Effects of mind-body exercise on balance function in pre-frail and frail older adults: a systematic review and meta-analysis.

BACKGROUND: Frailty and pre-frailty are common geriatric conditions associated with reduced physiological reserve and a higher risk of falls. Mind-body exercises such as Tai Chi, Baduanjin, and Yoga are widely recommended as low-intensity interventions, while their specific effects on different aspects of balance remain unclear. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effects of mind-body exercise on overall, dynamic, and static balance in pre-frail and frail older adults and to examine whether frailty stage and exercise characteristics influence outcomes. METHODS: Our literature search was conducted in PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, and VIP Databases up to March 2026. Randomized controlled trials comparing mind-body exercise with usual care, health education, or no intervention in pre-frail or frail older adults were included. Pooled effect sizes were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects models. Prespecified subgroup analyses were performed according to frailty stage, exercise frequency, session duration, and intervention length. RESULTS: Ten RCTs with 12 comparisons were included. Mind-body exercise showed significant improvements in overall balance (SMD = 0.54, 95% CI 0.17-0.91), dynamic balance (SMD = -1.08, 95% CI -1.41 to -0.76), and static balance (SMD = 1.36, 95% CI 0.43-2.30). Exploratory subgroup analyses suggested that interventions delivered 2-4 times weekly, lasting 31-60 min per session, and continuing for at least 13 weeks were associated with relatively more consistent effects; however, these findings should be interpreted cautiously because they were derived from indirect subgroup comparisons rather than formal dose-response analyses. CONCLUSION: Mind-body exercise appears to be an effective and practical strategy for improving balance in pre-frail and frail older adults, particularly when implemented early in the frailty trajectory.