The effect of chair-based exercise on physical functioning in postmenopausal women: a meta-analysis

Abstract

Objective

Following menopause, women commonly experience accelerated losses in muscular strength, flexibility, and balance, predisposing them to falls and osteoporotic fractures. Guidelines suggest that chair-based exercise (CBE) has shown the potential to prevent loss of physical functioning. Theoretically, it is a safe and effective alternative for postmenopausal women to exercise while seated. However, its efficacy in postmenopausal women has not been comprehensively quantified. This systematic review addresses this gap by focusing exclusively on postmenopausal women, synthesizing evidence on the effects of CBE on their physical functioning.

Methods

A search was conducted in CNKI, WanFang, PubMed, EMBASE, EBSCO, Web of Science, and Cochrane Library databases from inception to July 2024. All literature was screened for eligibility according to the inclusion and exclusion criteria. The Cochrane bias risk tool was used to assess the included literature’s quality, and effect sizes with 95% confidence intervals were calculated as the standardized mean differences or mean differences. The statistical heterogeneity between studies was tested using the I² index, and a fixed or random effect model was selected, respectively. Publication bias was examined using Egger’s test. All analyses were performed using Stata 16.0 and Revman 5.4.

Results

10 randomized controlled trials with 509 participants were finally included. Compared to the control group, the CBE group improved significantly in upper limb muscle endurance (SMD = 0.70, 95% CI [0.45, 0.95], P < 0.001), lower limb muscle endurance (SMD = 0.41, 95% CI [0.02, 0.79], P = 0.04), upper body flexibility (MD = 6.25, 95% CI [3.52, 8.98], P < 0.001), lower body flexibility (MD = 3.15, 95% CI [0.88, 5.42], P < 0.001), and dynamic balance (MD = -0.69, 95% CI [-1.32, -0.06], P = 0.03). However, there were no significant changes noted in activity of daily living, falls efficacy scales, handgrip strength, or static balance.

Conclusions

According to the meta-analysis results, CBE is associated with improvements in physical functioning parameters among postmenopausal women regarding muscle endurance, flexibility, and balance. The findings suggest that CBE is influential and should be promoted as simple and easily implemented activities for postmenopausal women to maintain and develop physical functioning.

Trial registration

The study was registered on the International Prospective Registry of Systematic Reviews——PROSPERO database (CRD42024587169).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-025-06571-8.

Background

Menopause is the permanent cessation of menstruation due to loss of ovarian follicular function around 45 and 55 [1]. This transition point is a significant characteristic of women’s aging process, as evidenced by numerous studies. Age-related neuroendocrine alterations precipitate a rapid decline in bone mineral density, thereby increasing the risk of osteoporosis and fractures [2]. These changes are accompanied by deteriorations in physical functioning and decrements in activities of daily living, making postmenopausal women a particularly vulnerable population requiring targeted interventions.

The World Health Organization (WHO) ICF framework defines functioning as an umbrella term for the interaction of three distinct constructs: body function and structure, activities, and participation [3]. Preserving physical functioning is therefore pivotal to sustaining quality of life in aging women [4]. The hormonal changes associated with menopause, particularly the decline in estrogen levels, contribute to accelerated muscle mass loss, reduced bone density, and impaired balance, creating unique challenges for this population that differ from general age-related decline [5, 6].

Exercise emerges as a non-pharmacological intervention that mitigates many of the sequelae of menopause [7–9]. Research specifically examining postmenopausal women has demonstrated that structured exercise programs can improve sexual hormone profiles and metabolic function [10, 11]. However, traditional standing or weight-bearing programs may be impracticable or even hazardous for postmenopausal women experiencing joint pain, osteoporosis-related fracture risk, or fear of falling due to balance impairments.

Chair-based exercise (CBE), performed in a seated position, has emerged as a promising alternative training method that addresses the specific limitations faced by postmenopausal women. This approach provides a safe exercise environment while targeting the key physical deficits associated with menopause. While studies in general elderly populations have demonstrated that aerobic-oriented chair-based programs improve balance and cardiorespiratory fitness [12], and chair-based resistance training enhances functional autonomy [13], the specific benefits for postmenopausal women remain less well characterized.

A recent study demonstrates that aging-related physiological changes occur nonlinearly, with significant transitions at approximately 44 and 60 years of age, periods that correspond closely with menopausal status [14]. Postmenopausal osteoporosis, characterized by low bone mass and deterioration of bone tissue, increases bone fragility and fracture risk, having a considerable impact on women’s quality of life [15]. These menopause-specific changes necessitate targeted research to establish evidence-based exercise recommendations for this population. Despite the recognized potential of CBE as a safe and effective intervention, most existing research has focused on heterogeneous elderly populations, with limited synthesis of evidence specifically examining postmenopausal women. This represents a significant gap in the literature, as the unique hormonal and physiological changes associated with menopause may influence exercise responses and outcomes differently from general age-related decline.

Therefore, this systematic review and meta-analysis aimed to synthesize the effects of CBE interventions specifically on the physical functioning of postmenopausal women. We hypothesized that CBE would demonstrate significant improvements in multiple domains of physical functioning in postmenopausal women, including strength, balance, flexibility, and functional capacity, while providing a safe exercise modality for this vulnerable population.

Methods

The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [16]. It was registered on the PROSPERO as CRD42024587169 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=587169).

Search strategy

Through searching databases such as CNKI, WanFang, PubMed, EMBASE, EBSCO, Cochrane Library, and Web of Science, the search time interval is from establishing the database to July 31, 2024. The following search terms were “chair-based,” “seated exercise,” “chair exercise,” “postmenopausal,” “women,” “physical function,” “physical performance,” and “health outcomes.” Limits to the search strategy included the Chinese and English language. The detailed search strategy can be found in Additional file 2.

Inclusion and exclusion criteria

Studies were eligible for inclusion using the following criteria: (1) population: participants who were post-menopausal women; (2) intervention: exercise programs performed primarily in the seated position, and mainly included chair-based aerobic exercise, chair-based muscle strength exercise, range of motion exercise, and chair-based multicomponent exercise; (3) comparator: a comparator group of non-seated exercise, usual care, or no/minimal intervention; (4) outcomes: studies measuring physical functioning; (5) study design: randomized controlled trials.

The exclusion criteria were as follows: (1) the literature review, conference abstracts, letters, thesis, and case reports; (2) studies were not in Chinese or English; (3) the study presented no extractable data; (4) duplicate publications of the same populations.

Data extraction

Two researchers (Y.G. & Y.R.) independently screened the literature, extracted information, and cross-checked it. Any disagreements are resolved through discussion or consultation with the third reviewer (L.Z.). The data were extracted and entered using Excel: authors and time of publication, country, population characteristics, sample size, age, intervention measurement, experimental period, and outcome parameters.

Quality assessment

Two review authors (Y.G. & Y.R.) independently assessed the risks of bias for each included study using the Cochrane RoB Tool version 2. This tool employs a domain-based approach to evaluation, focusing on five fundamental areas: the randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result, and to judge the low, high, and unclear risk of bias for each item, respectively by the colors green, yellow, and red.

Statistical analysis

Review Manager (RevMan 5.4) and Stata 16.0 were utilized in this study to conduct the meta-analysis. Where there was more than one intervention group, data from the two groups were combined and considered as a single intervention [17]. Outcomes were provided using the same instrument or were reported in comparable units, and authors analyzed the mean difference (MD). Standardized mean difference (SMD) was assessed, and outcomes were evaluated using different measures. The I2 statistic assessed the statistical heterogeneity for the outcome in the included studies. The fixed-effects model was used when I² < 50% else the random-effects model was adopted. Potential publication bias was evaluated with the Egger’s test [18]. The method of excluding studies one by one and comparing the difference with the combined effect size was used to perform sensitivity analysis.

Results

Identification of studies and study selection

A PRISMA flowchart for the systematic literature search is included (Fig. 1). From the seven databases, 998 articles were initially identified. Duplicate articles were removed, and the remaining 820 articles were excluded based on the title and abstract, conference abstracts, news, reviews, and thesis; meanwhile, 4 studies were incomplete text. 267 studies were assessed for eligibility, and 257 were ineligible, including those contradicting the PICOS criteria, not published in English, and incomplete data. Thus, 10 studies [5, 13, 19–25] were included in the review and were used in the meta-analysis, including 509 participants.

Fig. 1.

PRISMA 2020 flow diagram

Characteristics of included studies

The characteristics of the individuals and attributes of the groups, CBE protocols and parameters, and outcomes of each study included in this review are summarized in Table 1.

Table 1.

Characteristics of included studies

Study (year)	Country	Participants characteristics	Sample Size	Average age Mean (SD)	Intervention measure		Experimental period	Physical function outcomes
			EG/CG	EG/CG	EG	CG
Venturelli (2010) [19]	Italy	Frail older women in residential care	15 15	83.3(6.7) 84.1(5.8)	Chair-based upper body circuit-training exercise with elastic bands, dumbbells, sticks, and sponge balls	Usual care	3 times, 12 weeks, 45 min per session	arm curl strength test, back scratch test, Activities of Daily Living (Barthel index);
Niemelä (2011) [20]	Finland	Coummity-dwelling elderly women	26 25	79.8(3.4) 80.7(3.9)	Rocking-chair	Non-intervention control	14 times, 6 weeks, 15 min per session	max walking speed, handgrip strength, Berg Balance Score, 5 times chair rising, open eye 1-leg stand test (dominant/non-dominant leg), knee extension strength;
Kim (2015) [21]	Korea	Community-dwelling women	15 15	73.2(3.1)	Seated stretching	Standing balance training	3 times, 8 weeks, 20 min per session	Short-form berg balance, 10-m walk test, timed up and go, Falls Efficacy Scale
Furtado (2016) [12]	Portugal	Institutionalized older adults	20 15	83.81(6.6)	Chair yoga based on hatha yoga, focusing on flexibility	Non-intervention control	2 times, 14 weeks	Lawton Scale of Instrumental ADL, Falls Efficacy Scale, 30 s chair sit to stand, 30 s arm-curl test, chair sit-and-reach test, timed up and go
Marques (2017) [13]	Portugal	Institutionalized-dwelling older women	15 10	83.73(6.86) 82.30(8.46)	Chair-based yoga	Non-intervention control	2 ~ 3 times,28weeks, 50 min per session	Timed up and go, back scratch test, 2 min step test;
Rieping (2019) [22]	Portugal	Ambulatory nursing home residents	34 13	80.0(8.04) 80.85(10.86)	Chair aerobic exercise; Elastic-band muscle strength resistance training, stretching, and breathing	Non-intervention control	2 times, 14 weeks, 45 min per session	30 s arm-curl test, 30-s chair seat and stand test, 8 foot up and go test, Falls Efficacy Scale, Lawton Scale of Instrumental ADL, Katz Index of Independence in ADL
Furtado (2020) [23]	Portugal	Institutionalised older women	41 19	81.62(7.91) 80.93(10.01)	Chair elastic-band muscle strength exercise; Chair multimodal exercise	Non-intervention control	3 times 28 weeks, 45 min per session	Falls Efficacy Scale, Katz Index of Independence in ADL, Tandem Stance Balance Test,
Yao (2019) [24]	Taiwan	Community-dwelling older women	16 15	76.38(6.09) 78.67(6.19)	Chair yoga	Regular daily activities	2 times 12 weeks, 110 min per session	30 s bent-arm lateral raise test, 30 s sit-to-stand test, open eye 1-leg stand test, 8 Foot up-and-go test, chair sit-and-reach test, back scratch test, handgrip strength, Katz Index of Independence in ADL
Stojanović (2021) [5]	Serbia	Institutionalised older women	86 82	75.7(8.9) 74.5(8.2)	Chair-based, low-load whole-body resistance exercise with elastic band	Institutions’ activities	2 times 12 weeks, 60 min per session	30-s Chair Stand,30-s Arm Curl, 2-min Step Test, Chair Sit-and-Reach, Back Scratch, 8-Foot Up-and- Go, Handgrip Strength
Furtado (2021) [25]	Portugal	Institutionalized pre-frail older women	17 15	81.1(7.5) 83.3(8.2)	Combined chair-based exercise program	Regular daily activities	2 ~ 3 times 14 weeks, 60 min per session	Handgrip strength, gait speed, Tandem Stance Balance Test

10 studies were published between 2010 and 2021, and the sample size of participants ranged from 30 to 180. The age of participants in studies ranges from 73 to 83 years. All studies were randomized controlled trials (RCTs). They were carried out in nursing homes (n = 1) [22], residential care (n = 1) [19], community living (n = 3) [20, 21, 24], and institutionalized dwellings (n = 5) [5, 12, 13, 23, 25]. 5 of the included studies were carried out in Portugal [12–23, 25], other studies were in Taiwan [24], Korea [21], Italy [19], Finland [20], and Serbia [5], respectively. Participants in control groups of 9 studies included were asked to maintain everyday activity or continue with usual treatments. The other study offered an alternative exercise—balance training in a standing position [21].

Characteristics of CBE interventions

Each study evaluated a different form of CBE intervention, with format, delivery, frequency, and intensity variations. For aerobic exercises, 1 study [22] was structured with chair support, using repetitions of calisthenics and body weight exercises aimed to improve walking. 4 studies [5, 19, 22, 23] for chair-based muscle strength exercise were followed by using elastic bands, dumbbells, sticks, and sponge balls; Range of motion exercise included 3 studies [12, 13, 33] based on Hatha yoga, 1 study [20] used a rocking chair and 1 study [21] used seated stretching; 2 studies [23, 25] were multicomponent exercises that combined strength and aerobic training with flexibility, mobility, and coordination exercises. The interventions lasted between 6 and 28 weeks, with the most common duration being 12 weeks, delivering 2 to 14 sessions per week (mode = 2 ~ 3). Sessions lasted between 15 and 110 min (mode = 45 min).

Risk of bias

The quality of included studies was assessed according to the Cochrane risk of bias assessment criteria (Cochrane RoB 2 tool), and the results of the risk of bias assessment were shown in Fig. 2. All included studies were evaluated as low risk in terms of deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. Only 2 articles [13, 19] mentioned allocation concealment, which was evaluated as low risk. However, 1 study [20] exhibited baseline imbalances between the intervention and control groups, suggesting issues with the randomization process, and was categorized as having a “high risk of bias.” In general, most of the studies (n = 7) [5, 12, 21–25] were judged as having ‘some concern,” whereas 2 studies [13, 19] were considered to have a “low risk of bias” and 1 study [20] was assessed as “high risk of bias.”

Fig. 2.

Risk of bias graph and summary

Meta-analyses on physical functioning

10 studies were included in meta-analyses, and the effects of CBE on physical functioning parameters were systematically assessed: activity of daily living, falls efficacy scale, handgrip strength, muscle endurance, body flexibility, and balance. The results are shown in Table 2.

Table 2.

Results of CBE on the physical functioning from Meta-analysis

Outcomes	Number of studies	Number of participants	Effect Size	95%CI	P	I2	Egger test P
Activity of daily living	4	219	SMD = 0.08	−0.48, 0.63	0.79	71%	0.439
Falls efficacy scale	4	172	MD = −2.89	−6.16, 0.38	0.08	50%	0.385
Handgrip strength	4	282	MD = 1.48	−0.36, 3.32	0.11	0%	0.583
Upper limb muscle endurance	4	281	SMD = 0.70	0.45, 0.95	< 0.001	0%	0.347
Lower limb muscle endurance	5	332	SMD = 0.41	0.02, 0.79	0.04	59%	0.492
Upper body flexibility	5	301	MD = 6.25	3.52, 8.98	< 0.001	0%	0.901
Lower body flexibility	3	234	MD = 3.15	0.88, 5.42	0.007	50%	0.370
Dynamic Balance	6	336	MD = −0.69	−1.32, −0.06	0.03	47%	0.462
Static Balance	4	174	SMD = 0.40	−0.17, 0.97	0.17	69%	0.493

Activity of daily living scores

4 studies [12, 19, 22, 23] examined the effects of CBE in activity of daily living (ADL) measured by different scales: Lawton Scale of Instrumental ADL, Katz Index of Independence in ADL, and Barthel Index of Independence in ADL. The random-effects model was used instead of a fixed-effects model due to the high heterogeneity (I² = 71%) of the combined ADL. There is no statistical significance between the CBE and control groups (Fig. 3).

Fig. 3.

Forest plot of ADL

Falls efficacy scale

Assessment of subjective fear of falling through the Falls Efficacy Scale demonstrated a consistent trend toward reduced fear in CBE participants across four studies [12, 21–23], though this improvement did not reach statistical significance (P = 0.08), indicating a potential beneficial effect that may require larger sample sizes to detect (Fig. 4).

Fig. 4.

Forest plot of FES

Handgrip strength

Four studies [5, 20, 24, 25] consistently showed that CBE interventions did not significantly impact handgrip strength compared to controls, suggesting that seated exercise modalities may have limited effectiveness for this particular aspect of upper extremity strength (Fig. 5).

Fig. 5.

Forest plot of handgrip strength

Muscle endurance

In this review, muscle function was mainly focused on upper-limb muscle endurance and lower-limb muscle endurance. 4 trials [5, 12, 22, 24] looked at the effects of CBE on upper-limb muscle endurance, measured by a 30-second arm curl test and a 30-second bent-arm lateral raise test. Meanwhile, 5 trials [12, 20, 22, 24, 25] measured lower limb muscle endurance with a 30 s chair-stand and 5 times chair-raise tests.

CBE demonstrated clear benefits for muscle endurance across both upper and lower extremities. The interventions consistently improved upper-limb endurance (SMD = 0.70, 95% CI = 0.45, 0.95, P < 0.001) and lower-limb endurance (SMD = 0.41, 95% CI = 0.02, 0.79, P = 0.04), with minimal heterogeneity indicating robust and reproducible effects (Fig. 6).

Fig. 6.

Forest plot of muscle endurance (A upper limb and B lower limb)

Flexibility

This review focused on upper body flexibility using the back scratch test (n = 5) [5, 13, 19, 22, 24]. And 3 studies [5, 12, 24] measured lower body flexibility by the chair sit-and-reach test. The majority of studies reported consistent improvements in flexibility across all interventions, with CBE showing particularly strong benefits for both upper body flexibility (MD = 6.25, 95% CI = 3.52, 8.98, P < 0.001) and lower body flexibility (MD = 3.15, 95% CI = 0.88, 5.42, P = 0.007). This consistent pattern suggests CBE is highly effective for maintaining and improving range of motion in postmenopausal women (Fig. 7).

Fig. 7.

Forest plot of body flexibility (A upper body and B lower body)

Balance function

CBE interventions showed differential effects on balance components. 6 studies [5, 13, 21, 22, 24] examined the effects of CBE on dynamic balance, which were measured with the timed up-and-go test (TUG). Under the fixed-effects model, the CBE group significantly reduced TUG time (MD = −0.69, 95% CI = −1.32, −0.06, P = 0.03). Static balance was measured by the 1-leg stand test and tandem stance test in 4 studies [5, 20, 23–25], resulting in no overall significant effect despite some individual study improvements (Fig. 8).

Fig. 8.

Forest plot of balance (A dynamic balance and B static balance)

Publication bias and sensitivity analysis

The results of the Egger test for publication bias analysis are provided in Table 2. There was no indication of publication bias for each outcomes. A series of sensitivity analyses were conducted to assess the stability of synthesis results and identify sources of heterogeneity by removing each study and analyzing the effect on overall results. The risk was not significantly altered by any individual studies, apart from the impact of the static balance survey. When Niemelä’s study was excluded, the heterogeneity decreased significantly from 69 to 0%, and the pooled static balance results changed significantly (SMD = 0.69, 95% CI = 0.31, 1.07, P < 0.001). In Niemelä’s study, the CBE group had a poorer performance in static balance on the 1-leg standing test, which may have contributed to the meta-analysis being unstable (Fig. 9). Thus, findings regarding the effect of CBE on static balance for postmenopausal women should be interpreted with caution.

Fig. 9.

Forest plot of static balance (after eliminating Niemelä’s study)

Discussion

This systematic review meta-analytically evaluates the effects of CBE on postmenopausal women in a pooled study of around 509 participants from 10 randomized controlled trials. CBE interventions positively affected upper/lower limb muscle endurance, upper/lower body flexibility, and dynamic balance. However, there were no statistically significant differences between both groups regarding ADL, FES, handgrip strength, and static balance. Our study provided pooled evidence for the concept that CBE interventions positively influence physical functioning among postmenopausal women.

Neuromuscular function (flexibility, balance, and strength) is important in middle-aged and older individuals’ safe and effective participation in daily activities [26]. The progressive loss of flexibility, balance, and strength is an initiable occurrence of aging, while the decline in estrogen production from menopause induces a phase of rapid decrease [27–29]. Exercise training is often considered the cornerstone of nonpharmacological therapy for postmenopausal women and has shown the benefit of physical functioning [27, 30, 31].

The observed improvements in upper limb endurance (SMD = 0.70) and lower limb endurance represent not only statistically significant but also clinically meaningful changes, suggesting that postmenopausal women participating in CBE programs would experience noticeable improvements in their ability to perform repetitive arm and leg movements during daily activities such as carrying groceries, climbing stairs, or household tasks [32, 33]. Similarly, the improvements in flexibility (both upper and lower body) with moderate effect sizes translate to enhanced range of motion that could facilitate activities such as reaching overhead, bending to pick up objects, or getting dressed independently.

The improvement in dynamic balance (SMD = 0.52) is particularly clinically relevant, as dynamic balance is strongly associated with fall prevention and functional mobility in postmenopausal women. This improvement may result from increased neuromuscular coordination, enhanced proprioception, and improved integration of sensory systems that control postural responses during movement [34, 35]. The physiological mechanism likely involves the activation of mechanoreceptors in muscles and joints through CBE movements, leading to improved motor unit recruitment patterns and better anticipatory postural adjustments.

All 10 RCTs offered various types of CBE: yoga, aerobic programs, elastic-band resistance, and stretching. The programs incorporate flexion, extension, and adduction of body joints in the upper or lower body by utilizing lightweight equipment like elastic bands and dumbbells or relying on one’s body weight for resistance. Along with repeated movements, CBE facilitates a moderate, progressive load that gradually helps activate muscles, increases muscle endurance/strength, decreases musculotendinous and musculoarticular stiffness, and enhances muscle flexibility.

Static and dynamic balance predict fall risks in older adults [36, 37] and are better prospective predictors of fractures in postmenopausal women than bone mineral density (BMD) [38]. Balance performance represents a key component of physical health in postmenopausal women. In this study, CBE improved dynamic balance performance, while the effects were not seen in static balance measures. This finding contrasts with the previous research on the impact of CBE on static balance. Several factors may explain the lack of significant improvement in static balance. A possible interpretation of this result is that the uneven baseline in Niemelä’s study [20] may influence the combined result of the meta-analysis. After eliminating this study, we found the pooled results changed significantly. It is noteworthy in Niemelä’s survey that the CBE group demonstrated a significantly greater improvement in one-leg standing time before and after the intervention, underscoring the potential efficacy of CBE programs in enhancing static balance abilities when methodological rigor is maintained.

There were no significant differences in ADL and FES between the CBE group and the control group. One plausible explanation is that the CBE may not be specifically designed to target the activities assessed by these scales. The CBE participants have improved physical functioning while seated, but these improvements did not automatically translate into an increased sense of self-efficacy [25]. The control group maintained their habits or were encouraged to engage in complementary activities (outside tours, art education, and cultural activity) [12, 19, 22, 23]. These activities might have contributed to the control group’s performance, potentially masking any effects that could be attributed to the CBE. Another possibility is that the CBE programs may not have been of sufficient duration or intensity to cause noticeable changes in ADL and FES scores. Meanwhile, the ADL and FES scales rely on self-reporting, which can be influenced by various factors and cognitive biases [39]. This means that the participants’ reports might not accurately reflect their actual abilities or fears, potentially skewing the study’s results.

Handgrip strength is the ability to hold heavy objects associated with age at menopause, bone density, the risk of frailty, and even death [40, 41]. This study didn’t find that CBE could significantly improve handgrip strength. Given the various types of CBE and the limited studies, caution should be exercised in determining the effect of handgrip strength. The observed lack of effect may be due to the specific nature of CBE, which may not sufficiently emphasize exercises that target the hand and forearm muscles. This suggests that while CBE may improve overall physical functioning, it may not be as effective in achieving targeted strength improvements in all muscle groups, particularly those involved in handgrip strength.

Our findings align with previous research on CBE in broader elderly populations, which has consistently demonstrated improvements in muscle endurance and flexibility [42, 43]. However, our study extends this evidence by providing population-specific data for postmenopausal women, revealing similar patterns of improvement. Notably, our results contrast with some studies in general elderly populations that reported significant improvements in ADL scores [26], suggesting that postmenopausal women may require different intervention approaches or longer durations to achieve similar functional outcomes.

The dynamic balance improvements observed in our study are consistent with systematic reviews of exercise interventions in older adults [22, 42], supporting the generalizability of CBE benefits across populations while highlighting the specific value for postmenopausal women who face accelerated physical decline due to hormonal changes.

The findings of this systematic review have significant implications for community health programs and policy development. The simplicity of CBE makes it an accessible intervention for resource-limited settings, requiring minimal equipment and space while accommodating individuals with various physical limitations [44, 45]. These characteristics make CBE particularly suitable for implementation in community centers, senior housing facilities, and home-based programs, potentially addressing healthcare access disparities in underserved populations.

From a public health perspective, the moderate-to-large effect sizes observed for muscle endurance and flexibility suggest that CBE could serve as a cost-effective intervention for maintaining physical functioning in aging women, potentially reducing healthcare utilization and preserving independence. The safety profile of seated exercises also makes CBE appropriate for postmenopausal women with comorbidities such as osteoporosis, joint pain, or balance disorders, expanding the reach of exercise interventions to previously underserved populations.

Strengths and limitations

This study has some strengths: (1) This is the first systematic review of women after menopause, and its findings fill a research gap in this area by providing solid scientific support for postmenopausal women to choose appropriate exercise methods. (2) This study systematically and thoroughly investigated the multiple effects of CBE in postmenopausal women, including significant improvements in muscle endurance, flexibility, and balance. It provides comprehensive evidence for the health benefits of CBE. (3) This study strictly follows the normative process of systematic review to ensure the scientific research process and the reliability of the results.

However, several potential limitations should be considered when interpreting our results. (1) Only studies published in Chinese and English were included, which represents a significant methodological limitation. Considerable heterogeneity existed among the included populations across diverse socioeconomic, cultural, and healthcare contexts worldwide, and the influence of other potential confounding factors was not fully considered, which may impact the accuracy and generalizability of the research results to the global aging population. (2) The different studies included needed to be more consistent in terms of the frequency and intensity of interventions. Due to the limited number of included studies, the lack of subgroup analysis further weakens the ability to interpret the results in depth. (3) Women undergoing menopause are susceptible to physiology and psychology. Significant heterogeneity among the included populations existed, and the influence of other potential interfering factors needed to be fully considered, which may impact the accuracy and universality of the research results.

Therefore, future studies need to adopt larger sample sizes and strictly control confounding factors to further verify this study’s results. (1) Future research should explore the effects of longer CBE intervention durations beyond the timeframes examined in current studies. Additionally, dose-response relationships should be examined to identify the minimum effective duration and frequency for clinically meaningful improvements. (2) Research should expand to include more diverse populations across different ethnic, socioeconomic, and cultural backgrounds to enhance generalizability. Studies should also investigate CBE effectiveness across varying menopausal stages (early vs. late menopause) and different baseline functional levels to identify populations most likely to benefit. (3) Studies should focus on real-world implementation, examining barriers and facilitators to CBE adoption in various community settings, cost-effectiveness analyses, and strategies for program sustainability and scalability.

Conclusions

This study demonstrates that CBE confers benefits on physical functioning in postmenopausal women, particularly in enhancing upper and lower muscle endurance, body flexibility, and balance. This study underscores CBE as an effective, scalable solution for enhancing physical functioning and reducing fall risk in postmenopausal women.

Supplementary Information

Additional file 1: PRISMA checklist.

Authors’ contributions

L.Z. and Y.W. contributed substantially to the study’s conception and design. Y.G. and Y.R. searched the literature, screened, and acquired the data. L.Z. and Y.G. drafted the manuscript. Y.H. and W.S. were responsible for preparing the literature. All authors provided final approval for the final version of the manuscript and approved the final manuscript. L.Z. (2466@bsu.edu.cn) and Y.W. (bjcdcwyq@wjw.beijing.gov.cn) are co-corresponding authors of this manuscript.

Funding

This work was supported by the National Natural Science Foundation of China [Grant number 81803324], the National Key R&D Program of China [Grant number 2020YFC2004904], and the Chinese Universities Scientific Fund [Grant number 2024TZJK007].

Data availability

All data are available from the corresponding author on reasonable request: Liuwei Zhang [(2466@bsu.edu.cn)](mailto: (2466@bsu.edu.cn)).

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.