Comparative effectiveness of exercise and cognitive interventions for fall prevention in older adults: a Bayesian network meta-analysis

OBJECTIVES: To comparatively evaluate the effects of different exercise and cognitive interventions on fall prevention in older adults and to provide evidence-based guidance for clinical practice. STUDY DESIGN: Bayesian network meta-analysis. METHODS: This study systematically searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Database up to December 27, 2025, to identify randomized controlled trials (RCTs) on exercise and cognitive interventions for fall prevention in older adults. Data analyses were conducted using R 4.4.3 and Stata 16.0, with intervention effects expressed as odds ratios (ORs) and 95% confidence intervals (CIs). The surface under the cumulative ranking curve (SUCRA) was used to rank the relative effectiveness of interventions. RESULTS: A total of 47 randomized controlled trials involving 12,384 participants were included. Compared with usual care, exercise combined with cognitive training (ECT; 8 trials, n = 872, OR = 0.42, 95% CI: 0.24-0.67), cognitive training (CT; 5 trials, n = 549, OR = 0.50, 95% CI: 0.24-0.97), mind-body exercise (MBE; 27 trials, n = 3,078, OR = 0.61, 95% CI: 0.43-0.87), and multimodal exercise (ME; 15 trials, n = 2,280, OR = 0.66, 95% CI: 0.51-0.85) all demonstrated significant fall prevention effects in older adults. SUCRA rankings indicated that ECT had the highest probability of being the most effective intervention (88.5%), followed by MBE (76.6%), CT (69.8%), and ME (61.2%). CONCLUSION: This Bayesian network meta-analysis suggests that ECT may be the most effective intervention, with MBE, CT, and ME also showing benefits. The SUCRA rankings reflect probabilistic ordering rather than absolute effect sizes, and therefore should be interpreted with caution. Clinical interventions should be tailored to individual characteristics and functional needs.