Perturbation-based balance training improves reactive balance and reduces falls in older people: A systematic review and meta-analysis

Aim

Falls are common among older adults and deteriorate their quality of life. Perturbation-based balance training (PBT) is a task-specific exercise designed to improve reactive balance. This systematic review synthesised current evidence on the efficacy of PBT in reducing falls and fall-related risk factors in community-dwelling older adults.

Methodology

PubMed, CINAHL, EMBASE, and Cochrane databases were systematically searched from inception to June 2024. Randomised controlled trials (RCTs) evaluating the effects of PBT on falls or fall risk factors, including reactive balance assessed through laboratory-induced perturbations, were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias. A random-effects model was used for meta-analyses. Certainty of evidence was evaluated using the GRADE approach.

Results

Twenty-five RCTs involving 2,659 participants were included. Meta-analyses showed that PBT significantly reduced: fall rate by 23% (rate ratio 0.77, 95% CI [confidence interval]: 0.60–0.99, I ² =57%, low certainty), proportion of fallers by 17% (risk ratio 0.83, 95% CI: 0.74–0.93, I ² =0%), injurious falls by 24% (risk ratio 0.76, 95% CI: 0.58–0.98, I ² =0%), and laboratory falls by 58% (risk ratio 0.42, 95% CI: 0.31–0.58, I ² =43%). Improvements in reactive balance measures (e.g., margin of stability, hip height) were observed but not in other fall risk factors (e.g., gait).

Conclusion

PBT effectively improves reactive balance and reduces falls, including injurious falls, thus may effectively complement conventional exercise programs. Further high-quality trials are needed to optimise PBT protocols, identify key components, assess long-term benefits, and develop scalable, accessible delivery models suitable for routine clinical use.

Protocol registration

PROSPERO: CRD42022343368

What is already known

• Falls are common among older adults and contribute significantly to injury, disability, and healthcare burden.

• Most exercise-based interventions reduce falls by improving strength and voluntary balance control.

• Perturbation-based balance training (PBT) targets reactive balance—the ability to recover from unexpected slips or trips.

• Prior studies have suggested that PBT may reduce falls, but findings have been inconsistent and not comprehensively synthesised.

What are the new findings

• This systematic review and meta-analysis of 25 RCTs shows that PBT reduces fall rate (by 23%), number of fallers (by 17%), and injurious falls (by 24%).

• PBT substantially improves reactive balance, reducing laboratory-induced falls by 58%.

• No significant effects were observed for other fall risk factors such as strength or general balance.

• PBT is a promising and task-specific fall prevention strategy, but more high-quality trials and scalable approaches are needed.