By Will Boggs, MD

NEW YORK (Reuters Health) – Elderly people can learn better balance control, and hence lessen their risk of falling, with a training program that helps them respond to having their center of gravity or their stance displaced, according to a report in BMC Geriatrics published online May 31.

"Clinicians should not be anxious about prescribing balance-training exercises that can be very challenging for their older clients," Dr. Brian E. Maki from the University of Toronto, Ontario, Canada told Reuters Health. "Provided proper safety measures are taken (such as wearing a safety harness), older adults are often willing and able to complete exercises that challenge their balance, such as the perturbation-based program described in our paper."

Dr. Maki and colleagues developed a perturbation-based balance training program that targets specific aspects of balance-recovery reactions that are known to be impaired in older adults and associated with increased falling risk.

The perturbations used in the training program are unpredictable and challenge balance control in multiple directions, the report says, and they are applied in a manner that allows for well-controlled progressions in perturbation magnitude.

"Not only did we target balance-recovery reactions, we targeted specific types of reactions (stepping and grasping) and we targeted specific aspects of these reactions that have been shown to be impaired in older persons and related to increased risk of falling," Dr. Maki explained. "I think that it is crucial for researchers and clinicians to be aware of the importance of the ‘specificity-of-training’ principle and to realize that simple exercise prescriptions (eg, walking) may have many health benefits but will not necessarily improve critical aspects of balance control."

The investigators also tested their protocol in a pilot study that included eight older adults who were referred to a clinical falls-prevention program, due to problems with instability, falling and/or fear of falling. They were assigned, at random, to either the perturbation-based program or a program that focused on training of rapid volitional stepping and grasping movements.

"We found that our pilot subjects were equally willing to tolerate the perturbation training and, in fact, were more likely to feel that the perturbation training was beneficial, compared to the less challenging training," Dr. Maki said.

"We would hope to increase awareness among physicians and other clinicians of the importance of training more effective balance-recovery reactions for preventing their older clients from falling," Dr. Maki said. Furthermore, balance training will improve the confidence of elderly patients "and they will be more likely to maintain healthy levels of physical activity, which in turn will help to enhance their balance control."

An initial report of the first study of 30 older adults, presented June 18th at the Festival of International Conferences on Caregiving, Disability, Aging and Technology (FICCDAT) in Toronto, concludes: "Perturbation-based training improved some features of change-in-support balance reactions known to be related to increased risk for falls. Although further work is needed, these initial results support the viability of perturbation-based training as an intervention to reduce risk of falling in older adults."

One issue involving "further work" is to establish "whether the improvements in balance-recovery reactions that result from the training actually do lead to reduced risk of falling," Dr. Maki concluded. "Another direction for our future work is to show that the benefits of the training generalize to a wide range of loss-of-balance situations and different types of balance perturbations."

BMC Geriatrics 2007.