Reactive Balance Training for Accidental Falls

Overseen By David Jagroop

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: Toronto Rehabilitation Institute

Disqualifiers: Neurological conditions, Cognitive impairment, Osteoporosis, others

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

Compensation: Varies

Number of Visits: 6

Duration: 2 weeks

96 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

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

What data supports the effectiveness of the treatment Reactive Balance Training for reducing accidental falls?

Research shows that Reactive Balance Training (RBT) can help reduce the risk of falls in people with balance issues, including older adults and those recovering from a stroke. Studies found that RBT improves balance reactions and control, which are crucial for preventing falls in daily life. ^{1 2 3 4 5}

Is Reactive Balance Training safe for humans?

Reactive Balance Training (RBT) has been studied in various groups, including older adults and stroke survivors, and generally shows improvements in balance without serious adverse events reported. In a review of balance training, only one serious adverse event was noted, suggesting that RBT is generally safe for humans. ^{2 3 4 5 6}

How does Reactive Balance Training differ from other treatments for preventing falls?

Reactive Balance Training (RBT) is unique because it uses unexpected movements to challenge and improve balance, unlike traditional balance exercises that focus on static positions. This approach helps people better react to real-life situations like slips or trips, making it more effective for fall prevention. ^{3 4 5 7 8}

What is the purpose of this trial?

Falls in daily life are a serious risk for older adults. A new type of balance training, called reactive balance training (RBT) involves people losing balance many times so that they can practice fast balance reactions, like stepping reactions. Differences in training program features might explain differences in the results of previous RBT studies. Training intensity is the difficulty or challenge of the training program. It would be valuable to know if high-intensity RBT improves balance reactions quickly. The main goal of this study is to see if more intense RBT improves balance reactions faster than less intense RBT. The investigators will compare how quickly people improve balance reactions between high- and moderate-intensity RBT, and between RBT and a control program that does not include RBT. The investigators will also test if the improvements in balance reactions last after the training program is over. The secondary goals are to understand exactly how balance reactions improve with training, and to determine if people who complete RBT improve their general balance skills, and falls efficacy more than people who do not complete RBT.

Research Team

Avril Mansfield, PhD

Principal Investigator

University Health Network, Toronto

Eligibility Criteria

This trial is for community-dwelling older adults aged between 65 and 80 who are at risk of accidental falls. It aims to determine if high-intensity reactive balance training (RBT) can improve their balance reactions faster than moderate-intensity RBT or a control program without RBT.

Inclusion Criteria

I am between 65 and 80 years old and live in a community setting.

Exclusion Criteria

I can't stand by myself for 30 seconds or walk 10 meters without help.

I cannot do balance training due to severe bone loss.

Score below normative values on the Montreal Cognitive Assessment

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo reactive balance training (RBT) with either moderate or high intensity, or participate in a walking control group. Each participant completes 5 1-hour training sessions over 11 days.

2 weeks

5 visits (in-person)

Follow-up

Participants are monitored for improvements in balance reactions and other secondary outcomes post-training.

12 months

Multiple visits (in-person and virtual) at 1 week, 12 weeks, and 12 months post-training

Treatment Details

Interventions

• Reactive Balance Training

Trial Overview The study tests the effectiveness of different intensities of reactive balance training on improving quick balance reactions in older adults. Participants will be divided into groups receiving either high- or moderate-intensity RBT, or a control walking program, to compare improvements in balance and fall prevention skills.

Participant Groups

Group I: High intensity reactive balance training Experimental Treatment 1 Intervention

Participants will complete 5 1-hour training sessions over 11 days. During each training session, participants will complete 36 multi-directional (left-, right-, and forward-fall) perturbations. Participants assigned to high-intensity RBT will experience perturbations at 150% of the multi-step threshold; for example, for a multi-step threshold of 2 m/s\^2 the high intensity perturbation will be 3 m/s\^2.

Group II: Moderate intensity reactive balance training Active Control 1 Intervention

Participants will complete 5 1-hour training sessions over 11 days. During each training session, participants will complete 36 multi-directional (left-, right-, and forward-fall) perturbations. Participants assigned to moderate-intensity RBT will experience perturbations at 100% of the multi-step threshold; for example, for a multi-step threshold of 2 m/s\^2 the high intensity perturbation will be 2 m/s\^2.

Group III: Walking control group Placebo Group 1 Intervention

Participants assigned to the walking control group will complete 36 trials of unperturbed walking in each training session.

Who Is Running the Clinical Trial?

Toronto Rehabilitation Institute

Lead Sponsor

Trials

55

Recruited

6,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Findings from Research

Physiotherapists recognize the importance of measuring reactive balance for preventing falls and improving mobility, but their willingness to integrate this measurement into practice is influenced by factors such as patient characteristics, trust in the therapist-patient relationship, and the therapists' own fears.

To improve the assessment of reactive balance in rehabilitation, strategies should focus on building trust between physiotherapists and patients, addressing therapists' fears, and refining patient criteria for measurement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring factors influencing physiotherapists' perceptions of measuring reactive balance following a theory-based multi-component intervention: a qualitative descriptive study. Sibley, KM., Gardner, P., Bentley, DC., et al.[2022]

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]

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]

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 improved balance reaction impairments in individuals with sub-acute stroke, showing better outcomes in foot-off times and reduced reliance on preferred limb stepping compared to traditional balance training.

The study demonstrated that RBT not only led to immediate improvements post-intervention but also maintained these benefits at a 6-month follow-up, supporting its effectiveness in inpatient rehabilitation settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improvements in balance reaction impairments following reactive balance training in individuals with sub-acute stroke: A prospective cohort study with historical control. Schinkel-Ivy, A., Huntley, AH., Danells, CJ., et al.[2021]

Balance and functional strength training, including Tai Chi, significantly reduced the rate of falls and improved physical functioning in adults aged 65 and older, based on an overview of 5 systematic reviews involving 15,890 participants.

The training showed potential benefits for health-related quality of life, but the evidence was uncertain regarding falls requiring hospitalization, and only one serious adverse event was reported, indicating a generally safe intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Balance and functional training and health in adults: an overview of systematic reviews. McLaughlin, EC., El-Kotob, R., Chaput, JP., 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) showed greater effectiveness than conventional balance training (CBT) in improving postural control and reducing fall risk, particularly during stance perturbations, as evidenced by larger effect sizes in muscle activity and joint stabilization.

Both training methods enhanced neuromuscular timing and reflex activity in leg muscles, but RBT specifically improved stabilization strategies more effectively, suggesting it may be a superior approach for fall prevention across different age groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuromuscular and Kinematic Adaptation in Response to Reactive Balance Training - a Randomized Controlled Study Regarding Fall Prevention. Krause, A., Freyler, K., Gollhofer, A., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Exploring factors influencing physiotherapists' perceptions of measuring reactive balance following a theory-based multi-component intervention: a qualitative descriptive study. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Determining the optimal dose of reactive balance training after stroke: study protocol for a pilot randomised controlled trial. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

The Effect of Reactive Balance Training on Falls in Daily Life: An Updated Systematic Review and Meta-Analysis. [2023]

4. United States 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. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Improvements in balance reaction impairments following reactive balance training in individuals with sub-acute stroke: A prospective cohort study with historical control. [2021]

6. Canada pubmed.ncbi.nlm.nih.gov

Balance and functional training and health in adults: an overview of systematic reviews. [2021]

7. United States 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. [2020]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Neuromuscular and Kinematic Adaptation in Response to Reactive Balance Training - a Randomized Controlled Study Regarding Fall Prevention. [2022]