Can we stop older people from falling if we teach them how to step?

Balance exercise programs are an effective way to prevent falls in older people. Exercises are mostly focussed on controlling the center of mass while reducing the base of support, for example by standing on one leg. Balance control however also requires adaptive responses that would require a person to either increase or even reduce their base of support, by means of taking a step. Taking such a protective step is often the last resort to keep upright (and not fall) at the critical moment of slipping or tripping. Therefore, it seems logical that interventions training people how to take correct, rapid and well-directed steps may be very valuable in the prevention of falls in older adults.

We conducted a systematic review and meta-analysis of trials using step training to reduce falls or fall risk factors. We included both volitional (e.g., stepping onto step targets in various directions) and reactive (e.g., exposure to slip or trip perturbations) step training. The meta-analysis of seven studies, with a combined sample of 660 participants, showed that both reactive and volitional step training can prevent falls in older adults by 50% (see Figure). This falls reduction effect was consistent across type of step training (reactive/volitional), setting (community/institutional) and characteristics of participants (healthy/high-risk). An additional meta-analysis of five studies revealed that these stepping interventions also improved fall risk factors such as simple and choice stepping reaction time, single leg stance, timed up and go performance, but not muscle strength.

Our analysis shows that step training can significantly prevent falls by 50% in older people. Step training should be included in exercise programs designed to prevent falls. Step training can be done by asking people to take steps in various directions (volitional) or by exposing them to slips or trips in a protected environment (reactive). Both strategies work, but it is important that the training is performed in an upright position and undertaken in response to environmental challenges which mimic real-world fall situations. Some examples are stepping onto a target, avoiding an obstacle or responding to a perturbation. Reactive step training requires a perturbation module and full-body harness to make it safe. While very effective, this training option is unfortunately not readily available in clinical practice. However, volitional step training can be done in various settings including group exercise classes or even in the person’s home. Future studies should aim to improve feasibility of reactive step training.

Okubo, Y., Schoene, D., Lord, S.R., 2016. Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis. British Journal of Sports Medicine. http://bjsm.bmj.com/content/early/2016/01/20/bjsports-2015-095452.abstract

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