Comment: The quality of evidence is downgarded by study quality (unclear allocation concealment, the risk of attrition bias was high in 40% of studies) and inconsistency (heterogeneity in patients and interventions).
A Cochrane review [Abstract] 1 included 30 studies with a total of 2878 subjects. The mean age ranged from 68 to 85 years. Most studies included more women than men, with 4 studies recruiting women only. Twelve studies recruited participants at increased risk of falls; 3 of these recruited participants who also had fear of falling.The studies evaluated 3D exercise (Tai Chi and yoga), balance training or strength and resistance training. Two of these were cluster-randomised trials, two were cross-over trials and one was quasi-randomised.Exercise interventions were associated with a small to moderate reduction in fear of falling immediately post intervention (SMD 0.37 favouring exercise, 95% CI 0.18 to 0.56; 24 studies, n=1692). None of the subgroup analyses provided robust evidence of differences in effect in terms of either the study primary aim (reduction of fear of falling or other aim), the study population (recruitment on the basis of increased falls risk or not), the characteristics of the study exercise intervention or the study control intervention (no treatment or alternative intervention).
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