Effects of Backward Walking Training on Balance and Fall Risk in Older Adults: A Systematic Review and Meta-analysis

Objective: In this systematic review and meta-analysis, we aimed to evaluate the effectiveness of backward walking training (BWT) in improving balance and mobility in older adults. Design: Systematic review and meta-analysis. Methods: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library CENTRAL databases for articles published between January 2010 and July 2025. Randomized controlled trials (RCTs) involving adults aged ≥ 60 years who underwent BWT were included. The primary outcome was balance ability assessed using the Berg Balance Scale (BBS). Exclusion criteria were non-English language articles, inaccessible full texts, and non-RCT designs. Two independent reviewers screened the articles and assessed risk of bias using the Cochrane tool. Meta-analyses were performed using Review Manager (RevMan) 5.4 with a random-effects model. Heterogeneity was assessed using χ2 and I2 statistics. Results: Five RCTs with 208 participants were included. Three studies reported BBS-based outcomes, showing a significant overall mean difference of 4.75 points (95% confidence interval (CI): 1.48–8.02; Z = 2.85, p = 0.004). Individual effects included improvements ranging from approximately 1.7 to 7.0 points. However, heterogeneity was high (I2 = 97%), and the pooled estimate should be interpreted cautiously. Conclusions: BWT significantly improved balance and may be considered a useful intervention to enhance balance and functional mobility in older adults.