Balance exercise programs are an effective way to prevent falls in older people. Exercises are mostly focused 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 training people how to take correct, rapid and well-directed steps may be very valuable in the prevention of falls in older adults. Stepping ability typically has two components: volitional or proactive stepping (changing your walking pattern to proactively avoid a fall, such as taking a bigger step to step over an obstacle); and reactive stepping, which is the ability to respond to sudden changes in balance (for example, when slipping on a wet floor or tripping over an uneven surface).
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.
WHAT DID WE FIND?
Astoundingly, step training can prevent falls in older adults by 50%. This reduction in falls is consistent across the type of step training (reactive/volitional), living circumstance (community/institutional) and the falls-risk of participants (healthy/high-risk).
An additional meta-analysis of revealed that these stepping interventions also improved known fall risk factors such as simple and choice stepping reaction time, single leg stance, timed up and go performance, but not muscle strength.
SIGNIFICANCE AND IMPLICATIONS
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 and Lord SR (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: Jan 8., doi: 10.1136/bjsports-2015-095452.