Reactive Balance Training for Fall Prevention in Older Adults

Overseen By Shamali Dusane, MPT

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Illinois at Chicago

Must not be taking: Sedatives

Disqualifiers: Osteoporosis, Cognitive impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

90 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine how different types of perturbation training (exercises that simulate slips and trips) can improve balance and reduce fall risks in older adults and individuals who have had a stroke. Researchers will test three types of training devices to identify which one best helps the body learn to maintain stability and prevent falls. The trial seeks healthy older adults and individuals who have had a stroke and can walk at least 10 meters, even with a cane or walker. As an unphased trial, it offers participants the opportunity to contribute to innovative research that could enhance fall prevention strategies for themselves and others.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot be on any sedative drugs to participate.

What prior data suggests that these perturbation training devices are safe for fall prevention in older adults?

Research has shown that reactive balance training is generally safe for participants. One study found that this type of training, which includes exercises to improve balance and prevent falls, reduced the rate of falls by nearly half for people at risk. This indicates it is not only effective but also well-tolerated.

Another study highlighted that a specific type of balance training, called perturbation-based training, is gaining attention for its ability to prevent falls, especially in older adults. While some research indicates that more evidence is needed, the current data is promising for the safe use of these methods.

Overall, these findings suggest that reactive balance training is safe for most people and can significantly help reduce the risk of falls. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Reactive Balance Training for fall prevention in older adults because it offers innovative approaches that differ from traditional physical therapy and exercise programs. The overground training arm incorporates unexpected slips and trips during virtual reality walking tasks, helping participants adapt to real-world conditions. Treadmill training introduces perturbations to improve balance and stepping responses, enhancing the body's ability to recover from potential falls. Finally, the Surefooted training uses a safety harness and a variety of challenging surfaces to simulate slip-like or trip-like movements, encouraging participants to maintain stability in diverse conditions. These methods aim to improve balance in dynamic and unpredictable environments, potentially reducing fall risk more effectively than current options.

What evidence suggests that these perturbation training devices are effective for fall prevention?

Research has shown that balance training can help prevent falls. In this trial, participants will join one of three training arms: Overground training, Treadmill training, or Surefooted training. One study found that practicing recovery from slips and trips reduced falls by 46% compared to no training. Another study demonstrated a 23% decrease in falls among older adults who engaged in this training. This training improves balance by challenging stability and teaching the body to react better to slips and trips. Some studies also suggest it can help older adults react faster and walk more quickly. Overall, while results may vary, promising evidence indicates that this training could reduce the risk of falls. ^{1 2 5 6 7}

Who Is on the Research Team?

Tanvi Bhatt, PhD

Principal Investigator

University of Illinois at Chicago

Are You a Good Fit for This Trial?

This trial is for healthy young adults aged 18-55, and older adults aged 56-90 who can walk at least 10 meters with or without help. Participants should not have acute neurological, heart, muscle conditions or other systemic diseases, recent major surgery or hospitalization, and must not be taking sedatives.

Inclusion Criteria

I am young and healthy.

I haven't had major surgery or been hospitalized in the last 6 and 3 months, respectively.

I am not taking any sedative medications.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Participants undergo perturbation training using three different devices: ActiveStep treadmill, custom-designed over-ground walkway, and Surefooted Trainer. Training includes slip and trip perturbations under various conditions.

1 week

Multiple sessions (in-person)

Immediate Post-training Assessment

Assessment of changes in stability, limb support, and laboratory-induced falls immediately after training.

1 week

1 visit (in-person)

Follow-up

Participants are monitored for real-life falls and changes in physical activity over a long-term period.

12 months

Periodic check-ins (virtual or in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Reactive Balance Training

Trial Overview

The study compares three types of balance training to prevent falls: overground training (walking on solid ground), treadmill training (walking on a moving surface), and Surefooted training (using a special device). It tests how these trainings improve balance in response to sudden slips or trips.

How Is the Trial Designed?

Group I: Treadmill training Experimental Treatment 1 Intervention

Subjects randomly assigned to the treadmill training, would undergo either a stance or walking perturbation training protocol. The stroke subjects and older adults would be assigned to either the stance or walking perturbation training protocol. All the participants would be asked to perform voluntary stepping, backward and forward with both limbs pre and post perturbation training. Also, all the participants would perform walking trials with head mounted virtual reality system under three conditions: ice, beach and crowd.

Group II: Surefooted training Experimental Treatment 1 Intervention

Subjects randomly assigned to Surefooted (Surefooted LLC) would be donned a safety harness and instructed that "when you experience slip-like or trip-like movements, try to keep walking on the platform". Subjects would undergo 4-minute training block on each of the 6 different conditions. The first 3 training blocks would be unidirectional perturbation (either slip or trip) followed by 3 training blocks of mixed directional perturbations while the subjects are walking on the platform. 3 surface conditions- slippery (vinyl surface plate), normal friction with obstacles (surface plate with 6" tall structures embedded), and a foam surface with obstacles embedded would be used.

Group III: Overground training Experimental Treatment 1 Intervention

Subjects randomly assigned to overground slip will be made to walk at their comfortable natural walking speeds either for 5-8 trials on the instrumented walkway (7 m 1.5 m) at their self-selected preferred speed. All the participants would perform walking trials with head mounted virtual reality system under three conditions: ice, beach and crowd. After establishing baseline walking ability, a slip will be introduced without warning which will comprise the baseline slip test followed by a trip in the form of the trip plate. This is followed by a block of 8 trials for slip training, block of 8 trials for trip training and then the mixed block consisting of slip and trip trials interspersed with walking trials. Slips and trips could be induced under either of the limbs.

Who Is Running the Clinical Trial?

University of Illinois at Chicago

Lead Sponsor

Trials

653

Recruited

1,574,000+

Published Research Related to This Trial

A 12-week resistance training (RT) program and a 3-week perturbation-based training (PBT) program were tested on healthy older adults, showing that both interventions improved specific aspects of reactive balance, but did not enhance performance during perturbed treadmill walking.

The PBT specifically improved reactive balance during standing due to adaptations in stepping strategies, highlighting that while PBT is effective, its benefits may not generalize to all movement tasks, which is important for designing effective fall prevention interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adaptations in Reactive Balance Strategies in Healthy Older Adults After a 3-Week Perturbation Training Program and After a 12-Week Resistance Training Program. Van Wouwe, T., Afschrift, M., Dalle, S., et al.[2021]

In a study involving 35 older adults over 4 weeks, treadmill-based reactive balance training significantly improved rapid balance responses compared to Tai Chi, with participants showing a 13.5° smaller maximum trunk angle and a 24%-31% higher reactive balance rating after training.

While both training methods were effective, treadmill-based training was more effective in enhancing the ability to respond to trips and slips, indicating it may be a better option for improving balance in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of Treadmill Trip-Like Training Versus Tai Chi to Improve Reactive Balance Among Independent Older Adult Residents of Senior Housing: A Pilot Controlled Trial. Aviles, J., Allin, LJ., Alexander, NB., et al.[2020]

Reactive balance training (RBT) significantly improves balance in older adults, with the maximum trunk angle before training being a strong predictor of improvement, as shown in a study of 28 participants.

The speed of treadmill perturbations during RBT is also associated with better training outcomes, suggesting that these factors can help identify individuals who will benefit most from RBT interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improvement in trunk kinematics after treadmill-based reactive balance training among older adults is strongly associated with trunk kinematics before training. Aviles, J., Wright, DL., Allin, LJ., et al.[2021]

Reactive balance training (RBT) significantly reduces the likelihood of falls in daily life for older adults and individuals with balance impairments, with a fall risk ratio of 0.76 compared to control groups.

While RBT is effective in decreasing falls, it is associated with a higher prevalence of adverse events (29% in RBT vs. 20% in control), indicating that while it is beneficial, caution is needed regarding potential risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effect of Reactive Balance Training on Falls in Daily Life: An Updated Systematic Review and Meta-Analysis. Devasahayam, AJ., Farwell, K., Lim, B., et al.[2023]

Perturbation-based balance training (PBT) significantly improved reactive balance control in individuals with chronic stroke, as evidenced by a decrease in the frequency of extra steps taken in response to support-surface perturbations after 6 weeks of training.

In contrast, traditional balance training did not show similar improvements, highlighting the effectiveness of PBT in rehabilitation programs aimed at reducing fall risk in stroke patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does Perturbation-Based Balance Training Improve Control of Reactive Stepping in Individuals with Chronic Stroke? Schinkel-Ivy, A., Huntley, AH., Aqui, A., et al.[2019]

A systematic review of nine studies involving healthy older adults found that various gait perturbation methods, such as moveable floor platforms and treadmill adjustments, can effectively improve reactive recovery responses during walking.

Eight out of the nine studies reported enhancements in recovery responses, and some showed a reduction in falls, indicating that training with gait perturbations may be a promising strategy for preventing falls in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults. McCrum, C., Gerards, MHG., Karamanidis, K., et al.[2020]

This pilot randomized controlled trial involves 36 stroke survivors to evaluate the effects of different doses of reactive balance training (RBT) on balance control and confidence, aiming to inform a larger study on optimal RBT dosage.

Participants will be assessed at multiple time points, including 6 months post-discharge, to track falls and physical activity, which will help determine the feasibility and necessary sample size for future trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Determining the optimal dose of reactive balance training after stroke: study protocol for a pilot randomised controlled trial. Mansfield, A., Inness, EL., Danells, CJ., et al.[2021]

This study will evaluate the effectiveness of two different training schedules (random vs. block) in improving balance control among 50 older adults (over 70 years) through a 1-month perturbation-based balance training (PBBT) program.

The research aims to determine which training method better enhances both reactive and proactive balance functions, potentially reducing the risk of falls in older adults, a leading cause of injury in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examining Different Motor Learning Paradigms for Improving Balance Recovery Abilities Among Older Adults, Random vs. Block Training-Study Protocol of a Randomized Non-inferiority Controlled Trial. Nachmani, H., Paran, I., Salti, M., et al.[2021]

This study investigates the effectiveness of perturbation-based balance training (PBT) compared to conventional intensive balance training (CIBT) in improving reactive stepping ability in 24 adults with chronic incomplete spinal cord injury over 8 weeks.

The primary outcome measures the ability to recover balance using a single step, which will help determine which training method is more effective for enhancing balance control and reducing fall risk in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensive Balance Training for Adults With Incomplete Spinal Cord Injuries: Protocol for an Assessor-Blinded Randomized Clinical Trial. Unger, J., Chan, K., Scovil, CY., et al.[2023]

This pilot randomized controlled trial will evaluate the effectiveness of two different perturbation-based balance training (PBT) protocols over a 6-week period in 36 older adults at risk of falling, focusing on improving their reactive balance control.

The study will also assess the feasibility and acceptability of these training protocols, measuring factors like adherence, drop-out rates, and any adverse events, which are crucial for understanding how well these interventions can be implemented in real-world settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Hezel, N., Sloot, LH., Wanner, P., et al.[2023]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10587291/

Fall prevention by reactive balance training on a ...

A meta-analysis of different types of perturbation training showed a significantly 46% lower incidence of falls in the intervention group ...

2.

medrxiv.org

medrxiv.org/content/10.1101/2025.07.23.25331962v1.full-text

Perturbation-based balance training improves reactive ...

This systematic review and meta-analysis revealed PBT reduced fall rates in older adults by 23% compared to control groups receiving standard ...

3.

sciencedirect.com

sciencedirect.com/science/article/abs/pii/S0268003323002097

A systematic review of perturbation-based balance training ...

The results indicated insufficient evidence supporting that perturbation-based balance training reduces falls in the laboratory and everyday living conditions ...

4.

eurapa.biomedcentral.com

eurapa.biomedcentral.com/articles/10.1186/s11556-025-00375-w

Dose–response relationship of treadmill perturbation-based ...

Perturbation-based balance training (PBT) is especially beneficial for improving reactive balance and shows high potential for fall prevention.

5.

bmjopen.bmj.com

bmjopen.bmj.com/content/14/8/e080550

Perturbation-based balance training of older adults and ...

This study showed that PBT, in the short term, improved choice stepping reaction time and dual-task gait speed among community-dwelling older adults.

6.

medrxiv.org

medrxiv.org/content/10.1101/2022.01.27.22269969v2.full-text

The effect of reactive balance training on falls in daily life

RBT reduces the rate of falls in daily life by almost half among people with increased fall risk, compared to other types of exercise or no intervention.

7.

frontiersin.org

frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2022.1015394/full

Perturbation-based balance training: Principles ...

Perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults.