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% to 74% over the control. Lateral balance perturbation training may enhance traditional programs for fall prevention.
Copyright the Gerontological Society of America. Reproduced by permission of the publisher.

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