BACKGROUND: Whether exercise prevents fall-related injuries in different health conditions and with different training protocols is still unclear. This study aimed to determine the effect of exercise on fall-related injuries by participant characteristics and divergent exercise protocols. The safety and compliance of exercise were also examined. METHODS: Electronic database searches were conducted in PubMed, Web of Science, and Embase for randomised controlled trials that evaluated the influence of exercise on fall-induced injuries in older people. RESULTS: Twenty-five trials met the inclusion criteria. Exercise significantly reduced the risk of fall-related injuries in older adults, risk ratio (RR) 0.879 (95% confidence interval (CI) 0.832 to 0.928). Among the injuries, events needing medical care or resulting fractures were also decreased by exercise intervention, with RR 0.681 (0.562 to 0.825) and 0.561 (0.366 to 0.860), respectively. When analysis was stratified by participant characteristics and exercise protocols, we found that participants at high risk of falling, or with osteoporosis, were sensitive to exercise intervention. Combined exercise protocols and balance training were the most effective exercise types in reducing fall-related injuries. Exercise-associated beneficial effects were even significant in very old people (>= 80 years) and across the duration of interventions (< 6 months, 6 to 12 months and >= 12 months). Exercise only generated a very low injury rate per participant year (0.002, 95% CI 0 to 0.05) and showed relatively good compliance of exercise (as reported in the included papers) (78.5, 95% CI 72.8 to 84.2%). CONCLUSIONS: Exercise is effective in preventing fall-induced injuries across a variety of baseline participant characteristics and exercise protocols. Exercise was associated with a low injury rate and had a good compliance, suggesting it is a feasible approach to managing fall-related injuries.

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