title: Effectiveness of foot and ankle exercise programs on reducing the risk of falling in older adults: a systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Foot and ankle (FA) exercise programs might reduce the risk of falling in older adults. We sought to systematically review the current literature on FA exercise programs targeted at reducing the risk of falling in older adults.
  
  
  METHODS
  A systematic literature search was performed in the PubMed database, the Physiotherapy Evidence Database, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials. Articles were included based on the following criteria: 1) randomized controlled trial, 2) FA exercise program, and 3) use of fall risk-related motor outcomes (strength, balance, flexibility, and functional ability) or use of falls as an outcome. Weighted effect sizes (d) were calculated across studies for estimating the overall effect of FA exercises on the most frequently reported motor outcome parameters.
  
  
  RESULTS
  Eight publications met the inclusion criteria. Small to moderate overall effects were found for balance (d = 0.46, P < .001) and ankle flexibility (d = 0.29, P = .006). No significant overall effects were found for ankle plantarflexor strength (d = 0.11, P = .223) and walking performance (d = -0.05, P = .404). Controversial results were reported for other functional measures. Effects varied depending on the type of intervention. Only one study reported improved ankle evertor strength and a significant reduction in falls.
  
  
  CONCLUSIONS
  Evidence suggests that FA exercise can improve certain fall risk-related motor outcomes and reduce falls. Limited effects on strength and functional ability might be related to insufficient training intensity and lack of adherence. Further studies that include progressive strength and flexibility training are necessary to validate which FA exercise programs are most effective at preventing falls.
authors.affiliation: Interdisciplinary Consortium on Advanced Motion Performance College of Medicine, University of Arizona, Tucson, AZ.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwenk
authors.forename: Elise DeHaven
authors.initials: ED
authors.lastname: Jordan
authors.forename: Bahareh
authors.initials: B
authors.lastname: Honarvararaghi
authors.forename: Jane
authors.initials: J
authors.lastname: Mohler
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
authors.forename: Bijan
authors.initials: B
authors.lastname: Najafi
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000842:Ankle; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005528:Foot; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D011322:Primary Prevention / Q000379:methods*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular / Q000502:physiology*; D040242:Risk Reduction Behavior; D016896:Treatment Outcome