Digital balance training helped, but did not beat ordinary exercise

Design

Systematic review and network meta-analysis of randomised trials

Population

3,469 older adults across 60 trials

Primary outcome

Balance measures, including Timed Up and Go

Effect

Tele SMD 0.69, balance-platform exergaming 0.63 vs no treatment; none beat exercise

A network meta-analysis pooled 60 randomised trials of 3,469 older adults, comparing telerehabilitation, exergaming with balance platforms or motion capture, serious games and wearables against conventional exercise or no treatment.

Telerehabilitation (SMD 0.69), balance-platform exergaming (0.63) and motion-capture exergaming (0.58) all improved balance compared with no treatment, as did conventional exercise (0.35). None was better than conventional exercise. Certainty was moderate for only two comparisons; the rest were low or very low. No trial reported falls.

Technology can deliver balance training to people who will not attend a class, and dropout was similar. But the evidence does not justify paying more for it over well-delivered conventional exercise.

• Recommend structured balance exercise for older adults at risk of falls
• Consider telerehabilitation or exergaming for those who cannot attend in person
• Do not present digital programmes as superior to conventional exercise
• Remember that balance scores are not the same as fewer falls

Why it matters

It widens the options for delivering balance training without overselling technology.

Don't overread it

No included trial measured falls, so these are not evidence of fall prevention.

The statistics, in plain English

An SMD around 0.6 is a moderate effect. Most comparisons had low certainty, meaning future trials could change the estimates substantially.

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