Aim: The aging process might increase the energy expenditure of an individual to perform any task, including alteration in balance which can increase the risk of falls among the elderly people. The purpose of this study was to find out the effects of square stepping exercise (SSE) sequences on the physiological cost index in the elderly population. Methods: A total of 30 elder individuals were included for the study (>65 years). They had to practice square stepping exercise elementary 1 and elementary 2 patterns for four weeks with three times a week. Pre and post intervention, the individuals had to perform the 6 minute walk test to calculate the physiological cost index and berg balance scale’s components to check their balance score. Results: Every individual performed the square stepping exercise protocol and had a significant effect on their physiological cost index by reducing their energy expenditure while walking. It also showed significant improvement in the balance of the individuals. Conclusion: The square stepping exercise practiced showed a significant effect to lower the energy expenditure on physiological cost index and it also improves the balance. It also showed significant correlation coefficient between balance and physiological cost index or energy expenditure.