Balance Exergame Training in Older Adults With a History of Falls

Falls are a major health concern among older adults and can affect mobility, independence, and quality of life. Balance training is commonly used to improve postural control and reduce fall risk. However, conventional balance training mainly focuses on physical movement, whereas balance exergames combine physical exercise with cognitive challenges that may help improve both motor control and executive function. This study aims to investigate the effectiveness of balance exergame training on cortical excitability, cortical inhibition, and functional performance in older adults with a history of falls. A total of 42 Thai older adults aged 65-85 years with at least one fall during the previous 12 months will be recruited and randomly assigned to one of two groups: a balance exergame group or a conventional balance training group. The balance exergame group will participate in game-based balance training using Nintendo Wii Fit, including Ski Slalom, Table Tilt, Tightrope Tension, Balance Bubble, and Penguin Slide. Participants will perform weight-shifting activities on a balance board while responding to visual and auditory challenges during gameplay. The conventional balance training group will perform structured balance exercises involving sitting, standing, and walking activities. Both groups will participate in supervised training sessions lasting 60 minutes, three times per week, for eight weeks. Participants will undergo assessments before and after the intervention period. Study outcomes will include fear of falling, cognitive function, executive function, balance and movement performance, and neurophysiological measures of cortical excitability and inhibition assessed using transcranial magnetic stimulation (TMS). Additional assessments will examine sensory function and biomechanical characteristics of movement. The findings are expected to provide further understanding of the effects of balance exergame training on brain function and functional performance in older adults with a history of falls.

Inclusion Criteria: * Male or female individuals aged 65 to 85 years. * Ability to walk or perform daily activities independently without the use of an assistive device. * Stable health over the past 6 months, including well-controlled chronic conditions such as hypertension, diabetes, or benign paroxysmal positional vertigo (BPPV), with consistent medication use. * A history of at least one fall within the past year (i.e., the past 365 days), assessed on the day of evaluation. Exclusion Criteria: * Recent or severe abnormal symptoms (e.g., muscle weakness, joint limitations, headaches, or numbness) that may present during data collection or training. * Presence or history of vestibular disease, such as Meniere's disease. * Presence of skin diseases, such as psoriasis. * Presence of metal implants, such as pacemakers. * History of neurological disorders, such as advanced Parkinson's disease or stroke. * History of previous upper limb surgery, such as radial osteotomy. * History of previous lower limb surgery, such as total knee replacement. * History of musculoskeletal disorders, such as severe osteoarthritis. * History of severe cognitive disorders, such as dementia. * History of epilepsy or seizure disorders. * Severe vision or hearing deficits.