Comparison of Lateral Perturbation-Induced Step Training and Hip Muscle Strengthening Exercise on Balance and Falls in Community Dwelling Older Adults: A Blinded Randomized Controlled Trial.

BACKGROUND This factorial, assessor-blinded, randomized, and controlled study compared the effects of perturbation-induced step training (lateral waist-pulls), hip muscle strengthening, and their combination, on balance performance, muscle strength, and prospective falls among older adults. METHODS community-dwelling older adults were randomized to four training groups. Induced-step training (IST, n=25) involved 43 progressive perturbations. Hip abduction strengthening (HST, n=25) utilized progressive resistance exercises. Combined training (CMB, n=25) included IST and HST, and the control performed seated flexibility/relaxation exercises (SFR, n=27). Training involved 36 sessions over 12-weeks. The primary outcomes were the number of recovery steps and first step length, and maximum hip abduction torque. Fall frequency during 12 months after training was determined. RESULTS Overall, the number of recovery steps was reduced by 31%, and depended upon the first step type. IST and CMB increased the rate of more stable single lateral steps pre-post training than HST and SFR who used more multiple crossover and sequential steps. The improved rate of lateral steps for CMB exceeded the control (CMB/SFR rate ratio 2.68). First step length was unchanged, and HST alone increased hip torque by 25%. Relative to SFR, the fall rate ratios (falls/person/year) [95% confidence interval] were: CMB 0.26 [0.07 to 0.90], IST 0.44 [0.18 to 1.08], HST 0.30 (0.10 to 0.91). CONCLUSIONS Balance performance through stepping was best improved by combining perturbation and strength training and not strengthening alone. The interventions reduced future falls by 56% -74% over the control. Lateral balance perturbation training may enhance traditional programs for fall prevention.