Journal of the American Medical Directors Association · Jul 2, 2026

Perturbation-Based Balance Training Reduces Falls and Fall Injuries in Older People: Insights on Mechanisms and Training Parameters From a Systematic Review

By Sharma S, Szabo IZ, Danielsen MB et al.

OBJECTIVES: To evaluate the efficacy of perturbation-based balance training (PBT) in reducing falls, injurious falls, and fall risk factors in older adults. DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: Community-dwelling older adults (aged 65 years and older). METHODS: PubMed, CINAHL, EMBASE, and Cochrane databases were searched from inception to June 2024. Randomized controlled trials assessing the effects of PBT on falls or fall risk factors, including reactive balance via laboratory-induced perturbations, were included. Two reviewers independently screened studies and extracted data. Meta-analyses were conducted using a random-effects model, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: PBT significantly reduced fall rates by 23% (rate ratio, 0.77; 95% CI, 0.60-0.99; I² = 57%, low certainty) and injurious falls by 24% (rate ratio, 0.76; 95% CI, 0.58-0.98; I² = 0%) compared with controls. PBT improved reactive balance (eg, lab-induced falls) but had limited effects on other fall risk factors (eg, gait). In the dosage subgroup analysis, only PBT programs for at least 6 hours reduced falls by 33%. CONCLUSIONS AND IMPLICATIONS: PBT reduces falls and related injuries, likely through enhanced reactive balance rather than physical improvements. While most PBT programs are low doses (∼2 hours), higher doses (6+ hours) likely offer greater fall protection. Further high-quality trials using accessible PBT methods are required to inform policy and guideline development and support scalable implementation of PBT in fall-prevention strategies.

doi.org/10.1016/j.jamda.2026.106316PubMed 42391766Interventions