{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:03:33Z","timestamp":1784783013601,"version":"3.55.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Older adults with mild cognitive impairment (MCI) or dementia have a substantially elevated risk of falls compared with cognitively intact peers, and the consequences of falls in this population are more severe. Multiple exercise modalities, including aerobic exercise, resistance training, balance training, mind-body exercise, multicomponent programs, dual-task training, and exergaming, have been investigated for fall prevention, yet the comparative efficacy of these interventions in cognitively impaired populations remains unclear. Existing evidence relies on pairwise meta-analyses that compare only two interventions at a time, limiting the ability to determine which exercise type is most effective. We will conduct a systematic review and network meta-analysis (NMA) to compare the efficacy of different exercise interventions for fall prevention in older adults with MCI or dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We will include randomized controlled trials (RCTs) comparing any structured exercise intervention (aerobic exercise, resistance training, balance training, mind-body exercise, multicomponent exercise, dual-task training, or exergaming) with each other or with control conditions in adults aged 60 years or older with MCI or dementia. The co-primary outcomes will be the number of fallers (odds ratio) and the rate of falls (incidence rate ratio). Secondary outcomes will include balance, mobility, cognitive function, fear of falling, and exercise-related adverse events. We will search PubMed, Embase, Cochrane CENTRAL, Web of Science, CINAHL and three Chinese-language databases without language restrictions. Risk of bias will be assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Data will be synthesized using a frequentist random-effects NMA, with a Bayesian NMA as a sensitivity analysis. Treatments will be ranked using P-scores, and the certainty of evidence will be assessed using the Confidence in Network Meta-Analysis (CINeMA) approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This NMA aims to provide a synthesis of the comparative efficacy of exercise interventions for fall prevention in cognitively impaired older adults. Should the available evidence prove sufficient, the resulting treatment rankings may help inform evidence-based exercise prescription in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261303641<\/jats:ext-link>\n                      , PROSPERO ID: CRD420261303641.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1831444","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:30:16Z","timestamp":1784781016000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative efficacy of exercise interventions for fall prevention in older adults with cognitive impairment: protocol for a systematic review and network meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Jinsheng","family":"Lu","sequence":"first","affiliation":[{"name":"Department of General Practice, The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan","place":["Guangdong, China"]},{"name":"Department of General Practice, Foshan Hospital of Traditional Chinese Medicine, Foshan","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaojuan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of General Practice, The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan","place":["Guangdong, China"]},{"name":"Department of General Practice, Foshan Hospital of Traditional Chinese Medicine, Foshan","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyun","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of General Practice, The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan","place":["Guangdong, China"]},{"name":"Department of General Practice, Foshan Hospital of Traditional Chinese Medicine, Foshan","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danqin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of General Practice, The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan","place":["Guangdong, China"]},{"name":"Department of General Practice, Foshan Hospital of Traditional Chinese Medicine, Foshan","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoying","family":"Song","sequence":"additional","affiliation":[{"name":"Department of General Practice, The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan","place":["Guangdong, China"]},{"name":"Department of General Practice, Foshan Hospital of Traditional Chinese Medicine, Foshan","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuyan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of General Practice, The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan","place":["Guangdong, China"]},{"name":"Department of General Practice, Foshan Hospital of Traditional Chinese Medicine, Foshan","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingli","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of General Practice, The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan","place":["Guangdong, China"]},{"name":"Department of General Practice, Foshan Hospital of Traditional Chinese Medicine, Foshan","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoping","family":"He","sequence":"additional","affiliation":[{"name":"Department of General Practice, The Eighth Clinical Medical College of Guangzhou University of Chinese Medicine, Foshan","place":["Guangdong, China"]},{"name":"Department of General Practice, Foshan Hospital of Traditional Chinese Medicine, Foshan","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinyue","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Emergency, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou","place":["Guangdong, China"]},{"name":"Department of Emergency, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou","place":["Guangdong, China"]},{"name":"Department of Emergency, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Emergency, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou","place":["Guangdong, China"]},{"name":"Department of Emergency, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou","place":["Guangdong, China"]},{"name":"Department of Emergency, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou","place":["Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"161","DOI":"10.3138\/ptc.2016-14","article-title":"Risk factors associated with falls in older adults with dementia: a systematic review","volume":"69","author":"Fernando","year":"2017","journal-title":"Physiother Can."},{"key":"B2","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1093\/ageing\/afs012","article-title":"The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis","volume":"41","author":"Muir","year":"2012","journal-title":"Age Ageing."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e5521","DOI":"10.1371\/journal.pone.0005521","article-title":"Incidence and prediction of falls in dementia: a prospective study in older people","volume":"4","author":"Allan","year":"2009","journal-title":"PLoS ONE."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e105","DOI":"10.1002\/alz.051496","article-title":"Abd-Allah F, et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the global burden of disease study 2019","volume":"7","author":"Nichols","year":"2022","journal-title":"Lancet Public Health."},{"key":"B5","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1111\/jgs.15304","article-title":"Medical costs of fatal and nonfatal falls in older adults","volume":"66","author":"Florence","year":"2018","journal-title":"J Am Geriatr Soc."},{"key":"B6","doi-asserted-by":"publisher","first-page":"CD012424","DOI":"10.1002\/14651858.CD012424.pub2","article-title":"Exercise for preventing falls in older people living in the community","volume":"1","author":"Sherrington","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"B7","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.jphys.2017.12.001","article-title":"Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review","volume":"64","author":"Lam","year":"2018","journal-title":"J Physiother."},{"key":"B8","doi-asserted-by":"publisher","first-page":"afac205","DOI":"10.1093\/ageing\/afac205","article-title":"World guidelines for falls prevention and management for older adults: a global initiative","volume":"51","author":"Montero-Odasso","year":"2022","journal-title":"Age Ageing"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e40297","DOI":"10.1371\/journal.pone.0040297","article-title":"Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition","volume":"7","author":"Mirelman","year":"2012","journal-title":"PLoS ONE."},{"key":"B10","doi-asserted-by":"publisher","first-page":"421","DOI":"10.2147\/CIA.S71691","article-title":"Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis","volume":"10","author":"Burton","year":"2015","journal-title":"Clin Interv Aging"},{"key":"B11","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.jamda.2014.08.007","article-title":"Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: a systematic review and meta-analysis","volume":"16","author":"Chan","year":"2015","journal-title":"J Am Med Dir Assoc."},{"key":"B12","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1136\/bjsports-2016-096587","article-title":"Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis","volume":"52","author":"Northey","year":"2018","journal-title":"Br J Sports Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1002\/jrsm.1058","article-title":"Network meta-analysis, electrical networks and graph theory","volume":"3","author":"R\u00fccker","year":"2012","journal-title":"Res Synth Methods."},{"key":"B14","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins","year":"2023"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst Rev."},{"key":"B16","doi-asserted-by":"publisher","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann Intern Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1093\/ije\/31.1.140","article-title":"Meta-analyses involving cross-over trials: methodological issues","volume":"31","author":"Elbourne","year":"2002","journal-title":"Int J Epidemiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1111\/j.1365-2796.2004.01388.x","article-title":"Mild cognitive impairment as a diagnostic entity","volume":"256","author":"Petersen","year":"2004","journal-title":"J Intern Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.jalz.2011.03.005","article-title":"The diagnosis of dementia due to Alzheimer's disease: recommendations from the national institute on aging-Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease","volume":"7","author":"McKhann","year":"2011","journal-title":"Alzheimers Dement"},{"key":"B20","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1186\/1745-6215-12-125","article-title":"Reporting of complex interventions in clinical trials: development of a taxonomy to classify and describe fall-prevention interventions","volume":"12","author":"Lamb","year":"2011","journal-title":"Trials."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1618","DOI":"10.1111\/j.1532-5415.2005.53455.x","article-title":"Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus","volume":"53","year":"2005","journal-title":"J Am Geriatr Soc."},{"key":"B22","doi-asserted-by":"publisher","first-page":"304","DOI":"10.3138\/ptc.41.6.304","article-title":"Measuring balance in the elderly: preliminary development of an instrument","volume":"41","author":"Berg","year":"1989","journal-title":"Physiother Can."},{"key":"B23","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1111\/j.1532-5415.1986.tb05480.x","article-title":"Performance-oriented assessment of mobility problems in elderly patients","volume":"34","author":"Tinetti","year":"1986","journal-title":"J Am Geriatr Soc."},{"key":"B24","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The timed \u201cUp & Go\u201d: a test of basic functional mobility for frail elderly persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J Am Geriatr Soc."},{"key":"B25","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d. A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J Psychiatr res"},{"key":"B26","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc."},{"key":"B27","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1093\/ageing\/afi196","article-title":"Development and initial validation of the falls efficacy scale-international (FES-I)","volume":"34","author":"Yardley","year":"2005","journal-title":"Age Ageing."},{"key":"B28","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1136\/bmj.331.7521.897","article-title":"Simultaneous comparison of multiple treatments: combining direct and indirect evidence","volume":"331","author":"Caldwell","year":"2005","journal-title":"BMJ."},{"key":"B29","doi-asserted-by":"publisher","first-page":"130","DOI":"10.7326\/0003-4819-159-2-201307160-00008","article-title":"Conceptual and technical challenges in network meta-analysis","volume":"159","author":"Cipriani","year":"2013","journal-title":"Ann Intern Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B31","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.jclinepi.2005.06.006","article-title":"Imputing missing standard deviations in meta-analyses can provide accurate results","volume":"59","author":"Furukawa","year":"2006","journal-title":"J Clin Epidemiol."},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"B33","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials."},{"key":"B34","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ."},{"key":"B35","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1002\/jrsm.1037","article-title":"Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool","volume":"3","author":"Salanti","year":"2012","journal-title":"Res Synth Methods."},{"key":"B36","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1002\/sim.3767","article-title":"Checking consistency in mixed treatment comparison meta-analysis","volume":"29","author":"Dias","year":"2010","journal-title":"Stat Med"},{"key":"B37","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1002\/jrsm.1045","article-title":"Consistency and inconsistency in network meta-analysis: model estimation using multivariate meta-regression","volume":"3","author":"White","year":"2012","journal-title":"Res Synth Methods."},{"key":"B38","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12874-015-0060-8","article-title":"Ranking treatments in frequentist network meta-analysis works without resampling methods","volume":"15","author":"R\u00fccker","year":"2015","journal-title":"BMC Med Res Methodol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1136\/ebmental-2019-300117","article-title":"How to perform a meta-analysis with R: a practical tutorial","volume":"22","author":"Balduzzi","year":"2019","journal-title":"BMJ Mental Health."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v106.i02","article-title":"netmeta: an R package for network meta-analysis using frequentist methods","volume":"106","author":"Balduzzi","year":"2023","journal-title":"J Stat Softw."},{"key":"B41","doi-asserted-by":"publisher","first-page":"e76654","DOI":"10.1371\/journal.pone.0076654","article-title":"Graphical tools for network meta-analysis in STATA","volume":"8","author":"Chaimani","year":"2013","journal-title":"PLoS ONE."},{"key":"B42","doi-asserted-by":"publisher","first-page":"e1003082","DOI":"10.1371\/journal.pmed.1003082","article-title":"CINeMA: an approach for assessing confidence in the results of a network meta-analysis","volume":"17","author":"Nikolakopoulou","year":"2020","journal-title":"PLoS Med."},{"key":"B43","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1093\/ageing\/afi218","article-title":"Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials","volume":"35","author":"Hauer","year":"2006","journal-title":"Age Ageing."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1831444\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:30:32Z","timestamp":1784781032000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1831444\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":43,"alternative-id":["10.3389\/fmed.2026.1831444"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1831444","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"1831444"}}