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. 2025 Jan 9;20(1):e0312261.
doi: 10.1371/journal.pone.0312261. eCollection 2025.

Treadmill belt accelerations may not accurately replicate kinematic responses to tripping on an obstacle in older people

Dayeon C Jung  1   2 , Daina L Sturnieks  1   2 , Kirsty A McDonald  3 , Patrick Y H Song  1   4 , Michael K Davis  1   5 , Stephen R Lord  1   6 , Yoshiro Okubo  1   6
Affiliations

Treadmill belt accelerations may not accurately replicate kinematic responses to tripping on an obstacle in older people

Dayeon C Jung et al. PLoS One. .

Abstract

Background: Treadmill belt perturbations have high clinical feasibility for use in perturbation-based training in older people, but their kinematic validity is unclear. This study examined the kinematic validity of treadmill belt accelerations as a surrogate for overground walkway trips during gait in older people.

Methods: Thirty-eight community-dwelling older people were exposed to two unilateral belt accelerations (8 m s-2) whilst walking on a split-belt treadmill and two trips induced by a 14 cm trip-board whilst walking on a walkway with condition presentation randomised. Anteroposterior margin of stability (MoS), number of falls, and trunk and lower limb kinematics were quantified for the step prior and five recovery steps following the treadmill perturbations and the walkway trips which elicited elevating and lowering strategies.

Findings: Rates of falls following the treadmill accelerations and walkway trips were 0% and 13.1%, respectively. MoS was similar during the first recovery step (P>0.05) but less negative during subsequent recovery steps following treadmill belt accelerations than walkway trips (P<0.01) regardless of recovery strategy. Excluding the first recovery step in the lowering strategy, recovery step lengths, toe clearance, maximum trunk, hip and knee angles (P<0.05) were smaller during recovery on the treadmill compared to the walkway.

Interpretation: Destabilisation by treadmill belt accelerations quickly dissipated after only one recovery step but continued for multiple recovery steps following walkway trips. Smaller trunk displacement, step lengths, toe clearance and no falls on the treadmill indicate treadmill belt accelerations may not accurately simulate the biomechanical challenge of obstacle-induced trips in older people.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Images of trips on the walkway that induced an (A) elevating, (B) lowering recovery strategies, and (C) treadmill accelerations.
Fig 2
Fig 2. Kinematic data for one previous (Pre) and five recovery (Post1-5) steps following a treadmill acceleration (orange) and walkway (W) trip inducing elevating (blue) and lowering (green) strategies (n = 38).
Presented are (A) margin of stability (MoS), (B) extrapolated centre of mass (xCoM), (C) maximum centre of mass anteroposterior velocity (Max. CoM AP Vel), (D) step length and (E) maximum toe clearance (Max. Toe Clearance). Coloured dots represent individual datapoints. Bold coloured bars and vertical error bars are the average and 95% confidence intervals, respectively. Asterisks represent significant differences (* P<0.05, ** P<0.01, *** P<0.001) between the value of the step of interest on the walkway and the value of the corresponding step on the treadmill.
Fig 3
Fig 3. Trunk angle following a treadmill acceleration (orange) and walkway (W) trip inducing elevating (blue) and lowering (green) strategies (n = 38).
Time was normalised to previous (Pre) and recovery (Post1-5) steps. Vertical dashed lines represent perturbation onsets (i.e., a foot contact to the accelerated belt or the trip-board). Bold lines and shaded bands are average and 95% confidence intervals, respectively.
Fig 4
Fig 4
Maximum angle of the (A) Trunk, (B) Hip and (C) Knee for one previous (Pre) and five recovery (Post1-5) steps following a treadmill acceleration (orange) and walkway (W) trip inducing elevating (blue) and lowering (green) strategies (n = 38). Coloured dots represent individual datapoints. Bold coloured bars and vertical error bars depict the average and 95% confidence intervals, respectively. Asterisks represent significant differences (* P<0.05, ** P<0.01, *** P<0.001) between the value of the step of interest on the walkway and the value of the corresponding step on the treadmill.
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