# Gaming Against Frailty: Effects of Virtual Reality-Based Training on Postural Control, Mobility, and Fear of Falling Among Frail Older Adults

## TL;DR

A virtual reality training program improved balance, mobility, and confidence in older adults with frailty, offering a promising alternative to traditional exercises.

## Contribution

Demonstrates the effectiveness of VR-based training in improving postural control and balance confidence in frail older adults.

## Key findings

- VR training significantly improved postural control metrics like sway area and velocity.
- Participants showed better functional mobility and balance performance after VR intervention.
- Balance confidence increased, though fear of falling did not significantly decrease.

## Abstract

Background/Objectives: Frailty is a prevalent geriatric syndrome associated with impaired postural control and elevated fall risk. Although conventional exercise is a core strategy for frailty management, adherence remains limited. Virtual reality (VR)-based interventions have emerged as potentially engaging alternatives, but their effects on objective postural control and task-specific confidence in frail populations remain understudied. This study aimed to evaluate the effectiveness of a supervised VR training program using the Nintendo Ring Fit Plus™ on postural control, functional mobility, and balance confidence among frail community-dwelling older adults. Methods: Fifty-one adults aged ≥65 years classified as frail or prefrail were enrolled in a four-week trial. Participants were assigned to either a VR intervention group (n = 28) or control group (n = 23). Participants were non-randomly assigned based on availability and preference. Outcome measures were collected at baseline and post-intervention. Primary outcomes included center of pressure (CoP) metrics—sway area, mean velocity, and sway path. Secondary outcomes were the Timed Up and Go (TUG), Berg Balance Scale (BBS), Activities-specific Balance Confidence (ABC), and Falls Efficacy Scale–International (FES-I). Results: After adjusting for baseline values, age, and BMI, the intervention group showed significantly greater improvements than the control group across all postural control outcomes. Notably, reductions in sway area, mean velocity, and sway path were observed under both eyes-open and eyes-closed conditions, with effect sizes ranging from moderate to very large (Cohen’s d = 0.57 to 1.61). For secondary outcomes, significant between-group differences were found in functional mobility (TUG), balance performance (BBS), and balance confidence (ABC), with moderate-to-large effect sizes (Cohen’s d = 0.53 to 0.73). However, no significant improvement was observed in fear of falling (FES-I), despite a small-to-moderate effect size. Conclusions: A supervised VR program significantly enhanced postural control, mobility, and task-specific balance confidence in frail older adults. These findings support the feasibility and efficacy of VR-based training as a scalable strategy for mitigating frailty-related mobility impairments.