Effects of mind-body exercise on balance function in pre-frail and frail older adults: a systematic review and meta-analysis

Abstract

Background Frailty and pre-frailty are common geriatric conditions associated with reduced physiological reserve and a higher risk of falls. Mind–body exercises such as Tai Chi, Baduanjin, and Yoga are widely recommended as low-intensity interventions, while their specific effects on different aspects of balance remain unclear. Objective This systematic review and meta-analysis aimed to evaluate the effects of mind–body exercise on overall, dynamic, and static balance in pre-frail and frail older adults and to examine whether frailty stage and exercise characteristics influence outcomes. Methods Our literature search was conducted in PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, and VIP Databases up to March 2026. Randomized controlled trials comparing mind–body exercise with usual care, health education, or no intervention in pre-frail or frail older adults were included. Pooled effect sizes were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects models. Prespecified subgroup analyses were performed according to frailty stage, exercise frequency, session duration, and intervention length. Results Ten RCTs with 12 comparisons were included. Mind–body exercise showed significant improvements in overall balance (SMD = 0.54, 95% CI 0.17–0.91), dynamic balance (SMD = −1.08, 95% CI −1.41 to −0.76), and static balance (SMD = 1.36, 95% CI 0.43–2.30). Exploratory subgroup analyses suggested that interventions delivered 2–4 times weekly, lasting 31–60 min per session, and continuing for at least 13 weeks were associated with relatively more consistent effects; however, these findings should be interpreted cautiously because they were derived from indirect subgroup comparisons rather than formal dose–response analyses. Conclusion Mind–body exercise appears to be an effective and practical strategy for improving balance in pre-frail and frail older adults, particularly when implemented early in the frailty trajectory.