Feasibility of Treadmill Perturbation-Based Balance Training in Clinical Practice

Background: Perturbation-based balance training (PBT) is an emerging, task-specific approach to falls prevention in older adults and has shown promising results on preventing falls and improving (reactive) balance. However, its feasibility is insufficiently studied, as previous research often excluded clinical groups. This study aims to quantitatively assess whether PBT can be implemented in a heterogeneous population.

Methods: Participants from the ongoing iSeFallED study, which recruits older adults in the emergency department following a fall, were offered four PBT sessions on a perturbation treadmill: three sessions within two weeks and one follow-up session after six months. Each session lasted 45–60 minutes and included four perturbation blocks of 3:30 minutes, each comprising 16 perturbations of varying perturbation types and progressively increasing perturbation magnitudes.

Results: To date, 120 participants have been enrolled in the iSeFallED study. Of these 11 declined PBT, 12 withdrew before initiating PBT training, and 17 were excluded due to limited walking ability (n = 6), other physical constraints (n = 5), or other reasons. A comparison of baseline characteristics between participants who completed PBT (n = 57) and those who declined or were excluded (n =14), revealed that the latter were older (72.8 ± 8.6 vs. 79.3 ± 8.4 years) and more likely to use a walking aid in daily life (14% vs. 50%). Adverse events were reported in some cases, including mild hip or back pain (n = 10) and dizziness (n = 3).

Conclusions: Preliminary results indicate that PBT is feasible and well tolerated in a clinically heterogeneous population. However, insufficient walking capacity emerged as the primary barrier for successful participation. To improve accessibility for frail or high-risk individuals, preparatory gait training may be required. Ongoing recruitment and follow-up will provide further evidence on feasibility in this clinical context.