The effect of balance training on cognitive function in older adults with and without cognitive impairment: A systematic review and meta-analysis.

BACKGROUND

Exercise training has demonstrated benefits for cognitive function in older adults; however, most evidence is derived from aerobic or resistance exercises.

OBJECTIVES

To investigate the effects of balance training on cognitive function among older adults with and without cognitive impairment and to examine factors that may moderate training effects.

METHODS

A systematic literature search was conducted in the electronic databases MEDLINE, EMBASE, PsycINFO, and CINAHL from inception through October 2025. Randomized and non-randomized controlled trials of balance training were included if they recruited older adults (≥60 years) with or without cognitive impairment and assessed cognitive function. The methodological quality of the included studies was appraised using the Tool for the Assessment of Study Quality and Reporting in Exercise. Effect sizes were calculated as standardized mean differences (SMDs; Hedges' g). A multilevel random-effects model was used for the meta-analysis.

RESULTS

This systematic review included 54 articles comprising 4750 older adults, of which 17 studies providing 61 effect sizes were included in the meta-analysis. Overall, balance training demonstrated a small but significant improvement in pooled cognitive outcomes (SMD [95 % CI] = 0.17 [0.04, 0.30]). A significant pooled effect was observed for processing speed (0.27 [0.02, 0.52]), although differences across cognitive domains were not statistically significant (p = 0.070). We found that participant characteristics, intervention characteristics, and exercise dose significantly moderated the pooled effects on cognitive outcomes.

CONCLUSIONS

Balance training has modest cognitive benefits in older adults. Future studies should consider key moderators identified in this review to optimize cognitive outcomes.