Effect of Treadmill Perturbation-Based Balance Training on Fall Rates in Community-Dwelling Older Adults : A Randomized Clinical Trial

Abstract

This randomized clinical trial evaluates the effect of a perturbation-based balance training treadmill intervention vs standard treadmill walking on 12-month fall rates among community-dwelling older adults.

Key Points

Question

Does treadmill perturbation-based balance training (PBT) reduce daily-life fall rates among community-dwelling adults 65 years or older?

Findings

In this randomized clinical trial involving 140 highly functioning older adults, those who received an 4-session PBT intervention (totaling 80 minutes) experienced a statistically nonsignificant 22% reduction in daily-life fall rates over a 12-month period.

Meaning

Findings of this trial suggest the need for future studies to investigate possible effects of current treadmill PBT on daily-life falls.

Abstract

Importance

Falls are common and the leading cause of injuries among older adults, but falls may be attenuated by the promising and time-efficient intervention called perturbation-based balance training (PBT).

Objective

To evaluate the effects of a 4-session treadmill PBT intervention compared with regular treadmill walking on daily-life fall rates among community-dwelling older adults.

Design, Setting, and Participants

This 12-month, assessor-blinded randomized clinical trial was conducted from March 2021 through December 2022 in Aalborg University in Denmark. Participants were community-dwelling adults 65 years or older and were able to walk without a walking aid. Participants were randomized to either PBT (intervention group) or treadmill walking (control group). Data analyses were based on the intention-to-treat principle.

Interventions

Participants who were randomized to the intervention group underwent four 20-minute sessions of PBT, including 40 slip, trip, or mixed slip and trip perturbations. Participants who were randomized to the control group performed four 20-minute sessions of treadmill walking at their preferred speed. The 3 initial training sessions were completed within the first week, whereas the fourth session was performed after 6 months.

Main Outcomes and Measures

Primary outcome was the daily-life fall rates that were collected from fall calendars for the 12 months after the third training session. Secondary outcomes were the proportion of participants with at least 1 fall and recurrent falls, time to first fall, fall-related fractures, fall-related injuries, fall-related health care contacts, and daily-life slip and trip falls.

Results

A total of 140 highly functioning, community-dwelling older adults (mean [SD] age, 72 [5] years; 79 females [56%]), 57 (41%) of whom had a fall in the past 12 months, were included in this trial. Perturbation training had no significant effect on daily-life fall rate (incidence rate ratio [IRR]: 0.78; 95% CI, 0.48-1.27) or other fall-related metrics. However, there was a significant reduction in laboratory fall rates at the posttraining assessment (IRR, 0.20; 95% CI, 0.10-0.41), 6-month follow-up (IRR, 0.47; 95% CI, 0.26-0.86), and 12-month follow-up (IRR, 0.37; 95% CI, 0.19-0.72).

Conclusions and Relevance

Results of this trial showed that participants who received an 80-minute PBT intervention experienced a statistically nonsignificant 22% reduction in daily-life fall rates. There was no significant effect on other daily-life fall-related metrics; however, a statistically significant decrease in falls was found in the laboratory setting.

Trial Registration

ClinicalTrials.gov Identifier: NCT04733222