Square Stepping Exercise and Dynamic Balance in Older Adults: A Pre-Experimental Study

Abstract

Background: Age-related declines in strength, sensory integration, and neuromuscular control can impair dynamic balance and functional mobility. Square Stepping Exercise (SSE) combines multidirectional stepping with postural and cognitive demands and may be relevant to community-based balance training. 
Objective: To examine changes in dynamic balance after a four-week SSE program among older adults attending a community-based Posyandu in Bandung Regency.
Methods: This pre-experimental one-group pretest-posttest study included 15 of 17 older adults screened through purposive sampling in May 2026. Participants completed 12 SSE sessions over four weeks, three sessions per week. Dynamic balance was assessed using the Timed Up and Go Test (TUGT) before and after the program. Because the within-participant difference scores were not normally distributed, the Wilcoxon signed-rank test was used as the inferential analysis. Cohen’s dz was calculated as the mean within-participant change divided by the standard deviation of the difference scores.
Results: Mean TUGT time decreased from 14.60 ± 2.23 seconds at pretest to 11.60 ± 2.72 seconds at posttest. The mean reduction was 3.00 ± 0.85 seconds (95% CI, 2.53 to 3.47), with a large within-participant effect (Cohen’s dz = 3.55; 95% CI, 2.15 to 4.94). The Wilcoxon signed-rank test indicated a statistically significant reduction (p < 0.001).
Conclusion: TUGT performance improved after four weeks of SSE in this community-based sample. The observed change does not establish a causal effect of SSE because the study lacked a comparison group.