Dose-response relationships of sensorimotor-based interventions on balance performance in older adults: A systematic review and meta-regression analysis

Abstract

Falls are a severe public health challenge for older adults. Although sensorimotor-based interventions can remodel balance, their quantitative dose-response trajectories remain unknown, often leading to blindly accumulated doses. We aimed to identify optimal intervention strategies by deconstructing these non-linear dynamics. A comprehensive search of five databases up to February 2026 identified relevant randomized controlled trials (RCTs). We constructed a random-effects model using the standardized mean difference (Hedges’ g). Restricted cubic spline (RCS) and meta-regression models explored the non-linear dynamics of total intervention dose and the moderating effects of age. We included 24 studies comprising 1,110 participants. Sensorimotor-based interventions significantly improved dynamic balance (Timed Up and Go Test [TUGT]: g = −0.89, Q = 78.19; low-certainty evidence), static balance (Berg Balance Scale [BBS]: g = 0.94, Q = 21.14; high-certainty evidence), and neuromuscular control, including Center of Pressure with eyes open (COP-EO: g = −0.66, Q = 8.19; low-certainty evidence) and Center of Pressure with eyes closed (COP-EC: g = −0.34, Q = 3.54; moderate-certainty evidence). The RCS model suggested significant non-linear dose dependency for dynamic balance (P non-linearity  = 0.004), indicating a potential relative attenuation of effect sizes near a cumulative dose of 1000 minutes. Conversely, static balance showed no significant dose association. Increasing age significantly attenuated dynamic balance benefits (p = 0.047) but did not negatively affect static stability. The adaptive trajectories of dynamic and static balance responding to sensorimotor interventions diverge fundamentally. Based on these non-linear dose-response fluctuations and age-related characteristics, continuous time accumulation may not guarantee proportional linear returns. Optimizing fall prevention requires shifting toward precise interventions that consider dose-efficiency and age stratification rather than a “more is better” approach. Systematic Review Registration: INPLASY202630061.