Falls cause injury or death in healthy but frail older people. The efficacy of conventional falls prevention training for healthy older people may be sub-optimal, and perturbation training, a new approach that trains reflexive control of postural stability, has been evaluated in several trials. One systematic review of this new approach exists, but it included people with neurological diagnoses. The current systematic review aimed to evaluate if perturbation training can reduce falls in healthy frail older people and healthy young people. Included studies had to compare perturbation training to a control, in terms of falls incidence. Three separate protocols were devised for studies using different ages and falls outcomes. Sixteen eligible papers were found, comprising 849 participants. Perturbation training may be effective compared to no treatment in reducing laboratory-induced falls in older and younger people. Benefits may occur quickly, can be long-lived, and are generalisable. However, the efficacy of perturbation training in reducing community falls incidence in frail older people is uncertain. In all studies the quality of evidence is low to very low, and further rigorous research is required. PROSPERO registration number: CRD42016039911.

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