Feasibility of Aquatic Reactive Balance Training (AquaReBal) for Older Adults: Protocol for a Single-Arm Pre-Post Study

Introduction: Falls are a serious problem for older adults, and as the number of older adults increases rapidly, the burden of falls is expected to continue rising. Reactive balance training is an important component of balance and fall-prevention exercise programmes in older people at elevated fall risk. Despite its effectiveness for improving reactive balance control and preventing falls, land-based RBT programs can be associated with increased risk of adverse events, including joint pain, fear, and anxiety that results in participants withdrawing from the program. A water environment could minimize the barriers associated with land-based RBT. The aim of this research was to determine the feasibility and preliminary effectiveness of aquatic reactive balance training (AquaReBal). Methods: Older adults (n = 12-15) will be recruited and will complete twelve sessions of AquaReBal over 6 weeks. Feasibility outcomes (fidelity, acceptability, adherence, safety) will be assessed throughout the study. Interviews with participants will be conducted post-training to understand participants' experiences with the intervention. Secondary outcomes related to falls - physical activity, psychological consequences, generic health-related quality of life, and reactive balance control - will be assessed pre- and post-training; however, given the small sample size, these measures will be treated as exploratory and are not powered to detect change with precision. Falls in daily life will be recorded throughout the study until 6 months post-training. Conclusion: Findings from this study will inform the feasibility and design of AquaReBal, contributing to the development of aquatic interventions for fall prevention in older adults. .