Tai Chi, Exergaming, Perturbation and Dual-Task Training for Balance: What the Reviews Report
Reviews and trials of Tai Chi, exergaming and virtual reality, perturbation-based and stepping training and dual-task training for balance in older adults: each is reported to improve balance or reduce falls in its own sources, and one trial reports functional-task training as more effective than resistance training for balance (Mohammed 2021).
Reduce stance depth for painful knees/hips; use a chair nearby if unsteady.
- Two or more falls in the past 12 months, or any fall with injury
- Dizziness, lightheadedness, or fainting during standing or movement
- New or worsening unsteadiness, neurological symptoms, or numbness in the feet
- Fear of falling severe enough to restrict daily activity
What the evidence says
The sources on this entry are meta-analyses, systematic reviews and one randomised trial of balance training in older adults across several modalities. On Tai Chi, Chen 2023 (meta-analysis, 24 studies, 4,497 participants) reports that Tai Chi significantly reduced fall risk (RR 0.76) and improved balance in older adults, with effectiveness increasing with exercise duration and frequency; Li 2024 (meta-analysis, 22 studies, 2,170 participants) reports that Tai Chi effectively enhances balance and physical function in older adults, with notable potential for fall risk reduction; Guo 2024 (meta-analysis) reports that Tai Chi, yoga and resistance training significantly enhance balance and motor function; and Rand 2011 (meta-analysis, 24 studies, 2,154 participants) concludes that “Tai chi interventions are the most beneficial in increasing the balance confidence of older adults” (SMD 0.48, against 0.22 to 0.31 for exercise and multifactorial interventions). On virtual reality and exergaming, de Amorim 2018 (meta-analysis, 10 studies) reports that virtual reality therapy can improve balance and mobility in the elderly (SMD -0.848 for the Berg Balance Scale) and concludes that the findings on virtual reality therapy for balance training “seem promising”; Zhang 2025 (network meta-analysis, 93 studies, 5,114 participants) reports that exercise improves balance in healthy older adults, with a SUCRA value of 96.3% for exergames on the Berg Balance Scale; Chen 2021 (meta-analysis, 20 studies, 845 participants) reports exergames, especially combined with physical training, as a promising strategy to improve balance control and reduce falls in healthy older adults; and Cieślik 2024 (meta-analysis, 28 studies, 1457 participants) reports that commercially available VR exergaming with motion-capture feedback has demonstrated effectiveness for balance training compared with no treatment (SMD 0.86). On perturbation and stepping training, Okubo 2016 (meta-analysis, 7 studies, 660 participants) reports that both reactive and volitional stepping interventions reduce falls among older adults by approximately 50%, and Gerards 2017 (systematic review) reports that perturbation-based training appears to be a feasible and effective approach to falls reduction in clinical settings. On dual-task training, Varela-Vásquez 2020 (systematic review) reports that dual-task exercises can have an adequate influence on the improvement of balance and walking speed; Khan 2022 (systematic review) reports that motor-cognitive dual-task training improves balance and reduces fall incidence in older adults; and Khan 2025 (meta-analysis, 44 studies, 2782 participants) reports very low to moderate quality evidence for dual-task training as a single intervention to improve dynamic balance and functional mobility and reduce falls. One comparative trial, Mohammed 2021 (randomised trial), reports that both functional-task training and resistance training were effective in balance enhancement in older adults, with balance performance better in the functional-task group at the end of the program (d 0.49 for the Berg Balance Scale, 0.53 for Timed Up and Go). The review summary this entry was written from (SR09.2) covers these modalities together.
- Too gentle to help (Chen 2023 reports that Tai Chi significantly reduced fall risk and improved balance in older adults, and Rand 2011 concludes that “Tai chi interventions are the most beneficial in increasing the balance confidence of older adults”)
- Does not guarantee prevention of any fall or injury
- Not a substitute for medical evaluation of dizziness, syncope, or unexplained falls
- Cannot guarantee you will never fall
- Agreement
- The review summary this entry was written from does not say whether its sources agree at this claim. Direction recorded for 7 of 14 sources; not yet recorded for the rest. A review summary is the written synthesis this entry was first built from; it is not one of the sources counted here.
- The claim's outcome
- Outcome not yet recorded
- Certainty
- A source states a certainty rating for 1 outcome.
- Authors
- Sources share authors: Mohammad Khan (first author of 2 sources); Stanley Winser (senior author of 2 sources).
What each source measured and concluded (14)
- What it measured
- Balance performance (static and dynamic balance, mobility)
- How it measured it
- Berg Balance Scale (BBS), Timed Up and Go (TUG) test (validated tools)
- Direction it states for the claim's outcome
- Improved
- How it was read
- read in full text
- What it measured
- 1. Balance was measured using the Berg Balance Scale and Timed Up and Go (TUG) test, both validated tools. 2. These measurements were conducted using validated clinical assessment tools. 3. Secondary outcomes included mobility, flexibility, gait, and fall reduction. 4. Compared to control groups or other interventions.
- Direction it states for the claim's outcome
- Improved
- How it was read
- read in full text
- What the review says it includes
- systematic review and meta-analysis
- Studies and participants, as stated
- N = not reported participants across 10 studies
- What it measured
- Number of fallers, number of falls, balance assessment indicators (TUG, FRT, SLB, BBS, SPPB, FES, gait speed).
- How it measured it
- Standardized tests (TUG, FRT, SLB, BBS, SPPB, FES, gait speed assessment).
- How it was read
- read in full text
- What the review says it includes
- meta-analysis, systematic review
- Studies and participants, as stated
- N = 4,497 participants across 24 studies
- Heterogeneity, as stated
- Potential heterogeneity across studies
- What it measured
- Berg Balance Scale (BBS), Timed Up and Go Test (TUG), gait speed (GS), and one-leg stance with eyes open (OLSEO).
- How it measured it
- Validated clinical scales and tests: BBS, TUG, OLSEO, and GS.
- How it was read
- read in full text
- What the review says it includes
- systematic review and network meta-analysis
- Studies and participants, as stated
- N = 5,114 participants across 93 studies
- What it measured
- Balance confidence (BC) in older adults.
- How it measured it
- Validated scales: Activities-specific Balance Confidence (ABC) Scale, Falls Efficacy Scale (FES), Modified Falls Efficacy Scale (MFES).
- Direction it states for the claim's outcome
- Improved
- How it was read
- read in full text
- What the review says it includes
- systematic review and meta-analysis
- Studies and participants, as stated
- N = 2,154 participants across 24 studies
- What it measured
- Falls incidence
- How it measured it
- Prospective monitoring or retrospective reporting
- Direction it states for the claim's outcome
- Improved
- How it was read
- read in full text
- What it measured
- Number of falls during follow-up and the proportion of fallers.
- How it measured it
- Monthly fall diaries supplemented by follow-up telephone calls or face-to-face interviews.
- Direction it states for the claim's outcome
- Improved
- Its conclusion, in its own words
- “The findings indicate that both reactive and volitional stepping interventions reduce falls among older adults by approximately 50%.”
- How it was read
- read in full text
- What the review says it includes
- systematic review and meta-analysis
- Studies and participants, as stated
- N = 660 participants across 7 studies
- Heterogeneity, as stated
- Substantial heterogeneity within the training programs which limited subgroup analyses.
- What it measured
- Dynamic balance via Berg Balance Scale (BBS) and Fullerton Advanced Balance (FAB), functional mobility via Timed Up and Go (TUG), and fall frequency via self-report.
- How it measured it
- BBS and FAB are validated tools for dynamic balance, TUG is a validated measure for functional mobility, and fall frequency was measured through self-reported diaries and questionnaires.
- How it was read
- read in full text
- What the review says it includes
- systematic review with meta-analysis and meta-regression
- Studies and participants, as stated
- N = 2782 participants across 44 studies
- Heterogeneity, as stated
- High heterogeneity among studies
- What it measured
- 1. Primary outcomes: Falls (number of fallers, number of falls, fall efficacy via FES-I, Icon-FES, short FES-I); Balance control (static balance via BBS, Tinetti balance Assessment, OLS, FRT, postural sway path length and mean sway speed; dynamic balance via TUG). 2. Measurement tools: Validated scales (FES-I, Icon-FES, short FES-I), standardized tests (BBS, Tinetti, OLS, FRT, TUG). 3. Secondary outcomes: Postural control, dynamic balance improvements. 4. Compared to: Traditional physical training (PT).
- How it was read
- read in full text
- What the review says it includes
- meta-analysis, systematic review
- Studies and participants, as stated
- N = 845 participants across 20 studies.
- Heterogeneity, as stated
- LIMITATIONS: Small number of eligible RCTs, publication bias, heterogeneity in intervention protocols, lack of characterization of long-term effects and optimal intervention duration.
- What it measured
- 1. Primary outcomes: Balance and walking speed. 2. Measurement tools: Time Up and Go (TUG), Berg Balance Scale (BBS), Balance Evaluation System Test (BEST) - all validated. 3. Secondary outcomes: Static and dynamic equilibrium, gait performance, stride, cadence. 4. Compared to: Control groups (single-task training or no intervention), fixed vs. variable priority dual-task training.
- Direction it states for the claim's outcome
- Improved
- How it was read
- read in full text
- What the review says it includes
- systematic review
- Heterogeneity, as stated
- LIMITATIONS: Heterogeneity in exercises, lack of specification in secondary task difficulty, small sample sizes in some studies, and issues with transferability.
- What it measured
- Balance and falls
- How it measured it
- Validated scales like Berg Balance Scale (BBS), Timed Up and Go (TUG), and others; falls evaluated using number, percentage, and incidence rate ratio
- How it was read
- read in full text
- What the review says it includes
- systematic review
- Heterogeneity, as stated
- Heterogeneity in participant characteristics and study methods.
- What it measured
- Balance function using the Berg Balance Scale (BBS) and the Timed Up and Go test (TUG).
- How it measured it
- Validated tools: BBS and TUG.
- How it was read
- read in full text
- What it measured
- Balance, fall risk, and physical function via BBS, TUG, OLS-C, FES, FOF, SPPB.
- How it measured it
- Validated scales and tests such as BBS, TUG, OLS-C.
- How it was read
- read in full text
- What the review says it includes
- meta-analysis
- Studies and participants, as stated
- N = 2,170 participants across 22 studies
- What it measured
- Balance and functional mobility
- Direction it states for the claim's outcome
- Improved
- How it was read
- read in full text
- What the review says it includes
- meta-analysis
- Studies and participants, as stated
- N = 1457 participants across 28 studies
Certainty ratings the sources state (1)
- Rating, as the source states it
- very low to moderate
- Framework
- not named by the source
- Applies to
- AUTHOR CONCLUSION: "There is very low to moderate quality evidence for the use of DT training as a single intervention to improve dynamic balance and functional mobility and reduce falls in older adults."
- Stated by
- Khan et al. (2025)
Each source below is shown with its study design and a link to the original study, or, where it is not a completed research paper, with what kind of record it is; those are not counted. This is the audit trail.
Why do some records show a record type instead of a study design?
A study design is shown for a completed, peer-reviewed paper. A registered protocol, a preprint, a conference abstract, a referee report or a book chapter has not been through peer review as a finished paper, so it is labelled for what it is, and it is counted in no source count. Where a record could not be confirmed as a completed paper at all, it says so rather than guessing. They all stay in the list, and their DOI still resolves, because the count of what was screened is part of the audit trail.
- Protocol / registration A registered plan for a review or trial, not its results.
- Preprint Posted by its authors before peer review.
- Conference abstract A conference summary rather than a peer-reviewed paper.
- Peer-review report A referee's report on a paper, not the paper itself.
- Guideline / position stand A recommendation derived from evidence, which is a step further from the data than the evidence itself.
- Book chapter A chapter in a scholarly book rather than a journal paper.
- Type not recorded Our record does not say what kind of publication this is, so it is counted in no source count. That is a gap in our data, not a judgement about the research.