Background The 2018 Cochrane review update on interventions to prevent falls in older people in care facilities concludes that there is low-quality evidence that exercise prevents falls in this population. We described the trial characteristics of the recent 2021 Cochrane update and undertook an intervention component analysis (ICA). An ICA involves extraction of data from trial reports on key intervention content and implementation processes.

Methods Randomised controlled trials of exercise for falls prevention in aged care included in the 2021 Cochrane update were sourced. Line by line coding was conducted to identify intervention components and reported according to the Profane Taxonomy of Fall Prevention. Our ICA used an inductive approach to explore the nature of the exercise intervention features through trialists’ commentary in the discussion sections of papers.

Results We included 31 trials from 16 countries involving 3,846 participants. 17 (55%) trials included people with cognitive impairment, and 11 (35%) included older people with severe mobility disability. The primary intervention component was exercises involving strength training combined with gait, balance, and functional training in 18 (58%) trials and exercise dose varied from 1.5 to 112 hours. The ICA findings include themes related to intervention content and implementation processes: strength and balance exercise improves physical performance; individualised exercise prescription; moderate exercise challenge is sustainable; but extra economic and staff resources are required to implement successful programs.

Conclusion Information about critical features of exercise intervention and guidance for its implementation can guide clinicians and program providers in developing optimal interventions.