The intervention, which combines the physical and cognitive aspects of walking, could potentially be used in gyms, rehabilitation centres or nursing homes to improve safe walking and prevent falls in older adults or people with disorders which affect movement such as Parkinson's disease, researchers wrote in The Lancet journal.
Falls in adults aged 65 and over account for 1-2 per cent of all health-care expenditure in high-income countries, they said.
Even without injuries, falls often lead to fear of falling, avoiding leaving the house and depression, which in turn often leads to inactivity, muscle weakness, impaired balance and gait, more falls and more social isolation.
All participants were aged 60-90, were able to walk at least 5 minutes unassisted, on stable medication, and had reported at least 2 falls in the 6 months before the start of the study.
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Nearly half of all participants (130) had Parkinson's disease, and some (43) had mild cognitive impairment.
Participants were assigned to treadmill training with virtual reality (146), or treadmill training alone (136).
The virtual reality component consisted of a camera that captured the movement of participants' feet and projected it onto a screen in front of the treadmill, so that participants could 'see' their feet walking on the screen in real time.
Prior to training, participants in the treadmill only group had an average of 10.7 falls per six months, and participants in the treadmill plus virtual reality group averaged 11.9 falls per six months.
During the six months after training, the incidence rate of falls decreased in both groups, but the decrease was only statistically significant in the treadmill plus virtual reality group - 11.9 to 6.0 falls in the virtual reality group - a 42 per cent reduction; compared to a decrease from 10.7 to 8.3 in the treadmill only group.