Effect of Treadmill Perturbation-Based Balance Training on Fall Rates in Community-Dwelling Older Adults

Abstract

ImportanceFalls are common and the leading cause of injuries among older adults, but falls may be attenuated by the promising and time-efficient intervention called perturbation-based balance training (PBT).ObjectiveTo evaluate the effects of a 4-session treadmill PBT intervention compared with regular treadmill walking on daily-life fall rates among community-dwelling older adults.Design, Setting, and ParticipantsThis 12-month, assessor-blinded randomized clinical trial was conducted from March 2021 through December 2022 in Aalborg University in Denmark. Participants were community-dwelling adults 65 years or older and were able to walk without a walking aid. Participants were randomized to either PBT (intervention group) or treadmill walking (control group). Data analyses were based on the intention-to-treat principle.InterventionsParticipants who were randomized to the intervention group underwent four 20-minute sessions of PBT, including 40 slip, trip, or mixed slip and trip perturbations. Participants who were randomized to the control group performed four 20-minute sessions of treadmill walking at their preferred speed. The 3 initial training sessions were completed within the first week, whereas the fourth session was performed after 6 months.Main Outcomes and MeasuresPrimary outcome was the daily-life fall rates that were collected from fall calendars for the 12 months after the third training session. Secondary outcomes were the proportion of participants with at least 1 fall and recurrent falls, time to first fall, fall-related fractures, fall-related injuries, fall-related health care contacts, and daily-life slip and trip falls.ResultsA total of 140 highly functioning, community-dwelling older adults (mean [SD] age, 72 [5] years; 79 females [56%]), 57 (41%) of whom had a fall in the past 12 months, were included in this trial. Perturbation training had no significant effect on daily-life fall rate (incidence rate ratio [IRR]: 0.78; 95% CI, 0.48-1.27) or other fall-related metrics. However, there was a significant reduction in laboratory fall rates at the posttraining assessment (IRR, 0.20; 95% CI, 0.10-0.41), 6-month follow-up (IRR, 0.47; 95% CI, 0.26-0.86), and 12-month follow-up (IRR, 0.37; 95% CI, 0.19-0.72).Conclusions and RelevanceResults of this trial showed that participants who received an 80-minute PBT intervention experienced a statistically nonsignificant 22% reduction in daily-life fall rates. There was no significant effect on other daily-life fall-related metrics; however, a statistically significant decrease in falls was found in the laboratory setting.Trial RegistrationClinicalTrials.gov Identifier: NCT04733222

Knowledge mapping of trends and hotspots in the field of exercise and cognition research over the past decade

“…Exercise, especially multi-component exercise, can prevent, delay and reverse frailty, and improve the physical fitness of pre-frail/frail older adults [ 56 , 57 ]. Regular physical activity improved physical function and balanced performance, reducing the risk of falls among older individuals [ 58 , 59 ]. Proper strength training can help combat sarcopenia by preventing muscle loss and increasing both muscle mass and strength [ 60 ].…”

Feasibility, effectiveness and acceptability of two perturbation-based treadmill training protocols to improve reactive balance in fall-prone older adults (FEATURE): protocol for a pilot randomised controlled trial

“… 25 PBT may also hold great promise as a highly efficient fall prevention strategy in older adults, though current evidence is still not sufficient. While some studies found no fall-reducing effect of low-volume PBT, 26 27 other studies showed an impressive reduction in (trip-related) falls of about 50% over a 12-month follow-up period after just one and four PBT sessions, respectively. 28 29 This corresponds roughly to twice the effect of well-established fall prevention programmes, 14 while the training volume is significantly lower.…”

Empfehlungen für ein körperliches Training zur Sturzprävention bei älteren, selbständig lebenden Menschen

“…Nach dieser einmaligen Intervention reduzierten sich die Sturzereignisse im Folgejahr relativ zur Kontrollgruppe um über 40 Prozent. Dementgegen konnte eine kürzlich publizierte Studie in Dänemark bei gesunden älteren Menschen lediglich eine nicht signifikante 22 % Reduktion nach 80 Min multidirektionalem PBT, verteilt über vier TE, erzielen[130]. Auch ein erster pragmatischer RCT wurde inzwischen publiziert[131].…”