Reactive balance training improved stepping but did not prevent falls

Design

Assessor-blinded randomised controlled trial

Population

88 community-dwelling older people, mean age 72

Primary outcome

Laboratory-induced falls and daily-life falls over 12 months

Effect

No difference in falls (P = .19); better step length and reaction time

This assessor-blinded trial randomised 88 community-dwelling older people (mean age 72) to six weekly sessions of ReacStep — tether-release reactive stepping and deliberate slips using low-cost equipment — plus home strength training, or strength training alone.

Adherence was 90%. ReacStep improved maximum step length and choice stepping reaction time, but falls after laboratory-induced trips and slips did not differ, and nor did falls in daily life over 12 months (P = .19).

Perturbation training is appealing because falls happen when balance is suddenly challenged. This version, though safe and feasible, did not reduce falls, and the trial was too small to detect a modest effect.

• Keep strength and balance exercise at the core of falls prevention
• Reactive stepping training is safe and acceptable but not yet shown to cut falls
• Better stepping on tests does not guarantee fewer real-life falls
• Combine exercise with medication review, vision and home hazard checks

Why it matters

It shows that improving a test result is not the same as preventing a fall.

Don't overread it

With 88 participants, the trial could miss a modest reduction in falls.

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