The Role of Aquatic Training in Improving Risk of Falls in Older Adults: A Systematic Review With Meta-Analysis and Meta-Regression.

Abstract

This systematic review aimed to evaluate the effects of aquatic training (AT) on risk of falls in older people, compared with control groups or land-based training (LT) groups, and to know the possible moderators of the effect of AT on these outcomes. Clinical trials comparing the effect of AT with a control group or LT group in older people, assessing gait ability, balance, or muscle strength, were included. Embase, Cochrane, PubMed, and Scopus were searched until August 2025. The TESTEX (Tool for the assEssment of Study qualiTy and reporting in EXercise) scale was used to assess the risk of bias in the included studies. Random effect model was used, and effect sizes (ESs) were calculated with a 95% confidence interval. Thirty-one studies were included (1,702 participants). After AT, balance (ES = 1.16, 95% CI [0.72, 1.59], p < .001, I2 = 93%) and muscle strength (ES = 1.14, 95% CI [0.76, 1.53], p < .001, I2 = 92%) were improved compared with control group. Aerobic and combined training produced large ES in balance. Weekly training frequency and training progression moderated the effects of AT on balance, and participants' mean age moderated the effects of AT on strength. Overall, AT did not differ significantly from LT. The present study has limitations, including high heterogeneity in some comparisons and poor methodological quality of certain studies. AT is effective in improving fall risk factors such as balance and muscle strength, with large ES. The observed effects appear to be similar for both aquatic and LT. Significance/Implications: AT programs aiming to reduce fall risk incorporate either aerobic or combined aerobic and resistance training prescribed at least twice per week. Increasing the number of weekly sessions may further optimize balance improvements, and progression to higher training intensities appears beneficial for both balance and muscle strength.