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Reactive Balance Training: A Guide to Strengthening Your Balance Reactions

reacting to tripping so you don't fall

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Table of Contents

Balance presents one of the biggest challenges in the daily life of many seniors today. Various life circumstances and conditions can influence balance, equilibrium, and fall risk as we age.  

Techniques like Reactive Balance Training can help prevent predictable falls and train your body and brain for the daily challenges that may not be so easy to predict.

What is Reactive Balance Training?

Reactive balance training is a form of exercise aimed at improving fall prevention strategies and practicing balance reactions, such as a stepping reaction to prevent a stumble.

This exercise method requires you to respond quickly to an outside stimulus or activity to maintain balance.

RBT requires full-body movements and can improve the strength and stability of various muscles. More importantly, RBT aims to improve your response time and stepping accuracy to prevent a future fall. (1)

Many of my patients fall due to unexpected events, such as slipping on a wet surface or tripping over an object on the floor, like a rug or power cord. Falls among older adults due to slipping account for 40% of all outdoor falls. (2)

A large, quick step and weight shift are typically required to recover from losing balance from a slip or trip. Reactive balance training focuses on similar reactions to improve your ability to recover safely.

This type of training usually requires a controlled simulation of an unexpected external force to elicit a quick reaction. This can be accomplished in several ways, such as another person applying the force or slip platforms you can stand on.

For example, perturbation-based training — a standard method for reactive balance training — simulates the effect of a physical force acting on you, similar to someone bumping into you on a busy sidewalk.

The key to reactive balance training is that the force is unexpected, so you cannot anticipate your response before it happens.

reactive balance example on a wobbly bridge
Think of the unexpected movements of a wobbly bridge.

Who is Reactive Balance Training For?

RBT is applied to people who have trouble with their balance, have a history of falls, or are fearful of falling, and is typically implemented by a physical therapist.

It has been shown effective at reducing falls in patients with a variety of neurological conditions as well, including Parkinson’s disease and stroke. While it is effective for specific conditions, it has also been shown to reduce the fear of falling. (3)

Reactive balance training is most commonly done in a physical therapy clinic with one-on-one supervision to ensure safety. Due to the repetitive nature of this type of training, it is recommended to complete 2-3 sessions per week over several weeks for the best results. (3)

Remember that this type of training aims to intentionally cause you to lose your balance to elicit a reaction for recovery. For this reason, it can seem scary at first. Completing this training in a clinic with a trained professional can help reduce the risk of falls during your workout and make you feel safer.

Physical Therapy for Reactive Balance

Physical therapists are trained professionals with many skills to help you improve your balance.  

They may use a combination of safety precautions during a balance training session, such as a support harness or gait belt to catch you if you cannot recover independently to prevent a fall.

Repetition is a significant component of reactive balance training. Training activities will be repeated until you can appropriately respond and recover your balance independently. Based on your responses and improvement, the training can be progressed to make it more challenging. The goal is to improve your overall reaction time and reflexes. In contrast, traditional PT exercises often focus more on strength or flexibility.

Depending on the facility, your therapist may use various devices and equipment, and perturbation training is one of the most common forms of reactive balance training.

Your therapist can perform perturbation training with limited equipment by having you either stand or walk, then purposely bumping into you to elicit a balance reaction, like adjusting your posture or taking a step. Of course, this will be done in a safe, controlled environment.

A progression may utilize a variety of uneven surfaces for you to stand on, such as a wobble board, BOSU ball, or foam pad. A similar perturbation can then be performed as described above. Alternatively, your therapist may apply the perturbation force to the surface you are standing on (instead of to your body) for a new challenge.

Using a Slip Trainer for Improving Balance and Reducing Falls

Slip Training

Some clinics may utilize more high-tech options for reactive balance training, such as a typical treadmill and/or a slip trainer.  This harness system helps to support you from above to enhance your training and prevent injury.

Slip training can help to recreate more realistic slip-and-fall scenarios. With this training style, you might stand on a platform where the therapist can move unexpectedly, causing a step reaction. The harness is constructed to allow you to “fall” without the risk of hitting the ground with a force that might otherwise be dangerous.

Both treadmill and over-ground slip training have been shown to reduce the risk of falls more than traditional balance training. (2)

Balance practice at home

Reactive Balance Training at Home

Traditional reactive balance training with perturbations or slip training is not commonly prescribed for home use. Still, several exercises can help you practice some of these responses safely.  

The main goal of balance training is to reinforce step reactions and postural responses. However, the surprise factor is more difficult to simulate safely at home, so these exercises can be helpful to complement a therapist-guided RBT series.

When completing these exercises at home, set yourself up in a safe area to prevent injury. For example, I like having my patients stand beside their beds or near a countertop or other immovable surfaces to catch their balance if needed.  

Please note: It is ideal to practice this type of training when someone else is at home with you in the event of an accident or fall. Always discuss new exercises with your doctor first.

Reactive Balance Training with a Physical Therapist

Step Reactions:

  • Begin standing with a comfortable hips-width stance. Lean slightly forward while keeping the hips straight. You should start to feel your weight shift forward in your feet. Keep going until you have leaned too far outside your support base, forcing you to take a step to catch yourself.

  • You can repeat this in each direction — forward, back, side-to-side, and diagonally — to practice step reactions in all planes. Be sure you give yourself enough space to take a large step in each direction.

  • If you do not feel comfortable leaning outside your base of support, start by practicing large, quick steps in each direction from standing.

Alternating Lunges:

  • Start a comfortable stance. Take a large step forward, bending your knees into a lunge position.  It is not necessary to bend your knees farther than is comfortable.  Step your feet back together, then repeat on the other side.

  • If you feel confident with this movement, you can repeat this exercise by stepping backward or side-to-side into a similar lunge position.

Balance & Reach:

  • Start standing with one foot before the other as if you have just taken a small step forward.  

  • Practice reaching in multiple directions — side-to-side, across your body, up or down. Try to maintain your balance as you reach in various directions with varying speeds.

  • You can make this more challenging by standing on one foot while reaching or by narrowing your stance to a heel-to-toe position like you are on a balance beam.

  • You can also try having someone pass a balloon or a ball back and forth with you, causing the reaches to be more random, similar to the concept of perturbation training.

Other Options to Improve Balance

While these exercises do well to mimic some of the benefits of RBT, many forms of exercise, like strength training or cardiovascular exercise, can also improve balance to prevent future falls. Since many of the risk factors for falls in older adults involve coordination and strength, exercises like yoga and tai chi work well as balance exercises. They also encourage a deliberate focus on movement.

If you’re unfamiliar with these practices, you can also focus on moving slowly while going about your daily tasks to notice areas where you could use a little improvement.

For instance, when you stand up from a seated position, rather than hoisting yourself up with your arms, try to slowly rise from your seat. Likewise, slowly sit to work the same muscles one more time.

This simple addition to your day encourages underworked muscles in the legs and hips that are important for balance and many other daily activities.

While it is also important to manage problems like high blood pressure (which can lead to dizziness), simple exercises can help to get your body moving. By making daily tasks a balance exercise, you have one more tool to prevent falls leading to serious injury.


Reactive balance training is widely supported in research to help reduce the risk of falls. The goal of reactive balance training is to reinforce balance reactions and reflexes, most commonly the step reaction, to allow for recovery from a misstep, bump, or slip.

Traditional reactive balance training requires unexpected stimuli that you must respond to quickly to keep from falling. It is most commonly performed in a physical therapy clinic for safety reasons. You can also practice some exercises at home to practice these reactions. Still, it is most important you are safe while performing.

Balance problems are common, but support is available. If you regularly lose your balance, have fallen, or are simply afraid of falling, consult your physical therapist to explore some of these options today. 


  1. Barzideh A, Marzolini S, Danells C, Jagroop D, Huntley AH, Inness EL, Mathur S, Mochizuki G, Oh P, Mansfield A. Effect of reactive balance training on physical fitness poststroke: study protocol for a randomized non-inferiority trial. BMJ Open. 2020 Jun 30;10(6):e035740. doi: 10.1136/bmjopen-2019-035740. PMID: 32606059; PMCID: PMC7328813.

  2. Wang, Y., Bhatt, T. Liu, X., Wang S., Lee, A., Wang, E., Pai, Yi-Chung. Can treadmill-slip perturbation training reduce immediate risk of over-ground-slip-induced fall among community-dwelling older adults? Journal of Biomechanics. 2019. Feb 14. 84(58-66). https://doi.org/10.1016/j.jbiomech.2018.12.017

  3. Avril Mansfield, Jennifer S. Wong, Jessica Bryce, Svetlana Knorr, Kara K. Patterson, Does Perturbation-Based Balance Training Prevent Falls? Systematic Review and Meta-Analysis of Preliminary Randomized Controlled Trials, Physical Therapy, Volume 95, Issue 5, 1 May 2015, Pages 700–709, https://doi.org/10.2522/ptj.20140090