###### Abstract  
Each year, over 25% of adults aged sixty-five years old or older suffer a fall, and three million are treated for fall-related injuries due to lack of balance. Here, we aimed to investigate how virtual reality (VR)-based training affects balance performance and confidence in older adults. To accomplish this goal, we studied 21 healthy, older individuals between 60 and 85 years old, both pre- and post-training (6 weeks of training, twice per week (or 12 sessions)). The VR group donned an Oculus VR headset and consisted of nine participants (aged 75.9 \(\pm\) 3.7 years old), while the control group (aged 75.1 \(\pm\) 6.7 years old) performed training without a headset and consisted of eight participants that completed our study. To assess balance ability, we utilized the Balance Error Scoring System (BESS) and the Timed Up and Go (TUG) test. To assess balance confidence, we implemented the Activities-Specific Balance Confidence (ABC) Scale and, to assess fear of falling, the Tinetti Falls Efficacy Scale (FES). Further, we assessed depression (via the Geriatric Depression Scale (GDS)) and cognitive ability (via the Mini-Mental State Examination (MMSE)). The post-training results showed improvements in balance ability for both the VR and control groups, as well as changes in the relationship between balance confidence and balance ability for the VR group only. Further, improvements in cognitive ability were seen in the control group. This study is an indication that older individuals' balance ability may benefit from several weeks of targeted training. aging; elderly; virtual reality; balance training; balance confidence; falls +
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walking, climbing stairs, or reaching for objects. It encompasses a sense of assurance and self-efficacy in one's balance abilities. To investigate the effects of VR training on balance ability and FoF among older adults, numerous studies have explored its potential benefits [3,4]. However, existing research often falls short of addressing certain gaps within this domain. While some studies have demonstrated the efficacy of VR in enhancing balance among older adults, many have failed to comprehensively assess factors such as stability, balance confidence, cognitive abilities, and postural control using objective measures such as the Balance Error Scoring System (BESS) [5], the Activities-Specific Balance Confidence (ABC) Scale [6], and the Mini-Mental State Examination (MMSE) [7], among other significant assessments. Previous VR balance studies have not investigated balance confidence or depression, though some have explored cognitive ability [4,8]. These studies have consistently demonstrated significant enhancements in postural control, balance, gait, and functional mobility among older adults following VR-based interventions. However, none of these studies have investigated the impact of VR interventions on variables such as balance confidence in older adults. The use of VR training to help older adults with their balance issues has generated our research question on how VR training affects balance ability, balance confidence, and the relationship between the two. Our investigation aims to fill gaps in previous studies by examining the effects of several weeks of VR-based training on both balance confidence and ability in older adults. Specifically, we hypothesize that balance confidence will increase and FoF will decrease post-training. Additionally, we expect improvements in balance ability, measured through validated assessments. Further, the relationship between balance ability and confidence will change for those who receive VR-based training. This research provides valuable insights for healthcare practitioners, researchers, and policy-makers seeking evidence-based strategies to mitigate falls and enhance the well-being of older adults.