Hezel Natalie, Buchner Theresa, Becker Clemens, Bauer Jürgen M, Sloot Lizeth H, Steib Simon, Werner Christian
Geriatric Center, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
Optimization, Robotics, and Biomechanics, Institute of Computer Engineering, Heidelberg University, Heidelberg, Germany.
Eur Rev Aging Phys Act. 2025 May 16;22(1):8. doi: 10.1186/s11556-025-00375-w.
The inability to appropriately react to balance perturbations is a common cause of falls. Perturbation-based balance training (PBT) is especially beneficial for improving reactive balance and shows high potential for fall prevention. However, its dose-response relationship, feasibility, and acceptability remain to be determined among older adults at risk of falling. The FEATURE study aimed to compare the efficacy of two treadmill PBT protocols with different session numbers to improve reactive balance, and to evaluate their feasibility and acceptability in this population.
In this randomized controlled pilot trial, 36 older adults at risk of falling were allocated to receive either six (6PBT) or two treadmill PBT sessions (2PBT). Reactive balance in standing (Stepping Threshold Test [STT]) and walking (Dynamic Stepping Threshold Test [DSTT]) was assessed as primary outcome at baseline (T1), post-intervention (T2), and 6-week follow-up (T3). Secondary outcomes included measures on physical, psychological, and cognitive functioning. Feasibility was assessed via PBT adherence, planned perturbations completed, and adverse events; acceptability via questionnaire. Between-group changes over time were compared using repeated-measures analyses of variance with Bonferroni-corrected post-hoc tests. Data analyses followed the intention-to-treat principle.
A significant time effect was observed for the DSTT (p = 0.008), with both groups significantly improving from T1 to T2 (ps < 0.01). A significant interaction effect (p = 0.027) revealed that only the 6PBT group maintained these improvements (T1 vs. T3: p < 0.001) and scored significantly higher than the 2PBT group at T3 (p = 0.015). No significant interaction effects were found for the STT or any secondary outcome, but improvements over time were observed for dynamic balance, gait capacity, functional mobility, physical activity, concerns about falling, and executive functioning (time effects: ps < 0.05). PBT adherence, planned perturbations completed, and acceptability were high in both groups, with no significant between-group differences. No intervention-related serious adverse events were reported.
Findings suggest that a low number of treadmill PBT sessions can lead to task-specific improvements in reactive balance during walking, with a higher practice dose enhancing sustainability. Treadmill PBT appears feasible and well-accepted among older adults at risk of falling, regardless of sessions received.
DRKS00030805 ; prospectively registered December 14, 2022.
无法对平衡扰动做出适当反应是跌倒的常见原因。基于扰动的平衡训练（PBT）对改善反应性平衡特别有益，并且在预防跌倒方面显示出很高的潜力。然而，在有跌倒风险的老年人中，其剂量反应关系、可行性和可接受性仍有待确定。FEATURE研究旨在比较两种不同训练次数的跑步机PBT方案在改善反应性平衡方面的疗效，并评估其在该人群中的可行性和可接受性。
在这项随机对照试验中，36名有跌倒风险的老年人被分配接受六次（6PBT）或两次跑步机PBT训练（2PBT）。在基线（T1）、干预后（T2）和6周随访（T3）时，将站立（步幅阈值测试[STT]）和行走（动态步幅阈值测试[DSTT]）时的反应性平衡作为主要结局进行评估。次要结局包括身体、心理和认知功能的测量。通过PBT依从性、完成的计划扰动和不良事件评估可行性；通过问卷调查评估可接受性。使用重复测量方差分析和Bonferroni校正的事后检验比较组间随时间的变化。数据分析遵循意向性分析原则。
观察到DSTT有显著的时间效应（p = 0.008），两组从T1到T2均有显著改善（p < 0.01）。显著的交互效应（p = 0.027）表明，只有6PBT组维持了这些改善（T1与T3：p < 0.001），并且在T3时得分显著高于2PBT组（p = 0.015）。在STT或任何次要结局中未发现显著的交互效应，但随着时间的推移，动态平衡、步态能力、功能活动能力、身体活动、对跌倒的担忧和执行功能均有改善（时间效应：p < 0.05）。两组的PBT依从性、完成的计划扰动和可接受性都很高，组间无显著差异。未报告与干预相关的严重不良事件。
研究结果表明，少量的跑步机PBT训练可以导致行走过程中反应性平衡的特定任务改善，更高的训练剂量可增强可持续性。跑步机PBT在有跌倒风险的老年人中似乎是可行的且接受度良好，无论接受的训练次数如何。
DRKS00030805；2022年12月14日前瞻性注册。
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