Effects of Combined Cervical and Oculomotor Exercises on Dynamic Balance in Elderly

This study focuses on improving balance in elderly individuals (aged 60-80 years) who may experience dizziness or instability while walking or performing daily activities. Poor balance increases the risk of falls, which can lead to serious injuries and loss of independence.

The study compares two types of exercise programs:

One group performs combined cervical (neck) exercises + eye (oculomotor) exercises + Otago balance exercises The other group performs eye (oculomotor) exercises + Otago balance exercises only These exercises are done 3 times per week for 6 weeks, with each session lasting 30-45 minutes.

The goal is to determine whether combining neck and eye exercises improves balance more effectively than eye exercises alone.

This research may help:

Reduce fall risk in elderly people Improve mobility and independence Provide better rehabilitation programs for physiotherapists

Study Overview

• Status: Completed
• Conditions: Risk of Fall; Dynamic Balance
• Intervention / Treatment: Procedure: occulomotor with otago exercises; Procedure: Combined Cervical and Oculomotor Exercises with Otago Exercises

Detailed Description

Falls are a major health concern among older adults, frequently leading to serious injuries , and diminished participation in daily activities, which negatively affect overall quality of life. Therefore, designing effective, accessible, and evidence-based strategies to improve balance and prevent falls is essential for promoting healthy aging.because it introduces a novel approach that combines cervical proprioceptive exercises and oculomotor exercises alongside the Otago exercise program. While previous research has demonstrated that both cervical and oculomotor exercises independently enhance balance and reduce fall risk, their combined effects, particularly when integrated into a structured balance program like Otago, remain largely unexplored. By addressing this gap, the present study offers an innovative strategy that targets multiple systems involved in maintaining postural control., the combined intervention is designed to be practical, cost-effective, and easily implemented in various settings, including clinics, community centers, and at home., the study has the potential to guide physiotherapists and rehabilitation professionals toward adopting more holistic balance training protocols. Ultimately, the findings may contribute to reducing fall rates, promoting independence, and enhancing the overall quality of life in the elderly population.

• Study Type: Interventional
• Enrollment (Actual): 48
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Islamabad, Pakistan, 44000
    • Foundation University College of Physical Therapy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Male and female participants aged 60-80 years.
• DHI-mild score(0-30)
• Ability to follow instructions and participate in exercises.
• BBS moderate (21-40)
• Normal to corrected vision
• Negative Dix Hallpike

Exclusion Criteria:

• Diagnosed vestibular disorders
• Neurological or musculoskeletal conditions affecting balance.
• Patients with VBI

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: occulomotor exercises with otago exercises group B; Frequency: 3 sessions/week | Duration: 30-45 min * Week 1-2: Eye exercises 10-12 reps, VOR x1 (30-40 sec), basic balance training, walking 5-12 min * Week 3-4: Eye exercises 12-15 reps, VOR x1→x2 (1 min), moderate balance training, walking 12-15 min * Week 5-6: Eye exercises 15-20 reps, VOR x1+x2 (1-2 min), advanced balance training, walking 15-20 min	Procedure: occulomotor with otago exercises; Smooth pursuit exercises, where the eyes follow a moving target horizontally, vertically, and diagonally while keeping the head still. Saccadic eye movements, involving quick shifts of gaze between two stationary targets. Gaze stability (VOR x1 and VOR x2) exercises, involving head movements while maintaining focus on a target, and moving the head and target in opposite directions. All participants will perform the Otago exercise program, a well-established, evidence-based fall prevention program focusing on lower limb strengthening and dynamic balance. It includes: Strengthening exercises (e.g., knee extensions, hip abduction, calf raises).; Static and dynamic balance exercises (e.g., tandem stance, backward walking, sit-to-stand without using hands).; A progressive walking plan to improve endurance and confidence during ambulation.
Experimental: Group A (Cervical + Oculomotor + Otago); Frequency: 3 sessions/week | Duration: 30-45 min; Week 1-2: Cervical ROM 10-12 reps, chin tuck 5-7 sec ×10, isometrics 5-6 sec ×5-6, eye exercises 10-12 reps, VOR x1 (30-40 sec), walking 5-12 min * Week 3-4: Cervical ROM 12-15 reps, chin tuck 8-10 sec ×12, isometrics 7-8 sec ×8-10, eye exercises 12-15 reps, VOR x1→x2 (1 min), walking 12-15 min * Week 5-6: Cervical ROM 15-20 reps, chin tuck 10-12 sec ×15, isometrics 10 sec ×10-12, eye exercises 15-20 reps, VOR x1+x2 (1-2 min), walking 15-20 min	Procedure: Combined Cervical and Oculomotor Exercises with Otago Exercises; Cervical range of motion exercises in flexion, extension, rotation, and side bending (gentle, controlled movements). Chin tuck exercises in supine or sitting positions to activate deep cervical flexors. Isometric neck strengthening exercises (flexion, extension, lateral flexion), focusing on controlled, static holds. Occulomotor Exercises: Smooth pursuit exercises, where the eyes follow a moving target horizontally, vertically, and diagonally while keeping the head still. Saccadic eye movements, involving quick shifts of gaze between two stationary targets. Gaze stability (VOR x1 and VOR x2) exercises, involving head movements while maintaining focus on a target, and moving the head in opposite direction Otago exercises Strengthening exercises (e.g., knee extensions, hip abduction, calf raises). Static and dynamic balance exercises (e.g., tandem stance, backward walking, sit-to-stand without using hands). A progressive walking plan to improve endurance and confidence during ambulation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dynamic Balance	Berg Balance Scale (BBS) was used Cut-off Values Greater than 45 → Increased risk of falls 21-40 → Moderate balance impairment Outcome Interpretation Higher score = Better balance	6 weeks
Functional Mobility	The Timed Up and Go Test (TUG) was used Cut-off Values: less than 10 seconds → Normal mobility 10-19 seconds → Good mobility 20-29 seconds → Mild impairment; 30 seconds → Severe impairment > 13.5 seconds → Increased risk of falls (important clinical cutoff) Interpretation: Lower time indicates better performance	6 weeks
Dynamic Balance	Four Square Step Test was used to evaluate dynamic balance Cut-off Values: < 15 seconds → Normal performance > 15 seconds → Increased risk of falls Interpretation: Lower time indicates better balance	6 weeks
Dizziness related disability	4. Dizziness Handicap was used Cut-off Values: 0-30 → Mild handicap (used in inclusion criteria) 31-60 → Moderate handicap 61-100 → Severe handicap Interpretation: Higher score indicates greater dizziness-related disability	6 weeks

Collaborators and Investigators

• Sponsor: Foundation University Islamabad

Study record dates

Study Major Dates

• Study Start (Actual): November 18, 2025
• Primary Completion (Actual): May 10, 2026
• Study Completion (Actual): May 10, 2026

Study Registration Dates

• First Submitted: May 18, 2026
• First Submitted That Met QC Criteria: May 20, 2026
• First Posted (Actual): May 27, 2026

Study Record Updates

• Last Update Posted (Actual): May 27, 2026
• Last Update Submitted That Met QC Criteria: May 20, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Rehabilitation; Elderly; Dizziness; Otago Exercise Program; Fall Prevention; Postural Control; Dynamic Balance; Cervical Exercises; Oculomotor Exercises
• Additional Relevant MeSH Terms: Neurologic Manifestations; Sensation Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Dizziness
• Other Study ID Numbers: FUI/FUCP/CTR/Neuro/AmnaMalik

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No