Search Results (498)

Improving cyclist safety conditions in the urban context is a key strategy to promote sustainable transport modes and reduce noise and environmental pollution. Recent plans have also addressed this point. In September 2020, the UN General Assembly declared the Decade of Action for Road Safety 2021–2030, aiming to reduce the number of road deaths by at least half. To achieve this task and highlight the risk factor, after collecting and pre-processing cyclist crash data in the city of Rome between 2013 and 2020, Random Forest and Ordered Logistic Regression models are proposed. The crash dataset is also enriched with vehicular speed and flows, and geographical information. A DBSCAN Clustering Analysis is also proposed to identify anomalous areas in the city. The findings show that the presence of cycle paths, the presence of anthropic activities, such as shops, schools, and universities, play a risk mitigation role. Conversely, vehicular speed and heavy vehicles emerge as the main detected risk factors. Finally, spatial analysis indicates that commercial activities reduce cycle path safety due to complex interactions with other road users. Furthermore, historic areas present unique risks driven by pedestrian flows and poor road surfaces, despite low vehicular traffic. Full article

Background: Stroke and subclinical cerebral ischemia remain important neurological complications of transcatheter aortic valve replacement (TAVR). The Sentinel cerebral embolic protection (CEP) device is designed to capture embolic debris during TAVR, but its impact on clinical and imaging outcomes remains incompletely characterized. Methods: PubMed, Embase, and Cochrane databases were systematically searched for randomized controlled trials (RCTs) comparing Sentinel CEP versus no protection when TAVR was performed. Outcomes of interest included all stroke, disabling stroke, infarct volume by diffusion-weighted MRI in protected and unprotected areas, all-cause mortality, acute kidney injury, and major vascular complications. Risk ratios (RRs) and median differences with 95% confidence intervals (CIs) were calculated using random-effects models and trial sequential analysis (TSA) assessed evidence robustness. Results: Four RCTs including 10,986 patients were analyzed. Sentinel CEP did not significantly reduce clinical stroke (RR 0.88, 95% CI 0.69–1.12) or disabling stroke (RR 0.68, 95% CI 0.41–1.14). Pooled DW-MRI data showed a significant reduction in new ischemic lesion volume within Sentinel CEP-protected territories (difference in medians −75.7 mm³; 95% CI −130.4 to −21.0). Subgroup analyses in elderly, female, and high-surgical-risk patients revealed no benefit with Sentinel CEP. Additionally, TSA indicated that current data are underpowered for definitive conclusions. Conclusions: The Sentinel CEP device during TAVR did not significantly reduce clinical stroke but was associated with lower MRI-detected ischemic lesion volumes compared with no protection. Further adequately powered RCTs integrating clinical and imaging endpoints are needed to define its role in neuroprotection during TAVR. Full article

Despite major advances in guideline-directed cardiovascular therapy, residual cardiovascular risk persists, partly driven by oxidative stress, chronic inflammation, endothelial dysfunction, and mitochondrial injury not fully addressed by current drugs. Translation of plant-based cardioprotectants is constrained by preparation-dependent variability in extract chemistry (plant part/cultivar/processing and extraction method), low and variable systemic exposure for key actives (notably curcuminoids and many polyphenols), and clinically relevant safety/interaction considerations (e.g., hepatotoxicity reports with concentrated green tea extracts and antiplatelet-related bleeding-risk considerations for some botanicals). We therefore provide a mechanism- and translation-oriented synthesis of evidence for cardioprotective botanicals, chosen for long-standing traditional use and scientific validation with reproducible experimental data and, where available, human studies, including Crataegus monogyna, Allium sativum, Olea europaea, Ginkgo biloba, Leonurus cardiaca, and Melissa officinalis. Across studies, polyphenols (especially flavonoids and phenolic acids) and organosulfur compounds are most consistently associated with cardioprotection, while terpene-derived constituents and secoiridoids contribute mechanistically in plant-specific settings (e.g., Ginkgo and Olea). Predominantly in experimental models, these agents engage redox-adaptive (Nrf2), mitochondrial (mPTP), endothelial, and inflammatory (NF-κB) pathways, with reported reductions in ischemia–reperfusion injury, oxidative damage, and apoptosis. Clinical evidence remains heterogeneous and is largely confined to short-term studies and surrogate outcomes (blood pressure, lipids, oxidative biomarkers, endothelial function), with scarce data on hard cardiovascular endpoints or event reduction. Priorities include standardized, chemotype-controlled formulations with PK/PD-guided dosing and adequately powered randomized trials that assess safety and herb–drug interactions. Full article

Objective: To identify key predictors of clinical outcomes in burn survivors and clarify the role of mixed-depth burns and confounding by indication in observational rehabilitation research. Design: Retrospective cohort study using data from a burn rehabilitation registry (January 2024 to July 2025). Setting: Burn rehabilitation center. Participants: 120 adult patients (age ≥ 18 years) with burns affecting ≥1% total body surface area (TBSA) and complete baseline data. Interventions: Not applicable. Main Outcome Measures: Primary outcome was functional improvement (ΔFIM). Secondary outcomes included pain reduction (ΔPain), scar severity (Vancouver Scar Scale; VSS), Activities of Daily Living (ADL) improvement, and Range of Motion (ROM) recovery. Multivariable linear and logistic regression models were used to identify predictors. Results: Patients achieved significant improvements in function (mean ΔFIM = 11.3 ± 8.9 points) and pain (mean ΔPain = 1.28 ± 0.81). Having a mixed-depth burn was the strongest predictor of worse scar outcomes (β = 2.52, 95% CI: 0.93 to 4.12, p = 0.002) and failure to achieve full ROM (OR = 0.089, 95% CI: 0.008 to 0.930, p = 0.043). An apparent association between inpatient ward care and better scar outcomes (β = −1.30, p = 0.020) was determined to be an artifact of confounding by indication, as the outpatient group had a higher proportion of high-risk mixed-depth burns (6.2% vs. 3.5%). Longer therapy duration was the only significant predictor of achieving ADL goals (OR = 1.014, 95% CI: 1.002 to 1.026, p = 0.025). Conclusions: Injury characteristics, particularly the presence of a mixed-depth burn, emerged as the dominant predictors of long-term scar and functional outcomes. This study identifies mixed-depth burns as a potentially high-risk clinical phenotype requiring targeted therapeutic strategies and demonstrates the critical importance of accounting for confounding by indication when evaluating rehabilitation outcomes in observational burn research. Full article

Background: Immune checkpoint inhibitors (ICIs) improve cancer outcomes but may cause cardiovascular toxicity, including early subclinical myocardial injury. Conventional echocardiography has limited sensitivity, whereas speckle-tracking echocardiography (STE) allows for early detection of myocardial deformation. Data on short-term ICI-related effects on biventricular mechanics are limited, and atrial function remains poorly characterized. This study evaluated the early impact of ICI therapy on biventricular and biatrial mechanics using STE in patients with advanced cancer. Methods: In this prospective, single-center study, 28 consecutive patients with advanced cancer undergoing ICI therapy were followed for 3 months. Clinical, laboratory, electrocardiographic, and echocardiographic assessments were performed at baseline, 1 month, and 3 months. STE was used to assess left ventricular global longitudinal strain (LV-GLS) and circumferential strain; right ventricular GLS (RV-GLS); and left and right atrial reservoir, conduit, and contractile strain parameters. Subclinical LV dysfunction was defined as a relative LV-GLS reduction >15%. Logistic and Cox regression analyses identified predictors of strain impairment and adverse clinical events. Results: Conventional echocardiographic parameters, including left ventricular ejection fraction, remained stable. In contrast, LV-GLS declined progressively from 20.7 ± 2.1% to 17.6 ± 2.7% at 3 months (p = 0.002), with subclinical LV dysfunction observed in 85.7% of patients. RV-GLS also deteriorated despite preserved TAPSE. Both left and right atrial strain and strain-rate parameters showed an early and marked decline, accompanied by increased left atrial stiffness despite unchanged atrial volumes. Older age and higher neutrophil-to-lymphocyte ratio (NLR) were associated with LV-GLS impairment. Over a mean follow-up of 5.4 ± 3 months, baseline LV-GLS independently predicted adverse clinical events and mortality. Optimal cut-off values were 67 years for age, 4 for NLR, and 19.5% for LV-GLS. Conclusions: Short-term ICI therapy is associated with early, diffuse subclinical myocardial dysfunction involving both ventricles and atria, detectable only by STE. Comprehensive biventricular and biatrial strain assessment may enhance early cardio-oncology surveillance and risk stratification in ICI-treated patients. Full article

Asymmetry, defined as unequal neuromuscular activation or mechanical performance between contralateral limbs, plays a critical role in cycling efficiency and injury risk. While kinematic and kinetic measures are commonly used to assess asymmetry, surface electromyography (EMG) signals offer an additional perspective on neuromuscular asymmetry. This study evaluated muscle activation asymmetry during cycling using the Normalized Symmetry Index (NSI), a metric that quantifies differences in kinematics and kinetics between limbs, where higher values indicate greater asymmetry. NSI was calculated from EMG recordings of seven lower-limb muscles under two test conditions: step incremental and constant-power cycling to task failure. Twenty recreationally active participants performed both tests on a stationary ergometer while EMG data were collected bilaterally. Step incremental cycling resulted in a significant reduction in NSI for key muscles in the quadriceps group: vastus medialis (from 44% to 21%, p < 0.001), vastus lateralis (from 45% to 22%, p = 0.002), rectus femoris (from 54% to 24%, p < 0.001), and biceps femoris (from 52% to 29%, p = 0.003). No significant changes were observed for the tibialis anterior, soleus, or gastrocnemius medialis. In contrast, under constant-power conditions, NSI values remained unchanged over time for all muscles (all p > 0.05), with average NSI values ranging from 12% to 30%, indicating consistent bilateral activation. These findings highlight the sensitivity of surface EMG in detecting workload-dependent changes in muscle activation asymmetry and suggest that higher cycling intensities, compared to lower ones, may promote more balanced engagement of primary cycling muscles. Full article

Background: Lung adenocarcinoma in non-smoking women represents a distinct clinical entity that cannot be fully explained by traditional exposure-centered carcinogenic models. Although ambient air pollution is a recognized risk factor, sex-specific vulnerability suggests the involvement of additional biological modulators shaping inflammatory, immune, and proliferative responses. Main body: In this conceptual review, we integrate epidemiological, experimental, and mechanistic evidence to propose a multisystem framework of lung carcinogenesis in non-smoking women. We delineate a central carcinogenic spine encompassing lung epithelial injury, chronic inflammation, growth factor signaling activation—particularly epidermal growth factor receptor (EGFR) pathways—and tumor microenvironment remodeling. Within this framework, three interacting domains function as biological modulators that amplify carcinogenic processes: chemosensory–neural–immune modulation, hormonal–endocrine signaling including estrogen–EGFR crosstalk, and psychosocial stress–hypothalamic–pituitary–adrenal (HPA) axis dysregulation. These domains converge through feedback mechanisms that reinforce systemic dysregulation and tumor-promoting microenvironments. Implications: This integrative model provides a biologically grounded perspective on female-specific vulnerability to lung adenocarcinoma and informs precision prevention, risk stratification, and ESG-informed public health strategies beyond conventional exposure reduction. Full article

Background: Inter-limb asymmetry has implications for both athletic performance and healthcare practice. High baseline inter-limb asymmetries have been associated with impaired mobility, increased fall risk, and musculoskeletal injuries across the lifespan. Exercise interventions able to stimulate the stretch–shortening cycle (e.g., plyometric training and jump training) have been shown to have a good impact on asymmetries. Among these, Mini-Trampoline Training (MTT) has recently emerged as potentially effective in reducing asymmetries. Objectives: The study aimed to evaluate the acute effects of a single MTT session on muscle power and inter-limb asymmetry in young adults. Methods: Twenty-eight recreationally active participants (25.6 ± 2.4 years) completed one MTT session. Before (PRE) and after (POST) the MTT session, single-leg 6 m Timed Hop (6MTH) and countermovement jump (CMJ) tests were administered. Additionally, 6MTH values of the dominant (DOM) and non-dominant (NODOM) limbs were used to stratify participants according to higher (HBIA) or lower (LBIA) baseline inter-limb asymmetry, based on a commonly adopted Normalized Symmetry Index (NSI) threshold (NSI ≥ 10%, n = 12; NSI < 10%, n = 16). Repeated-measures mixed models were used to evaluate the effects of the MTT session on 6MTH, NSI, and CMJ. Results: Regardless of group and limb, significant (p < 0.0001) improvements in 6MTH (PRE: 2.5 ± 0.06 s; POST: 2.3 ± 0.05 s) were found. Interestingly, the MTT session had a significant (p = 0.01) effect on both groups, with a significant (p = 0.003) interaction with NSI values, showing an improvement for HBIA (PRE = 15.4 ± 1.1%, POST = 11.3 ± 2.1%), whereas a decrement in LBIA was recorded (PRE = 5.1 ± 0.6%, POST = 9.6 ± 1.5%). CMJ did not show any changes in HBIA (PRE: 36.2 ± 0.9 cm; POST: 35.1 ± 0.7 cm), while a significant (p = 0.007) decrease was found in LBIA (PRE: 34.8 ± 1.2 cm; POST: 33.2 ± 1.3 cm). Conclusions: A single MTT session induced acute neuromuscular fatigue, reflected by reduced CMJ performance and improved (~8%) inter-limb control during hopping. The HBIA group preserved jump height (~36 cm) and demonstrated a significant reduction in asymmetry (NSI: −4.1%), suggesting more balanced lower-limb recruitment. Conversely, LBIA showed a significant decrease in CMJ and an increased NSI (+4.5%), possibly reflecting fatigue-related compensatory strategies. Overall, a single MTT elicited distinct responses according to baseline asymmetry, supporting its potential as an adaptable modality for enhancing neuromuscular function in HBIA. Full article

Background/Objectives: Post-traumatic epileptogenesis is a frequent and clinically relevant consequence of traumatic brain injury (TBI), often contributing to worsened neurological and functional outcomes. In patients experiencing early post-injury seizures, rehabilitative strategies that support recovery while considering increased epileptogenic risk are needed. This case study explores the potential benefits of combining neurofeedback (NFB) with motor therapy on cognitive and motor recovery. Methods: A patient hospitalized for severe TBI who experienced an acute symptomatic seizure in the early post-injury phase underwent baseline quantitative EEG (qEEG), neuromotor, functional, and neuropsychological assessments. The patient then completed a three-week rehabilitation program (five days/week) including 30 sensorimotor rhythm (SMR) NFB sessions (35 min each) combined with daily one-hour motor therapy. qEEG and clinical assessments were repeated post-intervention and at 6-month follow-up. Results: Post-intervention qEEG showed significant reductions in Delta and Theta power, reflecting decreased cortical slowing and enhanced neural activation. Relative power analysis indicated reduced Theta activity and Alpha normalization, suggesting improved cortical stability. Increases were observed in Beta and High-beta activity, alongside significant reductions in the Theta/Beta ratio, consistent with improved attentional regulation. Neuropsychological outcomes revealed reliable improvements in global cognition, memory, and visuospatial abilities, mostly maintained or enhanced at follow-up. Depressive and anxiety symptoms decreased markedly. Motor and functional assessments demonstrated meaningful improvements in motor performance, coordination, and functional independence. Conclusions: Findings suggest that integrating NFB with motor therapy may support recovery processes and be associated with sustained neuroplastic changes in the early post-injury phase after TBI, a condition associated with elevated risk for post-traumatic epilepsy. Full article

Objectives: Against common belief, mandibular condyle fractures are not that rare, with morbidity rates ranging from 19 to 52%, depending on actual literature sources. Practitioners try to improve the surgical techniques applied to obtain the most satisfactory anatomical and functional effect. The purpose of this study is to identify the relationships that affect bone loss around screws and plates in mandibular condylar process fractures treated surgically using the Open Reduction and Internal Fixation (ORIF) technique. Materials and Methods: Our research covered 276 fractures of the base, low and high neck of the condylar process. No formal sample size calculation was performed; the study enrolled patients treated at the Department during the last 4 years, based on informed consent granted both prospectively and retrospectively compares to the actual treatment time. The study group was selected based on injury type and the ability to implement surgical treatment. The imaging modality selected for the study was computed tomography (CT), which was assessed in each case by the same operator. Therefore, there was no need to account for inter-rater variability in the results. Based on CT scans, we studied various parameters, including bone healing in the fracture area, bone loss in the screws and plates area, change in the length of the mandibular ramus following osteosynthesis and on the opposite side after 12 months, as well as deformities of the mandibular head. Results: Using screws and plates is the gold standard for treating mandibular condylar process fractures. The number of screws used affects the bone loss ratio around head of the screw. Another factor that impacts the results achieved is the distance from the plate edge to the lateral pole of the mandibular head. Statistical evaluation indicated that proximity to the lateral pole is a risk factor for bone resorption at the plate edge. Conclusions: Based on the collected data, it is possible to predict bone loss, determine the location and selection of plates and screws, as well as to plan the procedure, achieving the lowest possible loss rates. Full article

Obesity-associated inflammation underlies much of cardiometabolic pathology, reflecting the convergence of chronic, low-grade systemic immune activation with region-specific maladaptation of adipose depots. Among these, epicardial adipose tissue (EAT)—a visceral fat layer contiguous with the myocardium and sharing its microvasculature—functions as a cardio-proximal immunometabolic interface that influences atrial fibrillation, heart failure with preserved ejection fraction, and coronary atherogenesis through paracrine crosstalk. These relationships extend beyond crude measures of adiposity, emphasizing the primacy of local inflammatory signaling, adipokine flux, and fibro-inflammatory remodeling at the EAT–myocardium interface. Of importance, substantial weight reduction only partially reverses obesity-imprinted transcriptional and epigenetic programs across subcutaneous, visceral, and epicardial depots, supporting the concept of an enduring adipose memory that sustains cardiovascular (CV) risk despite metabolic improvement. Accordingly, therapeutic strategies should move beyond weight-centric management toward mechanism-guided interventions. Resolution pharmacology—leveraging specialized pro-resolving mediators and their cognate G-protein-coupled receptors—offers a biologically plausible means to terminate inflammation and reprogram immune–stromal interactions within adipose and CV tissues. Although preclinical studies report favorable effects on vascular remodeling, myocardial injury, and arrhythmic vulnerability, clinical translation is constrained by pharmacokinetic liabilities of native mediators and by incomplete validation of biomarkers for target engagement. This review integrates mechanistic, depot-resolved, and therapeutic evidence to inform the design of next-generation anti-inflammatory strategies for obesity-related CV disease. Full article

Background/Objectives: Combat trauma involving large joints is associated with a high risk of thromboinflammatory complications. Early identification of laboratory markers for hypercoagulability is essential to optimise perioperative management. This study aimed to evaluate the dynamics of inflammation and haemostasis indicators in patients with combat-related joint trauma and to identify the most informative markers for preoperative risk assessment. Methods: A total of 29 patients with combat injuries to the hip, knee, elbow, or ankle joints were examined. Blood samples were taken 1–3 days prior to surgery and again on the first postoperative day. Parameters of coagulation (e.g., PT, INR, fibrinogen, D-dimer, soluble fibrin complexes, antithrombin III), fibrinolysis, and inflammation (e.g., CRP, haptoglobin, sialic acid, ESR, LSI, LII) were analysed and compared to those of 30 healthy controls. Statistical analysis included Student’s t-test and Pearson’s correlation. Results: At baseline, patients demonstrated significant increases in inflammatory markers (CRP 64.2 ± 7.3 mg/L, ↑738.9%; haptoglobin 3.25 ± 0.4 g/L, ↑164.3%; ESR 46.8 ± 5.2 mm/h, ↑313.8%) and procoagulant activity (D-dimer 1.42 ± 0.18 µg/mL, ↑136.6%; fibrinogen 6.12 ± 0.51 g/L, ↑102.4%; soluble fibrin complexes 38.7 ± 4.9 mg/L, ↑597.3%), together with a reduction in antithrombin III activity (63.5 ± 6.2%, ↓39.5%) and prolonged fibrinolysis time (increase by 197%). Postoperatively, these abnormalities intensified, indicating a sustained thromboinflammatory response. Strong correlations were found between inflammatory and haemostatic markers. Conclusions: Combat trauma of large joints is associated with preoperative thromboinflammatory dysregulation, which is exacerbated by surgery. Monitoring specific biochemical and haematological markers—such as CRP, fibrinogen, D-dimer, and soluble fibrin complexes—may support preoperative risk assessment and postoperative monitoring strategies for hypercoagulable states in this high-risk group. These findings lay the groundwork for future prospective studies aimed at developing stratified therapeutic protocols and predictive models for thromboinflammatory complications in orthopaedic trauma care. Full article

Fishing is a widely practiced recreational activity that offers psychological, physical, and social benefits, but it also poses risks such as acute trauma and chronic overuse injuries. This narrative review aims to (1) synthesize current evidence on the musculoskeletal disorders, psychological outcomes, and environmental factors associated with recreational and sport fishing; (2) identify the physical, mental, and social health benefits reported across different angling disciplines; (3) characterize acute and chronic injury risks, including overuse syndromes and environment-related hazards; and (4) highlight gaps in the literature to guide future research directions in public health, rehabilitation, and preventive medicine. Materials and Methods: A narrative review was conducted in accordance with SANRA guidelines. A structured search of PubMed, Scopus, Web of Science and Google Scholar identified studies published between 2000 and 2025. Eligible sources included population surveys, clinical studies, therapeutic angling programs, epidemiological reports, and case studies addressing physical, psychological, or injury-related outcomes in recreational or sport fishing. Studies on commercial or occupational fishing were excluded. Evidence was synthesized thematically across benefit and risk domains. A total of 565 records were identified across four databases (PubMed, Scopus, Web of Science, Google Scholar). After screening, duplication, and full-text assessment, 41 studies met the eligibility criteria and were included in the narrative synthesis. The evidence indicates significant psychological benefits of fishing, including reductions in stress, improved mood, and clinically meaningful decreases in Post-Traumatic Stress Disorder (PTSD) symptoms reported in therapeutic fly-fishing programs. Musculoskeletal outcomes were more heterogeneous: chronic conditions such as low back pain and repetitive strain injuries of the shoulder, elbow, and wrist were commonly reported among regular anglers, particularly in physically demanding disciplines. Ice and sea fishing were associated with distinct environmental risks, including hypothermia, frostbite, and rare but documented fatal incidents. The results of this narrative review highlight the therapeutic potential of both recreational and sport fishing. However, they also point to the need for greater awareness of the risk of injury and environmental hazards associated with this type of fishing. Full article

Background and Objectives: Recent research has highlighted the importance of examining risk factors and their complex interrelationships in the development of lower limb injuries. This study aimed to investigate the direct, indirect, and mediating effects of endogenous neuromuscular and psychological risk factors on the incidence of non-contact lower limb injuries in football players. Materials and Methods: A sample of ninety-seven male football players underwent a structured preseason, on-field assessment. Demographic characteristics, injury history, and athlete burnout were collected through standardized questionnaires. Preseason evaluations included assessments of lower limb flexibility; isometric strength assessment of hamstring, hip abductors, and quadriceps using a handheld dynamometer; hamstring and core endurance; and the single-leg triple hop for distance test. All non-contact lower limb injuries were prospectively recorded throughout the competitive season. Partial Least Squares Structural Equation Modeling (PLS-SEM) method was applied to examine both direct and indirect associations between preseason risk factors and injury incidence. Results: Lower limb strength asymmetries (path coefficient (PC) 0.293, p = 0.004) and previous injuries (PC 0.233, p = 0.015) exhibited the strongest direct effects on the occurrence of new non-contact lower limb injuries. In addition, age acted as a moderating factor, amplifying the effect of lower limb strength asymmetries on injury risk. Moreover, previous injuries demonstrated both direct and indirect effects on neuromuscular characteristics and perceived burnout. Core and hamstring endurance tended to influence new injuries indirectly through strength asymmetries and were significantly affected by hamstring strength (PC 0.248, p = 0.015) and prior injuries (PC −0.207, p = 0.029). Conclusions: Injury prevention strategies should prioritize the improvement of core and hamstring endurance and the reduction in lower limb Strength Asymmetries, particularly among older football players. Furthermore, individualized preventive interventions for athletes with a previous history of injury are strongly recommended. Full article

Background: Falls are a leading cause of injury, disability, and loss of independence among community-dwelling older adults. Although exercise-based interventions are widely recommended for fall prevention, the comparative effectiveness of different exercise modalities remains insufficiently synthesized. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. Randomized and controlled trials were identified through searches of PubMed, Scopus, Web of Science, and CINAHL, including studies involving adults aged ≥60 years who participated in balance-based, strength-based, multimodal, Tai Ji Quan, Otago Exercise Program, or perturbation-based reactive balance training interventions. Methodological quality was assessed using the Cochrane Risk of Bias 2 (ROB-2) tool. Due to substantial clinical and methodological heterogeneity across interventions and outcome measures, a narrative synthesis was undertaken. Results: Twenty-seven trials met the inclusion criteria. Exercise interventions consistently reduced fall incidence across studies. Tai Ji Quan interventions were associated with approximately 31–58% reductions in falls, the Otago Exercise Program with 23–40% reductions, and multimodal strength–balance training with 20–45% reductions. Perturbation-based reactive balance training demonstrated particularly strong effects on laboratory-induced falls, with reductions ranging from 50–75%. Functional outcomes also improved across intervention types, including faster Timed Up and Go performance, increased gait speed, improvements of approximately 1.2–2.5 points in Short Physical Performance Battery scores, 15–35% gains in lower-limb strength, and enhanced reactive balance responses. Longer-duration interventions (12–24 months) generally demonstrated sustained reductions in fall risk. Conclusions: Evidence from randomized and controlled trials indicates that structured exercise interventions, particularly Tai Ji Quan, the Otago Exercise Program, multimodal strength–balance training, and perturbation-based reactive balance training, are effective in reducing falls and improving balance, mobility, and strength in community-dwelling older adults. These findings support the use of targeted, evidence-based exercise programs as central components of fall-prevention strategies in older populations. Full article