## Abstract  
Guidance through an exercise program improves balance and gait in older adults, but the efficacy of the timing these are given is unclear. The objective of this study is to evaluate the effects of guidance delivery time on balance, gait, falls, and cognitive functions. In a single (participants)-blinded clinical trial, a convenient sample of 24 older adults (\(aged\)\(74\pm 6\) years) were separated in two age-matched groups, both of which received a progressive 12-week Otago Exercise Program (OEP) for strength and balance. Group 1 received visual and verbal guidance before the performance of each of the exercises, while group 2 received the visual and verbal guidance only synchronously with the exercises. Balance, gait, fear of falling, and cognitive function were evaluated at baseline, week 6, and week 12 of the program. Fall incidence and exercise adherence were also documented. Significant improvements (\(p<0.05\)) were revealed in all assessed variables post intervention, regardless of the guidance delivery time. Only the mental function and the adherence to the exercise tended to be better when the guidance was given in advance of the exercise execution, but further studies of a bigger sample size and with a control group should be conducted before safe conclusions are extracted. Otago; guidance; balance; gait; falls; fear of falling; older adults +
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those older than 80 years [8; 9; 10; 11]. In the study of [PERSON] et al. (2016) where the OEP was undertaken in older adults, the frequency of falls, the fear of falling, and balance were all significantly improved [12]. Furthermore, [PERSON] et al. (2019) investigated the effects of the OEP combined with action observation training on balance and gait in older adults. Their findings showed significant improvement in balance, gait, and fear of falling measured by the Timed Up and Go (TUG) and Falls Efficacy Scale-International (FES-I), respectively [13]. As most of the studies agree that the OEP is an effective program for reducing falls and injuries in the elderly [2; 14], some researchers believe that improving cognition may be a very important mechanism by which the OEP reduces falls [15]. Moreover, many studies associate exercise with maintaining or even improving cognitive ability in the elderly [6; 16]. In general, the OEP is more effective for those who adhere to it. According to the program, a training frequency of three sessions per week is recommended, although lower levels of adherence may have favorable effects [14; 17]. The benefits of exercising are well known but the majority of older adults adhere to neither aerobic programs nor muscle strength programs. According to [PERSON] et al. (2018), older adults prefer working out with peers, reinforcing fun and general social benefits [18]. The OEP was originally designed as supervised home training. In recent years, it has also been performed as group training which gives a more interesting and socializing character with similar results [19]. Specifically, very recent systematic reviews and meta-analyses have confirmed that the group format for the OEP is more effective for improving static balance, dynamic balance, and perceived balance--measured by reporting fear of falling and older adult's confidence in maintaining balance--as well as physical functioning, than the individual format [20; 21; 22]. An additional element to which the OEP may owe its effectiveness is the leader's continuous verbal and visual guidance. The 'guidance' element during an exercise is very closely related to the informational role of feedback, which guides participants towards the correct performance of a movement pattern and enhances the learning process of the movement [23]. Indeed, this benefit of real time feedback is what the rehabilitation experts have been taken advantage of in order to build 2D, 3D, virtual reality, and augmented reality games for the rehabilitation of neurological patients [24] and for improving core stability and balance in elderly people [25].