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Introduction There is increasing evidence that perturbation-based balance training (PBT) is highly effective in preventing falls at older age. Different PBT paradigms have been presented so far, yet a systematic comparison of PBT approaches with respect to feasibility and effectiveness is missing. Two different paradigms of PBT seem to be promising for clinical implementation: 1. Technology-supported training on a perturbation treadmill (PBTtreadmill); 2. Training of dynamic stability mechanisms in the presence of perturbations induced by unstable surfaces (PBTstability). This study aimed to compare both program's feasibility and effectiveness in fall-prone older adults. Methods In this three-armed randomized controlled trial, seventy-one older adults (74.9 ± 6.0 years) with a verified fall risk were randomly assigned into three groups: PBTtreadmill on a motorized treadmill, PBTstability using unstable conditions such as balance pads and a passive control group (CG). In both intervention groups, participants conducted a 6-weeks intervention with 3 sessions per week. Effects were assessed in fall risk (Brief-BEST), balance ability (Stepping Threshold Test, Center of Pressure, Limits of Stability), leg strength capacity, functional performance (Timed Up and Go Test, Chair-Stand), gait (preferred walking speed) and fear of falling (Short-FES-I). Results Fifty-one participants completed the study. Training adherence was 91% for PBTtreadmill and 87% for PBTstability, while no severe adverse events occurred. An ANCOVA with an intention-to-treat approach revealed statistically significant group effects in favor of PBTstability in the Brief-BEST (p=.009, η²=.131) and the Limits of Stability (p=.020, η²=.110), and in favor of PBTtreadmill in the Stepping Threshold Test (p

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