The Effects of Ankle and Foot Exercises on Ankle Strength, Balance, and Falls in Older People: A Systematic Review and Meta-Analysis.

Abstract

Objective: Ankle-foot control is essential to maintain balance and gait stability. However, there has been limited evidence on the effect of ankle-foot exercises on balance and falls in older people. This study aimed to summarize the effects of ankle-foot exercises on ankle flexibility and strength, balance, mobility, and falls in older people and to identify determining factors for ankle-foot exercises to improve balance and mobility.

Methods: Cumulative Index to Nursing and Allied Health Literature, Embase, PubMed, and Physiotherapy Evidence Database (PEDro) were searched to identify randomized controlled trials that studied the effects of ankle-foot exercises on ankle control, balance, and falls in older people. The PEDro scale was used to evaluate the methodological quality of the studies. Meta-analyses were done for similar outcomes. The quality of evidence was rated by GRADE.

Results: Sixteen papers (n = 651) were included. Meta-analyses showed that ankle-foot exercises significantly improved ankle plantarflexion strength (SMD = 0.35, 95% CI = 0.04 to 0.65, low-quality evidence), ankle flexibility (SMD = 0.48, 95% CI = -0.01 to 0.96, low-quality evidence), and balance in an eyes-open condition (SMD = 0.41, 95% CI = 0.19 to 0.70, low-quality evidence). There was no significant change in ankle dorsiflexion strength (SMD = 0.29, 95% CI = -0.24 to 0.82, very low-quality evidence), balance under eyes-closed condition (SMD = 0.41, 95% CI = -0.1 to 0.92, very low-quality evidence), and gait speed (SMD = 0.36, 95% CI = -0.24 to 0.96, very low-quality evidence). Two studies reported insignificant findings on fear of falling, fall incidence, and risk of falls.

Conclusions: Very low- to low-quality evidence showed that ankle-foot exercises effectively improve ankle plantarflexion strength, flexibility, and balance with eyes open, whereas no effect on falls was found. Improvements in balance and gait tend to be associated with improvements in ankle strength and flexibility. Toe-strengthening exercise and training 3 times per week appear to be important for improving balance.

Impact: This review suggested that ankle-foot exercises might improve balance in older people. Determining factors leading to improvement in balance and mobility were identified. It paves the ground for further research to study the effect of ankle-foot exercises on fall prevention.

Lay summary: Ankle and foot exercises appear to be effective in improving ankle plantarflexion strength, flexibility, and balance performance in an eye-open condition. If you are an older adult who wants to improve your balance, your physical therapist may prescribe ankle and foot exercises as a supplemental component in a fall prevention program due to the observed improvements in balance and the safety and ease of the exercise.