# Remote exercise snacking and fall-related functional outcomes in older adults: a systematic review including a meta-analysis

## TL;DR

Short bursts of remote exercise can improve muscle strength and endurance in older adults, but have limited effects on balance.

## Contribution

This study is the first to systematically evaluate the effectiveness of remote exercise snacking on fall-related outcomes in older adults.

## Key findings

- Remote exercise snacking significantly improved lower-limb muscle strength and endurance in older adults.
- Balance improvements were not statistically significant.
- Adherence was high, especially with video-based guidance, and longer interventions with progression strategies showed better results.

## Abstract

Falls are a leading cause of injury and death among older adults, yet many encounter barriers to engaging in conventional exercise programs. Remote exercise snacking (ES) refers to performing multiple (≥2 times) short bursts (≤10 min) of exercise of any type or intensity daily in a non-laboratory setting (including multiple sets of interval training), with complete rest or at least a 30-min recovery period between each exercise session, this represents a flexible alternative; however, its effectiveness remains inconclusive. This study addresses an important evidence gap by systematically evaluates the impact of remote exercise snacking on lower-limb muscle performance, balance ability, as well as its acceptability and feasibility in older adults.

A systematic search was conducted in six databases (CINAHL, PubMed, Scopus, Cochrane Library, Web of Science and FMRS) from inception to May, 2025. Two reviewers independently performed study selection, data extraction, and risk of bias assessment following PRISMA guidelines. Studies meet the following eligibility criteria in accordance with PICOS, participants were insufficiently active older adults; intervention involved short bouts of exercise; comparator/control were no specific intervention; the primary outcomes was lower-limb muscle function, with secondary outcomes included balance and/or participant adherence or acceptbility; and study design were randomized crossover or randomized control only. Muscle performance and balance outcomes were synthesized through meta-analysis using Stata v15.1 with standardized mean difference (SMD), while adherence and acceptability were evaluated narratively.

Four publications comprising ten studies (n = 313, M/F: 170/143) were included. Remote exercise snacking significantly improved lower-limb muscle strength (SMDpooled = 0.29, 95% CI: 0.06–0.52, p = 0.01) and endurance (SMDpooled = 0.24, 95% CI: 0.01–0.46, p = 0.04), but showed no significant effect on balance (SMDpooled = 0.04, 95% CI: −0.14–0.23, p = 0.65). Subgroup analyses showed that greater improvements in strength were observed in interventions lasting 6 weeks or longer and in those that incorporated progression strategies. The overall mean adherence across the included studies was 85%, with adherence generally higher in interventions that provided video-based guidance.

Remote exercise snacking appears effective in improving lower-limb muscle function but shows limited impact on balance among healthy older adults. Intervention duration and the inclusion of progression are key determinants of efficacy. The delivery mode (e.g., written materials, video, or app-based platforms) and exercise type (e.g., bodyweight, Tai Chi, or combined formats) may influence the acceptability and feasibility of implementation. The main findings are summarized in a graphical abstract.

Identifier CRD42024627584.

Remote exercise snacking significantly improves muscle strength and endurance in older adults, but effects on balance are inconsistent. The study follows PRISMA guidelines and includes systematic reviews and meta-analysis. Different exercise types, session durations, and frequencies are analyzed with findings showing varied adherence and acceptability. Key protocols lasting over 26 weeks or including Tai Chi show better outcomes. Adherence ranges from seventy to ninety-eight percent, with multimedia guidance enhancing integration. Results emphasize the feasibility and benefits of remote exercise interventions.