OBJECTIVE: To consolidate the evidence on the effect of physical exercise on fear of falling in individuals with stroke. DATA SOURCES: PubMed, CINAHL, Cochrane Database and Medline. METHODS: An extensive database search was conducted to identify the randomised controlled trials that examined the effect of physical exercise on fear of falling post-stroke. Grading of Recommendation, Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence for each meta-analysis. RESULTS: Fourteen trials totalling 1211 participants were included in this review. Thirteen of these (1180 participants) were included in the meta-analyses. In the primary analysis, very low-quality evidence suggested that exercise reduced fear of falling post-stroke (standardized mean difference (SMD) 0.48; 95% confidence interval CI 0.23 to 0.72). The effect was diminished at three- to six-month follow-up after exercise training ended (SMD -0.09, 95% CI -0.27 to 0.10; high-quality evidence). In the sensitivity analyses, the treatment effect was more pronounced in individuals with a lower baseline Berg balance score (BBS <= 45, SMD 0.53 95% CI 0.17 to 0.88) and for those trials with exercise frequency of >= 3 sessions per week (SMD 0.70, 95% CI 0.39 to 1.01). Compared with circuit-based training consisting of a combination of walking, balance and strengthening exercises (SMD 0.27, 95% CI -0.09 to 0.63), walking programmes seemed to generate a larger effect on fear of falling (SMD 1.06, 95% CI 0.43 to 1.70). CONCLUSION: Physical exercise was beneficial for reducing fear of falling in individuals with stroke, particularly those with poorer balance ability.

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