# The Effects of a Cerebellar Transcranial Direct-Current Stimulation-Based Preventive Exercise Program on Physical Function and Fall Reduction Efficacy in Community-Dwelling Older Adults

## TL;DR

Using cerebellar transcranial direct-current stimulation before exercise improved strength and balance in older adults, but not static balance or fear of falling.

## Contribution

This study shows that combining c-tDCS with exercise enhances physical function in older adults more effectively than exercise alone.

## Key findings

- c-tDCS combined with exercise significantly improved lower-extremity muscle strength and dynamic balance in older adults.
- No significant changes were observed in static balance or fall efficacy after the 4-week intervention.
- Longer intervention durations or multicomponent approaches may be needed to improve static balance and reduce fear of falling.

## Abstract

What are the main findings?
Administration of cerebellar transcranial direct-current stimulation (c-tDCS) prior to an Otago Exercise Program (OEP)-based fall prevention exercise program significantly improved lower-extremity muscle strength (Five Times Sit to Stand Test, FTSST) and dynamic balance (Time Up to Go, TUG) in older adults.No significant changes were observed in static balance (Balancia) or fall efficacy (Falls Efficacy Scale—Korean ver., FES-K) following the short-term, 4-week intervention.

Administration of cerebellar transcranial direct-current stimulation (c-tDCS) prior to an Otago Exercise Program (OEP)-based fall prevention exercise program significantly improved lower-extremity muscle strength (Five Times Sit to Stand Test, FTSST) and dynamic balance (Time Up to Go, TUG) in older adults.

No significant changes were observed in static balance (Balancia) or fall efficacy (Falls Efficacy Scale—Korean ver., FES-K) following the short-term, 4-week intervention.

What are the implications of the main findings?
c-tDCS may serve as an effective adjunct modality that enhances neuroplasticity and motor control, thereby amplifying the strength and dynamic balance benefits of fall prevention exercise programs.Longer intervention durations or multicomponent approaches may be required to improve static balance and reduce psychological fear of falling.

c-tDCS may serve as an effective adjunct modality that enhances neuroplasticity and motor control, thereby amplifying the strength and dynamic balance benefits of fall prevention exercise programs.

Longer intervention durations or multicomponent approaches may be required to improve static balance and reduce psychological fear of falling.

Background/Objectives: Falls are a major cause of injury in older adults, closely related to declines in muscle strength, balance control, and sensory integration. Although exercise-based fall prevention programs are well supported, evidence on combining such programs with cerebellar transcranial direct-current stimulation (c-tDCS) remains limited. This study investigated the effects of c-tDCS applied before a modified Otago Exercise Program (OEP) on lower-extremity strength, balance, and fall efficacy in older adults. Methods: In this randomized controlled study, twenty-six community-dwelling older adults (median age [IQR]: experimental, 74.00 [10] years; control, 71.00 [10] years) were randomly assigned to either a c-tDCS + exercise group (n = 13) or a sham + exercise group (n = 13). The intervention was administered twice weekly for four weeks. The experimental group received 15 min of c-tDCS followed by 30 min of OEP-based exercise; the control group received sham stimulation under identical conditions. The outcome measures included the Five Times Sit to Stand Test (FTSST), Timed Up and Go (TUG), Balancia-based static balance (velocity average), and Falls Efficacy Scale—Korea (FES-K). Assessments were performed pre- and post-intervention. Results: The experimental group demonstrated significantly greater improvements than the control group (p < 0.05) in the Five Times Sit to Stand Test (r = 0.44) and Timed Up and Go test (r = 0.56). No significant changes were observed in static balance or fall efficacy in either group (p > 0.05). Conclusions: The combined use of c-tDCS and an OEP-based fall prevention exercise program effectively improved lower-extremity strength and dynamic balance in older adults. However, short-term intervention did not influence static balance or fall efficacy. Further studies using longer intervention periods and larger samples are warranted to verify these findings and clarify the mechanisms underlying c-tDCS-enhanced motor performance.