The effectiveness of exercise interventions on muscle strength and balance function in pre-frail older adults: a systematic review and Bayesian network meta-analysis

Background: Prefrailty represents a critical transitional phase in age-related functional decline among older adults, characterized by reduced muscle strength and impaired balance. While exercise interventions are recognized as effective in ameliorating these symptoms, the comparative efficacy of different exercise modalities remains unclear. Objective: To evaluate the effects of different exercise interventions on muscle strength and balance function in older adults with prefrailty. Design: This is a systematic review and Bayesian network meta-analysis. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) published up to March 2025. Seventeen RCTs involving older adults (age ≥ 60 years) with prefrailty were included, evaluating 10 exercise interventions (e.g., multicomponent training, elastic band exercise, progressive exercise combined with a Tai-chi snacking program, etc.). Primary outcomes included handgrip strength, the Short Physical Performance Battery (SPPB) score, and Timed Up-and-Go (TUG) test performance. A Bayesian framework was employed for the network meta-analysis to assess model convergence and perform consistency tests. The mean difference (MD) and its 95% confidence interval (95% CI) were used as indicators of effect size. Pairwise comparisons of different exercise interventions were conducted to demonstrate the relative effect differences between therapies intuitively. The surface under the cumulative ranking curve (SUCRA) was used to rank the interventions. Results: Seventeen RCTs involving 1,107 pre-frail older adults were included, of which 8 reported handgrip strength (671 patients), 9 reported SPPB score (693 patients), and 6 reported TUG time (263 patients). Elastic band exercise demonstrated the greatest effect on improving handgrip strength (SUCRA = 87.51%), while progressive exercise combined with the Tai-chi snacking program was most effective in enhancing the SPPB score (SUCRA = 90.03%) and shortening TUG time (SUCRA = 79.27%). Multicomponent training and Exergames training also demonstrated significant benefits in certain indicators. Conclusions: Exercise interventions can effectively improve muscle strength and balance function in pre-frail older adults, with elastic band exercise and progressive exercise combined with the Tai-chi snacking program being potential optimal choices. Future studies should focus on the effects of long-term interventions and their synergistic effects with other health strategies (e.g., nutritional interventions). Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251005061, identifier: PROSPERO (CRD420251005061).