تاثیر تصویرسازی حرکتی و مشاهده عمل بر تعادل ایستا و پویای زنان سالمند

Introduction
Aging is a complex biological, psychological, and social process accompanied by gradual structural and functional changes in multiple body systems, becoming prominent around the sixth decade of life. One of the critical changes in older adults is the decline in static and dynamic balance, largely due to deteriorations in sensory–motor systems, including visual, vestibular, and proprioceptive functions. Balance impairments not only reduce quality of life but also increase the risk of falls and secondary consequences, such as fractures and disability, imposing significant social and economic burdens on families and healthcare systems. Studies indicate that a substantial proportion of adults over 65, experience at least one fall annually, with many exhibiting varying degrees of balance dysfunction. In Iran, the proportion of older adults is projected to exceed 20% by 2050, highlighting the need for interventions that improve balance performance.

Although traditional physical exercises are effective in rehabilitation, limitations such as pain, physical weakness, and restricted access can hinder regular and safe participation. In this context, cognitive–motor approaches, such as Motor Imagery (MI) and Action Observation (AO), have emerged as low-risk, accessible strategies to enhance balance in older adults. MI involves mentally simulating movements, while AO focuses on observing movements performed by others. From a neurocognitive perspective, both approaches activate motor cortical areas, mirror neuron networks, and movement planning circuits, enabling motor learning and re-education without imposing significant physical load. Previous research has shown that MI and AO can improve static balance and functional mobility in older adults; however, comparative evidence on their specific effects remains limited. Therefore, the present study aimed to investigate and compare the effects of MI, AO, and traditional physical exercise on static and dynamic balance in elderly women.

Methods
This quasi-experimental study employed a pretest–posttest design with three groups (MI, AO, and control) involving 30 healthy older women with Mini-Mental State Examination (MMSE) scores ≥24. Participants were randomly assigned to groups, matched for imagery ability (R-MIQ) and cognitive status. Interventions were conducted over 18 sessions across six weeks with each session lasting approximately 40 minutes (20 minutes of main exercise, 10 minutes of rest, 10 minutes of exercise review).

Participants were randomly assigned to one of three groups: motor imagery (imagining simple balance tasks including standing for 2 seconds at the starting point, walking a 3-meter path while stepping over three obstacles, and returning to the starting point), action observation (observing video demonstrations of the same exercises), and control (engaging in their usual daily activities). Static balance was assessed using the Romberg test, and dynamic balance was measured with the Timed Up and Go (TUG) test. Romberg testing involved barefoot standing with eyes closed, recording the duration of maintained balance, whereas TUG measured the time required to stand, walk, turn, and return to a chair. Data were analyzed using SPSS v.23. Normality and homogeneity of variance were assessed using the Shapiro–Wilk and Levene tests, respectively. Main analyses included mixed ANOVA and Bonferroni post-hoc comparisons.

Results
For static balance, significant main effects of group and test and a group and time interaction were observed (P<0.05). Pre-intervention, no significant differences existed between groups. Post-intervention, both MI (P=0.031) and AO (P=0.036) groups showed significantly better performance than the control group, with no significant difference between MI and AO (P=1.0). Only the MI group demonstrated a significant within-group improvement from pre- to post-test (P=0.001), whereas AO and control groups did not. These findings indicate that motor simulation techniques positively affect static balance, with motor imagery having a particularly notable impact on postural stability in older adults.

For dynamic balance, only the main effect of time was significant (P<0.01), suggesting that all participants improved from pre- to post-test regardless of group. There were no significant main effects of group or group and time interaction, indicating that MI and AO alone were insufficient to significantly enhance dynamic balance. These results align with previous studies showing that dynamic balance relies on the integration of multiple sensory–motor and cognitive systems, and purely cognitive interventions have limited effects.

Conclusion
This study demonstrated that motor simulation interventions, particularly MI and AO, can meaningfully improve static balance in older adults and may serve as safe, cost-effective, and accessible strategies in rehabilitation programs. However, enhancing dynamic balance likely requires combining these methods with physical or task-specific exercises. MI may produce longer-lasting effects than AO by actively engaging proprioceptive feedback and neural circuits involved in postural control. These findings support incorporating MI and AO as complementary interventions in elderly rehabilitation programs to reduce fall risk and improve quality of life.

Future research should examine longer interventions (8–12 weeks) using combined AO+MI protocols with real-world functional exercises and employ precise measurement tools, such as gait analysis systems and force platforms. Developing standardized instructional videos and apps could facilitate home-based mental and observational practice, increasing adherence and motivation among older adults.

Footnotes

Acknowledgments
We sincerely appreciate all those who assisted us in conducting this research.

Conflict of Interest
The authors declare no conflicts of interest.

Authors' Contributions

The authors have made equal contributions in the design, implementation, and writing of various sections of the research.

Ethical Approval
This study was conducted in accordance with established research guidelines and adhered to all ethical principles. The experimental protocols were approved by the Review Board of the Graduate Studies Office at Shahid Rajaee Teacher Training University.