Age-related deficit in dynamic stability control after forward falls is affected by muscle strength and tendon stiffness

The purpose of the work was to determine whether the age-related muscle weakness diminishes older adults’ ability to use mechanisms responsible for maintaining dynamic stability after forward falls. Nine older and nine younger adults participated in this study. To analyse the capacities of the leg-extensor muscle–tendon units, all subjects performed isometric maximal voluntary plantarflexion and knee extension contractions on a dynamometer. The elongation of the gastrocnemius medialis and the vastus lateralis tendon and aponeuroses during isometric contraction was examined by ultrasonography. Recovery behaviour was determined after a sudden fall from two forward-inclined lean angles. Compared to older adults, younger adults had higher muscle strength and tendon stiffness. Younger adults created a higher margin of stability compared to older, independent of perturbation intensity. The main mechanism improving the margin of dynamic stability was the increase of the base of support. The results, further, demonstrated that the locomotion strategy employed before touchdown affects the stability of the stance phase and that muscle strength and tendon stiffness contributed significantly to stability control. We concluded that, to reduce the risk of falls, older individuals may benefit from muscle–tendon unit strengthening programs as well as from interventions exercising the mechanisms responsible for dynamic stability.     

Is there an association between variables of postural control and strength in prepubertal children?

The risk of sustaining falls and sports-related injuries is particularly high in children. Deficits in balance and muscle strength represent 2 important intrinsic fall and injury-risk factors. Therefore, the purpose of this study was to investigate the relationship between variables of static and dynamic postural control and isometric and dynamic muscle strength and to find out whether there is an association between measures of postural control and muscle strength in prepubertal children. Thirty children participated in this study (age 6.7 ± 0.5 years; body mass index 16.0 ± 1.8 kg·m(-2)). Biomechanic tests included the measurements of maximal isometric torque and rate of force development (RFD) of the plantar flexors on an isokinetic device, jumping power and height (countermovement jump [CMJ]) on a force plate, and the assessment of static and dynamic posture during bipedal stance on a balance platform. The significance level was set at p < 0.05. No significant associations were observed between variables of static and dynamic postural control. Significant positive correlations were detected between the RFD of the plantar flexors and CMJ height (r = 0.425, p < 0.01). No statistically significant associations were found between measures of postural control and muscle strength. The nonsignificant correlations between static and dynamic postural control and muscle strength imply that primarily dynamic measures of postural control should be incorporated in fall and injury-risk assessment and that postural control and muscle strength appear to be independent of each other and may have to be trained in a complementary manner for fall and injury-preventive purposes.     

Relationship between measures of balance and strength in middle-aged adults

The purpose of this study was to investigate the relationship between variables of static and dynamic postural control as well as between isometric and dynamic muscle strength. A single-group design was used. Thirty-two middle-aged healthy adults (mean age: 56 ± 4 years) performed measurements of static (unperturbed)/dynamic (perturbed) balance and of isometric (i.e., maximal isometric torque [MIT]; rate of torque development [RTD] of the plantar flexor)/dynamic (i.e., countermovement jump [CMJ] height and power) lower extremity muscle strength. No significant associations were observed between variables of static and dynamic postural control (r = +0.128-0.341, p > 0.05) and between measures of balance and strength (r = -0.189 to +0.316, p > 0.05). Significant positive correlations were detected between variables of isometric and dynamic strength ranging from r = +0.361 to +0.501 (p < 0.05). Further, simple regression analyses revealed that a 10% increase in the mean CMJ height (3.1 cm) was associated with 44.4 N·m and 118.4 N·m·s better MIT and RTD, respectively. The nonsignificant correlations between static and dynamic balance measures and between balance and strength variables imply that static and dynamic postural control and balance and strength are independent of each other and may have to be tested and trained complementarily.     

Effects of obesity on dynamic stability control during recovery from a treadmill-induced slip among young adults

This study sought to investigate the effects of obesity on falls and dynamic stability control in young adults when subject to a standardized treadmill-induced gait-slip. Forty-four young adults (21 normal-weight and 23 obese) participated in this study. After their muscle strength was assessed at the right knee under maximum voluntary isometric (flexion and extension) contractions, participants were moved to an ActiveStep treadmill. Following 5 normal walking trials on the treadmill, all participants encountered an identical and unexpected slip defined as a perturbation in the anterior direction with the magnitude of 24-cm slip distance and 2.4-m/s peak slip velocity. The trials were categorized as a fall or recovery based on the reliance of the subject on external support following the slip. Compared with the normal-weight group, the obese group demonstrated less relative muscle strength and fell more responding to the slip (78.3% vs. 40.0%, p=0.009). After adjusting the body height and gender, the results indicated that the obese group was 19.1-time (95% confidence interval: [2.06, 177.36]) more prone to a fall than the normal-weight group when experiencing the same treadmill-induced slip. The obese group showed significantly impaired dynamic stability after slip possibly due to the inability of controlling the trunk segment׳s backward lean movement. Obesity measurements explained more slip outcome variance than did the strength measurements (53.4% vs. 18.1%). This study indicates that obesity most likely influences the ability to recover from slip perturbations. It is important to develop interventions to improve the capability of balance recovery among individuals with obesity.     

Effects of vibration training in reducing risk of slip-related falls among young adults with obesity

This study examined the effects of controlled whole-body vibration training on reducing risk of slip-related falls in people with obesity. Twenty-three young adults with obesity were randomly assigned into either the vibration or placebo group. The vibration and placebo groups respectively received 6-week vibration and placebo training on a side-alternating vibration platform. Before and after the training, the isometric knee extensors strength capacity was measured for the two groups. Both groups were also exposed to a standardized slip induced by a treadmill during gait prior to and following the training. Dynamic stability and fall incidences responding to the slip were also assessed. The results indicated that vibration training significantly increased the muscle strength and improved dynamic stability control at recovery touchdown after the slip occurrence. The improved dynamic stability could be resulted from the enhanced trunk segment movement control, which may be attributable to the strength increment caused by the vibration training. The decline of the fall rates from the pre-training slip to the post-training one was greater among the vibration group than the placebo group (45% vs. 25%). Vibration-based training could be a promising alternative or additional modality to active exercise-based fall prevention programs for people with obesity.     

Age-related changes in posture response under a continuous and unexpected perturbation

Aging is a critical factor to influence the functional performance during daily life. Without an appropriate posture control response when experiencing an unexpected external perturbation, fall may occur. A novel six-degree-of freedom platform with motion control protocol was designed to provide a real-life simulation of unexpected disturbance in order to discriminate the age-related changes of the balance control and the recovery ability. Twenty older adults and 20 healthy young adults participated in the study. The subjects stood barefoot on the novel movable platform, data of the center of mass (COM) excursion, joint rotation angle and electromyography (EMG) were recorded and compared. The results showed that the older adults had similar patterns of joint movement and COM excursion as the young adults during the balance reactive-recovery. However, larger proximal joint rotation in elderly group induced larger COM sway envelop and therefore loss of the compensatory strategy of posture recovery. The old adults also presented a lower muscle power. In order to keep an adequate joint stability preventing from falling, the EMG activity was increased, but the asymmetric pattern might be the key reason of unstable postural response. This novel design of moveable platform and test protocol comprised the computerized dynamic posturography (CDP) demonstrate its value to assess the possible sensory, motor, and central adaptive impairments to balance control and could be the training tool for posture inability person.     

Age-related changes in the behavior of the muscle-tendon unit of the gastrocnemius medialis during upright stance

Mechanical properties of the muscle-tendon unit change with aging, but it is not known how these modifications influence the control of lower leg muscles during upright stance. In this study, young and elderly adults stood upright on a force platform with and without vision while muscle architecture and myotendinous junction movements (expressed relative to the change in the moment on the x-axis of the force platform) were recorded by ultrasonography and muscle activity by electromyography. The results show that the maximal amplitude of the sway in the antero-posterior direction was greater in elderly adults (age effect, P < 0.05) and was accompanied by an increase in lower leg muscle activity compared with young adults. Moreover, the data highlight that fascicles shorten during forward sway and lengthen during backward sways but more so for young (-4 ± 3 and -4 ± 3 mm/Nm, respectively) than elderly adults (-0.7 ± 3 and 0.8 ± 3 mm/Nm, respectively; age × sway, P < 0.001). Concurrently, the pennation angle increased and decreased during forward and backward sways, respectively, with greater changes in young than elderly adults (age × sway, P < 0.001). In contrast, no significant differences were observed between age groups for tendon lengthening and shortening during sways. The results indicate that, compared with young, elderly adults increase the stiffness of the muscular portion of the muscle-tendon unit during upright stance that may compensate for the age-related decrease in tendon stiffness. These observations suggest a shift in the control strategy used to maintain balance.     

Is there an association between variables of postural control and strength in adolescents?

Is there an association between variables of postural control and strength in adolescents? The risk of sustaining sport injuries is particularly high in adolescents. Deficits in postural control and muscle strength represent 2 important intrinsic injury risk factors. Therefore, the purpose of this study was to investigate the relationship between variables of static and dynamic postural control and isometric and dynamic muscle strength and to find out whether there is an association between measures of postural control and muscle strength. Twenty-eight adolescents participated in this study (age 16.8 ± 0.6 years; body mass index 20.5 ± 1.8 kg · m(-2)). Biomechanic tests included the measurements of maximal isometric leg extension force (MIF) and rate of force development (RFDmax) of the leg extensors on a leg press with the feet resting on a force platform, vertical jumping force, and height (countermovement jump [CMJ]) on a force plate and the assessment of static (1-legged stance on a balance platform) and dynamic (mediolateral perturbation impulse on a balance platform) postural control. The significance level was set at p < 0.05. No significant associations were observed between measures of static and dynamic postural control. Significant positive correlations were detected between variables of isometric and dynamic muscle strength with r-values ranging from 0.441 to 0.779 (p < 0.05). Based on these models, a 100-N increase in MIF of the leg extensors was associated with 3.9, 4.2, and 6.5% better maximal CMJ force, CMJ height, and RFDmax, respectively. No significant correlations were observed between variables of postural control and muscle strength. The nonsignificant correlation between static/dynamic postural control and muscle strength implies that primarily dynamic measures of postural control should be incorporated in injury risk assessment and that postural control and muscle strength are independent of each other and may have to be trained complementary for lower extremity injury prevention and rehabilitation purposes.     

Alteration in community-dwelling older adults' level walking following perturbation training

While perturbation training is promising in reducing fall-risk among older adults, its impact on altering their spontaneous gait pattern has not been investigated. The purpose of this study was to determine to what extent older adults' gait pattern would be affected by exposure to repeated slips. Seventy-three community-dwelling older adults (age: 72.6±5.4 years) underwent 24 repeated-slip exposure induced by unannounced unlocking and relocking of low-friction sections of a 7-m pathway upon which they walked. Full body kinematics and kinetics were recorded during the training. The gait parameters and the center of mass (COM) stability against backward balance loss were compared before and after the training. The results revealed that the training reduced fall incidence from 43.8% upon the novel slip to 0 at the end of training. After the training, subjects significantly improved gait stability by forward positioning of their COM relative to the base of support without altering gait speed. This forward COM shift resulted from a shortened step at the end of single stance and forward trunk leaning during double stance. They also adopted flat foot landing with knee flexed at touchdown (with an average change of 6.9 and 4.1 degrees, respectively). The perturbation training did alter community-dwelling older adults' spontaneous gait pattern. These changes enabled them to improve their volitional control of stability and their resistance to unpredictable and unpreventable slip-related postural disturbance.     

Effect of ageing and vision on limb load asymmetry during quiet stance

Although the identification and characterization of limb load asymmetries during quiet standing has not received much research attention, they may greatly extend our understanding of the upright stance stability control. It seems that the limb load asymmetry factor may serve as a veridical measure of postural stability and thus it can be used for early diagnostic of the age-related decline in balance control. The effects of ageing and of vision on limb load asymmetry (LLA) during quiet stance were studied in 43 healthy subjects (22 elderly, mean age 72.3+/-4.0 yr, and 21 young, mean age 23.9+/-4.8 yr). Postural sway and body weight distribution were recorded while the subject was standing on two adjacent force platforms during two 120 s trials: one trial was performed with the eyes open (EO), while the other trial was with the eyes closed (EC). The results indicate that LLA was greater in the old adults when compared with the young control subjects. The LLA values were correlated with the postural sway magnitudes especially in the anteroposterior direction. Eyes closure which destabilized posture resulted in a significant increase of body weight distribution asymmetry in the elderly but not in the young persons. The limb load difference between EO and EC conditions showed a significantly greater effect of vision on LLA in the elderly compared to the young subjects. The observed differences in the LLA may be attributed to the decline of postural stability control in the elderly. Ageing results in the progressive decline of postural control and usually the nervous system requires more time to complete a balance recovery action. To compensate for such a deficiency, different compensatory strategies are developed. One of them, as evidenced in our study, is preparatory limb unload strategy (a stance asymmetry strategy) which could significantly shorten reaction time in balance recovery.     

An application of scissored-pair control moment gyroscopes in a design of wearable balance assistance device for the elderly

Impaired balance control ability and degraded functional mobility increases the risk of falling in elderly people. The elderly show more postural sway when standing compared with young people. A sway fall occurs when the center of gravity moves outside the limit of stability. In order to reduce the fall risk from the excessive sway, this study presents the design of wearable balance assistance device for the elderly. Scissored-pair control moment gyroscopes were selected as a torque actuator. A two-axis inclination sensor was used to detect the inclined angle of the wearer’s body. The direction of sway was calculated from the detected inclined angle. The designed device weighs 8.2 kg with a height of 32 cm × width of 40 cm × depth of 22 cm. A multi-segment model of a standing human was used to investigate the device’s performance for balance recovery. According to the simulations, balance recovery in any direction was successfully accomplished with the appropriate initial angle. The relationship between the effective initial angle and detected inclined angle was subsequently established. The stability provided by activation of the device was able to limit the unstable user’s sway boundary. The designed device shows promise for use as a balance assistance device for the elderly.     

Deficient limb support is a major contributor to age differences in falling

Older adults are more likely than young to fall upon a loss of balance, yet the factors responsible for this difference are not well understood. This study investigated whether age-related differences in movement stability, limb support, and protective stepping contribute to the greater likelihood of falling among older adults. Sixty young and 41 older, safety-harnessed, healthy adults were exposed to a novel and unexpected forward slip during a sit-to-stand task. More older than young adults fell (76% vs. 30%). Falls in both age groups were related to lesser stability and lower hip height at first step touchdown, with 97.1% of slip outcomes correctly classified based on these variables. Decreases in hip height at touchdown had over 20 times greater effect on the odds of falling than equivalent decreases in stability. Three age differences placed older adults at greater risk of falling: older adults had lower and more slowly rising hips at slip onset, they were less likely to respond to slipping with ample limb support, and they placed their stepping foot less posterior to their center of mass. The first two differences, each associated with deficient limb support, reduced hip ascent and increased hip descent. The third difference resulted in lesser stability at step touchdown. These results suggest that deficient limb support in normal movement patterns and in the reactive response to a perturbation is a major contributor to the high incidence of falls in older adults. Improving proactive and reactive limb support should be a focus of fall prevention efforts.     

Down training of the elderly soleus H reflex with the use of a spinally induced balance perturbation.

The purpose of this study was to determine the ability of the elderly central nervous system to modulate spinal reflex output to functionally decrease a spinally induced balance perturbation. In this case, the soleus H reflex was used as the source of perturbation. Therefore, decreasing (down training) of the soleus H reflex was necessary to counteract this perturbation and to better maintain postural control. In addition to assessing the effect of this perturbation on the H reflex, static postural stability was measured to evaluate possible functional effects. Ten healthy young subjects (age: 27.0 +/- 4.6 yr) and 10 healthy elderly subjects (age: 71.4 +/- 5.1 yr) participated in this study. Subjects underwent balance perturbation on 2 consecutive days. On day 1 of perturbation, significant down training of the soleus H reflex was demonstrated in both young (-20.4%) and elderly (-18.7%) subjects. On day 2 of perturbation, significant down training of the soleus H reflex was again demonstrated in both young (-24.6%) and elderly (-21.0%) subjects. Analysis of static stability after the 2 days of balance perturbation revealed a significant 10.1% decrease in the area of sway in elderly subjects. In conclusion, this study demonstrated that healthy, elderly subjects compared with young subjects were equally capable of down training the soleus H reflex in response to a balance perturbation. Furthermore, the improvement in static stability through balance training may provide further evidence that balance can be retrained and rehabilitated in subjects with decreased reflex function.     

Effects of isometric training on the elasticity of human tendon structures in vivo.

The present study aimed to investigate the effect of isometric training on the elasticity of human tendon structures. Eight subjects completed 12 wk (4 days/wk) of isometric training that consisted of unilateral knee extension at 70% of maximal voluntary contraction (MVC) for 20 s per set (4 sets/day). Before and after training, the elongation of the tendon structures in the vastus lateralis muscle was directly measured using ultrasonography while the subjects performed ramp isometric knee extension up to MVC. The relationship between the estimated muscle force and tendon elongation (L) was fitted to a linear regression, the slope of which was defined as stiffness of the tendon structures. The training increased significantly the volume (7.6+/-4.3%) and MVC torque (33.9+/-14.4%) of quadriceps femoris muscle. The L values at force production levels beyond 550 N were significantly shorter after training. The stiffness increased significantly from 67.5+/-21.3 to 106.2+/-33.4 N/mm. Furthermore, the training significantly increased the rate of torque development (35.8 +/- 20.4%) and decreased electromechanical delay (-18.4+/-3.8%). Thus the present results indicate that isometric training increases the stiffness and Young's modulus of human tendon structures as well as muscle strength and size. This change in the tendon structures would be assumed to be an advantage for increasing the rate of torque development and shortening the electromechanical delay.     

Effect of muscle fatigue on the compliance of the gastrocnemius medialis tendon and aponeurosis

The aim of the present study was to examine whether or not the compliance of the gastrocnemius medialis (GM) tendon and aponeurosis is influenced by submaximal fatiguing efforts. Fourteen elderly male subjects performed isometric maximal voluntary plantarflexion contractions (MVC) on a dynamometer before and after two fatiguing protocols. The protocols consisted of: (1) submaximal concentric isokinetic contractions (70% isokinetic MVC) at 60 degrees /s and (2) a sustained isometric contraction (40% isometric MVC) until failure to hold the defined moment. Ultrasonography was used to determine the elongation and strain of the GM tendon and aponeurosis. To account for the axis misalignment between ankle and dynamometer, the kinematics of the leg were captured at 120 Hz. The maximum moment decreased from 85.9+/-17.9 Nm prior fatigue to 79.2+/-19 Nm after isokinetic fatigue and to 69.9+/-16.4 Nm after isometric fatigue. The maximal strain of the GM tendon and aponeurosis before fatigue, after isokinetic and after isometric fatigue were 4.9+/-1.1%, 4.4+/-1.1% and 4.3+/-1.1% respectively. Neither the strain nor the elongation showed significant differences before and after each fatiguing task at any 100 N step of the calculated tendon force. This implies that the compliance was not altered after either the isokinetic or the isometric fatiguing task. Therefore it was concluded that the strains during the performed submaximal fatiguing tasks, were too small to provoke any structural changes in tendon and aponeurosis.     

Mechanical properties of the triceps surae tendon and aponeurosis in relation to intensity of sport activity

The purpose of the present study was to investigate whether the mechanical properties (i.e. force strain relationship) of the triceps surae tendon and aponeurosis relate to the performed sport activity in an intensity-dependent manner. This was done by comparing sprinters with endurance runners and subjects not active in sports. Sixty-six young male subjects (26+/-5 yr; 183+/-6 cm; 77.6+/-6.7 kg) participated in the study. Ten of these subjects were adults not active in sports, 28 were endurance runners and 28 sprinters. All subjects performed isometric maximal voluntary plantar flexion contractions (MVC) on a dynamometer. The distal aponeuroses of the gastrocnemius medialis (GM) was visualised by ultrasound during the MVC. The results showed that only the sprinters had higher normalised stiffness (relationship between tendon force and tendon strain) of the triceps surae tendon and aponeurosis and maximal calculated tendon forces than the endurance runners and the subjects not active in sports. Furthermore, including the data of all 66 examined participants tendon stiffness correlated significantly (r=0.817, P<0.001) with the maximal tendon force achieved during the MVC. It has been concluded that the mechanical properties of the triceps surae tendon and aponeurosis do not show a graded response to the intensity of the performed sport activity but rather remain at control level in a wide range of applied strains and that strain amplitude and/or frequency should exceed a given threshold in order to trigger additional adaptation effects. The results further indicate that subjects with higher muscle strength possibly increase the margin of tolerated mechanical loading of the tendon due to the greater stiffness of their triceps surae tendon and aponeurosis.     

Exercise of mechanisms for dynamic stability control increases stability performance in the elderly

Old adults show a decreased recovery performance compared to young ones after unexpected perturbations increasing the risk of falls. Therefore, the purpose of the present study was to examine the effect of a specific training of mechanisms responsible for dynamic stability on the recovery performance of old adults after simulated forward falls and the contribution of muscle strength exercise. 38 old adults (two experimental groups each n=13 and a control group, n=12) participated in the study. Group 1 exercised the mechanisms responsible for dynamic stability like increase in base of support and counter-rotating segments around the centre of mass by practicing specific tasks including these mechanisms. Group 2 exercised these mechanisms of dynamic stability and muscle strength. The exercise volume was equal in both interventions (14 weeks, two times per week and ～1.5 h per session). Stability performance has been examined by simulated forward falls before and after the intervention. The two experimental groups improved in a similar extent (～35%) their ability to regain balance during forward falls after the intervention. The reason was a faster increase in base of support. Further, the performance enhancement was related to an increase in the rate of hip moment generation. Exercising the mechanisms responsible for dynamic stability control in old adults affects their ability to regain balance after forward falls. A faster utilization of these mechanisms due to improved neuromuscular coordination resulted in the significant performance enhancement.     

Effects of regular heel-raise training aimed at the soleus muscle on dynamic balance associated with arm movement in elderly women

The effects of low-intensity muscle training with heel-raises on dynamic balance associated with bilateral arm flexion were investigated in postmenopausal elderly women. Twenty-six elderly women were evenly grouped into training and control groups. Training group subjects performed 100 heel raises per day for 2 months. The training was aimed at hypertrophy of the soleus muscle, which has a relatively high proportion (ca. 90%) of slow-twitch muscle fibers and is one of the main postural muscles. Dynamic balance was measured while arm flexion was performed in response to a visual stimulus (simple-reaction condition) or at the subjects' own pace (own-timing condition). The following parameters were compared before and after the training period: plantar flexion strength, thicknesses of the gastrocnemius and soleus (by ultrasound), reaction time of the anterior deltoid in the simple-reaction condition, activation onset timing of postural muscles with respect to the deltoid, movement angles of ankle and hip joints, and postural fluctuation. In the training group only, the following training-related effects were demonstrated: (a) increase in plantar flexor strength and thickness of the soleus, (b) shortening of the deltoid reaction time, (c) earlier activation of the erector spinae in the simple-reaction condition and the soleus in the own-timing condition, and (d) increase in ankle movement in the own-timing condition and a decrease in postural fluctuation. This heel-raise training in the elderly can increase soleus thickness within the triceps surae and improve postural control modality and stability that are effectively contributed to by the leg muscle. This training consists of a low-intensity exercise that requires neither special machines nor a specific environment and can be performed safely for all old-aged groups.     

The relationship between dynamic balancing ability and posture-related modulation of the soleus H-reflex

Soleus H-reflex reveals down modulation with increased postural difficulty. Role of this posture-related reflex modulation is thought to shift movement control toward higher motor centers in order to facilitate more precise postural control. Present study hypothesized that the ability to modulate H-reflex is related to one’s ability to dynamically balance while in an unstable posture. This study examined the relationship between dynamic balancing ability and soleus H-reflex posture-related modulation. Thirty healthy adults participated. The soleus maximal H-reflex (Hmax), motor response (Mmax), and background EMG activity (bEMG) were obtained during three postural conditions: prone, open-legged standing, and closed-legged standing. Hmax/Mmax ratios were normalized via the corresponding bEMG in order to remove the effects of background muscle activity from the obtained H-reflex. Reflex modulation was calculated as the ratio of the normalized Hmax/Mmax ratios in one postural condition to another posture in a more difficult condition. Dynamic balancing ability was assessed by testing stability while standing on a wobble board. A significant negative correlation was observed between balancing scores and reflex modulation from open-legged standing to closed-legged standing. This suggests that the ability to modulate monosynaptic stretch reflex excitability in response to a changing posture is a significant factor for dynamic balancing.     

Adaptive recovery responses to repeated forward loss of balance in older adults

Experiments designed to assess balance recovery in older adults often involve exposing participants to repeated loss of balance. The purpose of this study was to investigate the adaptive balance recovery response exhibited by older adults following repeated exposure to forward loss of balance induced by releasing participants from a static forward lean angle. Fifty-eight healthy, community-dwelling older adults, aged 65-80 years, participated in the study. Participants were instructed to attempt to recover with a single step and performed four trials at each of three lean angles. Adaptive recovery responses at four events (cable release, toe-off of the stepping foot, foot contact and maximum knee flexion angle following landing in the stepping leg) were quantified for trials performed at the intermediate lean angle using the concept of margin of stability. The antero-posterior and medio-lateral margin of stability were computed as the difference between the velocity-adjusted position of the whole body centre of mass and the corresponding anterior or lateral boundary of the base of support. Across repeated trials adaptations in reactive stepping responses were detected that resulted in improved antero-posterior stability at foot contact and maximum knee flexion angle. Improved antero-posterior stability following repeated trials was explained by more effective control of the whole body centre of mass during the reactive stepping response and not by adjustments in step timing or base of support. The observed adaptations occurred within a single testing session and need to be considered in the design of balance recovery experiments.