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This large systematic review and Bayesian network meta-analysis examined how different forms of exercise affect balance in adults aged 60 and over. Researchers searched five major databases up to December 2025, identifying 423 randomised controlled trials involving 33,901 participants and more than 2,500 effect sizes. The aim was to compare not just overall balance outcomes but also specific balance domains — global, static, dynamic, proactive, and reactive — while accounting for fall risk level, supervision setting, and exercise dose.
Eighteen of the nineteen exercise modalities examined produced meaningful improvements in overall balance compared with inactive control groups; only stretching showed no clear benefit. Across the full range of exercises, perturbation training, sensory training, dance, and agility stepping produced the largest overall effects. When broken down by balance domain, Tai Chi showed the largest estimated benefit for global balance, perturbation training led for static balance, Pilates for dynamic balance, and agility stepping or aquatic exercise for proactive balance. Perturbation training was particularly effective in supervised settings and for those at higher fall risk, while sensory training showed the strongest signal for home-based programmes. The researchers caution that these estimates do not establish the superiority of any single modality, and that dose-response relationships were exploratory and non-linear.
Conclusion: Tai Chi is among the most beneficial exercise modalities for global balance in older adults, though the optimal exercise choice should be guided by the specific balance domain being targeted, the supervision context, and individual safety considerations.
Source: Wang J, Guo S, Yang Y and colleagues. Ageing research reviews (2026). View on PubMed (PMID 42600321) · doi:10.1016/j.arr.2026.103303
