Dynamic Balance & Gait

Planned stepping and turning drills that practise the stepping and turning of everyday walking; turning is a common fall moment. These are practiced, not reactive, drills - the evidence for unexpected-perturbation training is a separate practice. Perform in a clear space with support available.

How often: 1–5 sessions/week · trial frequency reported by the sources of the review summary this routine was written from (3 of 4 sources named by SR09.3 state one) · planning default: 2-3x/week · the review report’s bottom line: 2–3 sessions/week (the report's bottom-line parameter set)

When: any time · the sources state no time of day; the planner's slot is a default

The time slot is a planning choice: a swap can keep it.

The evidence applies to the practice, not to these particular steps — they are one way to carry it out.

1
Lateral Weight Shifts
10 shifts x 2
Warm-up.
Slot: pre-activity preparation
Scaffold: app-designed stepApp-designed prescriptionthe finding states no sets for this.
9 options for this requirement
These are the practices the completed Round-2 reviews name for pre-activity preparation. The evidence rating on this routine belongs to the practice and its dose, not to any one of these. Choosing one changes what you read on this page only — it is not saved on any session in your week, and it never changes what the routine prescribes. To keep a choice, make it on the session itself in My Week.
Ballistic stretching
Compared in the review
10 papers put it in this slot · dose unit not stated
Evidence and how-to
Dynamic stretching
Compared in the review
40 papers put it in this slot · dose in sets × time
Cannot be used here: This step's dose is measured in repetitions and this option's in sets × time. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Dynamic warm-up
Compared in the review
6 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Foam rolling
Compared in the review
7 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Hold-relax
Compared in the review
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · dose unit not stated
Evidence and how-to
PNF stretching
Compared in the review
4 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Static stretching
Compared in the review
39 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Strap-assisted
Compared in the review
1 paper put it in this slot · dose unit not stated
Evidence and how-to
Vibration-assisted
Compared in the review
1 paper put it in this slot · dose unit not stated
Evidence and how-to
2
Tandem Walk (Heel-to-Toe Walking)
10-15 steps x 3
Along a wall; eyes forward.
Slot: gait and stepping
Named by a Round-2 review (by reading)App-designed prescriptionthe finding states no sets for this.
7 options for this requirement
These are the practices the completed Round-2 reviews name for gait and stepping. The evidence rating on this routine belongs to the practice and its dose, not to any one of these. Choosing one changes what you read on this page only — it is not saved on any session in your week, and it never changes what the routine prescribes. To keep a choice, make it on the session itself in My Week.
Gait training
Compared in the review
2 papers put it in this slot · dose unit not stated
Evidence and how-to
Multicomponent programme
Compared in the review
1 paper put it in this slot · dose unit not stated
What the review holds
Otago Exercise Programme
Compared in the review
6 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Perturbation training
Compared in the review
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Square-stepping
Compared in the review
1 paper put it in this slot · dose in repetitions
Evidence and how-to
Tai Chi
Compared in the review
3 papers put it in this slot · dose in repetitions
Evidence and how-to
Yoga for balance
Compared in the review
2 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
What the review holds
3
Heel-to-Toe Line Walk
1 length x 3
Follow a taped line; support alongside.
Slot: gait and stepping
Named by a Round-2 review (by reading)App-designed prescriptionthe finding states no sets for this.
7 options for this requirement
These are the practices the completed Round-2 reviews name for gait and stepping. The evidence rating on this routine belongs to the practice and its dose, not to any one of these. Choosing one changes what you read on this page only — it is not saved on any session in your week, and it never changes what the routine prescribes. To keep a choice, make it on the session itself in My Week.
Gait training
Compared in the review
2 papers put it in this slot · dose unit not stated
Evidence and how-to
Multicomponent programme
Compared in the review
1 paper put it in this slot · dose unit not stated
What the review holds
Otago Exercise Programme
Compared in the review
6 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Perturbation training
Compared in the review
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Square-stepping
Compared in the review
1 paper put it in this slot · dose in repetitions
Evidence and how-to
Tai Chi
Compared in the review
3 papers put it in this slot · dose in repetitions
Evidence and how-to
Yoga for balance
Compared in the review
2 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
What the review holds
4
Walking with Turns / Pivots
4 turns x 2
Small steps through turns; turning is a common fall moment.
Slot: gait and stepping
Scaffold: app-designed stepApp-designed prescriptionthe finding states no sets for this.
7 options for this requirement
These are the practices the completed Round-2 reviews name for gait and stepping. The evidence rating on this routine belongs to the practice and its dose, not to any one of these. Choosing one changes what you read on this page only — it is not saved on any session in your week, and it never changes what the routine prescribes. To keep a choice, make it on the session itself in My Week.
Gait training
Compared in the review
2 papers put it in this slot · dose unit not stated
Evidence and how-to
Multicomponent programme
Compared in the review
1 paper put it in this slot · dose unit not stated
What the review holds
Otago Exercise Programme
Compared in the review
6 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Perturbation training
Compared in the review
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Square-stepping
Compared in the review
1 paper put it in this slot · dose in repetitions
Evidence and how-to
Tai Chi
Compared in the review
3 papers put it in this slot · dose in repetitions
Evidence and how-to
Yoga for balance
Compared in the review
2 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
What the review holds
5
Single-Leg Reach (Star Excursion)
6 reaches x 2 per leg
Chair beside you; reach conservatively.
Slot: dynamic balance
Scaffold: app-designed stepApp-designed prescriptionthe finding states no sets for this.
10 options for this requirement
These are the practices the completed Round-2 reviews name for dynamic balance. The evidence rating on this routine belongs to the practice and its dose, not to any one of these. Choosing one changes what you read on this page only — it is not saved on any session in your week, and it never changes what the routine prescribes. To keep a choice, make it on the session itself in My Week.
Agility drills
Compared in the review
1 paper put it in this slot · dose unit not stated
What the review holds
Gait training
Compared in the review
1 paper put it in this slot · dose unit not stated
Evidence and how-to
Multicomponent programme
Compared in the review
1 paper put it in this slot · dose unit not stated
What the review holds
Otago Exercise Programme
Compared in the review
7 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Pilates for balance
Compared in the review
1 paper put it in this slot · dose unit not stated
What the review holds
Proprioceptive training
Compared in the review
1 paper put it in this slot · dose unit not stated
Evidence and how-to
Square-stepping
Compared in the review
1 paper put it in this slot · dose in repetitions
Evidence and how-to
Tai Chi
Compared in the review
13 papers put it in this slot · dose in repetitions
Evidence and how-to
Tandem stance / walking
Compared in the review
2 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
VR / exergaming
Compared in the review
1 paper put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
6
Backward Walking
10 steps x 2
Clear space; use a rail.
Slot: gait and stepping
Named by a Round-2 reviewApp-designed prescriptionthe finding states no sets for this.
7 options for this requirement
These are the practices the completed Round-2 reviews name for gait and stepping. The evidence rating on this routine belongs to the practice and its dose, not to any one of these. Choosing one changes what you read on this page only — it is not saved on any session in your week, and it never changes what the routine prescribes. To keep a choice, make it on the session itself in My Week.
Gait training
Compared in the review
2 papers put it in this slot · dose unit not stated
Evidence and how-to
Multicomponent programme
Compared in the review
1 paper put it in this slot · dose unit not stated
What the review holds
Otago Exercise Programme
Compared in the review
6 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Perturbation training
Compared in the review
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
Evidence and how-to
Square-stepping
Compared in the review
1 paper put it in this slot · dose in repetitions
Evidence and how-to
Tai Chi
Compared in the review
3 papers put it in this slot · dose in repetitions
Evidence and how-to
Yoga for balance
Compared in the review
2 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in repetitions and this option's in duration. Converting between them is not something the research says, so the swap is refused rather than converted.
What the review holds

Safety, and where each line comes from

2 reported by the review's sources23 product safeguard (app-authored)4 source silent

Each line below says where it comes from. “Reported by the review’s sources” is the source’s own words about adverse events or contraindications. “Product safeguard” is written by this app, not by the research. “Source silent” means the studies behind this routine report nothing on that point, which is not the same as saying it carries no risk.

Who should modify or avoid this

Reported by the review's sourcesAbsolute: individuals with smoking history, recent physical therapy, fragility fractures, recent surgeries, and unstable medical conditions Relative: conditions requiring medical clearance
SR09.3 · canon row 2723, contraindications field · Perturbation-based balance training targeting both slip- and trip-induced falls among older adults: a randomized controlled trial · studied: WHAT: Perturbation-based Balance Training (PBT) targeting slipping and tripping. Specific exercises include stepping onto a low-friction surface for slip training and standing on a modified treadmill for trip training. HOW: Supervised by…
Product safeguard (app-authored)Keep obstacles low and path clear; supervise faster or reactive work.
From this routine’s block record, written by this app.
Product safeguard (app-authored)Valuable for older adults.
From this routine’s block record, written by this app.
Product safeguard (app-authored)Designed for adults who can stand unaided. A recent fall, a balance or vision condition, or a fear of falling changes what is appropriate here and calls for support within reach.

Prerequisites

Product safeguard (app-authored)Written for intermediate level. Equipment: floor-line, none. Warm up before the working sets, and learn each movement at a light load or short range before adding effort.
Source silentThe sources behind this routine's finding report nothing on prerequisites or starting level.

Hazards and adverse events

Reported by the review's sources79 out of 271 RBT participants reported adverse events, including 63 mild, 15 moderate, and 1 severe event
SR09.3 · canon row 2696, adverse events field · The effect of reactive balance training on falls in daily life: an updated systematic review and meta-analysis · studied: WHAT: Reactive Balance Training (RBT) involving repeated balance perturbations to evoke balance reactions. HOW: Supervised by therapists; frequency ranged from one session to three times a week; duration ranged from 15 minutes to 1.5…
Product safeguard (app-authored)Lateral Weight Shifts: Fall risk: keep support in reach; a gentle entry drill to single-leg loading.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Tandem Walk (Heel-to-Toe Walking): Fall risk: perform along a wall or rail; older adults should have a spotter until confident.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Heel-to-Toe Line Walk: Fall risk: use a support surface alongside the line; clear the floor of trip hazards.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Walking with Turns / Pivots: Fall risk: turning is a common fall moment—use small steps and keep support nearby.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Single-Leg Reach (Star Excursion): Fall risk: dynamic reaching challenges the base—keep a chair beside you and reach conservatively.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Backward Walking: Fall risk: you cannot see behind you—clear the space, use a rail, and prefer supervision for older adults.
From the exercise catalogue, written by this app.

Progression and regression

Product safeguard (app-authored)Lateral Weight Shifts: regress with Hold a counter; Smaller shifts; Feet wider and progress with Lift the unloaded foot briefly; Eyes closed; Add reach to the loaded side.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Tandem Walk (Heel-to-Toe Walking): regress with Walk beside a wall/counter for fingertip support; Allow a small gap between steps; Shorten distance and progress with Eyes forward with head turns; Walk on a line/tape; Carry a tray (dual-task).
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Heel-to-Toe Line Walk: regress with Wall support alongside; Wider foot placement; Fewer steps and progress with Eyes closed segments (supported); Backward heel-to-toe; Add cognitive task.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Walking with Turns / Pivots: regress with Hold a rail during the turn; Turn 90 degrees only; Slow down and progress with Faster turns; Turn to a verbal cue (reactive); Add head turn.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Single-Leg Reach (Star Excursion): regress with Fingertip support; Reach a shorter distance; Reach in one direction only and progress with Reach to floor targets/cones; Eyes on the reaching foot; Stand on foam pad.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Backward Walking: regress with Walk beside a rail; Very short steps; Have a spotter and progress with Longer path; Add turns; Dual-task counting.
From the exercise catalogue, written by this app.
Source silentThe sources behind this routine's finding report nothing on how to progress or regress it.

Stop conditions

Product safeguard (app-authored)Stop if you lose balance without support to hand, feel dizzy or lightheaded, or cannot recover a stumble in one step; sit down and rest before continuing.
Source silentThe sources behind this routine's finding report no stop conditions.

When to seek supervision or clearance

Product safeguard (app-authored)Two or more falls in the past 12 months, or any fall with injury
From this routine’s block record, written by this app.
Product safeguard (app-authored)Dizziness, lightheadedness, or fainting during standing or movement
From this routine’s block record, written by this app.
Product safeguard (app-authored)New or worsening unsteadiness, neurological symptoms, or numbness in the feet
From this routine’s block record, written by this app.
Product safeguard (app-authored)Fear of falling severe enough to restrict daily activity
From this routine’s block record, written by this app.
Product safeguard (app-authored)Ask a clinician or physiotherapist before starting if you have fallen in the past year, have a condition affecting balance or vision, or feel unsteady on your feet; do the first sessions with someone present.
Product safeguard (app-authored)Signs of a medical emergency (chest pain or pressure, trouble breathing, fainting, sudden weakness or numbness) mean 911 or your local emergency services; thoughts of self-harm or suicide mean the 988 Suicide & Crisis Lifeline. This app does not diagnose, treat or give personalised medical advice.
Source silentThe sources behind this routine's finding report nothing on supervision or clearance.

How to do it

These drills practice the adjustments real walking demands: stepping onto targets, changing direction, and clearing low obstacles.
Start with planned patterns at comfortable speed and progress to reactive cues and added complexity as control holds.

2–3×/week, 20–30 min, ≥6–12 weeks

This routine's specific parameters are a practical implementation of the practice's general finding; the finding itself doesn't validate this exact protocol.

What the evidence says

The evidence is inherited from the practice this routine implements. Any duration is allowed; the label shows where you land against the studied dose.

This practice is one way to carry out what the sources on the concept entry (phys.neuromotor.reactive-training-real-world-falls) studied: stepping and perturbation-based training and falls in older adults. Okubo 2016 (meta-analysis, 7 studies, 660 participants) reports that both reactive and volitional stepping interventions reduce falls among older adults by approximately 50%. Gerards 2017 (systematic review) reports that perturbation-based training appears to be a feasible and effective approach to falls reduction among older adults in clinical settings. Allin 2020 (randomised trial) reports that perturbation training improved reactive balance and fall incidence after laboratory-induced slips, with no improvement observed after laboratory-induced trips. The full account, source by source, is on the concept entry this practice links to (phys.neuromotor.reactive-training-real-world-falls).

Key sources

systematic reviewPerturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practiceMarissa H. G. Gerards, Christopher McCrum, A. Mansfield, K. Meijer (2017) · Geriatrics & Gerontology International · 10.1111/ggi.13082 · full text

meta-analysisStep training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysisY. Okubo, D. Schoene, S. Lord (2016) · British Journal of Sports Medicine · 10.1136/bjsports-2015-095452 · full text

PreprintThe effect of reactive balance training on falls in daily life: an updated systematic review and meta-analysisA. Devasahayam, Kyle Farwell, B. Lim et al. (2022) · medRxiv · 10.1101/2022.01.27.22269969 · full text

Each source is shown by its own study design.

3 sources: 1 meta-analysis, 1 randomised controlled trial, 1 systematic review

Agreement: The review summary this entry was written from does not say whether its sources agree at this claim. Direction recorded for 2 of 3 sources; not yet recorded for the rest. A review summary is the written synthesis this entry was first built from; it is not one of the sources counted here.
The claim's outcome: Outcome not yet recorded
Certainty: No source states a certainty rating.

What each source measured and concluded (3)

systematic review · 2017

Gerards et al. (2017) — Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice

What it measured: Falls incidence
How it measured it: Prospective monitoring or retrospective reporting
Direction it states for the claim's outcome: Improved
How it was read: read in full text

meta-analysis · 2016

Okubo et al. (2016) — Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis

What it measured: Number of falls during follow-up and the proportion of fallers.
How it measured it: Monthly fall diaries supplemented by follow-up telephone calls or face-to-face interviews.
Direction it states for the claim's outcome: Improved
Its conclusion, in its own words: “The findings indicate that both reactive and volitional stepping interventions reduce falls among older adults by approximately 50%.”
How it was read: read in full text
What the review says it includes: systematic review and meta-analysis
Studies and participants, as stated: N = 660 participants across 7 studies
Heterogeneity, as stated: Substantial heterogeneity within the training programs which limited subgroup analyses.

randomised controlled trial · 2020

Allin et al. (2020) — Perturbation-based balance training targeting both slip- and trip-induced falls among older adults: a randomized controlled trial

What it measured: Peak slip speed for slips and trunk angle at touchdown for trips.
How it measured it: Laboratory-induced slips and trips with motion capture system, force platform, and load cell.
How it was read: read in full text

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