Visual attention and postural stability among older adults participating in health-enhancing physical activity: a systematic review

Introduction: As the global population ages, declines in sensory, cognitive, and motor functions increase fall risk and compromise postural stability. Despite growing research, systematic reviews examining visual attention and postural stability-particularly through eye-tracking-remain scarce. Grounded in a network physiology perspective, this review aimed to (1) describe bibliometric characteristics, (2) thematize study purposes and outcomes, (3) map conceptual linkages through keyword network analysis, and (4) generate insights into the relationship between visual attention and postural stability in older adults during physical exercise interventions. Methods: Following a five-stage integrative review process using Covidence, 15 studies were included in the final analysis. Results: Bibliometric findings show that publications were multi-authored (93.33%), appeared in health-related journals (100%), peaked in 2022 (20.00%), and originated predominantly from the Americas (46.67%). Most studies focused on diagnosis (26.67%), involved healthy participants (46.67%), and used small samples (Md = 30; IQR = 28) in laboratory or clinical settings. Thematic analysis yielded five domains-Performance, Program, Process, Product, and Person (5Ps)-while keyword network analysis identified seven clusters: Vision, Virtual, Vulnerability, Visual-Motor, Velocity, Vestibular, and Vergence, collectively emphasizing a multifaceted, systems-oriented approach to fall prevention. Among visual attention metrics, fixation (21.15%) and saccades (19.23%) were most frequently assessed, and both were consistently associated with posture, balance, gait, and stability outcomes. Advanced metrics such as heat maps, pupil dilation, dwell time, and re-fixation remain underutilized. Discussion: Overall, this review establishes visual attention as a central and modifiable determinant of postural stability, with gaze-based, technology-assisted, multicomponent approaches warranting priority in fall prevention assessment and intervention. Systematic Review Registration: https://osf.io/bmsw6/overview.