Preliminary Effects of a Culturally Adapted Virtual Reality Exergame on Balance, Mobility, and Falls Self-Efficacy in Institutionalized Older Adults: A Pilot Quasi-Experimental Study

Aims To examine the feasibility and preliminary effects of a culturally adapted, low-cost virtual reality (VR) exergame based on the Indonesian hopscotch game engklek in institutionalized older adults.Methods In this two-site pilot quasi-experimental study in Indonesia, 16 older adults were allocated by facility to a semi-immersive smartphone-based VR exergame (n = 8; 12 week) or conventional group exercise (n = 8); balance, mobility, falls self-efficacy, and cognition were assessed.Results All participants completed the study without VR-related adverse events; one fall during control-group exercise was the only session-related adverse event. Between-group differences in balance (BBS +4.6; p = 0.003) and mobility (TUG −2.2 s; p = 0.012) survived Bonferroni correction; falls self-efficacy and cognition did not. Adherence was 90%.Conclusions This culturally adapted, low-cost VR exergame was feasible and safe, with preliminary balance and mobility gains; these exploratory findings require confirmation in an adequately powered randomized trial.