The effect of FallProof exercise programs on balance, fear of falling and quality of life in older adults: a systematic review with meta-analysis

Population ageing is associated with an increased risk of falls. Balance impairments and fear of falling further exacerbate this risk. This systematic review and meta-analysis aimed to assess the effect of FallProof exercise program on balance, fear of falling, and quality of life in older adults. PubMed, Web of Science, Scopus, and Google Scholar were searched from inception to November 6, 2025. Eligible studies were randomized controlled trials (RCTs) investigating the effects of FallProof in older adults and reporting outcomes on balance, fear of falling, or quality of life. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the ROB-2 tool. Random-effects meta-analyses were conducted to estimate pooled effect size. Statistical heterogeneity (I²), small-study effects, and certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation, GRADE) were assessed. Analyses were performed using R version 4.1. Eleven RCTs (n = 338; mean age 69.3 ± 5.9 years; age range 60.0-81.7 years; 26.3% female) were included. FallProof produced large and statistically significant improvements in static balance (SB; ES = 1.82, 95% CI 1.12–2.51; I² = 27%; GRADE: high), quality of life (ES = 1.33, 95% CI 0.64–2.02; I² = 56%; GRADE: low), and a large reduction in fear of falling (ES = − 2.40, 95% CI − 5.20 to − 1.28; I² = 84%; GRADE: low). Improvements in dynamic balance were not statistically significant (ES = 1.01, 95% CI − 1.12 to 2.51; I² = 91%; GRADE: very low), and evidence of publication bias was detected. FallProof exercise programs are associated with large improvements in static balance, fear of falling, and quality of life in older adults. However, high certainty of evidence was observed only for static balance, while evidence for fear of falling, quality of life, and dynamic balance remains limited due to small sample sizes, heterogeneity, and risk of bias. Overall, the findings are promising but preliminary. Larger, multicenter RCTs with long-term follow-up are required before FallProof can be routinely integrated into fall-prevention strategies. Prospective registration on PROSPERO (CRD420251107632), on 1 August 2025.