Objectives: Verbal instructions related to directing the focus of attention to the movement itself or to its effects on or outcomes in the environment affects learning and performing movement skills. The pattern of these effects differs with increase in task difficulty. The goal of this study was to explore the effects of support surface and attention focus on the balance in elderly.

Methods & Materials: Twenty-eight elderly (65 & older) with a history of one or more falls in the last year were participated in the study. The design of the study was two factors within group with repeated measures. Participants were tested in two conditions of moving and stable support surface and three conditions of baseline, internal, and external focus of attention.

Results: Difference in support surface from stable to moving (i.e. increasing task difficulty) generally decreased the level of performance. There was a strong interaction between conditions off support surface and conditions of attention focus (P<0.001). The maximum decrease in performance happened in internal focus of attention/moving support surface and the minimum decrease occurred in external focus of attention/moving support surface.

Conclusion: The effectiveness of the external focus of attention was most significant and more beneficial to the balance performance in the moving unstable support surface (increased task difficulty) than other conditions of attention focus. The interesting finding was that not instructing at all is more effective on balance performance than internal focus of attention instruction in elderly people with a history of falling.