Exercise With Balance and Cognitive Training Reduces Falls After Stroke

Physical exercise significantly reduces falls among people with stroke, according to a systematic review and meta-analysis published in Physical Therapy & Rehabilitation Journal by researchers at the Hong Kong Polytechnic University and collaborating institutions.

Stroke markedly increases fall risk, and the investigators noted that individuals with chronic stroke face more than double the fall risk of age- and gender-matched controls, with roughly 42% reporting recurrent falls. The review, registered on PROSPERO and reported according to PRISMA guidelines, set out to evaluate the effect of exercise on falls after stroke, and to identify participant and protocol characteristics associated with treatment response.

The analysis pooled 18 randomized controlled trials involving 1,536 participants, drawn from a search of PubMed, CINAHL, the Cochrane Database, PsycINFO, Embase, and Web of Science through August 2025. Exercise reduced the number of falls by an average of 39% (incidence rate ratio [IRR], 0.61; 95% CI, 0.47-0.78; low quality of evidence). The effect on injurious falls was less certain (IRR, 0.63; 95% CI, 0.37-1.05; moderate quality), and there was no significant reduction in the number of fallers (IRR, 0.88; 95% CI, 0.73-1.07; high quality).

In subgroup analyses, programs emphasizing balance training reduced falls by 49%, and those combining physical exercise with cognitive components — such as dual-task or Tai Chi–based training — reduced falls by 48%; both approaches also lowered injurious falls and the number of fallers. Strength training showed little effect, and results for walking-only programs were inconclusive. Benefits were more pronounced among people with chronic stroke and mild-to-moderate disability than among those with early subacute stroke or severe disability. The authors cited unblinded participants and therapists, self-reported fall data, and small samples in several trials as limitations affecting the overall low-to-moderate quality of evidence.

The study authors concluded that exercise interventions incorporating balance and cognitive elements may offer the greatest benefit and should be considered within stroke rehabilitation programs, while calling for further research to define optimal protocols across stroke subgroups.

Source: Li X, Chan YK, Tong YL, et al. Physical exercise reduces fall-related outcomes among people with stroke: a systematic review and meta-analysis. Physical Therapy & Rehabilitation Journal. Published online 2026. doi:10.1093/ptj/pzag098