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Balance is defined as the ability to maintain the body’s center of mass within the base of support to ensure stability and proper orientation. Ageing is a major contributor to balance impairment, leading to reduced postural control and a significantly increased risk of falls and mortality among older adults. Fear of falling (FOF) is described as a persistent concern about falling that results in avoidance of activities an individual is otherwise capable of performing. This fear is strongly associated with balance deficits, lower extremity muscle weakness, cognitive decline, and psychological factors such as depression. As a result, FOF negatively influences an individual’s perceived balance ability and restricts participation in activities of daily living, thereby reducing overall functional independence.

Physical activity (PA) is defined as any bodily movement produced by skeletal muscles that results in energy expenditure. Falls are a common problem in old age, with an annual prevalence ranging from 25% to 37% among individuals aged over 65 years. Fear of falling is one of the most common and significant risk factors for falls in older adults. Avoidance of physical activity due to fear of falling is a frequent psychological consequence, leading to reduced mobility and physical deconditioning. Regular physical activity has been shown to improve balance, reduce functional limitations, and lower fall risk among older adults. However, fear of falling often leads to decreased physical activity levels, creating a vicious cycle that further exacerbates balance deficits and fall risk.

Additionally, fear of falling and low physical activity levels demonstrate a synergistic effect, jointly increasing fall risk. Sedentary behavior has also been identified as a modifiable risk factor for falls. Lifestyle differences between urban and rural older adults may influence physical activity patterns, balance ability, and fall risk. Despite existing evidence on individual factors, limited research has explored the combined association between physical activity, fear of falling, and balance deficits. Therefore, this study aims to examine physical activity levels in older adults with balance deficits and fear of falling and to analyze the association between physical activity, fear of falling, and balance deficits among community-dwelling older individuals in both urban and rural settings