Exercise-Based Fall Prevention

Grabiner, Mark D.; Crenshaw, Jeremy R.; Hurt, Christopher P.; Rosenblatt, Noah J.; Troy, Karen L.

doi:10.1249/jes.0000000000000023

Cited by 82 publications

(49 citation statements)

References 34 publications

(34 reference statements)

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“…Importantly, there is limited evidence for falls risk reduction after such strength and balance exercise interventions alone in older adults with Parkinson's disease12, 13 or after a stroke 14. One potential reason for the inconsistency or lack of effectiveness of such general exercise interventions for falls reduction is the lack of task specificity to the recovery actions required to prevent a fall 15, 16. In order to recover balance after a postural disturbance, change‐in‐support movements (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Gerards

McCrum

Mansfield

et al. 2017

Geriatrics Gerontology Int

184

151

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Falls are a leading cause of injury, hospitalization and even death among older adults. Although various strength and balance exercise interventions have shown moderate reductions in falls incidence among healthy older adults, no significant falls incidence improvements have been consistently seen in frail older adults or in patient groups with an increased falls risk (e.g. people with Parkinson's disease and stroke). This might be due to a lack of task specificity of previous exercise interventions to the recovery actions required to prevent a fall. Perturbation‐based balance training (PBT) is an emerging task‐specific intervention that aims to improve reactive balance control after destabilizing perturbations in a safe and controlled environment. Although early studies were carried out predominantly in research laboratory settings, work in clinical settings with various patient groups has been proliferating. A systematic search of recent PBT studies showed a significant reduction of falls incidence among healthy older adults and certain patient groups (e.g. people with Parkinson's disease and stroke), with clinically relevant reductions in frail older adults. The most practical methods in clinical settings might be treadmill‐based systems and therapist‐applied perturbations, and PBT that incorporates multiple perturbation types and directions might be of most benefit. Although more controlled studies with long‐term follow‐up periods are required to better elucidate the effects of PBT on falls incidence, PBT appears to be a feasible and effective approach to falls reduction among older adults in clinical settings. Geriatr Gerontol Int 2017; 17: 2294–2303..

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Section: Introductionmentioning

confidence: 99%

“…by taking compensatory steps or by grasping nearby objects for support) and counter rotations of body segments can be executed 17, 18. Training that targets such balance recovery mechanisms might be more effective than general exercise 15, 16, 19, 20…”

Section: Introductionmentioning

confidence: 99%

Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Gerards

McCrum

Mansfield

et al. 2017

Geriatrics Gerontology Int

184

151

View full text Add to dashboard Cite

show abstract

“…It has previously been suggested that training involuntary compensatory recovery responses following sudden perturbations is more task specific than general strength and balance exercise for preventing a fall after a loss of balance [32–35]. Even voluntary stepping exercise, such as multidirectional stepping to targets, is not as specific as involuntary, reactive compensatory stepping where faster movement speeds and an inability to make use of anticipatory postural adjustments are characteristic [34–36].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults

McCrum

Gerards

Karamanidis

et al. 2017

Eur Rev Aging Phys Act

143

145

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BackgroundFalls are a leading cause of injury among older adults and most often occur during walking. While strength and balance training moderately improve falls risk, training reactive recovery responses following sudden perturbations during walking may be more task-specific for falls prevention. The aim of this review was to determine the variety, characteristics and effectiveness of gait perturbation paradigms that have been used for improving reactive recovery responses during walking and reducing falls among healthy older adults.MethodsA systematic search was conducted in PubMed, Web of Science, MEDLINE and CINAHL databases in December 2015, repeated in May 2016, using sets of terms relating to gait, perturbations, adaptation and training, and ageing. Inclusion criteria: studies were conducted with healthy participants of 60 years or older; repeated, unpredictable, mechanical perturbations were applied during walking; and reactive recovery responses to gait perturbations or the incidence of laboratory or daily life falls were recorded. Results were narratively synthesised. The risk of bias for each study (PEDro Scale) and the levels of evidence for each perturbation type were determined.ResultsIn the nine studies that met the inclusion criteria, moveable floor platforms, ground surface compliance changes, or treadmill belt accelerations or decelerations were used to perturb the gait of older adults. Eight studies used a single session of perturbations, with two studies using multiple sessions. Eight of the studies reported improvement in the reactive recovery response to the perturbations. Four studies reported a reduction in the percentage of laboratory falls from the pre- to post-perturbation experience measurement and two studies reported a reduction in daily life falls. As well as the range of perturbation types, the magnitude and frequency of the perturbations varied between the studies.ConclusionsTo date, a range of perturbation paradigms have been used successfully to perturb older adults’ gait and stimulate reactive response adaptations. Variation also exists in the number and magnitudes of applied perturbations. Future research should examine the effects of perturbation type, magnitude and number on the extent and retention of the reactive recovery response adaptations, as well as on falls, over longer time periods among older adults.Electronic supplementary materialThe online version of this article (doi:10.1186/s11556-017-0173-7) contains supplementary material, which is available to authorized users.

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“…To reduce the burden of falls in older adults falls prevention exercise programs that apply new research evidence into practice need to be developed. The ability to execute movements varying in speed, amplitude, complexity and additional cognitive load is critical for preventing falls (76) and thus stepping training programs that incorporate such aspects have resulted in substantial reductions of falls (15). We have proposed a framework for a stepping training program, reviewed the theory and evidence underlying it and described in detail the implementation of an exemplary 9 week, group-based stepping exercise program applying the suggested concept.…”

Section: Discussionmentioning

confidence: 99%

A Novel Square-Stepping Exercise Program for Older Adults (StepIt): Rationale and Implications for Falls Prevention

2020

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The ability to effectively execute compensatory steps is critical for preventing accidental falls, and consequently stepping training is an essential ingredient of fall prevention programs. In this paper, we propose a concept for stepping training that aims to maximize training effects by taking into account recent research evidence and a precise dosing of training ingredients. The concept addresses motor as well as cognitive falls-related aspects, it is suitable for individual as well as group based training, and it does not require costly equipment. Theory and evidence behind all of the training principles is reviewed, and an example of an exercise protocol is described in detail. Participants are presented with stepping patterns which they have to memorize and implement on a mat. In order to enable investigation of dose-response effects, the difficulty level systematically and gradually increases session by session based on four principles: execution speed, pattern complexity, pattern length and execution in dual-/multi-tasking conditions. The presented concept can be used as a framework for the development of further prevention and/or rehabilitation stepping exercise programs. Further studies using this exercise regimen or modified versions of it are encouraged.

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Exercise-Based Fall Prevention

Cited by 82 publications

References 34 publications

Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults

A Novel Square-Stepping Exercise Program for Older Adults (StepIt): Rationale and Implications for Falls Prevention

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