Comparative Effects of Stable and Unstable Surface Balance Training on Postural Control in Older Adults: A Secondary Analysis of a Randomized Controlled Trial

Abstract

Background
Postural control is essential for maintaining functional independence and preventing falls in older adults. Age-related
declines in sensory integration, muscle strength, and neuromuscular coordination contribute to impaired balance and
mobility. Balance training is an established intervention for improving postural stability; however, the comparative
effectiveness of stable and unstable surface training remains uncertain.
Objective
To compare the effects of stable and unstable surface balance training on postural control, functional mobility, and fear of
falling among community-dwelling older adults.
Methods
This secondary analysis used data from a randomized controlled trial involving 60 community-dwelling older adults aged
65–80 years. Participants originally received six weeks of supervised balance training on a firm surface (n = 20), foam
surface (n = 20), or dynamic surface (n = 20). For this analysis, participants were regrouped into a stable surface group
(firm surface; n = 20) and an unstable surface group (foam and dynamic surfaces combined; n = 40). Training was
conducted three times weekly for six weeks. Outcome measures included the Berg Balance Scale (BBS), Timed Up and
Go (TUG) Test, and Falls Efficacy Scale–International (FES-I). Between-group comparisons were performed using
independent-samples t-tests, with statistical significance set at p < 0.05.
Results
Both groups demonstrated improvements in postural control, functional mobility, and fear of falling following the
intervention. The unstable surface group achieved significantly higher post-intervention BBS scores than the stable surface
group (p < 0.001), indicating greater improvement in postural control. No significant between-group difference was
observed in post-intervention TUG performance (p = 1.000). Although post-intervention FES-I scores differed
significantly between groups (p = 0.003), this finding should be interpreted with caution because baseline FES-I scores
were also significantly different.
Conclusion
Both stable and unstable surface balance training were effective in improving balance, functional mobility, and confidence
among older adults. Unstable surface training provided additional benefits for postural control, while functional mobility
improved similarly in both groups. Progressive incorporation of unstable surface exercises may be considered as part of
comprehensive geriatric balance rehabilitation programmes.