## 4 Discussion  
Here, we aimed to investigate the effects of a VR-based training program on balance ability and balance confidence in healthy older adults pre- and post-training. The results of our study demonstrate that the VR training had an impact on balance performance in older adults; however, balance confidence and cognitive ability were not affected significantly. The control group also showed improvements in balance performance and cognitive ability,  
Figure 9: Mini-Mental State Examination (MMSE) results for VR group (circle) and control group (square), pre-training (open icons) and post-training (filled icons); pooled data with standard error bars shown. but not in balance confidence. For both groups, geriatric depression and falls efficacy did not change post-training. The improvement observed in the BESS scores suggests that the VR training intervention was effective in helping participants enhance their balance skills during the training. A similar improvement is evident when previous studies in the literature are considered [2]. However, traditional training without a headset was also effective in improving balance. The BESS results revealed intriguing insights into the effectiveness of different training interventions in improving balance among participants. The decrease in BESS scores signifies an increase in balance stability. In terms of balance training, these findings not only have implications for individuals seeking to improve their balance but also for clinicians and researchers involved in designing and implementing balance training interventions. The results from the T/foam, S/foam, and S/firm stances in our study indicate that the VR group exhibited better balance performance compared to the control group prior to the training. However, following the six-week training period, the control group showed more pronounced enhancements compared to the VR group. This is evident given the significant values produced for T/foam, SL/firm, and SL/foam after testing, as seen in the results above for the control group. In contrast, while the VR group also demonstrated changes in their balance performance post-training, the improvements were notable. Despite the control group's improvement, the results still underscore the potential of VR training as a valuable tool for improving balance performance in older adults. The controls had slightly poorer performance on average prior to the training compared to the VR group; this could be why bigger changes were observed post-training. With the reduction in average errors in the S/foam stance, there is evidence of the potential of VR training in aiding older adults with their balance abilities. The immersive and engaging nature of VR environments, coupled with multisensory stimulation, likely contributed to the improvement observed in the VR group. Furthermore, VR training may offer additional benefits beyond traditional exercise methods, such as enhanced motivation and enjoyment, which could promote adherence to exercise regimens among older adults. In light of previous research, the findings of our study align with the growing body of evidence supporting the efficacy of VR-based interventions in improving balance and reducing fall risk in older adults (e.g., [15]). Similarly, the significant reduction in errors observed in both the VR and control groups in the current study suggests the potential of exercise interventions, regardless of modality, in enhancing balance performance among older adults. The significant testing results for post- vs. pre-training assessments further support the effectiveness of both VR and traditional exercise methods in improving balance performance. Given the immersive and engaging nature of VR training, our expectations leaned towards the VR group showing significant improvements (decreases) in the TUG; however, based on the data, that was not observed. There were no significant changes observed in the TUG results for both groups. It may be inferred that gait speed was also not improved by the training.