Age-Related Associations between Reactive-Balance Stepping Responses, Self-Induced Stepping, and Gray-Matter Volume.

Overview

1. Department of Physical Therapy, Recanati School of Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
2. Department of Cognitive and Brain Sciences, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
3. Diagnostic Imaging Institute, Soroka University Medical Center, Beer-Sheva, Israel

Abstract

Introduction: The distinction between reactive and proactive balance control mechanisms in terms of age-related structural neural correlates is still scarce. From a biomechanical perspective, reactive stepping is a rapid response to sudden loss of stability, whereas proactive self-induced stepping requires anticipatory postural adjustments and longer duration. This study aims to explore how cortical and subcortical gray-matter volume correlates with variables of reactive and proactive stepping responses among older and young adults; and whether these stepping responses can be distinguished from one another in terms of their structural neural correlates (i.e., cortical and subcortical gray-matter volume).

Methods: Twenty-six older adults and nine young adults underwent structural MRI brain scanning. Self-induced stepping variables were derived from ground reaction force data, while kinematic parameters of reactive stepping, including step thresholds, were obtained using a three-dimensional motion capture system. Age-related differences in ground reaction force measures, stepping kinematics, and gray-matter volume in ten regions of interest were examined, followed by partial correlation analyses.

Results: Age-related impairments in reactive and proactive stepping performance were accompanied by significantly smaller gray-matter volume among older adults across all regions of interest (p ≤ 0.003), except for the brainstem (p = 0.026; post-correction significance level: p < 0.005). Partial correlation analyses including both older and young adults revealed significant associations whereby longer balance recovery durations and lower stepping thresholds were associated with lower gray-matter volume in prefrontal and cortical regions, and in the putamen and amygdala (r = −0.41 to −0.60, p ≤ 0.037; and r = 0.38 to 0.43, p ≤ 0.048, respectively). In self-induced stepping performance, longer preparation and step durations were significantly associated with lower precentral, cerebellar and amygdala gray-matter volume (r = −0.51 to −0.56, p ≤ 0.006).

Conclusion: Age-related differences in reactive stepping deficits were primarily associated with lower gray-matter volume in prefrontal, cortical, putamen, and amygdala regions, whereas self-induced stepping impairments were associated with precentral, cerebellar, and amygdala gray-matter volumes. These findings suggest distinct neural substrates underlying reactive versus self-initiated balance control. Further investigation needs to explore whether intervention programs in older adults may change gray-matter volume in these regions.

Reproduced under the paper's license (CC BY-NC), from the paper cited above.

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Data

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Data Availability Statement

All generated and analyzed data of this study are included in this article. The research data are not publicly available on legal or ethical grounds. However, data are available upon request. Further inquiries can be directed to the corresponding author.

Reproduced under the paper's license (CC BY-NC), from the paper cited above.

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Version 1, 29 September 2026: the first record

Recorded: type, language, journal, pages, dates, 6 authors, 5 keywords, 2 funders, 34 references.

Cite

This paper

Paran, I., Salti, M., Nachmani, H., Berdichevsky, Y., Shelef, I., & Melzer, I. (2026). Age-Related Associations between Reactive-Balance Stepping Responses, Self-Induced Stepping, and Gray-Matter Volume. Gerontology, 1-13. https://doi.org/10.1159/000551973

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