Effect of exercise interventions on fear of falling in older adults: a systematic review and network meta-analysis of randomised controlled trials

BACKGROUND: Fear of falling increases the risk of falls and reduces quality of life in older adults. This systematic review and network meta-analysis compared the efficacy of different exercise interventions for reducing fear of falling and evaluated post-intervention sustainability. METHODS: Five electronic databases were searched from inception to 24 October 2025. Methodological quality of included studies was assessed using the Cochrane Risk of Bias tool (RoB 2.0). Intervention effectiveness was ranked by the surface under the cumulative ranking curve. Statistical analysis was performed using StataMP 17. RESULTS: A total of 69 randomised controlled trials were included. Based on the cognitive construct, mind-body exercise significantly reduced fear of falling (SMD = -1.09, 95% CI -1.88 to -0.31). Exergaming was effective only for interventions under 3 months and in community-dwelling populations (P < .05), while multicomponent exercise, balance training and resistance training showed limited effects (P > .05). Based on the emotional construct, mind-body exercise (SMD = -0.63, 95% CI -1.13 to -0.13), multicomponent exercise (SMD = -0.52, 95% CI -0.89 to -0.15) and exergaming (SMD = -0.61, 95% CI -1.16 to -0.06) reduced fear of falling; however, for interventions of 3 months or longer, only mind-body exercise remained effective (P < .05). Balance training and resistance training had limited effects (P > .05). Follow-up findings suggested that these effects were not sustained over time (P > .05). CONCLUSION: Mind-body exercise consistently reduced fear of falling across both cognitive and emotional constructs, but these benefits were not maintained after the intervention ended. REGISTRATION: The protocol was registered on PROSPERO (CRD420251156631).