Perturbation-based balance training using trips and slips can reduce fall injuries in older adults: The SafeTrip randomised controlled trial

BACKGROUNDFall injuries in older adults are devastating and often caused by impaired reactive balance to unexpected trips and slips, which conventional exercise programs do not target. This study examined whether a low-dose perturbation balance training (PBT) program among older adults can improve balance recovery following trips and slips and reduce falls and fall injuries. METHODS111 older adults (65+ years) were randomised into an intervention or control group. The intervention group undertook one weekly PBT session for three weeks on the Trip and Slip Walkway, followed by three-monthly PBT booster sessions over one year, for a total of six sessions. The control group received an educational booklet. Blinded staff assessed laboratory-falls induced by a trip and slip with a safety harness at baseline and one year. Number of falls and fall injuries in daily life were collected weekly for one year. RESULTSCompared to the control group, the intervention group experienced a 26% reduction in laboratory falls at 12 months (RR = 0.74; 95% CI: 0.54, 0.99; P = .040) but not different in number of falls, trip-and slip-encounters in daily life. However, fall-related injuries were reduced by 57% (rate ratio = 0.43; 95% CI: 0.19, 0.94, P = .024) over one year. A reduction in falls occurred within the first three months, with greater benefit among participants who completed at least three training sessions. CONCLUSIONSA low-dose PBT program can improve reactive balance over 12 months and reduced injurious falls by 57%, with benefits likely due to enhanced reactive balance rather than proactive gait strategies. Older adults may require at least three sessions to achieve meaningful fall reduction, with periodic booster sessions to sustain benefits. Incorporating PBT into exercise programs may enhance their efficacy in preventing falls and fall injuries in daily life. Key PointsA low-dose perturbation-based training program (six sessions over 12 months) improved reactive balance at 12 months and reduced injurious falls by 57%. Benefits are likely due to task-specific improvements in reactive balance against trips and slips rather than proactive gait strategies or other risk factors. Incorporating PBT into exercise programs may improve their efficacy in preventing falls and fall injuries in daily life. Why does this paper matter?Falls are the leading cause of injury-related hospitalization and loss of independence in older adults. By targeting reactive balance--an ability neglected by conventional exercise programs--it offers a novel, evidence-based approach to enhance fall prevention and reduce injuries.