Systematic Review on Exercise-Based Interventions for Fall Risk, Pain, and Balance in Older Adults with Knee Osteoarthritis
Abstract
Introduction
Knee osteoarthritis (KOA) is highly prevalent among older adults and is associated with pain, impaired mobility, and an increased risk of falls. Exercise-based interventions are commonly recommended for symptom management; however, their effectiveness for fall prevention in older adults with KOA remains unclear.
Method
A systematic search of MEDLINE, PubMed, the Cochrane Library, Web of Science, CINAHL, and grey literature was conducted from inception to 30 October 2025. Randomised controlled trials including adults aged ≥60 years with clinically or radiographically diagnosed KOA were eligible. Exercise-based interventions targeting fall prevention were included. Outcomes comprised fall risk (subjective and functional measures), balance performance, and knee pain assessed using validated instruments. Random-effects meta-analyses were performed, and certainty of evidence was assessed using the GRADE approach.
Results
Twenty-four randomised controlled trials were included. Exercise-based interventions significantly reduced fall risk across both subjective and functional outcome measures. Subjective fall risk outcomes demonstrated a moderate effect favouring exercise interventions (SMD = 0.58, 95% CI 0.19 to 0.98; p = 0.004), while functional fall risk measures also showed significant improvement (SMD = 0.31, 95% CI 0.15 to 0.47; p = 0.0002). A small-to-moderate but statistically significant reduction in knee pain was observed (SMD = 0.38, 95% CI 0.25 to 0.50; p < 0.00001). In contrast, pooled balance outcomes were not statistically significant (SMD = 0.17, 95% CI −0.20 to 0.54; p = 0.36) and demonstrated substantial heterogeneity (I² = 87%). Certainty of evidence ranged from low to moderate.
Conclusion(s)
Exercise-based interventions reduce fall risk and produce modest but clinically meaningful reductions in knee pain in older adults with knee osteoarthritis. Although pooled improvements in balance outcomes were not statistically significant, these findings support the use of tailored, progressive, and functionally oriented exercise programmes for fall prevention in this high-risk population.