Effect of Treadmill Perturbation-Based Balance Training on Fall Rates in Community-Dwelling Older Adults: A Randomized Clinical Trial

Abstract

Importance: Falls 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).

Objective: To 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 participants: This 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.

Interventions: Participants 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 measures: Primary 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.

Results: A 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 relevance: Results 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 registration: ClinicalTrials.gov Identifier: NCT04733222.

Figure 1.. Participant Flowchart

PBT indicates perturbation-based balance training.

Figure 2.. Training Schedule

The figure illustrates the arrangement of the training sessions (A). During slip perturbations (B), the participant walked at their preferred walking speed when a sudden acceleration reversed the direction of the belt movement before the belt returned to the preferred walking speed. During trip perturbations (C), the participant walked at their preferred walking speed when a sudden small deceleration followed by a larger backward acceleration occurred before the belt returned to the preferred walking speed. Positive belt speed values (B and C) indicate the belt movement direction during regular walking. PBT indicates perturbation-based balance training; TW, treadmill walking; TWT, treadmill walking training.

Figure 3.. Comparison of the Number of Falls in the Intervention and Control Groups

PBT indicates perturbation-based balance training.