Dose–response relationship of treadmill perturbation-based balance training for improving reactive balance in older adults at risk of falling: results of the FEATURE randomized controlled pilot trial
Abstract Background The inability to appropriately react to balance perturbations is a common cause of falls. Perturbation-based balance training (PBT) is especially beneficial for improving reactive balance and shows high potential for fall prevention. However, its dose–response relationship, feasi...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
|
| Series: | European Review of Aging and Physical Activity |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s11556-025-00375-w |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849726142943068160 |
|---|---|
| author | Natalie Hezel Theresa Buchner Clemens Becker Jürgen M. Bauer Lizeth H. Sloot Simon Steib Christian Werner |
| author_facet | Natalie Hezel Theresa Buchner Clemens Becker Jürgen M. Bauer Lizeth H. Sloot Simon Steib Christian Werner |
| author_sort | Natalie Hezel |
| collection | DOAJ |
| description | Abstract Background The inability to appropriately react to balance perturbations is a common cause of falls. Perturbation-based balance training (PBT) is especially beneficial for improving reactive balance and shows high potential for fall prevention. However, its dose–response relationship, feasibility, and acceptability remain to be determined among older adults at risk of falling. The FEATURE study aimed to compare the efficacy of two treadmill PBT protocols with different session numbers to improve reactive balance, and to evaluate their feasibility and acceptability in this population. Methods In this randomized controlled pilot trial, 36 older adults at risk of falling were allocated to receive either six (6PBT) or two treadmill PBT sessions (2PBT). Reactive balance in standing (Stepping Threshold Test [STT]) and walking (Dynamic Stepping Threshold Test [DSTT]) was assessed as primary outcome at baseline (T1), post-intervention (T2), and 6-week follow-up (T3). Secondary outcomes included measures on physical, psychological, and cognitive functioning. Feasibility was assessed via PBT adherence, planned perturbations completed, and adverse events; acceptability via questionnaire. Between-group changes over time were compared using repeated-measures analyses of variance with Bonferroni-corrected post-hoc tests. Data analyses followed the intention-to-treat principle. Results A significant time effect was observed for the DSTT (p = 0.008), with both groups significantly improving from T1 to T2 (ps < 0.01). A significant interaction effect (p = 0.027) revealed that only the 6PBT group maintained these improvements (T1 vs. T3: p < 0.001) and scored significantly higher than the 2PBT group at T3 (p = 0.015). No significant interaction effects were found for the STT or any secondary outcome, but improvements over time were observed for dynamic balance, gait capacity, functional mobility, physical activity, concerns about falling, and executive functioning (time effects: ps < 0.05). PBT adherence, planned perturbations completed, and acceptability were high in both groups, with no significant between-group differences. No intervention-related serious adverse events were reported. Conclusions Findings suggest that a low number of treadmill PBT sessions can lead to task-specific improvements in reactive balance during walking, with a higher practice dose enhancing sustainability. Treadmill PBT appears feasible and well-accepted among older adults at risk of falling, regardless of sessions received. Trial registration DRKS00030805 ; prospectively registered December 14, 2022. |
| format | Article |
| id | doaj-art-0edc54e4dc264084a4c69c4aed2cee20 |
| institution | DOAJ |
| issn | 1861-6909 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | European Review of Aging and Physical Activity |
| spelling | doaj-art-0edc54e4dc264084a4c69c4aed2cee202025-08-20T03:10:17ZengBMCEuropean Review of Aging and Physical Activity1861-69092025-05-0122111710.1186/s11556-025-00375-wDose–response relationship of treadmill perturbation-based balance training for improving reactive balance in older adults at risk of falling: results of the FEATURE randomized controlled pilot trialNatalie Hezel0Theresa Buchner1Clemens Becker2Jürgen M. Bauer3Lizeth H. Sloot4Simon Steib5Christian Werner6Geriatric Center, Medical Faculty Heidelberg, Heidelberg UniversityGeriatric Center, Medical Faculty Heidelberg, Heidelberg UniversityGeriatric Center, Medical Faculty Heidelberg, Heidelberg UniversityGeriatric Center, Medical Faculty Heidelberg, Heidelberg UniversityOptimization, Robotics, and Biomechanics, Institute of Computer Engineering, Heidelberg UniversityDepartment of Human Movement, Training and Active Aging, Institute of Sports and Sports Sciences, Heidelberg UniversityGeriatric Center, Medical Faculty Heidelberg, Heidelberg UniversityAbstract Background The inability to appropriately react to balance perturbations is a common cause of falls. Perturbation-based balance training (PBT) is especially beneficial for improving reactive balance and shows high potential for fall prevention. However, its dose–response relationship, feasibility, and acceptability remain to be determined among older adults at risk of falling. The FEATURE study aimed to compare the efficacy of two treadmill PBT protocols with different session numbers to improve reactive balance, and to evaluate their feasibility and acceptability in this population. Methods In this randomized controlled pilot trial, 36 older adults at risk of falling were allocated to receive either six (6PBT) or two treadmill PBT sessions (2PBT). Reactive balance in standing (Stepping Threshold Test [STT]) and walking (Dynamic Stepping Threshold Test [DSTT]) was assessed as primary outcome at baseline (T1), post-intervention (T2), and 6-week follow-up (T3). Secondary outcomes included measures on physical, psychological, and cognitive functioning. Feasibility was assessed via PBT adherence, planned perturbations completed, and adverse events; acceptability via questionnaire. Between-group changes over time were compared using repeated-measures analyses of variance with Bonferroni-corrected post-hoc tests. Data analyses followed the intention-to-treat principle. Results A significant time effect was observed for the DSTT (p = 0.008), with both groups significantly improving from T1 to T2 (ps < 0.01). A significant interaction effect (p = 0.027) revealed that only the 6PBT group maintained these improvements (T1 vs. T3: p < 0.001) and scored significantly higher than the 2PBT group at T3 (p = 0.015). No significant interaction effects were found for the STT or any secondary outcome, but improvements over time were observed for dynamic balance, gait capacity, functional mobility, physical activity, concerns about falling, and executive functioning (time effects: ps < 0.05). PBT adherence, planned perturbations completed, and acceptability were high in both groups, with no significant between-group differences. No intervention-related serious adverse events were reported. Conclusions Findings suggest that a low number of treadmill PBT sessions can lead to task-specific improvements in reactive balance during walking, with a higher practice dose enhancing sustainability. Treadmill PBT appears feasible and well-accepted among older adults at risk of falling, regardless of sessions received. Trial registration DRKS00030805 ; prospectively registered December 14, 2022.https://doi.org/10.1186/s11556-025-00375-wExerciseFallsPostural controlDose–response relationshipFrail older adultsPatient acceptance of health care |
| spellingShingle | Natalie Hezel Theresa Buchner Clemens Becker Jürgen M. Bauer Lizeth H. Sloot Simon Steib Christian Werner Dose–response relationship of treadmill perturbation-based balance training for improving reactive balance in older adults at risk of falling: results of the FEATURE randomized controlled pilot trial European Review of Aging and Physical Activity Exercise Falls Postural control Dose–response relationship Frail older adults Patient acceptance of health care |
| title | Dose–response relationship of treadmill perturbation-based balance training for improving reactive balance in older adults at risk of falling: results of the FEATURE randomized controlled pilot trial |
| title_full | Dose–response relationship of treadmill perturbation-based balance training for improving reactive balance in older adults at risk of falling: results of the FEATURE randomized controlled pilot trial |
| title_fullStr | Dose–response relationship of treadmill perturbation-based balance training for improving reactive balance in older adults at risk of falling: results of the FEATURE randomized controlled pilot trial |
| title_full_unstemmed | Dose–response relationship of treadmill perturbation-based balance training for improving reactive balance in older adults at risk of falling: results of the FEATURE randomized controlled pilot trial |
| title_short | Dose–response relationship of treadmill perturbation-based balance training for improving reactive balance in older adults at risk of falling: results of the FEATURE randomized controlled pilot trial |
| title_sort | dose response relationship of treadmill perturbation based balance training for improving reactive balance in older adults at risk of falling results of the feature randomized controlled pilot trial |
| topic | Exercise Falls Postural control Dose–response relationship Frail older adults Patient acceptance of health care |
| url | https://doi.org/10.1186/s11556-025-00375-w |
| work_keys_str_mv | AT nataliehezel doseresponserelationshipoftreadmillperturbationbasedbalancetrainingforimprovingreactivebalanceinolderadultsatriskoffallingresultsofthefeaturerandomizedcontrolledpilottrial AT theresabuchner doseresponserelationshipoftreadmillperturbationbasedbalancetrainingforimprovingreactivebalanceinolderadultsatriskoffallingresultsofthefeaturerandomizedcontrolledpilottrial AT clemensbecker doseresponserelationshipoftreadmillperturbationbasedbalancetrainingforimprovingreactivebalanceinolderadultsatriskoffallingresultsofthefeaturerandomizedcontrolledpilottrial AT jurgenmbauer doseresponserelationshipoftreadmillperturbationbasedbalancetrainingforimprovingreactivebalanceinolderadultsatriskoffallingresultsofthefeaturerandomizedcontrolledpilottrial AT lizethhsloot doseresponserelationshipoftreadmillperturbationbasedbalancetrainingforimprovingreactivebalanceinolderadultsatriskoffallingresultsofthefeaturerandomizedcontrolledpilottrial AT simonsteib doseresponserelationshipoftreadmillperturbationbasedbalancetrainingforimprovingreactivebalanceinolderadultsatriskoffallingresultsofthefeaturerandomizedcontrolledpilottrial AT christianwerner doseresponserelationshipoftreadmillperturbationbasedbalancetrainingforimprovingreactivebalanceinolderadultsatriskoffallingresultsofthefeaturerandomizedcontrolledpilottrial |