A pilot study of reactive balance training using trips and slips with increasing unpredictability in young and older adults: Biomechanical mechanisms, falls and clinical feasibility.

BACKGROUND

Exposure to unpredictable trips and slips can improve balance recovery responses but it was not known if older adults can tolerate such high intensity training. The study aim was to determine if reactive balance in both young and older adults could be trained in a single day through exposure to slip and trip hazards hidden in unpredictable walkway locations.

METHODS

Ten young (20-40 yr) and ten older adults (65 + yr) completed 32 trials on a 10-meter trip and slip walkway; 14 slip trials, 14 trip trials and 4 no-perturbation trials presented in a pseudo-random order. Participant usual gait speed was regulated using a metronome and stepping tiles at fixed distances. Gait kinematics (Vicon motion capture), falls (> 30% body weight into the harness), anxiety and confidence to avoid falling were assessed.

FINDINGS

Margin of stability for balance recovery after slips substantially improved at training completion for older adults (effect size = 1.13, P = 0.019). Falls from slips also decreased: 44.4% to 0% in the young adults; and 28.6% to 14.3% in the older adults. Although confidence to avoid falling did not change, anxiety increased during training with one young and three older participants withdrawing during training.

INTERPRETATIONS

The findings indicate exposure to unpredictable perturbations improves reactive balance in young and older adults. However, improvements of balance recovery from trips were not significant. Elevated anxiety levels and a high dropout rate suggest the need for more individualised training over multiple days.