AI-Adaptive AR Training for Balance and Falls Prevention in Older Adults

August 21, 2026 updated by: Aimee Nelson, McMaster University

Artificial Intelligence-Enhanced Augmented Reality Training to Improve Mobility, Balance, and Prevent Falls in Older Adults: A Feasibility Study

Falls are a common problem in adults within the age of 55-80 years and can lead to injury and loss of independence. This study is testing a new type of balance training using augmented reality (AR). In this intervention, participants will see virtual objects, such as obstacles, placed in their environment and will practice stepping over or moving around them. The system will adjust the difficulty based on each person's performance. Participants will complete training sessions over several weeks. We will measure changes in balance, walking ability, and confidence before and after the program. The goal is to see if this training can help improve balance and reduce the risk of falls in older adults.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Falls are a significant health concern among older adults and can contribute to injury, fear of falling, reduced physical activity, functional decline, and loss of independence. Exercise-based interventions that target balance, gait, strength, and functional mobility can reduce fall risk in older adults. However, implementation outside supervised clinical settings may be limited by insufficient training dose, lack of individualized progression, and difficulty maintaining engagement.

Augmented reality (AR) provides an opportunity to deliver balance and mobility training while allowing participants to interact with virtual training elements within their physical environment. Previous studies have investigated AR-assisted exercise and rehabilitation approaches in older adults, including balance, gait, and mobility training. Although these approaches have demonstrated potential benefits, further research is needed to determine how AR-based training can be individualized and implemented effectively in community-dwelling older adults. Incorporating machine learning-based adaptation may enable training difficulty to be adjusted according to individual performance and provide an appropriate and progressive level of challenge.

This study will evaluate the feasibility and preliminary effects of an artificial intelligence (AI)-enhanced AR balance and mobility training program in community-dwelling older adults aged 55-80 years. The study will use a single-arm, open-label, repeated-measures design. Participants will complete a baseline assessment (T1), followed by an 8-week AR training intervention and an immediate post-intervention assessment (T2).

The intervention will consist of 3-5 training sessions per week for 8 weeks, with each session lasting approximately 30 minutes. Participants will perform standing- and walking-based activities presented through wearable AR smart glasses. Training activities will include obstacle negotiation, path following, step targeting, turning, and directional-change tasks designed to challenge functional balance and mobility. Training sessions may be completed at McMaster University or, for eligible participants, in the participant's home. Before beginning home-based training, the home environment will be assessed for suitability, and the participant will complete an initial on-site training session under direct supervision.

The AR training application was developed by the McMaster University research team and runs on a dedicated smartphone connected to the AR glasses. The application incorporates a machine learning model that adapts task difficulty according to individual participant performance using a challenge-point framework designed to maintain an approximately 80% task success rate. When performance exceeds this target, the system iteratively increases task difficulty, for example by increasing target speed or decreasing target size. When performance falls below the target, the system reduces task difficulty, for example by decreasing target speed or increasing target size. The model uses positional and movement data collected through the AR glasses together with training performance metrics, including target success rate, accuracy, response time, and movement speed, to evaluate participant performance and inform adjustments to training difficulty.

The primary objective is to evaluate the feasibility of the intervention based on participant retention, adherence to the prescribed training program, and weekly session completion. Secondary outcomes will characterize preliminary within-participant changes in balance, functional mobility, and balance confidence from baseline to immediately following the intervention. Assessments will include the Mini Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go (TUG), Activities-specific Balance Confidence (ABC) Scale, BTrack force plate assessments, and instrumented movement assessments using inertial measurement units (IMUs).

Findings from this feasibility study will inform the implementation and design of future studies evaluating individualized AR-based balance and mobility training in older adults.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
30

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Contact Backup

Study Locations

  • Canada
    • Ontario
      • Hamilton, Ontario, Canada, L8S 4L8
        • Ivor Wynne Center
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Aged 55 - 80 years
  • Able to ambulate independently with or without an assistive device
  • Able to understand and follow instructions unimpeded by significant cognitive barriers (MoCA score must be 24/30 or higher)
  • Self-reported balance concerns or perceived risk of falls (e.g., reduced balance confidence)
  • Must be able to provide a list of current medications to the experimenters and the changes in medications during the study
  • Vision that normal or near normal with/without the use of glasses/lenses
  • Able to understand and follow study instructions in English

Exclusion Criteria:

  • Engaging in any additional balance or mobility training programs while participating in the study
  • Diagnosed neurological conditions that substantially impair balance or mobility (e.g., stroke, Parkinson's disease, Traumatic Brain Injury)
  • Medical conditions that contraindicate moderate physical activity
  • Vision impairment that cannot be corrected by glasses or lenses

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Participants receive the 8-week AI-enhanced AR balance and mobility training, 3-5 sessions per week.
Participants will complete an 8-week AI-enhanced augmented reality balance and mobility training program, with 3-5 sessions per week lasting approximately 30 minutes each. Training includes standing- and walking-based tasks such as obstacle negotiation, path following, step targeting, turning, and directional changes. Task difficulty is adaptively adjusted based on participant performance using a machine learning model designed to maintain an approximately 80% task success rate.
Device: AI-Enhanced Augmented Reality Balance and Mobility Training
Participants will complete an 8-week AI-enhanced augmented reality (AR) balance and mobility training program, consisting of 3-5 sessions per week of approximately 30 minutes each. Using AR smart glasses connected to a dedicated smartphone, participants will perform standing- and walking-based tasks, including obstacle negotiation, path following, step targeting, turning, and directional changes. A machine learning model adapts task difficulty based on individual performance using a challenge-point framework targeting approximately 80% task success. Difficulty is iteratively increased or decreased based on performance, including adjustments to target speed and target size. Training may be completed at McMaster University or, following an initial supervised session and home safety assessment, at the participant's home.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Participant Retention Rate
Time Frame: From baseline (T1) through post-intervention assessment (T2), approximately 8 weeks
Retention will be calculated as the percentage of enrolled participants who complete the post-intervention assessment (T2): number completing T2 divided by the number enrolled at baseline (T1), multiplied by 100.
From baseline (T1) through post-intervention assessment (T2), approximately 8 weeks
Adherence to the Augmented Reality Training Program
Time Frame: Throughout the 8-week intervention
Adherence will be calculated for each participant as the percentage of prescribed AR training sessions completed during the 8-week intervention. Participants are prescribed 3-5 sessions per week, with each session lasting approximately 30 minutes.
Throughout the 8-week intervention
Weekly Augmented Reality Training Session Completion
Time Frame: Weekly throughout the 8-week intervention
Weekly training participation will be assessed based on the number of AR training sessions completed each week. Completion of 3-5 sessions per week will be used to characterize adherence to the intended training frequency.
Weekly throughout the 8-week intervention

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Change in Timed Up and Go (TUG) Performance
Time Frame: Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
Functional mobility will be assessed using the Timed Up and Go test. Participants stand from a seated position, walk 3 metres, turn, return, and sit down. Performance is measured in seconds, with shorter completion times indicating better functional mobility.
Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
Change in BTrackS Limits of Stability
Time Frame: Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
Limits of Stability will assess the participant's ability to voluntarily control center of pressure within the base of support. Participants move a cursor representing center of pressure across a computer display while standing on the BTrackS force plate. Performance is quantified by the area covered in square centimetres (cm²).
Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
Change in BTrackS Fall Risk Assessment
Time Frame: Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
Postural stability during quiet standing will be assessed using the BTrackS Fall Risk Assessment. Center-of-pressure path length is measured while participants stand with eyes closed and hands on their hips. The outcome is expressed as total center-of-pressure path length in centimetres.
Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
Change in BTrackS Weight Distribution
Time Frame: Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
The BTrackS Weight Distribution Test will assess left-right and front-back weight-bearing symmetry and center-of-pressure alignment while participants stand with their feet shoulder-width apart.
Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
Change in Mini Balance Evaluation Systems Test (Mini-BESTest) Score
Time Frame: Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
The Mini-BESTest assesses dynamic balance across anticipatory postural control, reactive postural responses, sensory orientation, and gait stability. Total scores range from 0 to 28, with higher scores indicating better balance performance.
Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
Change in Activities-specific Balance Confidence (ABC) Scale Score
Time Frame: Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
The Activities-specific Balance Confidence (ABC) Scale will assess perceived confidence in maintaining balance during everyday activities. Scores are expressed as a percentage, with higher scores indicating greater balance confidence.
Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
Change in Inertial Measurement Unit (IMU)-derived Gait and Turning Measures
Time Frame: Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks
Wearable inertial measurement units (IMUs) equipped with accelerometers and gyroscopes will be used during standardized walking and turning tasks to quantify spatiotemporal gait and turning characteristics, including gait timing, variability, and movement stability.
Baseline (T1) and immediately post-intervention (T2), approximately 8 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
McMaster University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
November 30, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
April 30, 2028

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
August 31, 2028

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
August 19, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 19, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
August 24, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 25, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 21, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
August 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 20142

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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