# Acceptability of treadmill perturbation-based balance training in older adults at risk of falling: A mixed-methods evaluation of participant and trainer perspectives

## TL;DR

This study evaluates how well older adults and trainers accept treadmill-based balance training designed to prevent falls, finding it generally acceptable but noting lower acceptance among those with a history of falls.

## Contribution

The study provides a mixed-methods evaluation of treadmill perturbation-based balance training acceptability from both participant and trainer perspectives.

## Key findings

- Treadmill PBT was generally well accepted by both participants and trainers.
- Participants with a history of falls showed lower acceptability of the training.
- Perceived safety, effectiveness, and adequate supervision were key facilitators of acceptability.

## Abstract

Perturbation-based balance training (PBT) specifically targets fall mechanisms and holds promise for fall prevention in older adults, but its reliance on near-fall exposure may pose a barrier to engagement. Successful implementation depends on acceptability among participants and trainers, yet a mixed-methods, multi-perspective evaluation of PBT acceptability is lacking.

To evaluate the acceptability of treadmill PBT in older adults at risk of falling and in trainers, and to examine associations with participant characteristics.

Twenty-nine participants (79.9 ± 5.5 years) completed a 6-week treadmill PBT intervention, delivered by three trainers. Retrospective acceptability was assessed using a questionnaire (maximum score: 35 pt. for participants, 30 pt. for trainers) and semi-structured focus groups (12 participants, all trainers), guided by Theoretical Framework of Acceptability (TFA) domains and additional context-specific topics. Associations between participant characteristics and questionnaire scores were analyzed using multivariate regression. Focus-group data were analyzed deductively using the TFA.

Median questionnaire scores were high for participants (28 [interquartile range, IQR 23–32] pt.) and trainers (26 [IQR 25–26] pt.). Fall history emerged as the only independent predictor of lower acceptability among participants. Focus groups revealed that both participants and trainers generally perceived PBT as acceptable. High perceived safety and effectiveness for improving reactive balance, adequate tailoring and supervision, and strong coherence were reported as facilitators. Potential barriers included anxiety, fall-related memories, the demanding nature of PBT, and setting-related factors (e.g., monotony, limited social interaction, missing handrails, narrow belt).

Treadmill PBT were generally well accepted by trainers and older adults at risk of falling but showed lower acceptability among participants with fall history. Implementing PBT in individuals with no fall history may help mitigate anxiety related to prior fall experiences and support higher acceptability.

DRKS00030805 (December 14, 2022).

The online version contains supplementary material available at 10.1007/s40520-025-03320-0.