Abstract
BackgroundPrevious research investigating exercise as a means of falls prevention in older adults has shown mixed results. Lack of specificity of the intervention may be an important factor contributing to negative results. Change-in-support (CIS) balance reactions, which involve very rapid stepping or grasping movements of the limbs, play a critical role in preventing falls; hence, a training program that improves ability to execute effective CIS reactions could potentially have a profound effect in reducing risk of falling. This paper describes: 1) the development of a perturbation-based balance training program that targets specific previously-reported age-related impairments in CIS reactions, and 2) a study protocol to evaluate the efficacy of this new training program.Methods/DesignThe training program involves use of unpredictable, multi-directional moving-platform perturbations to evoke stepping and grasping reactions. Perturbation magnitude is gradually increased over the course of the 6-week program, and concurrent cognitive and movement tasks are included during later sessions. The program was developed in accordance with well-established principles of motor learning, such as individualisation, specificity, overload, adaptation-progression and variability. Specific goals are to reduce the frequency of multiple-step responses, reduce the frequency of collisions between the stepping foot and stance leg, and increase the speed of grasping reactions. A randomised control trial will be performed to evaluate the efficacy of the training program. A total of 30 community-dwelling older adults (age 64–80) with a recent history of instability or falling will be assigned to either the perturbation-based training or a control group (flexibility/relaxation training), using a stratified randomisation that controls for gender, age and baseline stepping/grasping performance. CIS reactions will be tested immediately before and after the six weeks of training, using platform perturbations as well as a distinctly different method of perturbation (waist pulls) in order to evaluate the generalisability of the training effects.DiscussionThis study will determine whether perturbation-based balance training can help to reverse specific age-related impairments in balance-recovery reactions. These results will help to guide the development of more effective falls prevention programs, which may ultimately lead to reduced health-care costs and enhanced mobility, independence and quality of life.
Highlights
Previous research investigating exercise as a means of falls prevention in older adults has shown mixed results
Change-in-support balance reactions, which involve very rapid limb movements, play a critical role in responding to balance perturbations. These compensatory stepping and grasping reactions are the only line of defence against large perturbations, but are frequently recruited at lower magnitudes of perturbation [20,21]
The objective of the present study is to develop and test a perturbation-based balance-training program to counter specific, previously-reported age-related impairments in change-in-support stepping and grasping reactions
Summary
Previous research investigating exercise as a means of falls prevention in older adults has shown mixed results. Exercise programs that include a balance-training component have tended to be most effective [2], no previous studies have targeted specific aspects of balance-recovery reactions This lack of specificity may explain, in part, the failure to demonstrate a more pronounced reduction in fall rates. It is important for fall-prevention interventions to include a focus on balance-recovery reactions, because it is the ability, or inability, to respond effectively to a balance perturbation ('loss of balance') that determines whether or not a fall occurs. Change-in-support balance reactions, which involve very rapid limb movements (stepping, or reaching to grasp an object for support), play a critical role in responding to balance perturbations (for recent reviews, see [16,17,18,19]). These compensatory stepping and grasping reactions are the only line of defence against large perturbations, but are frequently recruited at lower magnitudes of perturbation (provided that subjects are permitted to react naturally, i.e. with no instructional or physical constraints on limb movement) [20,21]
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