The effects of the Otago exercise programme on actual and perceived balance in older adults: a meta-analysis

Key points

1. 01Significant small effects on static balance (Hedges's g = 0.388), dynamic balance (g = -0.228), proactive balance (g = 0.239), and perceived balance (g = -0.184)
2. 02Group-format OEP was more effective than individual-format for static, dynamic, and perceived balance
3. 03Sessions longer than 30 minutes produced greater improvements in static and perceived balance than sessions of 30 minutes or less
4. 04Effects were not related to training frequency or total intervention period
5. 05The programme is safe and feasible even for older adults who have previously fallen

How it was conducted

Design

Systematic review and meta-analysis of randomized controlled trials, following PRISMA guidelines

Databases searched

PEDro, PubMed, Embase, Web of Science, Oxford, Medline, and CINAHL (inception to 26 February 2021)

Included studies

12 RCTs with a total of 2807 participants; mean participant age 76.34 +/- 4.84 years

Intervention

Original Otago Exercise Programme (leg strengthening and balance retraining); individual or group format; session duration 20-60 minutes; 2-3 sessions per week; intervention length 12-52 weeks

Primary outcomes

Static, dynamic, proactive, and reactive balance; perceived balance (balance confidence and fear of falling)

Quality assessment

PEDro scale; average score 6.6/10 (high quality); low-quality studies (score <3) excluded

What they found

• Static balance: Hedges's g = 0.388 (95% CI 0.131 to 0.645, p = 0.003); high heterogeneity (I2 = 78.83%)
• Dynamic balance: Hedges's g = -0.228 (95% CI -0.352 to -0.104, p <0.001); moderate heterogeneity (I2 = 50.93%)
• Proactive balance: Hedges's g = 0.239 (95% CI 0.061 to 0.416, p = 0.009); high heterogeneity (I2 = 85.36%)
• Perceived balance: Hedges's g = -0.184 (95% CI -0.320 to -0.048, p = 0.008); moderate heterogeneity (I2 = 59.17%)
• Group format vs. individual format: greater effects on static balance (p = 0.008), dynamic balance (p = 0.004), and perceived balance (p = 0.004)
• Sessions >30 minutes vs. 30 minutes or less: greater effects on static balance (p = 0.007) and perceived balance (p = 0.014)
• No significant difference by control group type, training frequency, or total training period
• Participant compliance ranged from 77-93% (attendance-based) and 24-67% (protocol adherence-based) across reporting studies

Limitations

• No included study achieved complete blinding of participants and therapists, which may limit the credibility of results
• High heterogeneity was found for static balance (I2 = 78.83%) and proactive balance (I2 = 85.36%), meaning individual study characteristics varied considerably
• Reactive balance could not be analysed due to insufficient outcome measures in the included studies
• Most outcome measures relied on clinical tests rather than laboratory instruments, which may miss subtle balance changes

Why it matters

For patients

Older adults who want to reduce their risk of falling can expect meaningful improvements in balance and confidence from the Otago Exercise Programme, especially when done in a group setting with sessions lasting more than 30 minutes.

For clinicians

The OEP is supported by 12 high-quality RCTs and produces small but statistically significant improvements across multiple balance domains; prescribing it in a group format with sessions over 30 minutes is the evidence-based recommendation.

For readers

This meta-analysis of 2807 older adults confirms that the OEP improves both physical balance performance and psychological balance confidence, with group delivery outperforming home-based individual delivery.