Perturbation Training for Alzheimer's Disease

(STAD Trial)

Overseen By Feng Yang, PhD

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: Georgia State University

Disqualifiers: Hypotension, Hypertension, Osteoporosis, others

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

Compensation: Varies

Number of Visits: 2

30 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how people with Alzheimer's disease can learn skills to prevent falls through perturbation training, a balance training method. The goal is to determine if this training improves balance and reduces the risk of falls. Participants will either receive the training on a treadmill or walk on the treadmill without the training. The trial seeks individuals who are 65 or older, have a clinical diagnosis of Alzheimer's, and can walk and stand on their own for short distances. As an unphased trial, this study offers participants the chance to contribute to innovative research that could enhance fall prevention strategies for Alzheimer's patients.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that perturbation training is safe for people with Alzheimer's disease?

Research has shown that balance training, involving controlled movements to enhance stability, is generally safe and well-tolerated. It has helped older adults and individuals with conditions like Parkinson's disease reduce their risk of falling. In these studies, participants did not report major side effects; instead, they often experienced improved balance and fewer falls. The training typically involves practicing balance on a special treadmill, which remains safe, particularly with a safety harness to prevent falls during exercises. Although limited data exists for people with Alzheimer's disease, the positive results in similar groups suggest it is a promising and safe option. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about perturbation training for Alzheimer's disease because it offers a novel approach to improving balance and reducing fall risk, which are significant concerns for patients. Unlike traditional treatments that often focus on medication to manage cognitive symptoms, this method uses a single session of dynamic treadmill exercises to physically challenge and potentially enhance the body's ability to maintain stability. This technique is unique as it emphasizes physical rehabilitation through a safe, harnessed environment, aiming to directly address motor function and safety in daily activities. By potentially improving physical resilience with just one session, this could represent a practical and effective complement to existing Alzheimer's care strategies.

What evidence suggests that perturbation training is effective for Alzheimer's disease?

Research shows that perturbation training, a type of exercise, can help reduce falls in older adults. Studies have found that this training lowers fall rates by 23%. It is particularly beneficial for individuals with conditions like Parkinson's disease and stroke. The training enhances how people react when they begin to lose balance, which is crucial for fall prevention. In this trial, one group will receive perturbation training to evaluate its potential benefits for individuals with Alzheimer's disease. Although Alzheimer's differs, the success of this training in similar conditions suggests it might be helpful here too. ^{1 2 3 6 7}

Who Is on the Research Team?

Feng Yang, PhD

Principal Investigator

Georgia State University

Are You a Good Fit for This Trial?

This trial is for English-speaking individuals aged 65 or older with probable Alzheimer's Disease who can walk and stand independently. They must have certain scores on cognitive tests indicating moderate impairment but cannot have had perturbation training before, osteoporosis, other major psychiatric or neurological conditions, injuries, or uncontrolled blood pressure issues.

Inclusion Criteria

I can stand on my own for at least 30 seconds.

I can walk by myself for at least 25 feet.

Participants can read and understand English

Exclusion Criteria

I have a psychiatric or neurological condition.

I have very low or uncontrolled high blood pressure.

You have never received perturbation training.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Participants receive a single-session perturbation training treatment on a treadmill under the protection of a safety harness

1 session

1 visit (in-person)

Control

Control group undergoes harnessed walking on the treadmill without perturbation training

1 session

1 visit (in-person)

Follow-up

Participants are monitored for fall incidents and skill retention over six months

6 months

Periodic assessments (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Perturbation training

Trial Overview The study is testing the effectiveness of perturbation training in teaching people with Alzheimer's Disease how to resist falls better. Perturbation training involves controlled exposure to disturbances that challenge balance.

How Is the Trial Designed?

Group I: Training group Experimental Treatment 1 Intervention

This arm will receive a single-session perturbation training treatment on a treadmill under the protection of a safety harness.

Group II: Control group Placebo Group 1 Intervention

This arm will not receive perturbation training but will go through harnessed walking on the same treadmill for the same time as the other group.

Who Is Running the Clinical Trial?

Georgia State University

Lead Sponsor

Trials

71

Recruited

33,600+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

Alzheimer's Association

Collaborator

Trials

103

Recruited

44,300+

Published Research Related to This Trial

Perturbation-based balance training is emerging as a promising method for preventing falls in older adults, focusing on task-specific training that may lead to better adaptation and retention of balance skills.

While the approach shows potential efficacy, further research is needed to address safety concerns and practical implementation issues before it can be widely adopted in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. McCrum, C., Bhatt, TS., Gerards, MHG., et al.[2023]

Perturbation treadmill training (PTT) significantly improved reactive balance in individuals with Parkinson's disease, with a responder rate of 44% compared to only 10% for conventional treadmill training (CTT).

PTT was particularly effective for participants with lower initial balance and cognitive function, suggesting that this training method may be more beneficial for those at a more advanced stage of Parkinson's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Interindividual Balance Adaptations in Response to Perturbation Treadmill Training in Persons With Parkinson Disease. Klamroth, S., Gaßner, H., Winkler, J., et al.[2020]

In a study involving 45 older adults, increasing the practice dosage of treadmill slip-perturbation training to 40 repetitions did not lead to a significant reduction in falls or balance loss compared to a lower dosage of 24 repetitions.

The findings suggest that there is no clear dose-response relationship for practice dosage in slip-perturbation training, indicating that more repetitions beyond a certain threshold may not enhance the effectiveness of training for preventing falls in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can higher training practice dosage with treadmill slip-perturbation necessarily reduce risk of falls following overground slip? Lee, A., Bhatt, T., Liu, X., et al.[2021]

The study aims to evaluate whether perturbation-based balance training can effectively reduce fall occurrences in individuals with chronic stroke, addressing a significant post-stroke complication.

Participants will undergo training twice a week for 6 weeks, with follow-up assessments on falls and balance confidence over 12 months, potentially leading to improved mobility and daily activity engagement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perturbation training to promote safe independent mobility post-stroke: study protocol for a randomized controlled trial. Mansfield, A., Aqui, A., Centen, A., et al.[2019]

A review of nine studies involving 364 participants found insufficient evidence that perturbation-based balance training effectively reduces falls in individuals with stroke.

The training protocols varied widely among studies, leading to inconsistent results regarding the impact of this training on common fall risk factors, highlighting the need for more high-quality research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of perturbation-based balance training on reducing fall risk among individuals with stroke. Brown, D., Simpkins, C., Yang, F.[2023]

A short-term perturbation-based balance training (PBBT) program significantly improved reactive balance responses in stroke patients, as evidenced by higher multiple-step thresholds compared to a weight shifting and gait training group, with effect sizes of 1.07 and 1.10 for forward and backward translations, respectively.

Participants in the PBBT group also reported increased balance confidence, indicated by a moderate effect size of 0.74 on the Activity-specific Balance Confidence scale, highlighting the potential of PBBT in enhancing both physical and psychological aspects of balance in rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Perturbation-Based Balance Training in Subacute Persons With Stroke: A Randomized Controlled Trial. Handelzalts, S., Kenner-Furman, M., Gray, G., et al.[2019]

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]

Perturbation-based balance training (PBT) has shown significant reductions in falls incidence among healthy older adults and certain high-risk groups, such as those with Parkinson's disease and stroke, indicating its effectiveness in improving balance control.

PBT, particularly when using treadmill-based systems and therapist-applied perturbations, is a feasible intervention in clinical settings that may benefit frail older adults, although further controlled studies with long-term follow-up are needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perturbation-based balance training for falls reduction among older adults: Current evidence and implications for clinical practice. Gerards, MHG., McCrum, C., Mansfield, A., et al.[2023]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9583884/

Perturbation-based balance training: Principles, mechanisms ... Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults.

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

Perturbation-based balance training improves reactive ... Meta-analyses showed that PBT significantly reduced: fall rate by 23% (rate ratio 0.77, 95% CI [confidence interval]: 0.60–0.99, I2=57%, low ...

3. physio-pedia.com physio-pedia.com/Perturbation-Based_Balance_Training

Perturbation-Based Balance Training PBT has shown significant reductions in falls in older adults and in those with specific disorders eg Parkinson's disease or stroke compared to various control ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC1903355/

A perturbation-based balance training program for older adults This study will determine whether perturbation-based balance training can help to reverse specific age-related impairments in balance-recovery reactions.

5. withpower.com withpower.com/trial/phase-alzheimer-disease-3-2022-00af4

Perturbation Training for Alzheimer's Disease (STAD Trial) Research shows that perturbation-based balance training (PBT) can significantly reduce falls in older adults and people with conditions like Parkinson's disease ...

6. bmcgeriatr.biomedcentral.com bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-7-12

A perturbation-based balance training program for older adults This study will determine whether perturbation-based balance training can help to reverse specific age-related impairments in balance-recovery reactions.

7. mdpi.com mdpi.com/2077-0383/13/19/5790

Impact of Reactive Balance Training on a Perturbation ... A relatively short training period of approximately 90 min on a perturbation treadmill led to a significant and clinically meaningful increase in the physical ...