Otago exercise program consist of strengthening exercise of lower limb muscles and along with balance exercises. Knee flexors, knee extensors and hip abductors, which are particularly important or functional movements and walking. Ankle dorsiflexor and plantar flexor muscles, which are particularly important for recovering balance. Ankle cuff weights provide resistance to the knee flexors, knee extensors and hip abductors; the ankle dorsiflexors and plantar flexors are strengthened using body weight alone. The balance exercises are dynamic as well as static. They can help to maintain balance, postural control and functional mobility.

The program was designed specifically to prevent falls. It consists of a set of leg muscle strengthening and balance retraining exercises progressing in difficulty, and a walking plan. The exercises are individually prescribed and increase in difficulty during a series of visits under a trained instructor. ankle cuff weights (starting at 1kg) t

Dual task training (DTT) is an intervention that involves performing two tasks simultaneously, typically a motor task (e.g., walking, standing) and a cognitive task (e.g., solving a mental puzzle, counting). The aim is to improve balance, postural control, functional mobility, and cognitive function, which are crucial for reducing the risk of falls among older adults. As people age, they experience declines in several areas, including: Reduced muscle strength, flexibility, and coordination make movements like walking or maintaining balance more difficult, Declines in attention, memory, and executive functions (e.g., problem-solving, decision- making) can make it challenging to focus on multiple things at once. For older adults, this dual tasking can increase the risk of imbalance and falls. DTT aims to improve older adults' ability to manage these simultaneous demands, making daily life safer and more manageable. Dual task training focuses on performing a motor task and a c

Otago exercise program group 40 min/ thrice a week/ 8 weeks

1st week strengthening of knee flexors( prone lying), extensors ( in sitting) ,abductors( in standing) with 1-2 kg ankle cuff. Dorsi flexors, planter flexors(in standing on weight)/ hold 5-10 sec 5 reps/ 2 sets 2nd week Strengthening same as week 1 balance exercises.Knee bending( standing),tandem stance,sit to stand / with support/ 5-10 reps/2 sets 3rd week strengthening of all above Ms group with increase weight 2-3 kg ankle cuff or participant (The exercises are of moderate intensity; the person should not get unduly tired) balance exercise as 2nd week 4th week strengthening exs as in 3rd week balance exs: Knee bending, tandem stance( without support), forward walk,walking and turning around, side walk, one leg stand,sit to stand, stair climb( all with support)/5-10 reps 5th week strengthening exs of above ms group increase either weight 3-4 kg or repetitions 10-15 or hold time 10-15 sec 6th week strengthening same as 5

Berg balance scale is used to assess static and dynamic balance having 14 balance tasks Scoring: 5-point ordinal scale (graded 0-4) , Max score = 56 41-56 = low fall risk, 21-40 = medium fall risk, 0 -20 = high fall risk Perform at the start of treatment protocol, after 4 weeks and at the end of intervention

tool used for assessment of postural control is Dynamic gait index. It includes eight items, A four-point ordinal scale, ranging from 0-3. "0" indicates the lowest level of function and "3" the highest level of function.

Total Score = 24. < 19/24 = predictive of falls in the elderly, > 22/24 = safe ambulators

tool used to assess fall risk is FES-I. 16 items Questionnaire. individuals are instructed to score their concern of falling during an activity on a 4 point Likert scale with 1 as not concerned at all and 4 as very concerned. The item scores are summed up to obtain a total of 64. ≤ 16= no concern about falling > 16= concern about falling

tool used for assessment of functional mobility is Timed Up And Go. Uses 1 practice/3 trials for average score. If the participant perform it with in 10 sec will be consider normal, > 10 second= impaired functional mobility lead to moderate to high risk of fall.

Tool used for assessment of functional mobility strength is Sit to stand 30 sec: The score is the total number of stands with in 30 sec. For men and women above 60 years normal average score is 15 and 12 respectively below average score indicates a risk.