Network Meta-Analysis Compares Exercise Modes for Balance in Older AdultsPilates and Tech Exercises May Improve Balance in Older Adults

Population aging has increased demand for scalable strategies supporting balance-oriented rehabilitation, fall-risk management, and functional independence in older adults. Pilates and technology-assisted exercise, including AR/VR, exergaming, motion-sensing exercise, telerehabilitation, and technology-delivered Pilates, may be relevant, but comparative evidence and older-adult applicability remain uncertain. To compare Pilates, technology-assisted exercise, technology-delivered Pilates, conventional exercise, and control for balance- and postural-control-related outcomes using exploratory network meta-analysis and aging-public-health applicability mapping. We searched eight sources through 2 May 2026. The primary network included source-verified randomized trials with eligible balance/postural-control endpoints and extractable post-intervention arm-level data. Hedges’ g used exact small-sample correction, and random-effects frequentist network meta-analysis used restricted maximum likelihood. Risk of bias and certainty were assessed using RoB2 and a conservative GRADE/CINeMA-informed framework. The primary network included 12 studies, 25 analytic arms, and 491 participants; the broader sensitivity network included 14 studies, 29 arms, and 606 participants. Estimates versus control were 0.33 (95% CI −0.04 to 0.69) for conventional exercise, 0.64 (0.18 to 1.09) for Pilates, 0.69 (0.38 to 1.01) for technology-assisted exercise, and 0.69 (0.14 to 1.25) for technology-delivered Pilates. Applicability mapping identified direct older-adult community evidence (4 studies, 187 participants), aging-related clinical rehabilitation evidence (6 studies, 216 participants), and indirect non-geriatric evidence (2 studies, 88 participants). Certainty was low for technology-assisted exercise and very low for other active-versus-control comparisons. Active interventions generally favoured the intervention over control, but sparse evidence, heterogeneity, control variability, outcome-domain sensitivity, clinically fragile transitivity, and low/very low certainty preclude a definitive hierarchy. Findings may inform risk-stratified community programmes, home-based support, digital-equity planning, and implementation trials rather than justify a single preferred intervention, platform, or automated decision-support model. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261383909, PROSPERO, CRD420261383909.