87 s; 9 studies, n=545), and with eyes closed ((MD 1.60 s; 95% CI -0.01 to 3.20 s; 2 studies, n=176); walking speed (SMD 0.04; 95% CI -0.10 to 0.17; 15 studies, n=818); and the Berg Balance Scale (MD 1.84 points; 95% CI 0.71 to 2.97 points; 2 studies, n=80).
In general, the more effective programmes ran three times a week for three months and involved dynamic exercise in standing.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) inconsistency (heterogeneity in interventions and outcomes) and indirectness (differences in studied patients and reported outcomes, incomplete and inadequately reported data).
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