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Exercise effects on balance confidence and concerns about falling in older adults with cognitive impairment: a construct-stratified meta-analysis
Luo H, Zhang G, Long L, Chen W, Liu Y.. Research Square, 2026-09-14
Topic: Brain imaging, connectivity and assessment
Older adults with mild cognitive impairment (MCI) or dementia have elevated fall risk, but fall-related psychological outcomes represent distinct constructs that should not be pooled indiscriminately. We systematically reviewed randomised controlled trials of exercise interventions in adults with MCI or mild-to-moderate dementia and separately synthesised balance confidence, concerns about falling, and traditional falls efficacy. Seven databases were searched from inception to 1 July 2026. Eleven trials (950 randomised participants) were included. Six trials (327 participants) assessing balance confidence with the Activities-specific Balance Confidence Scale yielded a mean difference of 4.22 points (95% CI − 0.03 to 8.46; I² = 71.2%; 95% prediction interval − 5.20 to 13.63). Five trials (501 participants) assessing concerns about falling with FES-I-family instruments yielded Hedges’ g = 0.17 (95% CI − 0.18 to 0.51; I² = 21.5%; 95% prediction interval − 0.29 to 0.63). Traditional falls efficacy was reported by one 30-participant trial. Certainty of evidence was very low for balance confidence and traditional falls efficacy and low for concerns about falling. Exercise may improve balance confidence, but evidence remains highly uncertain, and a consistent reduction in concerns about falling is not established.
Key findings
- Six trials (327 participants) assessing balance confidence with the Activities-specific Balance Confidence Scale yielded a mean difference of 4.22 points (95% CI − 0.03 to 8.46; I² = 71.2%; 95% prediction interval − 5.20 to 13.63).
- Five trials (501 participants) assessing concerns about falling with FES-I-family instruments yielded Hedges’ g = 0.17 (95% CI − 0.18 to 0.51; I² = 21.5%; 95% prediction interval − 0.29 to 0.63).
- Traditional falls efficacy was reported by one 30-participant trial.
- Certainty of evidence was very low for balance confidence and traditional falls efficacy and low for concerns about falling.
- Exercise may improve balance confidence, but evidence remains highly uncertain, and a consistent reduction in concerns about falling is not established.
Study details
- Participants327
- Effect size71.2%; 21.5%
- Evidence strengthHigh
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 39 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 24 of the 62 points we could judge it on, which is 39 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Research Square) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 2 / 4 | 327 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 24 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 24 of the 62 points we could judge it on is 39 out of 100. |
| Total | 39 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
Luo, H., Zhang, G., Long, L., Chen, W., & Liu, Y. (2026). Exercise effects on balance confidence and concerns about falling in older adults with cognitive impairment: a construct-stratified meta-analysis. Research Square. https://doi.org/10.21203/rs.3.rs-10741058/v1
Vancouver
Luo H, Zhang G, Long L, Chen W, Liu Y. Exercise effects on balance confidence and concerns about falling in older adults with cognitive impairment: a construct-stratified meta-analysis. Research Square. 2026. doi:10.21203/rs.3.rs-10741058/v1.
BibTeX
@article{luo2026-bb061755,
author = {Luo, H. and Zhang, G. and Long, L. and Chen, W. and Liu, Y.},
title = {{Exercise effects on balance confidence and concerns about falling in older adults with cognitive impairment: a construct-stratified meta-analysis}},
journal = {Research Square},
year = {2026},
doi = {10.21203/rs.3.rs-10741058/v1},
url = {https://doi.org/10.21203/rs.3.rs-10741058/v1}
}
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