Falls are inadvertent events involving the descent of an individual to the ground or any other lower surface (1). These incidents pose a significant health risk, with over half of falls leading to soft tissue injuries, fractures, and other severe injuries, or even fatalities (2). Furthermore, even in the absence of physical harm, falls can inflict long-lasting psychological sequelae, including depression and an increased fear of falling, which can subsequently limit daily and social activities, deteriorate physical fitness and function, and exacerbate the risk of future falls (3, 4). Alarmingly, approximately 28 to 35% of individuals aged 65 and older experience a fall annually, with this proportion escalating to 32 to 42% among those aged 70 and above (5). These statistics highlight the pressing need for effective interventions to mitigate the burden of falls on older adults.

Risk factors for falls can be categorized into intrinsic and extrinsic categories. Intrinsic factors encompass aging, chronic illnesses, reduced muscle strength, gait and balance disorders, as well as cognitive impairments. Conversely, extrinsic factors comprise medication use, unfavorable environments, and hazardous activities (6). Notably, among these factors, diminished balance ability stands out as a primary cause of falls among older adults (7). Specifically, the balance ability of individuals aged 60 and above declines by approximately 16% every decade, thereby heightening their vulnerability to falls (8). Furthermore, impaired balance and gait function serve as potent predictors of fall risk in this population, underscoring their significance in assessing an individual’s predisposition to falls (9). Consequently, by assessing gait and balance abilities in older adults, it is feasible to anticipate fall risk and subsequently implement targeted preventive measures (10).

Dance, a harmonious blend of rhythmic motions, embodies intricate emotional, physical, cognitive, and social dimensions (11). Its diverse styles, intricate steps, and accompanying melodies hold a particular appeal for older adults, motivating them to engage in extended practice sessions (12, 13). This practice has been shown to exert a salutary influence on various risk factors associated with falls, including enhancements in balance, gait dynamics, strength, and flexibility (14–16). This benefit is particularly pronounced among individuals with chronic health conditions (17–21).

While several meta-analyses have unequivocally affirmed dance’s efficacy in mitigating the risk of falls among the older adult (22, 23), a notable gap remains in the literature regarding a direct comparison of the improvement effects elicited by different dance forms. Thus, there is a pressing need to explore and compare the specific contributions of various dance styles to the overall wellbeing and fall prevention of older adults.

Network Meta-analysis, an evolution from the conventional Meta-analysis framework, offers a robust methodology for identifying the “optimal” intervention options by comprehensively comparing their direct and indirect effects (24). The present study employs Network Meta-analysis to evaluate the efficacy of various dance interventions in mitigating falls among older adults. Our objective is to provide evidence-based recommendations for effective dance-based interventions that can contribute to reducing fall risk in this population. By doing so, we aim to contribute to the development of tailored and targeted fall prevention strategies tailored specifically for older individuals.

Approximately 30 to 40% of community-dwelling older adults aged 65 and above experience falls annually, with women facing a higher risk than men (58). Fall prevention is paramount in mitigating the decline of functional capacity in this population (59). Exercise interventions, including dancing, have been shown to enhance balance abilities, strengthen muscles, improve lower limb flexibility, diminish fall risks, and alleviate fall-related anxiety (60). Dancing, as a joyful and engaging physical activity (61), may offer more sustained benefits than traditional balance and strength training.

Meta-analytic evidence underscores the positive impact of dance interventions on static balance (assessed by BBS scores and SLS time), dynamic balance, and mobility (measured by TUG time) (17), all of which are crucial factors influencing fall risk in older adults (62). For older individuals with chronic conditions, especially with Parkinson’s disease, dance practice not only improves balance but also alleviates symptoms and enhances quality of life (63).

However, there is a dearth of consensus on the “optimal” dance intervention for minimizing fall risks in older adults. The studies included in this paper primarily assessed fall risk through TUG time, Tinetti score, BBS score and SLS time (49). By conducting both direct and indirect comparisons, we aimed to evaluate the efficacy of various dance interventions in reducing fall risks among older adults, thereby facilitating the selection of the most effective dance intervention.

Age-related alterations in the sensorimotor and neuromuscular systems adversely impact the performance of both static and dynamic postural control among older adults (64). To assess these changes, BBS is employed, which evaluates both dynamic and static balance through a comprehensive set of 14 mobility-related tasks categorized into three domains: sitting balance, standing balance, and dynamic balance (65). Berg Balance Score (BBS) was significantly improved in the creative dance group compared to the control group (p < 0.05). Additionally, Creative dance was the most effective intervention. Research indicates that training to respond to the rhythms of improvisational music can lead to the development of highly automated gait patterns, resulting in enhanced gait performance and improved balance and mobility (66). Creative dance, which requires participants to adapt improvisationally to changes in music such as rhythm, tempo, and melody, fosters continuous reactions to external stimuli within a dynamic spatio-temporal environment (67). This type of dynamic training (68) has been shown to be beneficial for improving physical factors associated with falls, including strength, dynamic balance, and mobility, thereby contributing to fall prevention (42).

The Timed Up and Go (TUG) time offers an observational assessment of gait patterns and indirectly quantifies critical fall risk factors, including muscle strength, balance, and gait stability among individuals (28). The network meta-analysis conducted on the Timed Up and Go (TUG) time revealed that among healthy older adult, interventions involving Folk dance, Creative dance, and Ballroom dance were all significantly more effective than the control group in improving performance. Notably, Folk dance emerged as the most efficacious intervention among the three dance styles evaluated.

Slow-paced dance and various support base patterns are pivotal factors in enhancing posture and balance adjustments. Folk dance training, which involves rhythmic motor coordination and control of movements or postures, contributes to the improvement of three bodily systems: the central nervous system, sensory nervous system, and muscular system (69). This type of training benefits the core muscles associated with balance capabilities (70). Muscle strength is a fundamental component for maintaining body balance during movement. Slow-motion exercises can effectively stimulate the functionality of core muscles. Traditional Srichiangmai dance represents an alternative form of aerobic exercise characterized by its slow tempo and low impact. By adhering to the musical rhythm, it engages muscles in various body parts to sustain dance poses, thereby aiding in the enhancement of muscle strength and the improvement of balance (71). Greek traditional dance often requires prolonged single-leg standing, a posture that strengthens the role of the ankle joint in static postural control, effectively reducing postural sway in older adults and significantly increasing single-leg standing time (72). Additionally, the diverse activities involved in traditional Greek dance, including head and body rotations, weight shifts, and transitions from double-leg to single-leg stances, continually challenge the postural control system. These movements have been shown to improve specific aspects of dynamic balance control (73). Thai classical dance is characterized by its slow, continuous dance and musical rhythms. The combination of its movements and rhythms is comparable to Tai Chi, and it also features intricate postures and coordination patterns. Thai classical dance training programs consist of various modes of stretching and repetitive movements, involving the head, upper body, and the entire body’s center of gravity on various support bases. Despite differing stimulation modes of sensory information, these activities necessitate adjustments to the postural system to maintain control over posture and body orientation, potentially influencing the dancer’s balance performance (74). Furthermore, folk dances are often associated with specific cultural backgrounds. Older adults participating in such dances may experience increased engagement and enjoyment due to cultural identity and social interaction, leading to additional physical and psychological benefits. Additionally, the popularity of folk dances among communities and older populations may provide greater access and opportunities for older adults to engage in these dances, thereby benefiting from their fall risk reduction effects.

The Network meta-analysis conducted using the Berg Balance Scale (BBS) revealed that, among patients with Parkinson’s disease, interventions involving Folk dance and Ballroom dance were both significantly more effective than the control group in improving performance. Additionally, Folk dance exhibited a superior intervention effect compared to Social dance.

The optimal exercise intervention for individuals with Parkinson’s disease (PD) should integrate cueing strategies, balance training, focused attention, and enhancement of physical fitness (75). Traditional folk dances have the capacity to stimulate specific deep limbic neuronal circuits, eliciting emotional engagement while incorporating movement elements within the rhythmic structure of the dance, which can be understood as a therapeutic modality (76). For instance, Irish Set Dancing has gained popularity among PD patients due to its relative simplicity and ease of learning and execution (39). This dance form combines dynamic balance activities with gait and skilled movements (39), leading to improvements in PD motor symptoms such as balance impairments, freezing of gait, and bradykinesia (75, 77, 78). Furthermore, Irish dance incorporates elements of exercise, socialization, and partner involvement, motivating PD patients to adhere to long-term physical activity (39). This integrated approach to Folk dance not only addresses the motor symptoms of PD but also fosters emotional well-being and social engagement, which are crucial components of patient care.

In older adult with Parkinson’s disease (PD), specific risk factors render them more susceptible to falls and fall-related injuries. Tango is a kind of social dance with the potential to mitigate balance impairments in this patient population, thereby aligning with previous meta-analytic findings that highlight its benefits (75, 79, 80). Argentine Tango, in particular, may enhance motor capabilities by targeting PD-related impairments such as spontaneous changes in movement direction/speed and frequent transitions between movement initiation and cessation. These features could specifically address difficulties in movement initiation, turning, and bradykinesia. For instance, patients with PD often exhibit slowed movements, but with the aid of external cues, they can achieve near-normal speed and amplitude of movements (77, 81). Such external cues may access cortical circuits, bypassing the dysfunctional basal ganglia in PD patients (82). Ballroom dance, particularly its social aspect, offers crucial external cues: music and a dance partner. Music serves as an auditory cue, enhancing gait speed, initiation speed, and step frequency when utilized. A partner, through physical contact, can further augment balance, as even mild touch can facilitate postural stability (83). The connection between partners may aid in movement initiation and increase or maintain step length and rhythm (84). While physical and psychological benefits accrue to PD patients engaging in exercise training, the severity of the disease influences motor responsiveness; thus, this should be considered when selecting intervention modalities. Only in patients with milder symptoms and slower disease progression (85) does exercise appear to reduce fall incidents.

Study Limitations: (1) The limited number of studies and modest sample sizes incorporated in this analysis may introduce bias into the study outcomes. To mitigate this, we recommend conducting a large-scale, multi-arm randomized controlled trial (RCT) specifically focused on dance interventions, thereby enabling a more robust evaluation of the effectiveness of individual dance types in preventing falls among older adults. (2) The heterogeneity in the fall indicators assessed across the included studies precludes the analysis of more generalized metrics. To address this, we suggest adopting standardized testing methodologies that comprehensively assess fall risk in older adults, thereby facilitating cross-study comparisons and enhancing the reliability of findings. (3) The research focused solely on the analysis of healthy older adult and patients with Parkinson’s disease, and did not comprehensively examine other chronic disease patient groups. Consequently, we propose that future dance interventions targeting patients with chronic diseases should be implemented, with careful consideration given to the potential moderating effects of age, gender, and disease severity on motor function outcomes.

Creative dance, Folk dance, and Ballroom dance effectively reduce the risk of falls in older adults. Creative dance enhanced the Berg Balance Score the most among healthy older adults, while Folk dance improved the Timed Up and Go test performance the best. Similarly, among patients with Parkinson’s disease, Folk dance exhibits the best effect in improving Berg Balance Scale scores. Future research should incorporate more high-quality randomized controlled trials (RCTs) to elucidate the effectiveness of different dance styles in mitigating falls among older adult with varying health statuses, thereby addressing the unique needs of diverse older adult for fall prevention.