Perturbation-based balance training on treadmills for falls prevention in older adults: a review of training protocols and reporting recommendations (ProRePBT)

Falls are a leading cause of injuries in older adults, often resulting from slipping and tripping. Perturbation-based balance training (PBT) applied on treadmills is an emerging task-specific approach to falls prevention but standardized training protocols are lacking. This review presents an overview of PBT protocols on treadmills, their theoretical justification and proposes recommendations for standardized reporting. A systematic search was conducted in PubMed, Embase, Web of Science, CINAHL, CENTRAL and Clinical Trials Registration on May 9, 2025 to identify RCTs, pilot studies, study protocols and trial registrations on treadmill-based PBT for falls prevention in healthy older adults or those diagnosed with stroke, Parkinson’s disease or multiple sclerosis. Studies were screened by two independent researchers. Data on general and PBT specific training parameters as well as the justification for those parameters were narratively synthesized. 1253 studies were identified. The eligibility criteria were met by 69 publications referring to 36 research projects. In total, 1928 participants were included, with 950 participants in the PBT groups. The training periods lasted from a single session to 12 weeks, including one to three sessions per week, each from 20 to 60 min. During standing and walking, from 24 up to 160 unannounced perturbations were induced, consisting of treadmill belt acceleration and deceleration as well as lateral displacements. Training intensity was often individually adjusted based on participant performance or subjective feedback, though methods varied widely. Perturbation frequency timing and the perturbed leg, as well as the theoretical justification for the training parameters were rarely reported. The results reveal a high heterogeneity in the PBT protocols. Furthermore, training parameters and their justification were insufficiently reported in many studies. Therefore, we propose a reporting standard for PBT protocols (ProRePBT) to increase comparability between studies, improve replicability, and facilitate implementation into clinical practice.