Effects of vestibular training on balance performance and sensory reweighting in older women: a randomized controlled trial

Abstract Background Age-related alterations in sensory integration impair postural control and increase fall risk in older adults. Vestibular rehabilitation training (VRT) has been proposed as an effective intervention to improve balance; however, its effects on the relative contribution of sensory systems remain unclear. Objective This study aimed to investigate the effects of an 8-week VRT program on balance performance and sensory reweighting in older women. Methods This randomized controlled trial included 29 older women who were randomly assigned to a VRT group ( n = 15) or a control group ( n = 14). The intervention consisted of supervised vestibular exercises performed three times per week for 8 weeks. Balance was assessed using a force plate, and the relative contribution of visual, vestibular, and proprioceptive systems was estimated across eight sensory conditions using a least squares approach. Measurements were obtained before and after the intervention. Results A significant Group × Time interaction was observed for balance index ( p = 0.01), indicating improved balance performance in the VRT group compared to controls. A significant Group × Time × Sensory System interaction was also found ( p = 0.049). Within the VRT group, vestibular dependence significantly decreased ( p = 0.015), whereas proprioceptive dependence significantly increased ( p = 0.009). At post-test, sensory dependence became more evenly distributed across the three sensory systems, while the VRT group also demonstrated lower visual dependence ( p = 0.018) and greater proprioceptive dependence ( p < 0.001) than the control group. Conclusion An 8-week vestibular training program improves balance performance and promotes adaptive sensory reweighting in older women by reducing vestibular dependence, enhancing proprioceptive contribution, and achieving a more balanced sensory organization. These findings support vestibular rehabilitation as an effective strategy for improving postural control and reducing fall risk in older adults. Trial registration The study was retrospectively registered in the Iranian Registry of Clinical Trials (IRCT) on May 19, 2026 (Registration number: IRCT20251115068000N1). Trial registry link: https://en.irct.ir/trial/89928 .