Effects of Backward Walking Training on Balance and Fall Risk in Older Adults: A Systematic Review and Meta-analysis

Objective: In this systematic review and meta-analysis, we aimed to evaluate the effectiveness of backward walking training (BWT) in improving balance and mobility in older adults.Design: Systematic review and meta-analysis.Methods: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library CENTRAL databases for articles published between January 2010 and July 2025.Randomized controlled trials (RCTs) involving adults aged 60 years who underwent BWT were included.The primary outcome was balance ability assessed using the Berg Balance Scale (BBS).Exclusion criteria were non-English language articles, inaccessible full texts, and non-RCT designs.Two independent reviewers screened the articles and assessed risk of bias using the Cochrane tool.Meta-analyses were performed using Review Manager (RevMan) 5.4 with a random-effects model.Heterogeneity was assessed using 2 and I statistics.Results: Five RCTs with 208 participants were included.Three studies reported BBS-based outcomes, showing a significant overall mean difference of 4.75 points (95% confidence interval (CI): 1.48-8.02;Z = 2.85, p = 0.004).Individual effects included improvements ranging from approximately 1.7 to 7.0 points.However, heterogeneity was high (I = 97%), and the pooled estimate should be interpreted cautiously.Conclusions: BWT significantly improved balance and may be considered a useful intervention to enhance balance and functional mobility in older adults.