Open research questions in Balance, Gait, and Falls Prevention

What the literature leaves open

• Longitudinal in functional performance cannot be changes or definitively interventional studies are warranted to verify whether selective strengthening of the hip abductors or ankle plantarflexors yields corresponding improvements in FRT and TUG metrics. Future longitudinal research with larger, diverse cohorts is warranted to validate whether selective strengthening of these key muscle groups directly translates to clinically meaningful improvements independence and reduced fall incidence.

  Predictors of Dynamic Balance and Functional Mobility in Community-Dwelling Older Adults: The Relative Contributions of Multi-Joint Lower-Extremity Muscle Strength · 2026 · DOI

• Future studies should examine the efficacy of incorporating vision screening as a component of multifactorial fall-prevention programs and further explore the impact of specific causes of vision changes such as disease progression or cataract surgery on fall risk.

  Dynamic trajectories in visual function and fall risk in older adults · 2026 · DOI

• Virtual reality (VR)-based rehabilitation has shown promise, but existing evidence is limited by small samples and insufficient evaluation of clinically meaningful outcomes.

  Virtual Reality-Based Rehabilitation versus Conventional Physiotherapy for Improving Balance, Functional Mobility, and Fall Risk in Parkinson's Disease: A Randomized Controlled Trial · 2026 · DOI

• Background: Virtual reality (VR)-based rehabilitation improves global balance and mobility in Parkinson's disease (PD), but whether this advantage extends uniformly across individual gait parameters, and what actually drives clinical improvement, remains unclear.

  Differential Effects of Virtual Reality Rehabilitation on Gait Parameters and Predictors of Treatment Response in Parkinson's Disease · 2026 · DOI

• Future large-scale, high-quality randomized controlled trials are warranted to validate these combined effects and further refine personalized exercise prescriptions for PD management.

  Which exercise intervention is most promising for Parkinson's balance? A network meta-analysis · 2026 · DOI

• However, literature is inconclusive if MCTs are superior to active comparison interventions, if delivery modes matter, and if people can transfer achieved effects to instrumental activities of daily living (IADL).

  EFFECTIVE MULTICOMPONENT-INTERVENTIONS ON PHYSICAL CAPACITY, COGNITIVE FUNCTION AND INSTRUMENTAL-ACTIVITIES-OF-DAILY-LIVING ARE NOT THE SAME FOR ELDERLY PEOPLE WITH NORMAL AND MILD-IMPAIRED-COGNITION · 2026 · DOI

• Background/Objectives: Traumatic Brain Injuries (TBIs) often cause profound functional impairments, yet the influence of TBI mechanisms on stair-climbing functional independence over extended timelines remains poorly understood.

  Divergent Recovery Trajectories: The Influence of Injury Mechanism on Stair-Climbing Outcomes After Traumatic Brain Injury - a TBI Model Systems Study · 2026 · DOI

• sensor placement procedures. J Electromyogr Kinesiol. (2000) 10(5):361–74. doi: 10.1016/s1050-6411(00)00027-4 sensors semg and for 50. Lu TW, Chen HL, Chen SC. Comparisons of the lower limb kinematics between young and older adults when crossing obstacles of different heights. Gait Posture. (2006) 23(4):471–9. doi: 10.1016/j.gaitpost.2005.06.005 51. Hakkinen K, Kallinen M, Izquierdo M, Jokelainen K, Lassila H, Malkia E, et al. Changes in agonist-antagonist emg, muscle csa, and force during strength training in middle-aged and older people. J Appl Physiol (1985). (1998) 84(4):1341–9. doi: 10.1152/jappl.1998.84.4.1341 52. DaSilva MM, Chandran VD, Dixon PC, Loh JM, Dennerlein JT, Schiffman JM, et al. Muscle co-contractions are greater in older adults during walking at self- selected speeds over uneven compared to even surfaces. J Biomech. (2021) 128:110718. doi: 10.1016/j.jbiomech.2021.110718 53. Reimann H, Fettrow T, Thompson ED, Jeka JJ. Neural control of balance during walking. Front Physiol. (2018) 9:1271. doi: 10.3389/fphys.2018.01271 54. Piche E, Chorin F, Zory R, Duarte Freitas P, Guerin O, Gerus P. Metabolic cost and co-contraction during walking at different speeds in young and old adults. Gait Posture. (2022) 91:111–6. doi: 10.1016/j.gaitpost.2021.10.014 55. Lu SH, Kuan YC, Wu KW, Wang TM, Lu TW. Cognitive-motor dual task induces strategic kinematic adjustments with increased toe-obstacle clearance for older adults during obstacle crossing. PLoS One. (2025) 20(10):e0334321. doi: 10.1371/journal. pone.0334321 56. Maki BE. Gait changes in older adults: predictors of falls or indicators of fear. J Am Geriatr Soc. (1997) 45(3):313–20. doi: 10.1111/j.1532-5415.1997.tb00946.x 57. Mansfield A, Wong JS, Bryce J, Knorr S, Patterson KK. Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Phys Ther. (2015) 95(5):700–9. doi: 10.2522/ptj. 20140090 58. Hill EC, Housh TJ, Keller JL, Smith CM, Anders JV, Schmidt RJ, et al. Low-load blood flow restriction elicits greater concentric strength than non-blood flow restriction resistance training but similar isometric strength and muscle size. Eur J Appl Physiol. (2020) 120(2):425–41. doi: 10.1007/s00421-019-04287-3 40. Pijnappels M, Bobbert MF, van Dieen JH. Push-off reactions in recovery after tripping discriminate young subjects, older non-fallers and older fallers. Gait Posture. (2005) 21(4):388–94. doi: 10.1016/j.gaitpost.2004.04.009 59. Kedziorek J, Blazkiewicz M. Influence of the base of support widths on postural control and feet loading symmetry during squat - preliminary study. Acta Bioeng Biomech. (2022) 24(2):55–63. doi: 10.37190/ABB-02033-2022-02 41.

  Effects of blood flow restriction combined with low-load resistance training on obstacle-crossing performance and lower limb function in older adults · 2026 · DOI

• BFR pressure was prescribed relative to each participant’s arterial occlusion pressure (AOP), in accordance with current methodological individualized BFR exercise (20, 38). AOP was determined using Doppler ultrasound, as described in Section 2.4. To improve tolerance and safety while maintaining an adequate BFR stimulus, the relative cuff pressure was progressively increased across the intervention period: 50% AOP during weeks 1–2, 60% AOP during weeks 3–5, and 70% AOP during weeks 6–8. Cuff pressure was maintained during each exercise set, released during the 30–60 s inter-set rest period, and reapplied before the subsequent set. This individualized, progressive, and intermittent AOP-based strategy was used to improve the consistency, safety, and tolerability of BFR application in older adults (20, 38). Participants were screened for contraindications to resistance exercise and blood flow restriction training before enrollment. During every session, participants were verbally monitored for fatigue, pain, numbness, paraesthesia, pressure excessive discomfort, dizziness, chest discomfort, abnormal shortness of breath, and delayed-onset muscle soreness. Although formal RPE scores were not recorded using a standardized scale, tolerance were monitored perceived exertion and exercise through standardized verbal questioning and observation by trained research staff. Delayed-onset muscle soreness was checked verbally before the next training session. Training was stopped or modified if a participant reported marked pain, Frontiers in Sports and Active Living 03 frontiersin.org Li et al. 10.3389/fspor.2026.1858963 numbness, paraesthesia, dizziness, chest discomfort, abnormal shortness of breath, excessive fatigue, or delayed-onset muscle soreness lasting more than 48 h. All adverse events were recorded throughout the intervention. Training adherence was calculated as the percentage of supervised training sessions completed out of the 24 prescribed sessions. A session was considered completed when the participant attended the supervised session and completed all prescribed exercises, with exercise modification permitted when needed for safety. The actual training loads, AOP values, applied cuff pressures, adherence, and safety outcomes are summarized in Supplementary Table S1. 2.4 Arterial occlusion pressure assessment AOP was determined using a portable Doppler ultrasound device (TE7, Mindray, China), following established BFR assessment procedures (20, 38).

  Effects of blood flow restriction combined with low-load resistance training on obstacle-crossing performance and lower limb function in older adults · 2026 · DOI

• joint kinetics, muscle morphology, sensorimotor assessments, separate agonist and antagonist EMG analyses, and mediation models these are needed performance changes. incorporating muscle strength testing, the mechanisms underlying to clarify that the 4.3 Balance performance The present study showed that BFR-LLRT was associated with improvements in selected balance-related outcomes, particularly mediolateral dynamic weight-shift performance, whereas changes in weight-bearing symmetry were angle-dependent and not uniformly favorable. This pattern suggests that the balance-related effects of BFR-LLRT were task-specific rather than generalized. In the Rhythmic Weight Shift test, greater improvements were observed in mediolateral weight shifting at moderate and fast speeds following BFR-LLRT. Effective mediolateral control of the center of mass is important for maintaining stability during dynamic tasks, and impairments in this domain have been associated with fall-related risk factors in older adults (53, 56, 57). The present findings therefore suggest that BFR-LLRT may be associated with improvements in selected components of mediolateral dynamic balance. These improvements may be related to training-associated changes in lower-limb function; however, the present study did not directly assess muscle strength, joint kinetics, muscle morphology, or sensorimotor function, and therefore cannot determine the mechanisms underlying these changes. Previous studies have reported that low-load blood flow restriction training may improve strength-related outcomes under low mechanical loads, which may be relevant to functional task performance (58). In the present study, improvements in selected mediolateral RWS outcomes may indicate favorable changes in laboratory-based dynamic weightshift performance, particularly under conditions requiring rapid mediolateral weight transfer. In contrast, the Weight-Bearing Squat results demonstrated a clear angle-dependent pattern. Symmetry improved at 90° knee flexion in the BFR-LLRT group, whereas increased asymmetry was observed at 30° and 60°. At 0°, asymmetry increased over time in both groups, but no significant group × time interaction was detected. These findings suggest that changes in bilateral loading were influenced by task demands, knee joint position, and mechanical constraints, rather than reflecting a uniform improvement in balance. Previous studies have similarly shown that postural control and loading strategies in older adults are highly context-dependent and vary according to task difficulty and biomechanical requirements (57).

  Effects of blood flow restriction combined with low-load resistance training on obstacle-crossing performance and lower limb function in older adults · 2026 · DOI

• Several limitations should be considered. First, self-reported of falls, ADL, and depressive symptoms are subject to recall biases. And among participants with cognitive impairment, self-reported depressive symptoms may be subject to measurement bias. Second, the use of listwise deletion to handle missing longitudinal data may introduce potential selection bias and reduce statistical power if the data are not missing completely at random. Future studies may consider using Full Information Maximum Likelihood or multiple imputation methods to better handle missing data under less restrictive assumptions. Third, the two-year interval between CHARLS follow-up waves may fail to capture short-term fluctuations in health status or falls, thereby missing periods of transient risk. Besides, the GBMTM method adopted in this study is a data-driven approach, and the selection of ARTICLE IN PRESS ARTICLE IN PRESS ACCEPTED MANUSCRIPT trajectory groups is model-dependent. Classification is probabilistic in nature, and some degree of uncertainty. Finally, while we adjusted for a range of confounders, unmeasured factors such as medication use (e.g. psychotropics), detailed environmental hazards and social support could partially explain the associations. Future studies incorporating real-time fall monitoring, objective functional assessments, and environmental factors would help validate these trajectory patterns and elucidate proximate triggers of falls within high-risk subgroups.

  Multi-trajectory patterns of ADL, cognition, and depression with fall risk: evidence from a longitudinal study in China · 2026 · DOI

• However, it remains unclear whether passive waist-mounted IMU data collected during naturalistic movement and social interaction can quantify clinician-rated cognitive and balance outcomes, particularly at the subdomain level, in an interpretable and demographically fair manner.

  Wearable sensing for quantifying cognitive and balance functions in naturalistic movements of older adults with mild cognitive impairment in therapeutic environments · 2026 · DOI

• BackgroundGait training incorporating visual feedback or rhythmic auditory cueing has shown promising results in neurological conditions but has rarely been investigated in clinical rehabilitation for persons with Multiple Sclerosis (pwMS).

  Treadmill training with rhythmic auditory cueing and/or visual feedback for persons with Multiple Sclerosis: feasibility and effects on gait parameters in a clinical randomized controlled trial · 2026 · DOI

• Introduction Monocular RGB-based human pose estimation is increasingly applied in field-based movement assessments; however, systematic projection-related errors inherent to the simplified camera geometry remain insufficiently characterized relative to laboratory-based biomechanical standards.

  Geometry-informed correction of projection bias in browser-based monocular squat assessment · 2026 · DOI

• should be acknowledged. Cognitive dysfunction and pain were assessed using owner-reported questionnaires, rather than clinical diagnosis, to capture the lived experience of the dogs. However, these questionnaires do not they capture functional establish specific diagnoses, behavioral the longitudinal design and mixed-effects modeling accounted for repeated measures within dogs, causal relationships between cognitive decline and gait changes cannot be inferred. Also, despite normalizing the stride length to withers height, differences in conformation and gait mechanics across breeds may still influence stride characteristics that were not explicitly modeled in our inclusion required dogs to be ambulatory analysis. Moreover, in the home. Furthermore, while FIGURE 3 Association between owner-reported cognitive impairment and thoracic limb height-adjusted stride length. Scatter plot illustrating the relationship between CADES total score and mean thoracic limb height-adjusted stride length (TL SLadj). Solid line represents the linear regression fit with shaded band indicating the 95% confidence interval. Increasing CADES scores were associated with shorter TL SLadj. CADES, Canine Dementia Scale; TL, thoracic limb; SLadj, height-adjusted stride length. decline that persisted after adjustment for age and ownerreported pain. Our findings in aging dogs parallel human observations, supporting the notion that spatial gait parameters may capture aspects of neurodegenerative change beyond simple movement slowing. In a secondary analysis, we evaluated the relative contributions of TL SLadj and on-leash gait speed to cognitive status. When both were included in a multivariate model, mean TL SLadj remained significantly associated with CADES scores, whereas gait speed did not. This suggests that while these measures are biomechanically related, height-adjusted stride length might capture a distinctive spatial signal of cognitive impairment that is not fully explained by raw walking velocity. Even though we measured PL SL and adjusted the measurements to dogs’ withers height, no consistent age-related pattern was observed in this population. This was supported by a significant limb-by-age interaction in the mixed-effects model, indicating that thoracic and pelvic limb stride lengths do not change in parallel with aging. Pelvic limb gait characteristics in aging dogs are frequently affected by coxofemoral osteoarthritis, stifle joint diseases, and lumbosacral pathology (13, 25). As a result, PL SL may capture overlapping effects of orthopedic disease and central neurologic aging, making it more difficult to isolate changes specifically associated with cognitive decline. In addition locomotion is generated by a to these orthopedic influences, central pattern generator that produces rhythmic motor activity through modular, limb- and joint-specific neural circuits (26). These centrally generated patterns are continuously modulated by sensory input, including proprioceptive, visual, and vestibular information required for postural control and navigation (27).

  Thoracic limb stride length is associated with cognitive impairment in aging dogs · 2026 · DOI

• the sample size limits generalizability. Second, potential should be acknowledged. First, small The author(s) declared that financial support was received for this work and/or its publication. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT) (RS-2022- NR074530).

  Motor performance and 3D gait pattern characteristics in older adult women with early mild cognitive impairment: a pilot study · 2026 · DOI

• The lack of standardized VR protocols across healthcare settings, limited clinician training, cost-related con- straints, and technological accessibility issues, particularly among older adults or individuals with cognitive decline, remain signifi- cant hurdles.

  Advancing rehabilitation in Parkinson’s disease through virtual reality: a narrative review · 2026 · DOI

• ABSTRACT Introduction Near falls, defined as recoverable postural instability, are increasingly recognised as important experiences that can provide insight into balance and mobility in older people, yet they are often underreported and inconsistently documented.

  From Near Falls to Compensated Loss of Balance: A Concept Analysis in Older People · 2026 · DOI

• Walking endurance is commonly assessed using the 6-min walk test (6MWT), but its duration may limit repeated assessments in the subacute phase, and shorter alternatives [2-min walk test (2MWT) and first 2-min performance of the 6MWT (2′6MWT)] remain insufficiently characterized across different walking environments.

  Comparison of the 2-min walk test and the first 2-min performance of the 6-min walk test across walking conditions in subacute stroke · 2026 · DOI

• One of the limitations of this study is that only one IMU from a single company was used, and future studies may use various devices to address this issue57. Another limitation is that we did not have complete diary records for the entire period when IMU data was collected, which could introduce bias. We also asked the participants to record their activities in the diary ‘at least three times per day’, which may result in varying levels of detail and accuracy in the diary data across participants. It should also be noted that MET estimates based on diary entries are inherently subjective. Furthermore, it would have been interesting to compare data from ankle and wrist IMUs worn on the most-affected dominant, and the most-affected non-dominant side, respectively. We suggest to further investigate in this topic in future studies with a larger sample and in other PD subpopulations, as well as in further conditions where physical activity is affected. Future studies may also investigate our hypotheses about how and why tremor influences RMSE values.

  Body placement of inertial measurement units differentially affects physical activity assessment accuracy in drug-naïve Parkinson’s disease · 2026 · DOI

• One of the most notable limitations of this study is the sample size. The initially calculated sam- ple size exceeded the number of patients that could be recruited to carry out this study. This limitation reduces the precision of the estimates and restricts the generalizability of the findings to the population of frail patients with Parkinson’s disease, as well as the ability to infer cause-and-effect relationships. A limitation of this study is the unequal group sizes (nine in the IG versus six in the CG), which may have resulted in random imbalances despite non-significant baseline differences. The loss of two participants in the CG after the study began slightly accentuated this imbalance, although overall group homogeneity was maintained and the initial random allocation was GeroScience preserved. Nevertheless, with such a small sample, residual imbalances cannot be ruled out, which may limit the generalizability of the results. Another limitation was the inability to blind both the physiotherapist administering the treatment and the patients themselves. Although the evaluator was blinded to group allocation, some participants may have inadvertently revealed their group membership. It was not possible to determine the exact time at which the decline in patients’ health status began fol- lowing the completion of physiotherapy intervention, although it appears to occur within three months.

  Feasibility and safety of a home-based physical therapy intervention to reverse frailty in patients with Parkinson’s disease: an exploratory pilot randomized clinical trial · 2026 · DOI

• 19 Further research is required to determine why the associations differ somewhat for self-reported sitting versus self-reported TV viewing. However, further research is required to understand the nature and direction of this relationship to better understand whether the relationship between sedentary behavior and type 2 diabetes is truly causal. Those well-being concepts typically blend cognitive/evaluative and affective components40 and this question is limited to the cognitive/evaluative aspects widely known as quality of life.

  Multicomponent Behavior Change Technique Intervention for Caregivers of People With Alzheimer Disease and Related Dementias: Protocol for a Single-Arm, Personalized Behavioral Trial to Disrupt Sedentary Time · 2026 · DOI

• that should be considered. The use of a preexperimental design without a control group limits the ability to establish causal relationships. In addition, the relatively small sample size 54 and short observation period may affect the generalizability of the findings. Therefore, future studies using more rigorous designs, larger samples, and longer follow-up periods are recommended to confirm these results and evaluate their impact on fall incidence. Further research using more rigorous study designs, such as randomized controlled trials with larger sample sizes and longer follow-up periods, is recommended to confirm the effectiveness of the Edu-Board intervention and to evaluate its impact on clinical outcomes, including fall incidence.

  IMPLEMENTATION OF AN EDUCATIONAL BOARD INNOVATION TO PREVENT FALLS AMONG HOSPITALIZED CANCER PATIENTS · 2026 · DOI

• study sought not only to emphasize sleep quality but also to align with the study’s purpose of providing interventions prior- A limitation of this study is that the data were collected mainly from participants residing in Seoul and Incheon, which limits itized according to the special circumstances of communi- the generalizability of the findings.

  Factors influencing fear of falling among community-dwelling older women living alone based on the senescent sleep model: A descriptive correlational study · 2026 · DOI

• A key strength of this feasibility study was its mixed methods approach, which added valuable context to the quantitative outcomes. High completion rates of the explor- atory outcome measures among participants who completed the study (>90%) support the suitability of the data collection methods used in this study for older adults. However, the participants recruited lacked ethnic diversity and were skewed toward participants with higher education. While exercise frequency was captured via participant diaries, we did not collect data on exercise intensity (eg, heart rate, per- ceived exertion) or exercise quality during independent home sessions. This limits our ability to fully assess interven- tion fidelity and determine whether differences between phases may have been influenced by variations in exercise dose or execution. Future trials should incorporate objective or structured monitoring of home-based exercise intensity and quality to strengthen fidelity assessment. Furthermore, conducting the study exclusively in English—due to funding constraints—also limited inclusivity. Future trials should consider translation services to improve representativeness and reach.

  Supervised and Self-Directed Technology-Based Dual-Task Exercise Training Program for Older Adults With a History of Falls: Mixed Methods Feasibility Study. · 2026 · DOI

Most-cited papers in Balance, Gait, and Falls Prevention

• Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus · Journal of the American Geriatrics Society · 2005 · 1,684 citations
• World guidelines for falls prevention and management for older adults: a global initiative · Age and Ageing · 2022 · 1,324 citations
• Circumstances and consequences of falls in independent community-dwelling older adults · Age and Ageing · 1997 · 911 citations
• Reducing Frailty and Falls in Older Persons: An Investigation of Tai Chi and Computerized Balance Training · Journal of the American Geriatrics Society · 1996 · 764 citations
• Subsystems Contributing to the Decline in Ability to Walk: Bridging the Gap Between Epidemiology and Geriatric Practice in the InCHIANTI Study · Journal of the American Geriatrics Society · 2000 · 672 citations
• Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012–2018 · MMWR Morbidity and Mortality Weekly Report · 2020 · 556 citations
• Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review · Age and Ageing · 2004 · 521 citations
• Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people · Age and Ageing · 2007 · 506 citations
• Age-related differences in walking stability · Age and Ageing · 2003 · 466 citations
• Preventing Falls Among Community-Dwelling Older Persons: Results From a Randomized Trial · The Gerontologist · 1994 · 398 citations

Most recent work

• The Role of Artificial Intelligence and Machine Learning in Balance Classification Using Center of Pressure – A Comprehensive Review · International Journal of Online and Biomedical Engineering (iJOE) · 2026
• Multimodal data on bipedal locomotion during prolonged treadmill recordings at varying speeds · Scientific Data · 2026
• Access to a telehealth falls prevention program: mixed-method analysis from a health equity perspective · medRxiv · 2026
• The Effects of multicomponent exercise on mild cognitive impairment in elderly population: a randomized control trial · Journal of Medical Sciences · 2026
• Effect of Nordic walking versus retro walking on balance, physical fitness, and quality of life in young-old individuals: A comparative study · Aging Medicine and Healthcare · 2026
• Development of a Dual-task Walking Assessment Method Using Mixed Reality Technology：Comparison of Difficulty Levels in Healthy Young Adults · The Japanese Journal of Rehabilitation Medicine · 2026
• Hybrid ConvTransLSTM for spatio-temporal classification: identifying early Parkinson’s disease from gait patterns · Neural Computing and Applications · 2026
• Predictors of Poor Post-discharge Exercise Adherence in Older Inpatients with Musculoskeletal Disorders · Annals of Geriatric Medicine and Research · 2026
• Exercise and aging: Unlocking health beyond 65 years old · Aging advances. · 2026
• Physics-informed hierarchical transformer for wearable sensor-based gait fatigue assessment · Frontiers in Public Health · 2026

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