Balance Recovery Training for Fall Prevention in Retirement Communities

Falls are the leading cause of injuries and injury-related deaths among older adults over the age of 65 in the United States. To help reduce the number of these falls, there is growing interest in using reactive balance training to improve the reactive response to common perturbations (e.g., tripping and slipping). The goal of this study was to compare treadmill-based reactive balance training versus Tai Chi performed at, and among residents of, older adult senior housing. We hypothesized that participants randomized to reactive balance training (RBT) would show better performance on reactive balance tests compared to participants randomized to Tai Chi. We also hypothesized that participants randomized to Tai Chi would show better performance on clinical tests of balance and mobility compared to participants randomized to RBT. The long-term goal of this work is to demonstrate the value of RBT over Tai Chi for preventing falls resulting from sudden, external perturbations.

Thirty-five residents of five senior housing facilities were allocated to either treadmill-based reactive balance training or Tai Chi training. Both interventions were performed three times per week for four weeks, with each session lasting approximately 30 minutes. A battery of balance tests was performed at baseline, and again one week, one month, three months, and six months post-training. The battery included six standard clinical tests of balance and mobility, and a test of reactive balance performance.

Study Overview

• Status: Completed
• Conditions: Accidental Falls, Aged, Exercise Movement Techniques
• Intervention / Treatment: Other: Tai Chi exercise; Other: Balance recovery training

• Study Type: Interventional
• Enrollment (Actual): 35
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 70 years and older (OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Must be age 70 or older
• Must be a resident of local continuing care retirement community (CCRC)
• Must be able to walk down a long hallway without any aids (cane, walker, etc.)
• Must not have a fragility fracture in the past 10 years
• Must not smoke
• Must not be in physical therapy
• Must not perform more than 150 minutes/week of moderate to vigorous aerobic activity
• Must score 24 or higher on Folstein Mini Mental Status Exam
• Must have less than 20% probability of major osteoporotic fracture as assessed by the fracture risk assessment tool (FRAX) score
• Must not have recently (within 1 year) participated in Tai Chi

Study Plan

How is the study designed?

Design Details

• Primary Purpose: PREVENTION
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Tai Chi exercise intervention; Participants will perform 30-minute Tai Chi sessions (Yang Short form) 3 times a week for 4 weeks.	Other: Tai Chi exercise; Participants will perform Tai Chi exercises (Yang short form) for 30 minutes, 3 times a week for 4 weeks. Each session will be led by an experienced Tai Chi instructor.
EXPERIMENTAL: Balance recovery training; Participants will practice balance recovery on a modified treadmill for approximately 30-minutes per session, 3 sessions a week for 4 weeks.	Other: Balance recovery training; Participants will practice recovering their balance after a perturbation similar to tripping while walking. Each of these 'balance recovery training' sessions will last approximately 30 minutes, and will be performed 3 times per week for 4 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maximum Torso Angle at 0.8 Mph	maximum torso angle during a simulated trip, and be measures in degrees. Larger angles indicate worse performance.	1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
Maximum Torso Angle at 1.6 Mph	maximum torso angle during a simulated trip, and be measures in degrees. Larger angles indicate worse performance.	1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reactive Balance Rating	The reactive balance rating evaluates performance in response to six separate tests on a treadmill involving sudden acceleration of the belt to elicit a loss of balance from stance. The administrator scores as 0, 1, or 2: a) the overall effectiveness of the initial stepping response to each treadmill acceleration, and b) the amount of support provided by the harness or spotter next to the participant. These scores are then combined using a rubric to determine the overall reactive balance rating. The reactive balance rating is a score on a scale from 0 to 12 where higher scores indicates a better outcome. More details are available at: Madigan ML, Aviles J, Allin LJ, Nussbaum MA, Alexander NB. A Reactive Balance Rating Method That Correlates With Kinematics After Trip-like Perturbations on a Treadmill and Fall Risk Among Residents of Older Adult Congregate Housing. The Journals of Gerontology: Series A. 2018: 73(9): 1222-1228.	1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
Step Length at 0.8 Mph	step length during reactive balance trial.	1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
Timed-up-and-go Test	The timed-up-and-go tests is measured in seconds. Longer times indicate worse performance.	1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
Unipedal Stance Time Test	The unipedal stance time is measured in seconds, up to a maximum of 30 seconds. Longer times indicate better performance.	1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
Maximum Step Length Test	Maximum step length is measured in inches. Longer maximum step length indicates better performance.	1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
Activities-specific Balance Confidence (ABC) Scale	Activities-specific balance confidence scale ranges from 0 to 100. Larger values indicate more confidence (i.e. better outcome).	1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
Performance-oriented Mobility Assessment (POMA)	The Performance-oriented Mobility Assessment is a common clinical test for assessing a person's static and dynamic balance abilities. The test is in two short sections that contain one examining static balance, and the other gait. The section examining static balance includes 9 individual tests scored 0, 1, or 2 by the test administrator based upon their observation of the balance performance (higher is better). The section on gait includes 7 individual tests scored 0, 1, or 2 by the test administrator based upon their observation of the gait performance (higher is better). All of these individual test scores are then summed to determine the overall Performance-oriented Mobility Assessment score. The overall Performance-oriented Mobility Assessment score is on a scale from 0 to 28. Larger values indicate better mobility. Additional details are published here: Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. JAGS 1986; 34: 119-126.	1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
Berg Balance Test	The Berg balance test is measures that evaluates static balance and fall risk using 14 individual sub-tests. It includes static and dynamic activities of varying complexity. The test administrator scores performance on each sub-test as either a 0, 1, 2, 3, or 4. All scores are sub-tests are then summed to determine the overall Berg balance test score. The Berg balance test score is on a scale from 0 to 56. Larger values indicate better balance. More information is available at: Berg, K., Wood-Dauphine, S.L. and Williams, J.L. Measuring balance in the elderly: validation of an instrument. Can. J. Public Health, 83(S2): S7-S11, 1992.	1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
Step Length at 1.6 Mph	step length during reactive balance trial.	1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention

Collaborators and Investigators

• Sponsor: Texas A&M University
• Collaborators: University of Michigan; Virginia Polytechnic Institute and State University
• Investigators: Principal Investigator: Michael Madigan, PhD, Virginia Polytechnic Institute and State University

Publications and helpful links

General Publications

• Madigan ML, Aviles J, Allin LJ, Nussbaum MA, Alexander NB. A Reactive Balance Rating Method That Correlates With Kinematics After Trip-like Perturbations on a Treadmill and Fall Risk Among Residents of Older Adult Congregate Housing. J Gerontol A Biol Sci Med Sci. 2018 Aug 10;73(9):1222-1228. doi: 10.1093/gerona/gly077.

Study record dates

Study Major Dates

• Study Start (ACTUAL): September 1, 2015
• Primary Completion (ACTUAL): May 1, 2017
• Study Completion (ACTUAL): May 1, 2017

Study Registration Dates

• First Submitted: August 12, 2015
• First Submitted That Met QC Criteria: September 15, 2015
• First Posted (ESTIMATE): September 16, 2015

Study Record Updates

• Last Update Posted (ACTUAL): July 14, 2020
• Last Update Submitted That Met QC Criteria: June 29, 2020
• Last Verified: June 1, 2020

More Information

Terms related to this study

• Other Study ID Numbers: TexasAMU

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All outcome measures at the time points described above will be shared with other researchers.
• IPD Sharing Time Frame: These data will be made available starting one year after publication.
• IPD Sharing Access Criteria: Access will be provided for supplementary analyses. IPD will be shared via email.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF