Ping Guo, Shijie Chen, Jiahao Zou, Fujue Ji, Lu Wenju
Previous reviews have not simultaneously synthesized the effects of yoga on lower-extremity muscle strength, distinct static and dynamic balance domains, and quality of life while examining possible variation according to intervention frequency, duration, and session length in older adults. It also sought to identify standardized and effective yoga protocols and to inform appropriate intervention strategies for improving these outcomes in older adults. Following the PICOS framework, relevant studies published up to December 31, 2025, were identified through systematic searches of PubMed, Web of Science Core Collection, and Embase. After screening 3222 records identified through the database searches, 21 studies involving 1471 unique participants were included in the systematic review and meta-analysis, and the data were analyzed using RStudio. The primary unadjusted analyses suggested potential benefits for dynamic balance, lower-extremity muscle strength, and quality of life, but not static balance. After trim-and-fill adjustment, the dynamic-balance estimate became non-significant, the lower-extremity muscle-strength estimate was reduced to borderline significance, and the quality-of-life estimate remained unchanged. In conclusion, the primary unadjusted analyses suggested potential benefits of yoga for dynamic balance and lower-extremity muscle strength, but neither finding was robust to the trim-and-fill sensitivity analysis: the adjusted dynamic-balance estimate was non-significant, and the adjusted lower-extremity muscle-strength estimate was reduced to borderline significance. The quality-of-life estimate remained significant and unchanged, whereas no clear overall benefit was observed for static balance. The exploratory subgroup analyses were hypothesis-generating and did not provide sufficient evidence to recommend an optimal weekly frequency, intervention duration, or session length.