Retention of improvement in gait stability over 14  weeks due to trip-perturbation training is dependent on perturbation dose

Perturbation training is an emerging approach to reduce fall risk in the elderly. This study examined potential differences in retention of improvements in reactive gait stability over 14 weeks resulting from unexpected trip-like gait perturbations. Twenty-four healthy middle-aged adults (41-62 years) were assigned randomly to either a single perturbation group (SINGLE, n = 9) or a group subjected to eight trip-like gait perturbations (MULTIPLE, n = 15). While participants walked on a treadmill a custom-built brake-and-release system was used to unexpectedly apply resistance during swing phase to the lower right limb via an ankle strap. The anteroposterior margin of stability (MoS) was calculated as the difference between the anterior boundary of the base of support and the extrapolated centre of mass at foot touchdown for the perturbed step and the first recovery step during the first and second (MULTIPLE group only) perturbation trials for the initial walking session and retention-test walking 14 weeks later. Group MULTIPLE retained the improvements in reactive gait stability to the perturbations (increased MoS at touchdown for perturbed and first recovery steps; p < 0.01). However, in group SINGLE no differences in MoS were detected after 14 weeks compared to the initial walking session. These findings provide evidence for the requirement of a threshold trip-perturbation dose if adaptive changes in the human neuromotor system over several months, aimed at the improvement in fall-resisting skills, are to occur.