Neuromuscular, Balance, and Gait Factors Associated with Falls and Fall-Related Outcomes in Individuals with COPD: A Systematic Review.

Background: Individuals with chronic obstructive pulmonary disease (COPD) have a higher incidence of falls than age-matched peers, which may result in injury, loss of independence, and reduced quality of life. Although falls have often been attributed to general deconditioning, impairments in muscle strength, balance, and gait may also contribute. This systematic review synthesized evidence on the relationships between these factors and falls or fall-related outcomes in people with COPD. Methods: PubMed, Web of Knowledge, Scopus and Google Scholar were searched for English-language studies published up to November 2024. Twenty-five original studies involving 1295 participants met the inclusion criteria. Methodological quality was assessed using a modified Downs and Black checklist. Results: Seventeen of the 25 studies reported a significant association between at least one examined factor and fall history or fall risk. Balance impairment showed the most consistent relationship, with positive associations reported in 14 of 17 studies. Evidence regarding muscle strength was mixed: some studies linked quadriceps weakness to increased fall risk, including one reporting an odds ratio of 2.9, whereas others found no significant association. Altered gait characteristics, particularly increased step-time variability, were also associated with falls. Conclusion: Balance and gait impairments are consistently associated with falls and fall-related outcomes in individuals with COPD, whereas the relationship with muscle strength is less consistent. Given the predominance of observational studies, prospective research and controlled trials are needed to clarify causal pathways and determine whether targeted balance and strength training can reduce fall risk as part of pulmonary rehabilitation.