Effect of perturbation-based balance training distribution on stability and fall risk in faller older adults: A...

Falls are the leading cause of injury among older adults, often occurring during walking. Effective training programs are essential for reducing falls, and the distribution of practice may influence motor skill learning. This randomized clinical trial investigated the effects of different perturbation-based balance training (PBT) session distributions on postural stability and fall risk in older adults with a history of falls. Thirty participants were randomly allocated to either a massed practice group (2 sessions/day; n = 15) or a distributed practice group (1 session/day; n = 15). Both groups underwent four PBT sessions involving acceleration and deceleration perturbations, followed by a retention test one week later. We assessed the margin of stability (MoS), the number of falls during sessions, and dynamic balance using the Mini-BESTest before and after training. Assessments were performed by evaluators blinded to group allocation. Groups did not differ in any of the variables investigated. Significant improvements were observed in MoS during the deceleration perturbation sessions (p < 0.05), with an increase between sessions 1 and 4, and between session 1 and the retention test (p < 0.05). The number of falls was reduced over the sessions (p < 0.001), and there was an improvement in dynamic balance in the Mini-BESTest after PBT, particularly in reactive control and gait dynamics (p < 0.001). The distribution of PBT sessions, whether massed or distributed, did not affect fall-related outcomes in fall-prone older adults. These findings support the use of flexible PBT schedules for fall prevention. This trial was registered in the Brazilian Clinical Trials Registry (RBR-9dhx6kj; UTN: U1111-1276-4396).