Therefore the effectiveness, or not, of an intervention program cannot be evaluated or reproduced reliably if the intensity at which exercises are performed is not known. If balance exercise intensity could be quantified then research could then compare higher and lower intensity balance exercises while frequency, type and time of exercise could be held constant. We could then examine how intense balance exercises need to be to induce a training effect. This would inform balance rehabilitation exercise prescription. If low intensity is effective it may be cost effective for older adults to exercise at home unsupervised, however if only the highest intensities of exercises are effective there may need to be investment

in the health workforce to supervise older adults completing more challenging exercise programs to reduce the risk of incident or harm while achieving a training effect. As demonstrated in part by the capture-recapture see more analysis there is a possibility that this review may have missed a small number of papers, programs, or instruments reported to measure the intensity of balance exercises. However, the searches in this review were rigorous, identifying 148 trials, supplementing these with published exercise programs when available, and seeking instruments not yet used in randomised

trials. The different foci of the 23 systematic reviews included in our capture recapture analysis would have served to inflate our estimate of the number of trials missed. This is because systematic reviews with Selleckchem GS-7340 different foci are more likely to contain unique papers, which would increase the estimate of missing trials. An instrument to measure the intensity of balance challenge is needed to consistently describe the intensity of balance exercises prescribed in research and clinical practice. Once an

instrument to rate the intensity of balance exercises has been developed, further research could determine the level of balance exercise intensity required to improve the balance of older adults, and how to prioritise resources to fund the most cost-effective program delivery models that best reduce falls, fall-related injuries, and subsequent health and aged care costs. The review demonstrates overwhelmingly that the reporting of the intensity of balance exercise programs is grossly only inadequate. To date, the intensity prescription of balance exercises has not been clearly described or adequately measured in research studies. The use of taxonomies of task difficulty as a proxy for balance exercise intensity does not show how an individual experiences balance challenges. The adaptation of the rating of perceived exertion to measure balance exercise intensity may be worthy of further investigation. Comprehensive work in this area is required to develop a psychometrically sound measure of balance exercise intensity. eAddenda:Appendices 1, 2, and 3 available at jop.