Effects of Otago exercise program on physical function in older adults: A systematic review and meta-analysis of randomized controlled trials

Maintaining physical function is critical for older adults to achieve healthy aging. The Otago exercise program (OEP) has been widely used to prevent falls for older adults. However, the effects of OEP on physical function remain controversial and the possible effects modifiers have not been assessed. To evaluate the effects of OEP on physical function in older adults and to explore potential moderators underlying the effects of OEP. We searched five electronic databases and relevant systematic reviews to identify studies. We included randomized controlled trials (RCTs) evaluating the effects of OEP as a single intervention on physical function among older adults aged 65 and over. Meta-analysis was performed using the random-effects model. Standardized mean differences (SMD) for physical function changes, pertinent to balance, strength, and mobility, were outcome measures. Subgroup analyses on exercise protocol and participants' characteristics were performed. Thirteen RCTs consisting of 2402 participants were included in this systematic review and meta-analysis. Results indicated a significant effect of OEP on balance (SMD=0.59, 95% CI: 0.22∼0.96), lower body strength (SMD=0.93, 95% CI: 0.31∼1.55), and mobility (SMD=–0.59, 95% CI: –0.95∼–0.22) against control groups. No significant OEP effects were found on upper body strength (MD=1.48, 95% CI: –0.58∼3.55). Subgroup analysis revealed that the video-supported delivery mode was more effective for improving balance (P=0.04) and mobility (P=0.02) than the face-to-face mode. Session durations over 30 minutes was more effective on lower body strength (P<0.001) and mobility (P<0.001) than those 1–30 minutes. Program period of 13–26 weeks was more effective on mobility (P=0.02) than those of 4–12 weeks. However, the effects of OEP on physical function were not associated with age groups, and baseline falling risks. The OEP could improve physical function including balance, lower body strength, and mobility in older adults. Implementing the OEP in video-supported, more than 30 minutes per session and 4–12 weeks may be the most appropriate and effective exercise protocol for improving physical function among older adults. More RCTs with rigorous design and larger scale are needed to further assess the effectiveness of diverse OEP protocols and quantify the dose–effect relationship.