Reactive / Perturbation Training (Supervised)

Reactive balance is highly effective for real-world fall prevention but involves deliberate loss of balance. Perform ONLY with a trained partner/spotter and clear surroundings; ideally professionally supervised.

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: 1-2x/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 before reactive work.
Slot: pre-activity preparation
Scaffold: app-designed stepApp-designed prescriptionthe finding states total hours without saying per what; the 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
Reactive Stepping Drill
8-10 cued steps x 2
Spotter present; start anticipated then randomize.
Slot: reactive / perturbation
Scaffold: app-designed stepApp-designed prescriptionthe finding states total hours without saying per what; the finding states no sets for this.
10 options for this requirement
These are the practices the completed Round-2 reviews name for reactive / perturbation. 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
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · 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
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
Perturbation training
Compared in the review
3 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
Proprioceptive training
Compared in the review
1 paper put it in this slot · dose unit not stated
Evidence and how-to
Reactive balance
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
Square-stepping
Compared in the review
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · dose in repetitions
Evidence and how-to
Tai Chi
Compared in the review
6 papers put it in this slot · dose in repetitions
Evidence and how-to
Tandem stance / walking
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
VR / exergaming
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
3
Nudge / Perturbation Recovery
8-10 gentle nudges x 2
Trained partner gives light, unpredictable nudges.
Slot: reactive / perturbation
Named by a Round-2 review (by reading)App-designed prescriptionthe finding states total hours without saying per what; the finding states no sets for this.
10 options for this requirement
These are the practices the completed Round-2 reviews name for reactive / perturbation. 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
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · 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
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
Perturbation training
Compared in the review
3 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
Proprioceptive training
Compared in the review
1 paper put it in this slot · dose unit not stated
Evidence and how-to
Reactive balance
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
Square-stepping
Compared in the review
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · dose in repetitions
Evidence and how-to
Tai Chi
Compared in the review
6 papers put it in this slot · dose in repetitions
Evidence and how-to
Tandem stance / walking
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
VR / exergaming
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
4
Hop-and-Stick (Landing Stabilization)
5 reps x 2 per side
Non-slip flat ground; stick each landing 2-3s.
Slot: reactive / perturbation
Scaffold: app-designed stepApp-designed prescriptionthe finding states total hours without saying per what; the finding states no sets or reps for this.
10 options for this requirement
These are the practices the completed Round-2 reviews name for reactive / perturbation. 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
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · 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
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
Perturbation training
Compared in the review
3 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
Proprioceptive training
Compared in the review
1 paper put it in this slot · dose unit not stated
Evidence and how-to
Reactive balance
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
Square-stepping
Compared in the review
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · dose in repetitions
Evidence and how-to
Tai Chi
Compared in the review
6 papers put it in this slot · dose in repetitions
Evidence and how-to
Tandem stance / walking
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
VR / exergaming
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
5
Single-Leg Stand
20s hold x 2 per leg
Cool-down stability; support nearby.
Slot: post-activity
Named by a Round-2 reviewApp-designed prescriptionthe finding states total hours without saying per what; the finding states no sets or duration for this.
5 options for this requirement
These are the practices the completed Round-2 reviews name for post-activity. 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
1 paper put it in this slot (inferred by the extraction, not stated in the paper) · dose unit not stated
Evidence and how-to
Dynamic stretching
Compared in the review
3 papers put it in this slot · dose in sets × time
Evidence and how-to
Foam rolling
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 sets × time 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
PNF stretching
Compared in the review
3 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in sets × time 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
8 papers put it in this slot · dose in duration
Cannot be used here: This step's dose is measured in sets × time 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

Safety, and where each line comes from

2 reported by the review's sources21 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)By design these provoke near-falls, do not attempt high intensity unsupervised.
From this routine’s block record, written by this app.
Product safeguard (app-authored)For older adults and athletes able to train under supervision.
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 advanced level. Equipment: 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)Reactive Stepping Drill: Fall risk: rapid stepping under surprise—supervise, clear the area, and stop if fatigued.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Nudge / Perturbation Recovery: Fall risk: high—requires a trained partner/spotter and clear space; ideally supervised.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Hop-and-Stick (Landing Stabilization): Fall risk: impact and single-leg landing—use on non-slip flat ground; not for acute joint issues or high fall risk.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Single-Leg Stand: Fall risk: high—keep firm support within reach; strong predictor of fall risk, progress gradually.
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)Reactive Stepping Drill: regress with Anticipated cues; Support within reach; Slower cadence and progress with Random multidirectional cues; From narrow stance; Add a cognitive cue.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Nudge / Perturbation Recovery: regress with Smaller nudges; Stand near a rail; Anticipated (not surprise) pushes and progress with Larger/faster perturbations; Narrow stance; From single-leg stance.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Hop-and-Stick (Landing Stabilization): regress with Step instead of hop; Two-foot landing; Shorter hop and progress with Longer/higher hop; Single-leg landing; Land onto a foam pad.
From the exercise catalogue, written by this app.
Product safeguard (app-authored)Single-Leg Stand: regress with Hold a chair back or counter; Keep toe of lifted foot lightly touching floor (kickstand); Hold 10s and progress with Eyes closed; Stand on foam pad; Add arm reaches or ball toss (dual-task).
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

Okubo 2016 states that reactive step training requires a full body harness and individual supervision. The drills progress from gentle to more unpredictable perturbations.

1–2×/week with many perturbation trials; benefits reported from short structured courses

The evidence behind this practice doesn't establish a dose-response relationship, so this specific frequency and duration is a reasonable design choice, not a research-backed number.

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: perturbation-based and stepping 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, especially with treadmill-based systems and therapist-applied perturbations. Allin 2020 (randomised trial) reports that perturbation training improved reactive balance and fall incidence after laboratory-induced slips (18% against 80% at baseline), with no improvement 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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