BACKGROUND: Beam walking is a new test to estimate dynamic balance. We characterized dynamic balance measured by the distance walked on beams of different widths in five age groups of healthy adults (20, 30, 40, 50, 60 years) and individuals with neurological conditions (i.e., Parkinson, multiple sclerosis, stroke, age: 66.9 years) and determined if beam walking distance predicted prospective falls over 12 months. METHODS: Individuals with (n = 97) and without neurological conditions (n = 99, healthy adults, age 20-60) participated in this prospective longitudinal study. Falls analyses over 12 months were conducted. The summed distance walked under single (walking only) and dual-task conditions (walking and serial subtraction by 7 between 300 to 900) on three beams (4, 8, and 12-cm wide) was used in the analyses. Additional functional tests comprised grip strength and the Short Physical Performance Battery. RESULTS: Beam walking distance was unaffected on the 12-cm-wide beam in the healthy adult groups. The distance walked on the 8-cm-wide beam decreased by 0.34 m in the 20-year-old group. This reduction was ~ 3 × greater, 1.1 m, in the 60-year-old group. In patients, beam walking distances decreased sharply by 0.8 m on the 8 versus 12 cm beam and by additional 1.6 m on the 4 versus 8 cm beam. Beam walking distance under single and dual-task conditions was linearly but weakly associated with age (R2 = 0.21 for single task, R2 = 0.27 for dual-task). Age, disease, and beam width affected distance walked on the beam. Beam walking distance predicted future falls in the combined population of healthy adults and patients with neurological conditions. Based on receiver operating characteristic curve analyses using data from the entire study population, walking ~ 8.0 of the 12 m maximum on low-lying beams predicted future fallers with reasonable accuracy. CONCLUSION: Balance beam walking is a new but worthwhile measure of dynamic balance to predict falls in the combined population of healthy adults and patients with neurological conditions. Future studies are needed to evaluate the predictive capability of beam walking separately in more homogenous populations. Clinical Trial Registration Number NCT03532984.

Biomechanics and Motor Control Lab School of Physical Education and Sport of Ribeirao Preto University of Sao Paulo Ribeirão Preto Brazil

Center for Human Movement Sciences Medical Center University of Groningen University of Groningen 9713 AV Groningen The Netherlands

Department of Kinesiology Hungarian University of Sports Science 1123 Budapest Hungary

Department of Neurology Somogy County Kaposi Mór Teaching Hospital 7400 Kaposvár Hungary

Department of Otorhinolaryngology Head and Neck Surgery University of Pécs Medical School 7622 Pécs Hungary

Department of Sport and Sport Science Exercise and Human Movement Science University of Freiburg Freiburg Germany

Department of Sport Biology Institute of Sport Sciences and Physical Education University of Pécs 7622 Pécs Hungary

Digital Development Center Széchenyi István University 9026 Győr Hungary

Faculty of Health Sciences Doctoral School of Health Sciences University of Pécs 7622 Pécs Hungary

Faculty of Physical Education and Sport Charles University Prague Czech Republic

Faculty of Sociology Otemon Gakuin University Ibaraki Osaka 567 8502 Japan

Graduate Program in Rehabilitation and Functional Performance Ribeirão Preto Medical School University of São Paulo Ribeirão Preto Brazil

Institute of Sport Research Sports University of Tirana Tirana Albania

Lentis Center for Rehabilitation Groningen The Netherlands

See more in PubMed

Horak FB, Henry SM, Shumway-Cook A. Postural perturbations: new insights for treatment of balance disorders. Phys Ther. 1997;77(5):517–533. doi: 10.1093/ptj/77.5.517. PubMed DOI

Hortobágyi T, Uematsu A, Sanders L, Kliegl R, Tollar J, Moraes R, et al. Beam walking to assess dynamic balance in health and disease: a protocol for the "BEAM" multicenter observational study. Gerontology. 2018;18:1–8. PubMed PMC

Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50–58. doi: 10.1001/jama.2010.1923. PubMed DOI PMC

Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–148. doi: 10.1111/j.1532-5415.1991.tb01616.x. PubMed DOI

Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94. doi: 10.1093/geronj/49.2.M85. PubMed DOI

Leach JM, Mellone S, Palumbo P, Bandinelli S, Chiari L. Natural turn measures predict recurrent falls in community-dwelling older adults: a longitudinal cohort study. Sci Rep. 2018;8(1):4316. doi: 10.1038/s41598-018-22492-6. PubMed DOI PMC

Granacher U, Bridenbaugh SA, Muehlbauer T, Wehrle A, Kressig RW. Age-related effects on postural control under multi-task conditions. Gerontology. 2011;57(3):247–255. doi: 10.1159/000322196. PubMed DOI

Appeadu MK, Bordoni B. Falls and Fall Prevention in Older Adults. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Bruno Bordoni declares no relevant financial relationships with ineligible companies.; 2024. PubMed

Gschwind YJ, Kressig RW, Lacroix A, Muehlbauer T, Pfenninger B, Granacher U. A best practice fall prevention exercise program to improve balance, strength/power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC Geriatr. 2013;9(13):105. doi: 10.1186/1471-2318-13-105. PubMed DOI PMC

Costa A, Santos LOD, Mauerberg-deCastro E, Moraes R. Task difficulty has no effect on haptic anchoring during tandem walking in young and older adults. Neurosci Lett. 2018;14(666):133–138. doi: 10.1016/j.neulet.2017.12.052. PubMed DOI

Uematsu A, Tsuchiya K, Suzuki S, Hortobágyi T. Cognitive dual-tasking augments age-differences in dynamic balance quantified by beam walking distance: a pilot study. Exp Gerontol. 2018;114:27–31. doi: 10.1016/j.exger.2018.10.016. PubMed DOI

Montero-Odasso M, Schapira M, Soriano ER, Varela M, Kaplan R, Camera LA, et al. Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol A Biol Sci Med Sci. 2005;60(10):1304–1309. doi: 10.1093/gerona/60.10.1304. PubMed DOI

Li W, Keegan TH, Sternfeld B, Sidney S, Quesenberry CP, Jr, Kelsey JL. Outdoor falls among middle-aged and older adults: a neglected public health problem. Am J Public Health. 2006;96(7):1192–1200. doi: 10.2105/AJPH.2005.083055. PubMed DOI PMC

Crenshaw JR, Bernhardt KA, Achenbach SJ, Atkinson EJ, Khosla S, Kaufman KR, et al. The circumstances, orientations, and impact locations of falls in community-dwelling older women. Arch Gerontol Geriatr. 2017;73:240–247. doi: 10.1016/j.archger.2017.07.011. PubMed DOI PMC

Sawers A, Hafner BJ. Narrowing beam-walking is a clinically feasible approach for assessing balance ability in lower-limb prosthesis users. J Rehabil Med. 2018;50(5):457–464. doi: 10.2340/16501977-2329. PubMed DOI PMC

Sipp AR, Gwin JT, Makeig S, Ferris DP. Loss of balance during balance beam walking elicits a multifocal theta band electrocortical response. J Neurophysiol. 2013;110(9):2050–2060. doi: 10.1152/jn.00744.2012. PubMed DOI PMC

Batistela RA, Oates A, Costa AAS, Santos LO, Moraes R. Trunk balance control during beam walking improves with the haptic anchors without the interference of an auditory-cognitive task in older adults. Gait Posture. 2020;81:166–171. doi: 10.1016/j.gaitpost.2020.07.067. PubMed DOI

da Silva Costa AA, Hortobágyi T, Otter RD, Sawers A, Moraes R. Beam width and arm position but not cognitive task affect walking balance in older adults. Sci Rep. 2022;12(1):6854. doi: 10.1038/s41598-022-10848-y. PubMed DOI PMC

da Silva Costa AA, Moraes R, Hortobágyi T, Sawers A. Older adults reduce the complexity and efficiency of neuromuscular control to preserve walking balance. Exp Gerontol. 2020;15(140):111050. doi: 10.1016/j.exger.2020.111050. PubMed DOI

Speers RA, Ashton-Miller JA, Schultz AB, Alexander NB. Age differences in abilities to perform tandem stand and walk tasks of graded difficulty. Gait Posture. 1998;7(3):207–213. doi: 10.1016/S0966-6362(98)00006-X. PubMed DOI

Milani G, Costa AAS, Junqueira EB, Campoi EG, Campoi HG, Santiago PRP, et al. Three days of beam walking practice improves dynamic balance control regardless of the use of haptic anchors in older adults. Neurosci Lett. 2022;11(781):136682. doi: 10.1016/j.neulet.2022.136682. PubMed DOI

Ganz N, Gazit E, Giladi N, Dawe RJ, Mirelman A, Buchman AS, et al. Automatic quantification of tandem walking using a wearable device: new insights into dynamic balance and mobility in older adults. J Gerontol A Biol Sci Med Sci. 2021;76(1):101–107. doi: 10.1093/gerona/glaa235. PubMed DOI PMC

Poncumhak P, Srithawong A, Duangsanjun W. Validation of the circular tandem walk test and optimal cutoff score to determine the risk of falls in active community-dwelling older adults. J Aging Phys Act. 2022;30(5):799–805. doi: 10.1123/japa.2021-0265. PubMed DOI

Joo B, Marquez JL, Osmotherly PG. Ten-second tandem stance test: a potential tool to assist walking aid prescription and falls risk in balance impaired individuals. Arch Rehabil Res Clin Transl. 2022;4(1):100173. PubMed PMC

Beghi E, Gervasoni E, Pupillo E, Bianchi E, Montesano A, Aprile I, et al. Prediction of falls in subjects suffering from parkinson disease, multiple sclerosis, and stroke. Arch Phys Med Rehabil. 2018;99(4):641–651. doi: 10.1016/j.apmr.2017.10.009. PubMed DOI

Sanders KM, Stuart AL, Scott D, Kotowicz MA, Nicholson GC. Validity of 12-month falls recall in community-dwelling older women participating in a clinical trial. Int J Endocrinol. 2015;2015:210527. doi: 10.1155/2015/210527. PubMed DOI PMC

Ruopp MD, Perkins NJ, Whitcomb BW, Schisterman EF. Youden Index and optimal cut-point estimated from observations affected by a lower limit of detection. Biom J. 2008;50(3):419–430. doi: 10.1002/bimj.200710415. PubMed DOI PMC

Woollacott MH, Tang PF. Balance control during walking in the older adult: research and its implications. Phys Ther. 1997;77(6):646–660. doi: 10.1093/ptj/77.6.646. PubMed DOI

Chiu MC, Wu HC, Chang LY, Wu MH. Center of pressure progression characteristics under the plantar region for elderly adults. Gait Posture. 2013;37(3):408–412. doi: 10.1016/j.gaitpost.2012.08.010. PubMed DOI

Asai T, Oshima K, Fukumoto Y, Yonezawa Y, Matsuo A, Misu S. Does dual-tasking provide additional value in timed "up and go" test for predicting the occurrence of falls? A longitudinal observation study by age group (young-older or old-older adults) Aging Clin Exp Res. 2021;33(1):77–84. doi: 10.1007/s40520-020-01510-6. PubMed DOI

Cho H, Heijnen MJH, Craig BA, Rietdyk S. Falls in young adults: the effect of sex, physical activity, and prescription medications. PLoS ONE. 2021;16(4):e0250360. doi: 10.1371/journal.pone.0250360. PubMed DOI PMC

Verma SK, Willetts JL, Corns HL, Marucci-Wellman HR, Lombardi DA, Courtney TK. Falls and fall-related injuries among community-dwelling adults in the United States. PLoS ONE. 2016;11(3):e0150939. doi: 10.1371/journal.pone.0150939. PubMed DOI PMC

Rodrigues F, Domingos C, Monteiro D, Morouco P. A Review on aging, sarcopenia, falls, and resistance training in community-dwelling older adults. Int J Environ Res Public Health. 2022;19(2). PubMed PMC

Fhon JRS, Silva ARF, Lima EFC, Santos Neto APD, Henao-Castano AM, Fajardo-Ramos E, et al. Association between sarcopenia, falls, and cognitive impairment in older people: a systematic review with meta-analysis. Int J Environ Res Public Health. 2023;20(5). PubMed PMC

Muehlbauer T, Gollhofer A, Granacher U. Association of balance, strength, and power measures in young adults. J Strength Cond Res. 2013;27(3):582–589. doi: 10.1519/JSC.0b013e31825c2bab. PubMed DOI

Tomioka K, Iwamoto J, Saeki K, Okamoto N. Reliability and validity of the International Physical Activity Questionnaire (IPAQ) in elderly adults: the Fujiwara-kyo Study. J Epidemiol. 2011;21(6):459–465. doi: 10.2188/jea.JE20110003. PubMed DOI PMC

Ramsey KA, Zhou W, Rojer AGM, Reijnierse EM, Maier AB. Associations of objectively measured physical activity and sedentary behaviour with fall-related outcomes in older adults: a systematic review. Ann Phys Rehabil Med. 2022;65(2):101571. doi: 10.1016/j.rehab.2021.101571. PubMed DOI

Jiang Y, Wang M, Liu S, Ya X, Duan G, Wang Z. The association between sedentary behavior and falls in older adults: a systematic review and meta-analysis. Front Public Health. 2022;10:1019551. doi: 10.3389/fpubh.2022.1019551. PubMed DOI PMC

Clemson L, Stark S, Pighills AC, Fairhall NJ, Lamb SE, Ali J, et al. Environmental interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2023;3(3):CD013258. PubMed PMC

Dubbeldam R, Lee YY, Pennone J, Mochizuki L, Le Mouel C. Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks. Eur Rev Aging Phys Act. 2023;20(1):2. doi: 10.1186/s11556-023-00312-9. PubMed DOI PMC

Li Y, Hou L, Zhao H, Xie R, Yi Y, Ding X. Risk factors for falls among community-dwelling older adults: a systematic review and meta-analysis. Front Med (Lausanne) 2022;9:1019094. doi: 10.3389/fmed.2022.1019094. PubMed DOI PMC

Muehlbauer T, Besemer C, Wehrle A, Gollhofer A, Granacher U. Relationship between strength, power and balance performance in seniors. Gerontology. 2012;58(6):504–512. doi: 10.1159/000341614. PubMed DOI

Granacher U, Lacroix A, Muehlbauer T, Roettger K, Gollhofer A. Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology. 2013;59(2):105–113. doi: 10.1159/000343152. PubMed DOI

Hortobágyi T, Teixeira LA, Duysens J, Granacher U, van Dieën J, Moraes R. Is standing sway an accurate measure of fall risk and predictor of future falls in older adults? Br J Mot Beh. 2020;14(1):1–3. doi: 10.20338/bjmb.v14i01.176. DOI

Xu Q, Ou X, Li J. The risk of falls among the aging population: a systematic review and meta-analysis. Front Public Health. 2022;10:902599. doi: 10.3389/fpubh.2022.902599. PubMed DOI PMC

Kakara R, Bergen G, Burns E. Understanding the association of older adult fall risk factors by age and sex through factor analysis. J Appl Gerontol. 2023;1:7334648231154881. PubMed PMC

Rehman RZU, Zhou Y, Del Din S, Alcock L, Hansen C, Guan Y, et al. Gait analysis with wearables can accurately classify fallers from non-fallers: a step toward better management of neurological disorders. Sensors (Basel). 2020;20(23). PubMed PMC

Zhou Y, Romijnders R, Hansen C, Campen JV, Maetzler W, Hortobagyi T, et al. The detection of age groups by dynamic gait outcomes using machine learning approaches. Sci Rep. 2020;10(1):4426. doi: 10.1038/s41598-020-61423-2. PubMed DOI PMC

Zhou Y, Zia Ur Rehman R, Hansen C, Maetzler W, Del Din S, Rochester L, et al. Classification of neurological patients to identify fallers based on spatial-temporal gait characteristics measured by a wearable device. Sensors (Basel). 2020;20(15). PubMed PMC

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