Reactive Balance Training for Stroke

Overseen By Azadeh Barzideh, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Toronto Rehabilitation Institute

Disqualifiers: Parkinson's, Amputation, Cognitive impairments, others

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

Compensation: Varies

Number of Visits: Unknown

Duration: 8 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether Reactive Balance Training (RBT) can enhance aerobic capacity and strength in individuals who have experienced a stroke. RBT is an exercise that prevents falls by improving balance through quick, whole-body movements. It may also offer benefits similar to traditional aerobic and strength exercises. The trial compares RBT to a program focused on aerobic and strength training (AST) to determine which is more effective. This trial may suit individuals who had a stroke over six months ago, can stand independently for more than 30 seconds, and can manage brief balance challenges while wearing a safety harness. As an unphased trial, this study provides a unique opportunity to contribute to innovative research that could improve post-stroke recovery strategies.

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. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that Reactive Balance Training is safe for people with stroke?

Research shows that reactive balance training (RBT) can help stroke survivors improve their ability to step and catch themselves if they start to fall. Other studies suggest that RBT can lower the risk of falling by enhancing this quick stepping response. However, there isn't enough evidence yet to confirm its effectiveness in reducing falls in everyday life.

Researchers are testing RBT because it involves full-body movement, which might improve both balance and strength, similar to exercises like brisk walking or lifting weights. Since the mid-2000s, RBT has been considered safe for preventing falls, especially in older adults. Although specific safety details from these studies are limited, its growing popularity suggests it is generally well-tolerated.

For any concerns, discussing them with the study team or a healthcare provider is advisable. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Reactive Balance Training for stroke recovery because it focuses on enhancing patients' ability to regain balance in real-life scenarios, which is often a major challenge post-stroke. Unlike traditional stroke rehabilitation, which typically emphasizes general aerobic and strength training, this approach aims to improve the body's automatic responses to prevent falls. By simulating unexpected balance disturbances, this method may help patients develop the reflexes needed to maintain stability in everyday situations, potentially leading to improved mobility and independence.

What evidence suggests that Reactive Balance Training is effective for improving fitness in stroke patients?

Research has shown that reactive balance training (RBT), one of the treatments studied in this trial, might help stroke survivors improve their balance. Some studies suggest that RBT can lower the risk of falls by enhancing the body's response when balance is lost. While evidence indicates that RBT can improve balance, its effect on boosting confidence in maintaining balance remains less clear. The training involves full-body movement, which might also enhance fitness and muscle strength, similar to brisk walking. Participants who have repeatedly engaged in RBT have demonstrated better balance. Overall, RBT appears promising for improving balance and might also aid in fitness and strength. Another treatment arm in this trial involves aerobic and strength training, serving as an active comparator. ^{1 2 3 6 7}

Who Is on the Research Team?

Avril Mansfield, PhD

Principal Investigator

University Health Network, Toronto

Are You a Good Fit for This Trial?

This trial is for community-dwelling adults who had a stroke more than 6 months ago, can stand without support for over 30 seconds, and handle multiple balance disturbances with a safety harness. It's not for those meeting current exercise guidelines, with lower limb amputations, severe cognitive issues, ongoing physiotherapy including aerobic or strength training, contraindications to exercise testing like unstable angina or significant arrhythmias, recent injuries that could worsen with exercise, previous perturbation training within the year, too tall/heavy for the harness system (>2.1m/150kg), other neurological conditions affecting balance like Parkinson's disease.

Inclusion Criteria

I can stand on my own for more than 30 seconds without using my arms for support.

I can handle sudden movements while secured in a safety harness.

I had a stroke more than 6 months ago and live at home.

Exclusion Criteria

I don't have conditions that make exercise testing unsafe for me.

I am taller than 2.1 meters and/or weigh more than 150 kilograms.

I am currently in a physiotherapy program that includes exercises for my legs.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo Reactive Balance Training (RBT) or Aerobic and Strength Training (AST) to improve aerobic capacity and strength

8 weeks

Weekly sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 months

Fortnightly postcard submissions and follow-up calls

What Are the Treatments Tested in This Trial?

Interventions

• Aerobic and Strength Training (AST)
• Reactive Balance Training

Trial Overview The study compares 'Reactive Balance Training' (RBT) which may improve both aerobic capacity and strength due to its whole-body movements against traditional Aerobic and Strength Training (AST). The goal is to see if RBT can match AST in improving fitness components while also enhancing balance control and confidence better than AST among people who have had a stroke.

How Is the Trial Designed?

Group I: Reactive balance training Experimental Treatment 1 Intervention

Group II: Aerobic and strength training Active Control 1 Intervention

Who Is Running the Clinical Trial?

Toronto Rehabilitation Institute

Lead Sponsor

Trials

55

Recruited

6,000+

University of Toronto

Collaborator

Trials

739

Recruited

1,125,000+

Heart and Stroke Foundation of Canada

Collaborator

Trials

131

Recruited

72,600+

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06555016

Optimal Intensity of Reactive Balance Training Post-stroke A new type of balance training, called reactive balance training (RBT). may help to reduce this risk of falling. In some previous studies participants improved ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9329815/

A Systematic Review and Meta-Analysis - PMC PBT may improve balance in patients with stroke, however its effect on balance confidence was limited. The quality of the evidence was low or very low.

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. medrxiv.org medrxiv.org/content/10.1101/2025.07.24.25332137v1.full.pdf

Optimal reactive balance training characteristics post-stroke In this context, the present study aimed to examine the relationship between the characteristics of RBT and improvements in reactive balance ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10875131/

Advances in balance training to prevent falls in stroke ... Reactive balance training (RBT) is a novel exercise designed to improve reactive balance control, its effect in reducing falls has been ...

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

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

7. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0327937

Investigating the optimal reactive balance training intensity in ... The risk of falls may be mitigated using reactive balance training (RBT) which has been shown to effectively reduce fall risk by enhancing reactive stepping ...