independent functioning is at the core of successful aging , and independent mobility is 
 critical to independent function .
exercise is recommended for older adults because it 
 promotes physical and mental health , may improve mobility , and prevents walking 
 difficulties1 . walking places demands on 
 the musculoskeletal ( the muscles , bones , and joints ) , cardiopulmonary ( the heart and lungs ) , 
 and nervous ( the brain , spinal cord , and peripheral nerves ) systems1 .
such persistent walking exercises not only prevents lifestyle diseases such as 
 hypertension , arteriosclerosis and diabetes , but also aids their treatment while also 
 improving the potential positive effects such as improved pulmonary function , stronger 
 immunity , enhanced muscle strength , higher bone density , stress reduction , and better 
 emotional stability .
balance has been defined as the ability to maintain one s equilibrium as the center of 
 gravity shifts ( dynamic balance e.g. walking and running ) , and while the center of gravity 
 remains stationary ( static balance e.g. standing or sitting)2 .
static balance 
 refers to the ability to maintain the center of gravity within the base of support during 
 the stationary phase , while dynamic balance refers to the ability to maintain the center of 
 gravity within the base of support during movement .
dynamic balance ability is closely 
 associated with walking ; hence , its loss weakens a person s ability to appropriately respond 
 to different environments and tasks3 . 
 according to previous studies that compared forward and backward walking , backward walking 

in addition , it contributed to improved 
 gait ability as it increased the strength of knee joints and activities of the quadriceps . 

recently , such effects have been manifested through the application of various approaches 
 such as walking exercises on treadmill and flat land , backward walking exercises , and 
 robot - assisted walking exercises in stroke patients with hemiplegia to improve gait and 
 balance ability4 . moreover , a variety of 
 studies on forward walking have been conducted to improve gait and balance ability .
however , 
 little research has been carried out to determine the therapeutic effects of backward 
 walking .
therefore , the present study aimed to examine the effects of forward and backward 
 walking on gait and balance ability .
in all , 33 healthy subjects without a history of orthopedic surgery were selected , and the 
 study was conducted after consent for participation was obtained for this study .
all 
 procedures were reviewed and approved by the institutional ethics committee of eulji 
 university hospital . in all , 16 subjects were randomly assigned to the experimental group 
 and 17 subjects to the control group .
subject s average age , height , and weight in the 
 experimental and control groups were 21.45  2.12 and 20.15  1.07  years ; 176.54  11.05 and 
 174.12  7.38  cm ; and 77.05  6.21 and 72.11  7.62  kg , respectively .
sufficient explanation 
 of this study s intent and the overall purpose was given , and voluntary consent for 
 participation in this study was obtained from all subjects .
subjects walked for 1  min to determine their natural gait velocity before the experiment , 
 and all subjects walked barefoot on a treadmill ( hm50ex , daeho , korea ) , for 20  min , five 
 times per week , for a total of 4 weeks .
the average gait velocity was 3  km / h on a 10% slope . 

after the intervention , equipment to measure balance ( good balance , metitur , finland ) was 
 used to quantitatively measure balance ability . to measure balance functions , the subject 
 was instructed to stand on a triangular platform and maintain a symmetric standing posture 
 with the legs shoulder - width apart .
the arms were placed comfortably by the sides of the hip joint and the 
 center of pressure ( cop ) was measured for 30  s in this posture with the eyes open .
the cop 
 was measured three times and the average value was calculated . a pedometer ( gait rite , k634-db , epson inc
. , usa ) was used to collect data for 
 temporo - spatial gait characteristics such as velocity , step length , stride length , single 
 support , double support and cadence of the experimental and control groups . for precise 
 analysis of gait
, the subjects were asked to walk along a 2 m - long walkway for three 
 sessions , and the average values were used .
the subjects , with heads lifted and looking 
 straight ahead , walked barefoot while lightly shaking their upper arms5 .
, 
 differences in the general characteristics of the experimental and control groups were 
 compared using independent t - tests .
comparisons of variables before and after training 
 within each group were made using paired sample t - tests .
comparisons of pre- and post - test 
 differences in variables between the experimental and control groups were performed using 
 the independent t - test .
an effect size < 0.2 
 reflects a negligible mean difference ; 0.20.5 , a small difference ; 0.50.8 , a moderate mean 
 difference ; and > 0.8 , a large difference .
statistical analysis was performed at a 95% 
 confidence level , and p values<0.05 were considered statistically significant .
no significant differences in the baseline characteristics were observed between the two 
 groups ( p>0.05 ) ( table 1table 1.characteristics of the experimental and control groups , with values presented as 
 mean ( standard deviation)eg ( n=16)cg ( n=17)pre - testpost - testpre - testpost - testbalancemedial - lateral ( mm / s)147.0 ( 41.6)138.1 ( 38.6)142.1 ( 36.4)138.8 ( 35.2)anterior - posterior ( m / s)188.2 ( 39.1)180.5 ( 36.2)183.4 ( 37.2)179.6 ( 43.6)gaitstep length ( cm)55.4 ( 6.4)59.9 ( 7.3)55.2 ( 5.2)57.1 ( 6.7)velocity ( m / s)84.6 ( 4.3)94.5 ( 5.2)78.3 ( 4.2)82.3 ( 3.2)double support ( % ) 16.9 ( 9.4)20.3 ( 8.1)17.5 ( 7.2)19.8 ( 8.7)cadence ( steps / min)101.4 ( 13.2)108.4 ( 12.4)81.6 ( 11.2)84.5 ( 15.2)eg : experimental group ; cg : control group .
thirty - three subjects ( experimental group=16 , control group=17 ) completed 
 this experiment .
the experimental group showed significant increments in medial - lateral and 
 anterior - posterior balance , step length , and velocity compared to the pre - intervention 
 results ( p<0.05 ) .
in addition , the control group showed significant increments in 
 anterior - posterior balance and velocity compared to the pre - intervention results 
 ( p<0.05 ) .
significant differences in post - training gains in anterior - posterior balance , 
 step length , and velocity were observed between the experimental and control groups 
 ( p<0.05 ) .
the effect size for gains in the experimental and control groups was very 
 marked in step length , and velocity ( effect size=0.82 , 0.91 , respectively ) .
furthermore , this exercise can minimize the 
 burden on joints and increase muscle strength in the lower limbs .
in addition , this exercise 
 does not cause adverse effects on the body through the stimulation of the major muscle in a 
 rhythmic and dynamic fashion . this exercise does not require any special tools or equipment , 
 which makes it effective and safe to reduce health risks .
the present study investigated the effects of forward and backward walking on gait and 
 balance ability of healthy subjects . according to the research findings , backward
previous studies have reported that 
 backward walking reduced step length and improved gait speed , indicating that it was an 
 effective to increase the endurance of lower limbs8 .
the findings of the present study are in line with previous research findings . according to 
 another comparison study ,
backward walking stimulated muscles in the lower limbs and showed 
 higher energy consumption in the lower limbs when combined with knee flexion and hip 
 extension9 .
in addition , greater 
 activity of the quadriceps during backward walking as well as increased stability in the 
 stance phase of walking was reported with this intervention10 . as for the mechanism of walking , backward walking has less impact on the kneecaps and 
 patello - femoral joints as the metatarsal joints come in contact with the surface first . 

however , forward walking has a relatively greater impact on the ankle and knee joints since 
 walking is only possible with flexion of the knee or hips because ankles show minor 
 movement . even though backward walking is not practiced in day - to - day life , it is effective 
 in stimulating muscles of the knee joints and quadriceps in a more balanced manner11 . therefore , it appears that people who 
 complain of pain in the knees may note some positive therapeutic effects with backward 
 walking exercise .
the present study has limitations , as the intervention period was too short to generalize 
 the effect of backward walking .
in addition , there has been no post - study follow - up of the 
 participants ; moreover , there were a small number of participants .
therefore , more 
 significant results will be noted in future studies if the intervention period is extended 
 and environmental factors are accounted for more thoroughly . in addition , in order to 
 prevent monotony while performing backward walking alone , a walking exercise program that 
 combines forward and side walking would be necessary .
 in this study , the therapeutic effects of backward walking were examined . 
 [ subjects and 
 methods ] in all , 16 subjects were randomly assigned to an experimental group and 17 to a 
 control group . 
 all subjects walked barefoot on a treadmill ( hm50ex , daeho , korea ) for 
 20  min , five times per week , for a total of 4 weeks . 
 the average gait velocity of the 
 subjects was 3  km / h on a 10% slope . 
 the experimental group walked backwards and the 
 control group walked forwards . 
 [ results ] the experimental group showed significant 
 increments in both medial - lateral and anterior - posterior balance , step length , and 
 velocity compared with the pre - intervention results . in addition , the control group showed 
 significant increments in anterior - posterior balance and velocity compared to the 
 pre - intervention results . 
 significant differences in post - training gains in 
 anterior - posterior balance , step length , and velocity were observed between the 
 experimental and control groups . 
 [ conclusion ] backward walking positively affected gait 
 and balance ability after intervention . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION