Action simulation as an intervention to improve balance, mobility and gait in healthy older adults: A scoping review

Falls in older adults are a significant public health concern. Action simulation interventions involving action observation and/or motor imagery have been proposed as alternative or adjunct strategies to physical exercise for reducing fall risk. These approaches may minimize barriers to physical practice and may specifically target deficits in motor planning that are linked to falls. The purpose of this scoping review is to examine how action simulation interventions have been applied and evaluated in healthy older adults. A systematic search of six databases and repositories was conducted. Studies were included if they used action simulation interventions in healthy, community-dwelling adults aged 60+ years and examined movement outcomes related to balance, gait or functional mobility. Nineteen studies with 587 older adults were included. Motor imagery was the most common action simulation intervention (n = 11 [58%]), and most studies were randomized controlled trials (n = 14 [74%]). Only one study examined long-term effects on balance and gait performance (i.e., 1-month post-intervention). Studies varied widely in the outcomes examined, including static and dynamic balance, gait, mobility, and psychological outcomes, and reported findings were heterogeneous across studies and outcome domains. Limited reporting of intervention implementability was identified across the included studies. Overall, this review highlights the heterogeneity of how action simulation interventions have been applied and evaluated to improve balance, mobility and gait outcomes in older adults. However, if action simulation techniques are to be adopted as a fall prevention strategy, more studies examining acceptability are needed.