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| Name | Class |
|---|---|
| Canadian Institutes of Health Research (CIHR) | OTHER_GOV |
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Falls in daily life are a serious risk for older adults. A new type of balance training, called reactive balance training (RBT) involves people losing balance many times so that they can practice fast balance reactions, like stepping reactions. Differences in training program features might explain differences in the results of previous RBT studies. Training intensity is the difficulty or challenge of the training program. It would be valuable to know if high-intensity RBT improves balance reactions quickly. The main goal of this study is to see if more intense RBT improves balance reactions faster than less intense RBT. The investigators will compare how quickly people improve balance reactions between high- and moderate-intensity RBT, and between RBT and a control program that does not include RBT. The investigators will also test if the improvements in balance reactions last after the training program is over. The secondary goals are to understand exactly how balance reactions improve with training, and to determine if people who complete RBT improve their general balance skills, and falls efficacy more than people who do not complete RBT.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| High intensity reactive balance training | Experimental | Participants will complete 5 1-hour training sessions over 11 days. During each training session, participants will complete 36 multi-directional (left-, right-, and forward-fall) perturbations. Participants assigned to high-intensity RBT will experience perturbations at 150% of the multi-step threshold; for example, for a multi-step threshold of 2 m/s^2 the high intensity perturbation will be 3 m/s^2. |
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| Moderate intensity reactive balance training | Active Comparator | Participants will complete 5 1-hour training sessions over 11 days. During each training session, participants will complete 36 multi-directional (left-, right-, and forward-fall) perturbations. Participants assigned to moderate-intensity RBT will experience perturbations at 100% of the multi-step threshold; for example, for a multi-step threshold of 2 m/s^2 the high intensity perturbation will be 2 m/s^2. |
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| Walking control group | Sham Comparator | Participants assigned to the walking control group will complete 36 trials of unperturbed walking in each training session. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Reactive balance training | Behavioral | Reactive balance training involves clients experiencing repeated balance perturbations so that they can practice and improve control of reactions to avoid falling after a loss of balance. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of reactive steps | Learning rate for number of steps to recover from 'backward fall' balance perturbations | Two weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Step initiation time | Time from perturbation onset time to foot off time | One week and 12 weeks post-training |
| Step execution time | Time from foot off to foot contact of the first step |
| Measure | Description | Time Frame |
|---|---|---|
| Fall incidence | Falls in daily life | 12 months post-training |
| Injurious fall incidence | 12-months post-training | |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Avril Mansfield, PhD | Contact | 416-597-3422 | 7831 | avril.mansfield@uhn.ca |
| David Jagroop | Contact | 416-597-3422 | 7614 | david.jagroop@uhn.ca |
| Name | Affiliation | Role |
|---|---|---|
| Avril Mansfield, PhD | University Health Network, Toronto | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Health Network | Recruiting | Toronto | Ontario | M5G 2A2 | Canada |
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| ID | Term |
|---|---|
| D016138 | Walking |
| ID | Term |
|---|---|
| D008124 | Locomotion |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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| Walking | Behavioral | Overground walking |
|
| One week and 12 weeks post-training |
| Step length | Difference in foot position from foot off to foot contact | One week and 12 weeks post-training |
| Braking impulse | Antero-posterior shear force generated over time on step contact | One week and 12 weeks post-training |
| Mechanical margin of stability | Distance between the extrapolated centre of mass (incorporating centre of mass position and velocity) and the edge of the base of support | One week and 12 weeks post-training |
| Balance evaluation systems test | Scale ranges from 0-100, with higher scores indicating better outcome | One week and 12 weeks post-training |
| Falls efficacy scale - International | Scale range: 10-100; higher values indicate worse outcome | One week, 12 weeks, and 12 months post-training |
| 5-level EuroQoL health status measure (EQ-5D-5L) |
Scale range for descriptive component: 5-25, higher values indicate worse outcome; Scale range for visual analogue scale: 0-100, higher values indicate better outcome |
| One week, 12 weeks, and 12 months post-training |
| Number of participants with fear of falling | One week, 12 weeks, and 12 months post-training |
| Number of participants with activity curtailment due to fear of falling | One week, 12 weeks, and 12 months post-training |
| D015444 | Exercise |
| D009043 | Motor Activity |