Fall Prevention Through the Lens of a Sprints Coach: Reflections on my ISPGR Promising Scientist Award (PSA) Talk

ISPGR was delighted to award Dr Christopher McCrum its 2025 Promising Scientist Award (PSA). In his PSA Plenary Talk at the 2025 World Congress in Maastricht, Netherlands, Dr McCrum reflected on how viewing fall prevention through the lens of elite sprint coaching has influenced the questions he asks, the methods he uses, and the way he interprets results. This post summarizes the key ideas and messages from that lecture.

Last year at the 2025 ISPGR World Congress, I was honoured to receive this award and to give a presentation about the first stages of my scientific career. I discussed not so much about the scientific nuts and bolts of my research but on one of the perspectives that I look at my research from and how that has aided me throughout my research so far. In this blog post, I will give a brief summary of the key points and messages of my talk.

My background and main motivation for my studies during my bachelor and masters was (elite) sports coaching, specifically in sprinting. At first glance, elite sprint performance and fall prevention in older adults may seem worlds apart. But the central argument of my talk was that changing perspectives can unlock new insights and progress, particularly in a field as complex as fall prevention. This idea resonated strongly with the broader theme of the ISPGR conference, which emphasized interdisciplinary collaboration and the value of looking beyond traditional disciplinary boundaries [1].

In my work, fall prevention is not about preventing all falls, nor is it about minimizing movement or risk-taking. Most falls in older adults occur due to trips and slips during walking, often involving large, sudden balance disturbances. These are the events I am primarily interested in understanding and preventing. Equally important is recognizing that older adults are not a homogeneous group, and that the mechanisms underlying a fall matter. Preventing a slow collapse during a transfer is not the same problem as recovering from a sudden trip during walking.

In sprint coaching, performance can be viewed through interacting “targets”, for example: Structure (e.g. muscle–tendon properties); Capacity (e.g., strength and power); or Technique/skill/coordination. Crucially, coaching also forces you to ask where an individual sits on each of these dimensions relative to the point of diminishing returns. Strength is not always the limiting factor. More conditioning is not always the answer. Sometimes, what matters most, is skill or technique.

This perspective influenced how I approached fall prevention research from early on. Rather than asking only whether older adults are weaker, slower, or less active, I became interested in whether they are given the opportunity to practice the specific skills required to resist and recover from balance loss. As a result, a large part of my research has focused on perturbation-based balance training (PBT) – exposing people to repeated, unexpected balance disturbances during walking so that they can learn to recover more effectively [2]. My own and others’ research consistently shows that older adults are capable of rapid adaptation to repeated perturbations. Improvements in reactive gait recovery can occur within a single session, and can be partly retained over weeks and even years.

Ageing is associated with well-documented declines in muscle-tendon properties, strength, power, and Type II muscle fibre size. These factors are clearly relevant for movement and fall risk, and exercise interventions targeting them are effective at reducing falls at the population level. However, while muscle , they do not appear to be the primary limiting factors for learning to recover from a trip during walking [3]. From a coaching perspective, this is not surprising: improving strength does not automatically translate into improved skill unless the skill itself is trained.

Another recurring theme in the field is whether being physically active protects against age-related declines in reactive balance. Our data suggest a nuanced answer. Reactive gait recovery does decline with age, even when older adults are matched to younger individuals on habitual physical activity [4]. However, the capacity to adapt to repeated perturbations is largely preserved: Older adults can still learn, even if their baseline performance is lower. This distinction matters. It suggests that interventions do not only need to consider how to prevent physical decline but also how to leverage preserved adaptability through appropriate task-specific training.

One outcome of taking a more skill-based perspective is the recognition that the ability to resist or avoid falls is not actually a single ability. We can distinguish between:

• Proactive gait adaptability: detecting threats and adjusting gait accordingly (e.g., stepping over an obstacle)
• Gait robustness: resisting disturbances without losing balance (e.g., tolerating uneven cobblestones without tripping or losing balance)
• Reactive gait recovery: responding effectively once balance is lost (e.g., a recovery step after a trip)

Each of these processes might be improved through different overlapping and interacting mechanisms: direct skill improvements; indirect changes in gait; and psychological factors such as confidence or threat perception [5].

Looking back over more than a decade of research, what stands out is not a single result, but how much the questions themselves were shaped by perspective. Approaching fall prevention through the lens of a sprint coach led me to prioritize task specificity, skill acquisition, and considering dose–response and dose-generalisability relationships [6] – ideas that are familiar in sport, but historically underemphasized in fall prevention. This does not mean that this perspective is definitive, complete or correct. But it illustrates the value of interdisciplinary thinking, particularly in a field where progress depends on integrating biomechanics, neuroscience, psychology, and clinical practice.

If there is one takeaway from my ISPGR lecture, it is that fall prevention, and posture and gait research more broadly, may benefit as much from changing how we think as from changing what we measure. Societies and conferences that actively encourage cross-disciplinary dialogue play a crucial role in making that possible [1].

References

1: Filtjens B, McCrum C. (2026) Perspectives on interdisciplinary posture and gait research from the ISPGR 2025 World Congress: Where do we stand and what are the next steps? Gait & Posture 124: 110058. doi: 10.1016/j.gaitpost.2025.110058

2: McCrum C, Bhatt TS, Gerards MHG, Karamanidis K, Rogers MW, Lord SR, Okubo Y. (2022) Perturbation-based Balance Training: Principles, Mechanisms and Implementation in Clinical Practice. Frontiers in Sports and Active Living. 4:1015394. doi: 10.3389/fspor.2022.1015394

3: McCrum C, Grevendonk L, Schaart G, Moonen-Kornips E, Jörgensen JA, Gemmink A, Meijer K, Hoeks J. (2021) Type II muscle fibre properties are not associated with balance recovery following large perturbations during walking in young and older adults. bioRxiv doi: 10.1101/2021.11.26.470167

4: Grevendonk L. Connell NJ, McCrum C, Fealy CE, Bilet L, Bruls YMH, Mevenkamp J, Schrauwen-Hinderling VB, Jörgensen JA, Moonen-Kornips E, Schaart G, Havekes B, de Vogel-van den Bosch J, Bragt MCE, Meijer K, Schrauwen P, Hoeks J. (2021) Impact of aging and exercise on skeletal muscle mitochondrial capacity, energy metabolism, and physical function: a cross-sectional study. Nature Communications. 12: 4773. doi: 10.1038/s41467-021-24956-2

5: van der Hulst EG, Meijer K, Meyns P, McCrum C. (2025) Design Considerations for Technology-assisted Fall-Resisting Skills Training Trials in Older Adults: A Pilot and Feasibility Study. medRxiv doi: 10.1101/2025.10.03.25337262

6: Karamanidis K, Epro G, McCrum C, König M. (2020) Improving trip and slip-resisting skills in older people: perturbation dose matters. Exercise and Sport Sciences Reviews. 48(1): 40-47. doi: 10.1249/JES.0000000000000210

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