BACKGROUND: Balance impairments are the leading causes of falls in older adults. Aquatic-based exercises have been broadly practiced as an alternative to land-based exercises; however, the effects on dynamic balance have not been comprehensively reviewed and compared to land exercises. Thus, the purpose of this systematic review and meta-analysis was to compare the effectiveness of aquatic exercises (AE) to land exercises (LE) on dynamic balance in older adults. METHODS: Electronic databases (PubMed, Medline, CINAHL, SPORTDiscus, PsycINFO), from inception to November 2019, were searched. Studies met the following eligibility criteria: randomized controlled trials, English language, older adults aged 65 years or older, a minimum of one AE and LE group, at least one assessment for dynamic balance. For the meta-analysis, the effect sizes of dynamic balance outcomes were calculated using a standardized mean difference (SMD) and a 95% confidence interval (CI). RESULTS: A total of 11 trials met the inclusion criteria, and 10 studies were eligible for the meta-analysis. The meta-analysis presented that older adults in AE groups demonstrated comparable enhancements in dynamic steady-state balance (SMD -0.24; 95% CI -0.81 to 0.34), proactive balance (SMD -0.21; 95% CI -0.59 to 0.17), and balance test batteries (SMD -0.24; 95% CI -0.50 to 0.03) compared with those in LE groups. CONCLUSIONS: AE and LE have comparable impacts on dynamic balance in older adults aged 65 years or older. Thus, this review provides evidence that AE can be utilized as a reasonable alternative to LE to improve dynamic balance and possibly reduce the risk of falls.

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