14 sources: 10 meta-analyses, 1 randomised controlled trial, 3 systematic reviews
Physical · Practice
Exergame / VR Balance Program (Home)
Balance-focused exergames or virtual-reality apps with real-time feedback: one way to carry out what the sources on the concept entry report, that virtual reality therapy can improve balance and mobility in the elderly (de Amorim 2018) and that VR exergaming with motion-capture feedback is effective for balance training compared with no treatment (Cieślik 2024).
2–3×/week
Any levelHome or clinic
Before you start
Use supported/seated modes and clear the area.
When to seek a professional
- 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
- Motion sickness or dizziness during VR use
How to do it
- This program uses balance-focused exergames or virtual-reality apps that provide real-time feedback and scaling difficulty.
- Choose games that deliver real balance challenge, clear the play area of obstacles, and use seated/supported options if higher risk.
2–3×/week, 20–45 min, ≥6–12 weeks
The research behind this entry establishes something about dose, but not these exact parameters; treat them as a practical way to apply the finding rather than as the finding itself.
Balance-game console or VR headset; clear spaceOlder adultsFor most adultsNew to this
What the evidence says
What the sources say
This practice is one way to carry out what the sources on the concept entry (phys.neuromotor.balance-modality-specificity) studied: balance training in older adults across several modalities, virtual reality and exergaming among them. de Amorim 2018 (meta-analysis, 10 studies) reports that virtual reality therapy can improve balance and mobility in the elderly, with 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. Cieślik 2024 (meta-analysis, 28 studies, 1457 participants) reports that commercially available VR exergaming with a motion-capture feedback mechanism has demonstrated effectiveness for balance training compared with no treatment (SMD 0.86), particularly at doses above 134 minutes per week, and Chen 2021 (meta-analysis, 20 studies, 845 participants) reports exergames, especially combined with physical training at 90 to 119 minutes a week for more than 8 weeks, as a promising strategy to improve balance control and reduce falls in healthy older adults. The full account, source by source, is on the concept entry this practice links to (phys.neuromotor.balance-modality-specificity).
Common misconceptions
- 'Games aren't real training' (well-designed exergames deliver genuine balance challenge)
What we won't claim
- Does not guarantee prevention of any fall or injury
- Not a substitute for medical evaluation of dizziness, syncope, or unexplained falls
- In-game scores are not clinical measures
14 sources: 10 meta-analyses, 1 randomised controlled trial, 3 systematic reviews
- 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)
randomised controlled trial · 2021
Mohammed et al. (2021) — Balance Enhancement in Older Adults: Is Functional-Task Training Better Than Resistance Training in Enhancing Balance in Older Adults?
- 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
meta-analysis · 2018
Amorim et al. (2018) — Virtual reality therapy for rehabilitation of balance in the elderly: a systematic review and META-analysis
- 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
meta-analysis · 2023
Chen et al. (2023) — Tai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials
- 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
meta-analysis · 2025
Zhang et al. (2025) — Effects of different exercise modalities on balance performance in healthy older adults: a systematic review and network meta-analysis of randomized controlled trials
- 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
meta-analysis · 2011
Rand et al. (2011) — Interventions for addressing low balance confidence in older adults: a systematic review and meta-analysis.
- 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
systematic review · 2017
Gerards et al. (2017) — Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice
- 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
meta-analysis · 2016
Okubo et al. (2016) — Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis
- 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.
meta-analysis · 2025
Khan et al. (2025) — Effectiveness of dual-task exercise in improving balance and preventing falls among older adults: systematic review with meta-analysis and meta-regression
- 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
meta-analysis · 2021
Chen et al. (2021) — Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis
- 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.
systematic review · 2020
Varela-Vásquez et al. (2020) — Dual-task exercises in older adults: A structured review of current literature
- 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.
systematic review · 2022
Khan et al. (2022) — A Systematic Review Exploring the Theories Underlying the Improvement of Balance and Reduction in Falls Following Dual-Task Training among Older Adults
- 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.
meta-analysis · 2024
Guo et al. (2024) — Effects of different exercise types on balance function in healthy older adults and Parkinson’s patients: a systematic review
- 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
meta-analysis · 2024
Li et al. (2024) — Effectiveness of Tai Chi exercise on balance, falls, and motor function in older adults: a meta-analysis
- 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
meta-analysis · 2024
Cieślik et al. (2024) — Balance Board or Motion Capture? A Meta-Analysis Exploring the Effectiveness of Commercially Available Virtual Reality Exergaming in Enhancing Balance and Functional Mobility Among the Elderly
- 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)
Khan et al. (2025), for its own outcome
- 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)
Key sources (16) · 2 not counted
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.
randomised controlled trialBalance Enhancement in Older Adults: Is Functional-Task Training Better Than Resistance Training in Enhancing Balance in Older Adults?
meta-analysisVirtual reality therapy for rehabilitation of balance in the elderly: a systematic review and META-analysis
PreprintInfluence of reactive balance training program characteristics on reactive balance control and fall risk: a systematic review and meta-analysis
meta-analysisTai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials
meta-analysisEffects of different exercise modalities on balance performance in healthy older adults: a systematic review and network meta-analysis of randomized controlled trials
meta-analysisInterventions for addressing low balance confidence in older adults: a systematic review and meta-analysis.
systematic reviewPerturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice
meta-analysisStep training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis
meta-analysisEffectiveness of dual-task exercise in improving balance and preventing falls among older adults: systematic review with meta-analysis and meta-regression
PreprintThe effect of reactive balance training on falls in daily life: an updated systematic review and meta-analysis
meta-analysisComparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis
systematic reviewDual-task exercises in older adults: A structured review of current literature
systematic reviewA Systematic Review Exploring the Theories Underlying the Improvement of Balance and Reduction in Falls Following Dual-Task Training among Older Adults
meta-analysisEffects of different exercise types on balance function in healthy older adults and Parkinson’s patients: a systematic review
meta-analysisEffectiveness of Tai Chi exercise on balance, falls, and motor function in older adults: a meta-analysis
meta-analysisBalance Board or Motion Capture? A Meta-Analysis Exploring the Effectiveness of Commercially Available Virtual Reality Exergaming in Enhancing Balance and Functional Mobility Among the Elderly
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.
Explore all 718 studies in Neuromotor (Balance/Agility/Coordination) →
The full evidence base this focus area draws on, every study with its design and DOI.What it is for
Feel steadier on my feetMove more freelyReduce my risk of fallingStay capable as I get older