Effectiveness of exercise intervention on mobility, postural control, and falls for older adults with mild cognitive impairment: A systematic review and network meta-analysis.

Objective: To review and synthesize the effectiveness of exercise interventions on mobility, postural control, and falls in older adults with mild cognitive impairment (MCI).

Data sources: This review was registered with PROSPERO (CRD42023453320) and adhered to the PRISMA guidelines. PubMed, Embase, APA PsycInfo, Cochrane Library, Web of Science, CINAHL, and SPORTDiscus were searched from inception until September 2024.

Study selection: Randomized controlled trials (RCTs) examining the effectiveness of exercise interventions on mobility, postural control, and falls in older adults with MCI.

Data extraction: Data extraction included author names, publication years, participant characteristics, intervention details, outcomes, key results, and attrition rates. Data accuracy was verified by two reviewers, with discrepancies resolved through consultation with a third reviewer.

Data synthesis: Thirty-two RCTs met the criteria for qualitative systematic review, with 22 RCTs included in the pairwise meta-analysis and network meta-analysis. Aerobic exercise [SMD 1.07 (95% CI: 0.62-1.52)], multicomponent exercise [SMD 0.46 (95% CI: 0.18-0.74)], and simultaneous cognitive-motor training [SMD 0.56 (95% CI: 0.23-0.89)] significantly improved gait speed during single-task (p<0.05). Aerobic exercise was the most effective intervention for single-task walking performance (99.3%), while Exergaming was the most effective for Timed Up and Go performance (100.0%) according to the surface under the cumulative ranking. Paddling exercise [SMD 0.42 (95% CI: 0.16-0.68)] effectively increased handgrip strength (p<0.05). However, network meta-analyses revealed no intervention demonstrating significant effects on postural control performance (Berg Balance Scale and Functional Reach Test scores). The effect of exercise on falls remained inconclusive due to limited number of studies.

Conclusions: Aerobic exercise, multicomponent exercise, and combined cognitive-motor training, significantly enhance gait speed and functional performance in older adults with MCI. However, the effect of exercise on fall risk remains unclear. These findings underscore the potential of tailored exercise interventions to improve physical function in this vulnerable population.