1.    Introduction
Aging is a significant period in human life, marking an important stage that brings various challenges and changes. Elderly individuals not only undergo biological and physiological changes, but they also encounter important life events such as retirement, the death of friends and family members, relocation, withdrawal from social activities, and shifts in social relationships and financial status. This period is naturally associated with a decline in both physical and mental abilities (1). One of the mental challenges faced by the elderly is a decrease in psychological well-being. Psychological well-being refers to the aspects of life that contribute to an individual's overall sense of wellness, which extends beyond merely experiencing pleasure. Instead, it encompasses striving for personal growth, perfection, and the realization of one’s potential (2). Falling and the fear of falling can lead to significant negative psychological and physiological consequences. Among the psychological impacts, quality of life is particularly affected by falls and the fear of falling. Quality of life is defined as the social, mental, physical, and health dimensions of life, shaped by an individual's experiences, beliefs, perceptions, and expectations (3). Therefore, preventing or reducing the likelihood of falls in elderly individuals through structured exercise programs can greatly contribute to their health and quality of life. In turn, this can also lead to significant savings in healthcare costs by reducing the need for medical interventions related to falls. Given this context, the primary question of the present research is: Do mindfulness, balance, and combined exercises affect psychological well-being and the fear of falling in inactive elderly individuals?
2.    Methods
This study employed a semi-experimental design with pre-test and post-test assessments. The subjects were 48 elderly men aged 65 to 75 years, who were voluntarily selected from the elderly population of Mashhad, Iran, through convenience sampling. The sample size was determined using G-Power software. After random assignment, participants were divided into four groups of 12: (1) Mindfulness Training Group, (2) Balance Training Group, (3) Combined Training Group, and (4) Control Group. Data collection involved a questionnaire that gathered personal information, sports history, and responses to the International Fall Efficacy Questionnaire (IFEQ) and the Leaf Balance Test. The IFEQ consists of 16 items, each rated on a four-point scale ranging from "completely worried" to "not worried at all," with scores ranging from one to four. The Leaf Balance Test includes 14 steps, with each step scored from 0 to 4 based on the quality of performance. Participants in the intervention groups underwent 16 sessions of 60 minutes each (three times a week) focused on either balance exercises, mindfulness exercises, or a combination of both. The control group did not receive any training during this period. After the training period, all groups participated in the post-test, which mirrored the pre-test assessments. To analyze the differences between the groups, analysis of covariance (ANCOVA) and post hoc tests were conducted using SPSS 19, with a significance level set at less than 5%.
3.    Results
As seen in Table 1, there is a significant difference in the effects of mindfulness, balance, and combined exercises on the fear of falling in inactive elderly individuals. Duncan's post hoc test was used to determine the location of intergroup differences.
As shown in Table 2, the mean scores of the control group (subset three) differ significantly from the other groups. In other words, all three training groups performed better than the control group. This means that all three exercise methods—balance, mindfulness, and combined exercises—had an impact on reducing the fear of falling in inactive elderly individuals. The findings revealed that among the exercise methods, the combined exercise method (balance and mindfulness) had the greatest impact on reducing the fear of falling in inactive elderly individuals. It also showed that there is no significant difference between the effects of balance exercises and mindfulness exercises on the fear of falling in inactive elderly individuals, as both methods equally contributed to reducing their fear of falling.


4.    Conclusion
Mindfulness, balance, and combined exercises can serve as effective intervention methods for improving psychological well-being and reducing the fear of falling in the elderly. Mindfulness enhances attention to external cues and increases engagement in the components of the athlete's movement attention system during states of balance. In other words, maintaining postural balance is a complex, integrated system involving numerous interactive components, each contributing to the complexity required to sustain balance. Participants who did not benefit from mindfulness (control group) seemed unable to integrate these interactive components effectively, resulting in greater difficulties in maintaining balance. Mindfulness likely exerts its effects through physiological changes, as well as by reducing stress levels, promoting relaxation, increasing alertness, and fostering a focus on present events. These factors positively influence performance and reduce the stress associated with the fear of falling in inactive elderly individuals. Given the multi-segmented structure of the human body, any voluntary movement disturbs balance, necessitating compensatory postural adjustments. These involuntary, automatic movements ensure accurate and coordinated motion, with the controlling muscles for these postural adjustments activating before the voluntary muscles. Considering the principle of specificity in functional training, it is likely that this type of training affects the activation of muscles responsible for predicting postural adjustments and voluntary movements, thus contributing to improved balance control.

Ethical Considerations
Compliance with ethical guidelines
Participants in this research were assured that their information would remain confidential. All participants were fully informed about the study process and signed informed consent forms prior to their participation. This study adheres to ethical publication standards and complies with the regulations of the ethics committee. It also follows the executive regulations of the Law on Prevention and Combating Fraud in Scientific Works.
Funding
This research did not receive any financial support from government, private, or non-profit organizations.
Authors' contributions
All authors were involved in the design, implementation, and writing of all parts of this research.
Conflicts of interest
The authors declare that there are no conflicts of interest associated with this article.