Perturbation-Based Balance Training Using Repeated Trips on a Walkway vs. Belt Accelerations on a Treadmill: A Cross-Over Randomised Controlled Trial in Community-Dwelling Older Adults.

Patrick Y. H. Song,Daina L. Sturnieks,Yoshiro Okubo,Michael K. Davis,Stephen R. Lord

doi:10.3389/fspor.2021.702320

Abstract

Background: Walkway and treadmill induced trips have contrasting advantages, for instance walkway trips have high-ecological validity whereas belt accelerations on a treadmill have high-clinical feasibility for perturbation-based balance training (PBT). This study aimed to (i) compare adaptations to repeated overground trips with repeated treadmill belt accelerations in older adults and (ii) determine if adaptations to repeated treadmill belt accelerations can transfer to an actual trip on the walkway.Method: Thirty-eight healthy community-dwelling older adults underwent one session each of walkway and treadmill PBT in a randomised crossover design on a single day. For both conditions, 11 trips were induced to either leg in pseudo-random locations interspersed with 20 normal walking trials. Dynamic balance (e.g., margin of stability) and gait (e.g., step length) parameters from 3D motion capture were used to examine adaptations in the walkway and treadmill PBT and transfer of adaptation from treadmill PBT to a walkway trip.Results: No changes were observed in normal (no-trip) gait parameters in both training conditions, except for a small (0.9 cm) increase in minimum toe elevation during walkway walks (P < 0.01). An increase in the margin of stability and recovery step length was observed during walkway PBT (P < 0.05). During treadmill PBT, an increased MoS, step length and decreased trunk sway range were observed (P < 0.05). These adaptations to treadmill PBT did not transfer to a walkway trip.Conclusions: This study demonstrated that older adults could learn to improve dynamic stability by repeated exposure to walkway trips as well as treadmill belt accelerations. However, the adaptations to treadmill belt accelerations did not transfer to an actual trip. To enhance the utility of treadmill PBT for overground trip recovery performance, further development of treadmill PBT protocols is recommended to improve ecological authenticity.

Highlights

Falls in older people are a major health issue associated with significant morbidity, mortality (James et al, 2020), and economic burden (Davis et al, 2010)
The treadmill perturbation-based balance training (PBT) resulted in improved margin of stability (MoS), XCoM, step length, and less trunk sway following a belt acceleration, but contrary to our second hypothesis, treadmill PBT did not transfer to better recovery to a first trip on the walkway
Adaptations to PBT Using Trips on a Walkway. This trial demonstrated that older adults could improve their balance recovery following walkway trips

Summary

Introduction

Falls in older people are a major health issue associated with significant morbidity, mortality (James et al, 2020), and economic burden (Davis et al, 2010). It has been suggested that the effects of conventional balance exercise are limited due to a lack of “task-specificity” to the balance recovery responses required to prevent falls (Grabiner et al, 2014). This has led to the development of perturbation-based balance training (PBT) which is a task-specific intervention exposing participants to repeated unexpected perturbations to improve reactive balance control (Mansfield et al, 2015; Gerards et al, 2017). This study aimed to (i) compare adaptations to repeated overground trips with repeated treadmill belt accelerations in older adults and (ii) determine if adaptations to repeated treadmill belt accelerations can transfer to an actual trip on the walkway

Objectives

Methods

Results

Discussion

Conclusion