Abstract
The ability to effectively execute compensatory steps is critical for preventing accidental falls, and consequently stepping training is an essential ingredient of fall prevention programs. In this paper, we propose a concept for stepping training that aims to maximize training effects by taking into account recent research evidence and a precise dosing of training ingredients. The concept addresses motor as well as cognitive falls-related aspects, it is suitable for individual as well as group based training, and it does not require costly equipment. Theory and evidence behind all of the training principles is reviewed, and an example of an exercise protocol is described in detail. Participants are presented with stepping patterns which they have to memorize and implement on a mat. In order to enable investigation of dose-response effects, the difficulty level systematically and gradually increases session by session based on four principles: execution speed, pattern complexity, pattern length and execution in dual-/multi-tasking conditions. The presented concept can be used as a framework for the development of further prevention and/or rehabilitation stepping exercise programs. Further studies using this exercise regimen or modified versions of it are encouraged.
Highlights
In order to release older adults and healthcare systems from the burden of accidental falls, it is important to timely detect fall risk factors and develop effective interventions for falls prevention
Accidental falls in older adults can be frequently attributed to the inability to step precisely on the ground and to incorrect weight-transferring during everyday activities such as walking [2, 3] or in situations that require a simultaneous performance of several tasks [4]
Balance exercise programs often focus on standing balance tasks, where the center of mass has to be statically controlled over the base of support
Summary
In order to release older adults and healthcare systems from the burden of accidental falls, it is important to timely detect fall risk factors and develop effective interventions for falls prevention. The last way to increase the difficulty level is the progress from single-task (only reproducing the stepping patterns) in week 1–3, to dual tasking in week 4–6, when participants will have to conduct an additional motor (e.g., balance an object on their hands, clap hands front and behind their backs, browsing magazines, unbutton their shirt, hold ball above their heads/behind their backs etc.) or cognitive task (targeting two executive functions: verbal fluency (naming words associated with certain given words, naming objects, animals, vegetables, professions that start or end with a certain letter etc.) and memory/concentration (counting onwards, serial sevens, serial threes, spelling words backwards etc.) while executing the stepping pattern.
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