Variable vs Fixed Auditory-Cued Stepping Training

Reduced physical activity is associated with diminished neuromuscular reactivity and postural control. While auditory-cued stepping/gait training has demonstrated benefits for balance and stepping performance in clinical populations (e.g., stroke, Parkinson's disease), evidence in healthy, sedentary young adults remains limited. Motor-learning theory suggests that greater practice variability - in both timing and spatial direction - promotes superior motor adaptation and retention compared with fixed, predictable practice conditions. This randomized controlled trial will compare a combined variable-timing and variable-direction auditory-cued stepping training protocol against a fixed-timing, fixed-direction protocol, in terms of their effects on dynamic balance (Y-Balance Test) and stepping adaptability (Choice Stepping Reaction Time), in sedentary young adults aged 18-35 years, over a 4-week supervised training period.

Inclusion criteria

• Age 18-35 years
• Sedentary lifestyle (International Physical Activity Questionnaire short-form 'inactive/low' category, or <150 minutes/week of moderate-to-vigorous physical activity)
• Able to stand and walk independently without an assistive device
• Normal or corrected-to-normal hearing and vision
• Body Mass Index (BMI) 18.5-29.9 kg/m²
• Willing and able to provide written informed consent and comply with the 4-week training schedule and assessment sessions

Exclusion criteria

• Diagnosed neurological, vestibular, or orthopedic/musculoskeletal condition known to affect balance or gait (e.g., stroke, Parkinson's disease, vestibular disorders, lower-limb fracture/surgery in the past 6 months)
• History of falls within the past 12 months
• Hearing impairment or use of a hearing aid/cochlear implant
• Uncorrected visual impairment
• Regular participation in structured exercise, sport, or balance/agility training (>150 min/week of moderate-to-vigorous activity)
• Pregnancy
• Cardiovascular, respiratory, or other medical contraindication to physical exertion/exercise testing
• Current use of medication known to affect balance, reaction time, or central nervous system function (e.g., sedatives, anti-vertigo medication)
• Cognitive or communication impairment that would limit the ability to follow auditory-cued instructions
• Concurrent enrollment in another balance, stepping, or exercise-intervention study