Author(s): MICHALSKA, J., BRACHMAN, A., HADYK, V., PIKULA, W., KAMIENIARZ, A., Institution: ACADEMY OF PHYSICAL EDUCATION, Country: POLAND, Abstract-ID: 2015

INTRODUCTION:
Rapid technological advances have led to the development of increasingly innovative and engaging approaches to balance training. Among these, exercise performed in virtual reality has gained growing attention as a promising rehabilitation tool. By diverting the participant's focus away from the exercise itself, virtual reality-based training enhances task engagement, allows for the implicit integration of cognitive demands, and introduces elements of motivation and competition. Accordingly, the primary aim of this study was to compare different forms of virtual environment-based training with conventional exercises in terms of their effectiveness in improving balance and reducing fall-related risk in older adults.
METHODS:
Eighty-one community-dwelling adults aged over 60 years were randomly allocated to one of five groups: HTC (fully immersive virtual reality training), VBC (augmented reality-based training), TM (augmented reality training combined with treadmill walking), HBE (home-based exercise), or CG (passive control group). Step initiation was assessed using two force platforms under four experimental conditions: unimpeded transition, obstacle clearance, step-up, and step-down. Center of foot pressure displacement was analyzed across three phases: phase 1 - quiet standing prior to step initiation; phase 2 - forward stepping; and phase 3 - quiet standing following step initiation.
RESULTS:
Baseline analyses confirmed group comparability, with no significant differences in age (Kruskal-Wallis p = 0.686), baseline fear of falling as assessed by the FES-I (Kruskal-Wallis p = 0.073), or sex distribution (chi-square p = 0.061). Across all groups, step initiation performance improved over time, as evidenced by significant reductions in transition time (TT) in all experimental conditions (paired t-tests pooled across groups: all p < 0.001). The largest improvements were observed during obstacle clearance tasks. Specifically, TT decreased by approximately 0.680 s in the HTC group (d = -1.20; p < 0.001), 0.695 s in the VBC group (d = -0.97; p < 0.001), 0.567 s in the TM group (d = -0.57; p < 0.001), and 0.520 s in the HBE group (d = -0.69; p < 0.001), whereas a smaller yet significant reduction was observed in the CG (0.12 s; d = -0.35; p < 0.05). No significant changes in body sway during quiet standing before or after step initiation were detected in any group or condition (p > 0.05).
CONCLUSION:
Virtual reality-based exercise represents an effective and feasible approach to improving dynamic balance performance in older adults. However, while all active interventions yielded beneficial effects, evidence supporting the superiority of any specific training modality over passive control remains limited. These findings support the clinical applicability of virtual reality-based balance training as a scalable and engaging intervention for fall prevention in the ageing population.
FUNDING: RID/SP/0053/2024/01.