Elderly PopulationNCT07150364
Comparison of Square Stepping Exercise and Wobble Board Exercise in Elderly Population
A study testing Square Stepping Exercise and Wobble Board Exercise in people with Elderly Population, run by Riphah International University at 1 site in Pakistan.
Trial summary
Cognitive decline and balance issues are key contributors to falls. Square Stepping Exercise (SSE) and Wobble Board Exercise (WBE) both are the promising forms of balance training. Read more about this study
- Who is it for?
- Ages 60 years and olderHealthy volunteers can take part
- Conditions the study is for
- Elderly Population
- What is being tested?
- Square Stepping Exercise and Wobble Board Exercise
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 38 participants
- Where
- 1 sitePakistan
- Study dates
- 17 Nov 2024to 30 Jan 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 60 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Elderly individuals age 60 years and above of both genders according to the guidelines of World Health Organization (WHO).
- Participants whose Mini Mental State Examination (MMSE) score will be >24/30 ensuring sufficient cognitive ability to follow instructions and participate in exercise.
- Participants whose Berg Balance Scale scores of more than 41/56 ensuring that the participants have moderate level of balance ability.
- Vital signs within normal range for elderly population.
- Ability to walk independently with or without an assistive device (e.g., canes).
Who cannot join
- Participants who have severe musculoskeletal or neurological disorders affecting gait or balance (e.g., Parkinson's disease, and stroke) because of the complex impacts of these conditions on general cognitive and physical functions.
- Participants who undergoes recent fractures or injuries affecting participation in physical activity.
- Participants who have uncontrolled cardiovascular or metabolic conditions (e.g., uncontrolled hypertension, and diabetes mellitus) that could significantly interfere with exercise.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Khursheed Old Home
Lahore, Punjab Province, 54800
Fatima Tariq, 03344255033, Fatima.tariq@riphah.edu.pk
Hafsa Ahsan, MS-NMPT
About this study
Official title: Comparison of Square Stepping Exercise and Wobble Board Exercise on Cognition, Balance and Fall Risk in Elderly Population
Cognitive decline and balance issues are key contributors to falls. Square Stepping Exercise (SSE) and Wobble Board Exercise (WBE) both are the promising forms of balance training. Therefore, the aim of this study is to compare these two exercises to determine their effects on cognition, balance, and fall risk in elderly population.
Read the detailed description
The study in 2016 described the effects of square stepping exercises versus traditional balance exercises on improving balance and reducing fear of falling in the elderly. The Mini Mental State Examination (MMSE), Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Fall Efficacy Scale (FES) were used for assessments. Both groups showed significant improvements in BBS and TUG scores (p<0.0001), but the square stepping exercise group demonstrated more significant gains. The study concluded that square stepping exercises were more effective in enhancing balance and reducing fear of falling compared to traditional balance exercises.This study addresses a notable gap in existing literature by comparing the effects of Square Stepping Exercise and Wobble Board Exercise in improving cognition, balance, and fall risk among the elderly. While both exercises have been recognized individually for their benefits, but their comparative effectiveness remains understudied. By focusing on this comparison, this study aim is to fill this gap and offer valuable insights into the most effective intervention for enhancing functional independence and promoting healthy aging.
- Conditions
- Elderly Population
- Being tested
- Square Stepping Exercise, Wobble Board Exercise
- Keywords
- Balance, Cognition, Fall risk, Square-stepping exercise, Wobble board
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Square Stepping ExerciseOther
5 days per week for 6 weeks. 30 minutes per session with appropriate rest interval in between.
Wobble Board ExerciseOther
5 days per week for 6 weeks. 30 minutes per session with appropriate rest interval in between.
| Study group | Role | What they receive |
|---|---|---|
| Square Stepping Exercise | Experimental | In SSE, step patterns are performed on a mat Receives: Other: Square Stepping Exercise |
| Wobble Board Exercise | Experimental | Person is standing on a wobble board, that unexpectedly translates or tilts Receives: Other: Wobble Board Exercise |
What is being measured
The primary outcome is the main question the study is designed to answer.
Fall Efficacy Scale- international (FES- I)
The FES-I is designed to assess concern about falling while performing basic and instrumental indoor and outdoor activities. This scale consists of 16 items (10 items from the original FES and six additional social activities items). Each item is scored with a four- point scale (1 = not concerned at all, 4 = very concerned). The summation of scores gives a total score from 16 (absence of FOF) to 64 (extreme concern of falling). This scale was used as a criterion scale in the present study with a cutoff point of 23.
Measured: 6th week
Mini Mental State Examination (MMSE)
The Mini-Mental State Examination (MMSE) is a widely used tool for screening cognitive function and assessing the severity of cognitive impairment. It assesses areas such as orientation, registration, attention and calculation, recall, language, and visual construction. The MMSE consists of 30 questions with a maximum score of 30 points in which score between 24-30 is consider normal, score 18-23 is consider mild cognitive impairment and score between 0-17 is consider severe cognitive impairment.
Measured: 6th week
Berg Balance Scale (BBS)
The BBS evaluates a participant's balance based on 14 items scored and takes 15-20 min to complete. The score for each item ranges from 0 to 4 points, with an overall maximum score of 56 points. Balance is evaluated by asking participants to perform a variety of sitting, transferring and standing positions. In an assessment of which cut- off scores on the BBS best predict the risk of falling. The score of 41-56 indicates low risk of fall, 21-40 indicates medium risk of fall, and 0-20 indicates the high risk of fall.
Measured: 6th week
Secondary outcomes (1)
Time up and Go test (TUG)
The TUG is a performance-based measure of functional mobility initially developed to identify mobility and balance impairments in older adults. The TUG test takes only a few minutes to complete. In this test, participants are asked to stand up from a chair, walk 3 m, turn, walk 3 m back and sit down again. The time taken to perform this task indicates high or low falls risk. The cut- off scores reported in the articles varied from 10.9 seconds to 13 seconds.
Measured: 6th week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Sep 2025
- Study start17 Nov 2024
- Primary completion30 Nov 2025 (estimated)
- Study completion30 Jan 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (14)Papers the sponsor has linked to this study.
- Other trials for Elderly PopulationStudies of the same condition, open and under way.
- More trials run by Riphah International UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 38 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Fatima Tariq, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07150364
- Sponsor's protocol ID
- REC/RCR&AHS/24/02101
- Status last verified
- Aug 2025
- First submitted
- 24 Aug 2025
- Last updated
- 2 Sep 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Delbaere K, Valenzuela T, Lord SR, Clemson L, Zijlstra GAR, Close JCT, Lung T, Woodbury A, Chow J, McInerney G, Miles L, Toson B, Briggs N, van Schooten KS. E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial. BMJ. 2021 Apr 6;373:n740. doi: 10.1136/bmj.n740.
PubMed 33824131Forbes PA, Chen A, Blouin JS. Sensorimotor control of standing balance. Handb Clin Neurol. 2018;159:61-83. doi: 10.1016/B978-0-444-63916-5.00004-5.
PubMed 30482333Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018 Apr 24;319(16):1705-1716. doi: 10.1001/jama.2017.21962.
PubMed 29710140Henry M, Baudry S. Age-related changes in leg proprioception: implications for postural control. J Neurophysiol. 2019 Aug 1;122(2):525-538. doi: 10.1152/jn.00067.2019. Epub 2019 Jun 5.
PubMed 31166819Franzel K, Koschate J, Freiberger E, Shigematsu R, Zieschang T, Tietgen S. Square-stepping exercise in older inpatients in early geriatric rehabilitation. A randomized controlled pilot study. BMC Geriatr. 2024 Apr 10;24(1):326. doi: 10.1186/s12877-024-04932-3.
PubMed 38600478Thomas E, Battaglia G, Patti A, Brusa J, Leonardi V, Palma A, Bellafiore M. Physical activity programs for balance and fall prevention in elderly: A systematic review. Medicine (Baltimore). 2019 Jul;98(27):e16218. doi: 10.1097/MD.0000000000016218.
PubMed 31277132Kawabata M, Gan SR, Shen-Hsing AC. Effects of Square Stepping Exercise on cognitive, physical, psychological, and group functioning in sedentary older adults: A center-based hybrid trial. BMC Geriatr. 2024 Apr 25;24(1):374. doi: 10.1186/s12877-024-04904-7.
PubMed 38664613Taghavi Asl A, Shojaedin SS, Hadadnezhad M. Comparison of effect of wobble board training with and without cognitive intervention on balance, ankle proprioception and jump landing kinetic parameters of men with chronic ankle instability: a randomized control trial. BMC Musculoskelet Disord. 2022 Sep 30;23(1):888. doi: 10.1186/s12891-022-05706-x.
PubMed 36180870Rudnicka E, Napierala P, Podfigurna A, Meczekalski B, Smolarczyk R, Grymowicz M. The World Health Organization (WHO) approach to healthy ageing. Maturitas. 2020 Sep;139:6-11. doi: 10.1016/j.maturitas.2020.05.018. Epub 2020 May 26.
PubMed 32747042Meimandi M, Fadavi-Ghaffari M, Taghizadeh G, Azad A, Lajevardi L. Falls Efficacy Scale and Single Item Question: Screening Accuracy for Older Adults Residing in Nursing Homes. Clin Gerontol. 2021 Oct-Dec;44(5):544-551. doi: 10.1080/07317115.2020.1858467. Epub 2020 Dec 15.
PubMed 33320074Dewan N, MacDermid JC. Fall Efficacy Scale-International (FES-I). J Physiother. 2014 Mar;60(1):60. doi: 10.1016/j.jphys.2013.12.014. Epub 2014 May 3. No abstract available.
PubMed 24856947Patnode CD, Perdue LA, Rossom RC, Rushkin MC, Redmond N, Thomas RG, Lin JS. Screening for Cognitive Impairment in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020 Feb 25;323(8):764-785. doi: 10.1001/jama.2019.22258.
PubMed 32096857Meekes WM, Korevaar JC, Leemrijse CJ, van de Goor IA. Practical and validated tool to assess falls risk in the primary care setting: a systematic review. BMJ Open. 2021 Sep 29;11(9):e045431. doi: 10.1136/bmjopen-2020-045431.
PubMed 34588228Zahedian-Nasab N, Jaberi A, Shirazi F, Kavousipor S. Effect of virtual reality exercises on balance and fall in elderly people with fall risk: a randomized controlled trial. BMC Geriatr. 2021 Sep 25;21(1):509. doi: 10.1186/s12877-021-02462-w.
PubMed 34563120
Study at a glance
From the registry record, last updated by the sponsor on 2 Sep 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison of Square Stepping Exercise and Wobble Board Exercise on Cognition, Balance and Fall Risk in Elderly Population
- ClinicalTrials.gov ID
- NCT07150364
- Acronym / sponsor ID
- REC/RCR&AHS/24/02101
- Conditions
- Elderly Population
- Keywords
- Balance, Cognition, Fall risk, Square-stepping exercise, Wobble board
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 38 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 17 Nov 2024 (actual)
- Primary completion
- 30 Nov 2025 (estimated)
- Study completion
- 30 Jan 2026 (estimated)
- First posted
- 2 Sep 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Cognitive decline and balance issues are key contributors to falls. Square Stepping Exercise (SSE) and Wobble Board Exercise (WBE) both are the promising forms of balance training. Therefore, the aim of this study is to compare these two exercises to determine their effects on cognition, balance, and fall risk in elderly population.
Detailed description
The study in 2016 described the effects of square stepping exercises versus traditional balance exercises on improving balance and reducing fear of falling in the elderly. The Mini Mental State Examination (MMSE), Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Fall Efficacy Scale (FES) were used for assessments. Both groups showed significant improvements in BBS and TUG scores (p<0.0001), but the square stepping exercise group demonstrated more significant gains. The study concluded that square stepping exercises were more effective in enhancing balance and reducing fear of falling compared to traditional balance exercises.This study addresses a notable gap in existing literature by comparing the effects of Square Stepping Exercise and Wobble Board Exercise in improving cognition, balance, and fall risk among the elderly. While both exercises have been recognized individually for their benefits, but their comparative effectiveness remains understudied. By focusing on this comparison, this study aim is to fill this gap and offer valuable insights into the most effective intervention for enhancing functional independence and promoting healthy aging.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Square Stepping Exercise | Experimental | Other: Square Stepping ExerciseIn SSE, step patterns are performed on a mat |
| Wobble Board Exercise | Experimental | Other: Wobble Board ExercisePerson is standing on a wobble board, that unexpectedly translates or tilts |
Who may qualify
- Ages
- 60 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Elderly individuals age 60 years and above of both genders according to the guidelines of World Health Organization (WHO).
- Participants whose Mini Mental State Examination (MMSE) score will be >24/30 ensuring sufficient cognitive ability to follow instructions and participate in exercise.
- Participants whose Berg Balance Scale scores of more than 41/56 ensuring that the participants have moderate level of balance ability.
- Vital signs within normal range for elderly population.
- Ability to walk independently with or without an assistive device (e.g., canes).
Key exclusion criteria (3 listed)
- Participants who have severe musculoskeletal or neurological disorders affecting gait or balance (e.g., Parkinson's disease, and stroke) because of the complex impacts of these conditions on general cognitive and physical functions.
- Participants who undergoes recent fractures or injuries affecting participation in physical activity.
- Participants who have uncontrolled cardiovascular or metabolic conditions (e.g., uncontrolled hypertension, and diabetes mellitus) that could significantly interfere with exercise.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Square Stepping Exercise5 days per week for 6 weeks. 30 minutes per session with appropriate rest interval in between. | Other | Square Stepping Exercise |
| Wobble Board Exercise5 days per week for 6 weeks. 30 minutes per session with appropriate rest interval in between. | Other | Wobble Board Exercise |
Primary outcome
Fall Efficacy Scale- international (FES- I)
Time frame: 6th week
The FES-I is designed to assess concern about falling while performing basic and instrumental indoor and outdoor activities. This scale consists of 16 items (10 items from the original FES and six additional social activities items). Each item is scored with a four- point scale (1 = not concerned at all, 4 = very concerned). The summation of scores gives a total score from 16 (absence of FOF) to 64 (extreme concern of falling). This scale was used as a criterion scale in the present study with a cutoff point of 23.
Mini Mental State Examination (MMSE)
Time frame: 6th week
The Mini-Mental State Examination (MMSE) is a widely used tool for screening cognitive function and assessing the severity of cognitive impairment. It assesses areas such as orientation, registration, attention and calculation, recall, language, and visual construction. The MMSE consists of 30 questions with a maximum score of 30 points in which score between 24-30 is consider normal, score 18-23 is consider mild cognitive impairment and score between 0-17 is consider severe cognitive impairment.
Berg Balance Scale (BBS)
Time frame: 6th week
The BBS evaluates a participant's balance based on 14 items scored and takes 15-20 min to complete. The score for each item ranges from 0 to 4 points, with an overall maximum score of 56 points. Balance is evaluated by asking participants to perform a variety of sitting, transferring and standing positions. In an assessment of which cut- off scores on the BBS best predict the risk of falling. The score of 41-56 indicates low risk of fall, 21-40 indicates medium risk of fall, and 0-20 indicates the high risk of fall.
1 secondary outcome
Time up and Go test (TUG)
Time frame: 6th week
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Sep 2025.
- Background: PubMed 33824131Delbaere K, Valenzuela T, Lord SR, Clemson L, Zijlstra GAR, Close JCT, Lung T, Woodbury A, Chow J, McInerney G, Miles L, Toson B, Briggs N, van Schooten KS. E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial. BMJ. 2021 Apr 6;373:n740. doi: 10.1136/bmj.n740.
- Background: PubMed 30482333Forbes PA, Chen A, Blouin JS. Sensorimotor control of standing balance. Handb Clin Neurol. 2018;159:61-83. doi: 10.1016/B978-0-444-63916-5.00004-5.
- Background: PubMed 29710140Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018 Apr 24;319(16):1705-1716. doi: 10.1001/jama.2017.21962.
- Background: PubMed 31166819Henry M, Baudry S. Age-related changes in leg proprioception: implications for postural control. J Neurophysiol. 2019 Aug 1;122(2):525-538. doi: 10.1152/jn.00067.2019. Epub 2019 Jun 5.
- Background: PubMed 38600478Franzel K, Koschate J, Freiberger E, Shigematsu R, Zieschang T, Tietgen S. Square-stepping exercise in older inpatients in early geriatric rehabilitation. A randomized controlled pilot study. BMC Geriatr. 2024 Apr 10;24(1):326. doi: 10.1186/s12877-024-04932-3.
- Background: PubMed 31277132Thomas E, Battaglia G, Patti A, Brusa J, Leonardi V, Palma A, Bellafiore M. Physical activity programs for balance and fall prevention in elderly: A systematic review. Medicine (Baltimore). 2019 Jul;98(27):e16218. doi: 10.1097/MD.0000000000016218.
- Background: PubMed 38664613Kawabata M, Gan SR, Shen-Hsing AC. Effects of Square Stepping Exercise on cognitive, physical, psychological, and group functioning in sedentary older adults: A center-based hybrid trial. BMC Geriatr. 2024 Apr 25;24(1):374. doi: 10.1186/s12877-024-04904-7.
- Background: PubMed 36180870Taghavi Asl A, Shojaedin SS, Hadadnezhad M. Comparison of effect of wobble board training with and without cognitive intervention on balance, ankle proprioception and jump landing kinetic parameters of men with chronic ankle instability: a randomized control trial. BMC Musculoskelet Disord. 2022 Sep 30;23(1):888. doi: 10.1186/s12891-022-05706-x.
- Background: PubMed 32747042Rudnicka E, Napierala P, Podfigurna A, Meczekalski B, Smolarczyk R, Grymowicz M. The World Health Organization (WHO) approach to healthy ageing. Maturitas. 2020 Sep;139:6-11. doi: 10.1016/j.maturitas.2020.05.018. Epub 2020 May 26.
- Background: PubMed 33320074Meimandi M, Fadavi-Ghaffari M, Taghizadeh G, Azad A, Lajevardi L. Falls Efficacy Scale and Single Item Question: Screening Accuracy for Older Adults Residing in Nursing Homes. Clin Gerontol. 2021 Oct-Dec;44(5):544-551. doi: 10.1080/07317115.2020.1858467. Epub 2020 Dec 15.
- Background: PubMed 24856947Dewan N, MacDermid JC. Fall Efficacy Scale-International (FES-I). J Physiother. 2014 Mar;60(1):60. doi: 10.1016/j.jphys.2013.12.014. Epub 2014 May 3. No abstract available.
- Background: PubMed 32096857Patnode CD, Perdue LA, Rossom RC, Rushkin MC, Redmond N, Thomas RG, Lin JS. Screening for Cognitive Impairment in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2020 Feb 25;323(8):764-785. doi: 10.1001/jama.2019.22258.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Fatima Tariq principal investigator
Riphah International University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Square Stepping Exercise and Wobble Board Exercise in people with Elderly Population, run by Riphah International University at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 2 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Imran Amjad, Phd (03324390125, imran.amjad@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Fall Efficacy Scale- international (FES- I) (time frame: 6th week). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07150364, which also lists 14 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Sep 2025.