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Perturbation-based balance training reduces fall rates by 23% and injurious falls by 24%Perturbation Training May Reduce Fall Risk for Older Adults

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Key Takeaway
Consider perturbation-based balance training to reduce fall rates and injuries, especially with doses of at least 6 hours.

This meta-analysis evaluates the efficacy of perturbation-based balance training (PBT) among community-dwelling older adults aged 65 years and older. The analysis synthesized data from randomized controlled trials to determine the impact of PBT on fall rates, injurious falls, and associated risk factors.

Key findings indicate that PBT reduced fall rates by 23% (rate ratio, 0.77; 95% CI, 0.60-0.99) and injurious falls by 24% (rate ratio, 0.76; 95% CI, 0.58-0.98). Furthermore, a subgroup analysis of PBT programs lasting at least 6 hours showed a reduction in fall rates of 33%. While reactive balance improved following intervention, the authors noted limited effects on other fall risk factors such as gait.

The certainty for the reduction in fall rates is low. Clinical application suggests that PBT may reduce falls and injuries by enhancing reactive balance rather than physical improvements. Higher doses, defined as programs of at least 6 hours, are likely to offer greater protection against falls compared to lower doses.

How this fits prior evidence

This meta-analysis extends prior evidence regarding fall prevention in older adults. It complements findings that exergaming reduces fall rates with a 0.53 incidence rate ratio and the KOKU digital programme which improves Berg Balance Scores by a mean difference of 6.35. While emergency department interventions also show a reduction in fall incidence, this meta-analysis specifically highlights the role of PBT and higher dosages (at least 6 hours) in improving reactive balance to reduce falls.

Researchers looked at how perturbation-based balance training (PBT) affects falls among adults aged 65 and older. This type of training involves movements designed to challenge a person's stability. The study found that these programs were linked to a 23% reduction in overall fall rates and a 24% reduction in injurious falls.

The results suggest that the improvement comes mostly from better reactive balance rather than changes in walking patterns or gait. People who participated in longer training programs, specifically those lasting at least 6 hours, saw even higher success with a 33% reduction in fall rates.

While these findings are promising, it is important to note that the evidence for reduced fall rates has low certainty. Additionally, the training did not show significant improvements in other factors like walking speed or gait. Talk to your doctor to see if this specific type of balance training is right for your personal health goals.

What this means for you:
Perturbation-based balance training may reduce falls and injuries in older adults by improving reactive balance.

Common questions

What is perturbation-based balance training?

Perturbation-based balance training (PBT) involves exercises that challenge your stability. These movements are designed to improve reactive balance, which helps you stay steady when you lose your footing. The study suggests this specific type of training is more effective for preventing falls than simply improving walking patterns.

How much does this training reduce the risk of falling?

The analysis showed that PBT was linked to a 23% reduction in fall rates and a 24% reduction in injurious falls. For those who participated in programs lasting at least 6 hours, the reduction in fall rates was even higher, reaching 33%.

Does this training improve how people walk?

The study found that while PBT helps with reactive balance, it had limited effects on other fall risk factors like gait. This means the training is specifically helpful for reacting to sudden movements rather than changing your everyday walking style.

Study Details

Study typeMeta analysis
EvidenceLevel 1
Follow-up780.0 mo
PublishedAug 2026
View Original Abstract ↓
OBJECTIVES: To evaluate the efficacy of perturbation-based balance training (PBT) in reducing falls, injurious falls, and fall risk factors in older adults. DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Community-dwelling older adults (aged 65 years and older). METHODS: PubMed, CINAHL, EMBASE, and Cochrane databases were searched from inception to June 2024. Randomized controlled trials assessing the effects of PBT on falls or fall risk factors, including reactive balance via laboratory-induced perturbations, were included. Two reviewers independently screened studies and extracted data. Meta-analyses were conducted using a random-effects model, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: PBT significantly reduced fall rates by 23% (rate ratio, 0.77; 95% CI, 0.60-0.99; I = 57%, low certainty) and injurious falls by 24% (rate ratio, 0.76; 95% CI, 0.58-0.98; I = 0%) compared with controls. PBT improved reactive balance (eg, lab-induced falls) but had limited effects on other fall risk factors (eg, gait). In the dosage subgroup analysis, only PBT programs for at least 6 hours reduced falls by 33%. CONCLUSIONS AND IMPLICATIONS: PBT reduces falls and related injuries, likely through enhanced reactive balance rather than physical improvements. While most PBT programs are low doses (∼2 hours), higher doses (6+ hours) likely offer greater fall protection. Further high-quality trials using accessible PBT methods are required to inform policy and guideline development and support scalable implementation of PBT in fall-prevention strategies.
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