{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T21:25:35Z","timestamp":1788211535783,"version":"build-2803163510"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"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. Physiol."],"abstract":"\n Background<\/jats:title>\n Falls are a leading cause of injury and death among older adults, yet many encounter barriers to engaging in conventional exercise programs. Remote exercise snacking (ES) refers to performing multiple (\u22652 times) short bursts (\u226410 min) of exercise of any type or intensity daily in a non-laboratory setting (including multiple sets of interval training), with complete rest or at least a 30-min recovery period between each exercise session, this represents a flexible alternative; however, its effectiveness remains inconclusive. This study addresses an important evidence gap by systematically evaluates the impact of remote exercise snacking on lower-limb muscle performance, balance ability, as well as its acceptability and feasibility in older adults.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A systematic search was conducted in six databases (CINAHL, PubMed, Scopus, Cochrane Library, Web of Science and FMRS) from inception to May, 2025. Two reviewers independently performed study selection, data extraction, and risk of bias assessment following PRISMA guidelines. Studies meet the following eligibility criteria in accordance with PICOS, participants were insufficiently active older adults; intervention involved short bouts of exercise; comparator\/control were no specific intervention; the primary outcomes was lower-limb muscle function, with secondary outcomes included balance and\/or participant adherence or acceptbility; and study design were randomized crossover or randomized control only. Muscle performance and balance outcomes were synthesized through meta-analysis using Stata v15.1 with standardized mean difference (SMD), while adherence and acceptability were evaluated narratively.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Four publications comprising ten studies (n = 313, M\/F: 170\/143) were included. Remote exercise snacking significantly improved lower-limb muscle strength (SMDpooled = 0.29, 95% CI: 0.06\u20130.52, p = 0.01) and endurance (SMDpooled = 0.24, 95% CI: 0.01\u20130.46, p = 0.04), but showed no significant effect on balance (SMDpooled = 0.04, 95% CI: \u22120.14\u20130.23, p = 0.65). Subgroup analyses showed that greater improvements in strength were observed in interventions lasting 6 weeks or longer and in those that incorporated progression strategies. The overall mean adherence across the included studies was 85%, with adherence generally higher in interventions that provided video-based guidance.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Remote exercise snacking appears effective in improving lower-limb muscle function but shows limited impact on balance among healthy older adults. Intervention duration and the inclusion of progression are key determinants of efficacy. The delivery mode (e.g., written materials, video, or app-based platforms) and exercise type (e.g., bodyweight, Tai Chi, or combined formats) may influence the acceptability and feasibility of implementation. The main findings are summarized in a graphical abstract.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n Identifier CRD42024627584.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fphys.2026.1709619","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T05:31:43Z","timestamp":1770787903000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Remote exercise snacking and fall-related functional outcomes in older adults: a systematic review including a meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Simin","family":"Zhang","sequence":"first","affiliation":[{"name":"National Research Center for Rehabilitation Technical Aids","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingkuai","family":"Wang","sequence":"additional","affiliation":[{"name":"College of Education, Beijing Sport University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruting","family":"Lin","sequence":"additional","affiliation":[{"name":"College of Education, Beijing Sport University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyu","family":"Shuai","sequence":"additional","affiliation":[{"name":"Physical Education Department, College of Basic Education, Beijing College of Finance and Commerce","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeping","family":"Lv","sequence":"additional","affiliation":[{"name":"National Research Center for Rehabilitation Technical Aids","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chu","family":"Wang","sequence":"additional","affiliation":[{"name":"National Research Center for Rehabilitation Technical Aids","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Research Center for Rehabilitation Technical Aids","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian","family":"Yang","sequence":"additional","affiliation":[{"name":"National Research Center for Rehabilitation Technical Aids","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubo","family":"Wang","sequence":"additional","affiliation":[{"name":"National Research Center for Rehabilitation Technical Aids","place":["Beijing, China"]},{"name":"College of Education, Beijing Sport University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemin","family":"Zhang","sequence":"additional","affiliation":[{"name":"National Research Center for Rehabilitation Technical Aids","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s13102-025-01062-0","article-title":"The effects and durability of an 8-week dynamic neuromuscular stabilization program on balance and coordination in adult males with intellectual disabilities: a randomized controlled trial","volume":"17","author":"Babagoltabar-Samakoush","year":"2025","journal-title":"BMC Sports Sci. Med. Rehabil."},{"key":"B2","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s40798-023-00646-9","article-title":"Chronic effects of different intensities of power training on neuromuscular parameters in older people: a systematic review with meta-analysis","volume":"9","author":"Bandeira-Guimar\u00e3es","year":"2023","journal-title":"Sports Med. Open"},{"key":"B3","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.pcad.2020.11.002","article-title":"Overcoming barriers to physical activity in underserved populations","volume":"64","author":"Bantham","year":"2021","journal-title":"Prog. Cardiovasc Dis."},{"key":"B4","doi-asserted-by":"crossref","DOI":"10.4324\/9780203771587","volume-title":"Statistical power analysis for the behavioral sciences","author":"Cohen","year":"2013"},{"key":"B5","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1590\/1516-4446-2018-0030","article-title":"Effects of resistance exercise training and stretching on chronic insomnia","volume":"41","author":"D'Aurea","year":"2019","journal-title":"Braz J. Psychiatry"},{"key":"B6","doi-asserted-by":"publisher","first-page":"100262","DOI":"10.1016\/j.advnut.2024.100262","article-title":"The effect of time-restricted eating combined with exercise on body composition and metabolic health: a systematic review and meta-analysis","volume":"15","author":"Dai","year":"2024","journal-title":"Adv. Nutr."},{"key":"B7","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1007\/s40279-016-0640-8","article-title":"Frequency: the overlooked resistance training variable for inducing muscle hypertrophy?","volume":"47","author":"Dankel","year":"2017","journal-title":"Sports Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2973","DOI":"10.1111\/jgs.17375","article-title":"Interventions for preventing falls and fall-related fractures in community-dwelling older adults: a systematic review and network meta-analysis","volume":"69","author":"Dautzenberg","year":"2021","journal-title":"J. Am. Geriatr. Soc."},{"key":"B9","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1111\/j.0006-341x.2000.00455.x","article-title":"Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis","volume":"56","author":"Duval","year":"2000","journal-title":"Biometrics"},{"key":"B10","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1186\/s12877-022-03207-z","article-title":"Feasibility and acceptability of a remotely delivered, home-based, pragmatic resistance 'exercise snacking' intervention in community-dwelling older adults: a pilot randomised controlled trial","volume":"22","author":"Fyfe","year":"2022","journal-title":"BMC Geriatr."},{"key":"B11","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":"B12","doi-asserted-by":"publisher","first-page":"i3","DOI":"10.1136\/injuryprev-2019-043286","article-title":"The global burden of falls: global, regional and national estimates of morbidity and mortality from the global burden of disease study 2017","volume":"26","author":"James","year":"2020","journal-title":"Inj. Prev."},{"key":"B13","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1007\/s40279-023-01983-1","article-title":"Exercise snacks and other forms of intermittent physical activity for improving health in adults and older adults: a scoping review of epidemiological, experimental and qualitative studies","volume":"54","author":"Jones","year":"2024","journal-title":"Sports Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1249\/01.mss.0000121945.36635.61","article-title":"Fundamentals of resistance training: progression and exercise prescription","volume":"36","author":"Kraemer","year":"2004","journal-title":"Med. Sci. Sports Exerc"},{"key":"B15","doi-asserted-by":"publisher","first-page":"74","DOI":"10.15758\/ajk.2024.26.3.74","article-title":"Effects of online-based exercise on body composition and muscular function during the COVID-19 pandemic","volume":"26","author":"Lee","year":"2024","journal-title":"Asian J. Kinesiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1002\/9781119536604.ch5","article-title":"Collecting data","author":"Li","year":"2019","journal-title":"Cochrane Handb. Syst. Rev. Interventions"},{"key":"B17","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1123\/japa.2020-0391","article-title":"Feasibility and acceptability of home-based exercise snacking and Tai chi snacking delivered remotely to self-isolating older adults during COVID-19","volume":"30","author":"Liang","year":"2022","journal-title":"J. Aging Phys. Act."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1180939","DOI":"10.3389\/fragi.2023.1180939","article-title":"The acceptability of homebased exercise snacking and Tai-chi snacking amongst high and low function UK and Taiwanese older adults","volume":"4","author":"Liang","year":"2023","journal-title":"Front. Aging"},{"key":"B19","doi-asserted-by":"publisher","first-page":"572","DOI":"10.14283\/jfa.2024.32","article-title":"The efficacy of 12-Week progressive home-based strength and tai-chi exercise snacking in older adults: a mixed-method exploratory randomised control trial","volume":"13","author":"Liang","year":"2024","journal-title":"J. Frailty Aging"},{"key":"B20","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s12966-025-01753-4","article-title":"Enablers and barriers to physical activity among older adults of low socio-economic status: a systematic review of qualitative literature","volume":"22","author":"Malkowski","year":"2025","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e26779","DOI":"10.2196\/26779","article-title":"Evaluating the effectiveness of gamification on physical activity: systematic review and meta-analysis of randomized controlled trials","volume":"24","author":"Mazeas","year":"2022","journal-title":"J. Med. Internet Res."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1186","DOI":"10.1186\/s12889-020-09268-2","article-title":"Epidemiological and clinical characteristics of fall-related injuries: a retrospective study","volume":"20","author":"Mekkodathil","year":"2020","journal-title":"BMC Public Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1007\/s40279-024-02009-0","article-title":"Resistance exercise minimal dose strategies for increasing muscle strength in the general population: an overview","volume":"54","author":"Nuzzo","year":"2024","journal-title":"Sports Med."},{"key":"B24","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":"B25","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1186\/s12877-019-1250-8","article-title":"Effects of individualized tai-Chi on balance and lower-limb strength in older adults","volume":"19","author":"Penn","year":"2019","journal-title":"BMC Geriatr."},{"key":"B26","doi-asserted-by":"publisher","first-page":"7516939","DOI":"10.1155\/2019\/7516939","article-title":"Exercise snacking to improve muscle function in healthy older adults: a pilot Study","volume":"2019","author":"Perkin","year":"2019","journal-title":"J. Aging Res."},{"key":"B27","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1186\/s12877-025-06043-z","article-title":"Home-based geriatric rehabilitation after inpatient rehabilitation: a redesign and feasibility study","volume":"25","author":"Preitschopf","year":"2025","journal-title":"BMC Geriatr."},{"key":"B28","article-title":"Progression models in resistance training for healthy adults","volume":"41","year":"2009","journal-title":"Med. & Sci. Sports & Exerc."},{"key":"B29","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1007\/s40279-024-02123-z","article-title":"Effects of resistance training volume on physical function, lean body mass and lower-body muscle hypertrophy and strength in older adults: a systematic review and network meta-analysis of 151 randomised trials","volume":"55","author":"Radaelli","year":"2025","journal-title":"Sports Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"afad059","DOI":"10.1093\/ageing\/afad059","article-title":"Effectiveness of exercise on fall prevention in community-dwelling older adults: a 2-year randomized controlled study of 914 women","volume":"52","author":"Rikkonen","year":"2023","journal-title":"Age Ageing"},{"key":"B31","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":"B32","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"Bmj"},{"key":"B33","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/s13102-024-00845-1","article-title":"Effects of combination of strength and balance training on postural control and functionality in people with chronic ankle instability: a systematic review and meta analysis","volume":"16","author":"Su","year":"2024","journal-title":"BMC Sports Sci. Med. Rehabil."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.smhs.2024.02.006","article-title":"Exercise snacks and physical fitness in sedentary populations","volume":"7","author":"Wang","year":"2025","journal-title":"Sports Med. Health Sci."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e000817","DOI":"10.1136\/bmjsem-2020-000817","article-title":"Effect of Tai chi on muscle strength, physical endurance, postural balance and flexibility: a systematic review and meta-analysis","volume":"7","author":"Wehner","year":"2021","journal-title":"BMJ Open Sport Exerc Med."},{"key":"B36","article-title":"WHO global report on falls prevention in older Age. Ageing life course fam community health WHO glob Rep Falls prev older age","year":"2008"},{"key":"B37","doi-asserted-by":"publisher","first-page":"103089","DOI":"10.1016\/j.ctim.2024.103089","article-title":"Tai chi for balance and postural control in people with peripheral neuropathy: a scoping review","volume":"86","author":"Yang","year":"2024","journal-title":"Complement. Ther. Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1186\/s13102-024-00936-z","article-title":"Effects of proprioceptive training on sports performance: a systematic review","volume":"16","author":"Y\u0131lmaz","year":"2024","journal-title":"BMC Sports Sci. Med. Rehabil."},{"key":"B39","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1093\/ije\/dyw142","article-title":"Exercise interventions and prevention of fall-related fractures in older people: a meta-analysis of randomized controlled trials","volume":"46","author":"Zhao","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1007\/s40520-023-02652-z","article-title":"Barriers and facilitators to older adult participation in intergenerational physical activity program: a systematic review","volume":"36","author":"Zhou","year":"2024","journal-title":"Aging Clin. Exp. Res."},{"key":"B41","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/s12877-025-05685-3","article-title":"Association of lower-limb strength with different fall histories or prospective falls in community-dwelling older people: a systematic review and meta-analysis","volume":"25","author":"Zhu","year":"2025","journal-title":"BMC Geriatr."}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1709619\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T05:31:44Z","timestamp":1770787904000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1709619\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,11]]},"references-count":41,"alternative-id":["10.3389\/fphys.2026.1709619"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2026.1709619","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,11]]},"article-number":"1709619"}}