Effectiveness of Balance Exercise and Brisk Walking on Alleviating Nonmotor and Motor Symptoms in People With Mild-to-Moderate Parkinson Disease: A Randomized Clinical Trial With 6-Month Follow-up.

OBJECTIVE: To investigate the effects of balance exercise and brisk walking on nonmotor and motor symptoms, balance and gait functions, walking capacity, and balance confidence in Parkinson disease (PD) at posttraining and 6-month follow-up. DESIGN: Two-arm, assessor-blinded randomized controlled trial SETTING: University research laboratory and the community PARTICIPANTS: Ninety-nine eligible individuals with mild-to-moderate PD INTERVENTIONS: Participants were randomized to balance and brisk walking group (B&B, n=49) or active control group (n=50). B&B received ten 90-minute sessions of balance exercises and brisk walking supervised by physical therapists for 6 months (week 1-6: weekly, week 7-26: monthly), whereas control practiced whole-body flexibility and upper limb strength exercise at same dosage (180 min/wk). Both groups performed unsupervised home exercises 2-3 times/wk during intervention and continued at follow-up. MAIN OUTCOME MEASURES: Primary outcomes were Movement Disorder Society Unified Parkinson Disease Rating Scale nonmotor (MDS-UPDRS-I) and motor (MDS-UPRDS-III) scores. Secondary outcomes were mini-Balance Evaluation Systems Test (mini-BEST) score, comfortable gait speed (CGS), 6-minute walk test (6MWT), dual-task timed-Up-and-Go (DTUG) time, and Activities-Specific Balance Confidence Scale score. RESULTS: Eighty-three individuals completed the 6-month intervention with no severe adverse effects. The mean between-group (95% CI) difference for the MDS-UPDRS nonmotor score was 1.50 (0.19-2.81) at 6 months and 1.09 (-0.66 to 2.85) at 12 months. The mean between-group (95% CI) difference for the MDS-UPDRS motor score was 3.75 (0.69-6.80) at 6 months and 4.57 (1.05-8.01) at 12 months. At 6 and 12 months, there were significant between-group improvements of the B&B group in mini-BEST score, CGS, 6MWT, and DTUG time. CONCLUSIONS: This combined balance and brisk walking exercise program alleviates nonmotor and motor symptoms and improves walking capacity, balance, and gait functions posttraining, with positive carryover effects for all except nonmotor outcomes, at 6-month follow-up in mild-to-moderate PD.

Association between fear of falling and falls following acute and chronic stroke: a systematic review with meta-analysis.

OBJECTIVES: To examine the association between falls and fear of falling in people with stroke and to evaluate the differences between patients with acute stroke and those with chronic stroke with regard to any such association. METHODS: Articles were searched in Medline, CINAHL, AMED, Embase, PsycINFO, Cochrane Library of Reviews and PEDro from inception until March 2023. Experimental, observational or explorative studies investigating the association between fear of falling and falls in people with stroke were included. Articles were screened by 2 independent reviewers. Data were extracted by an independent reviewer. RESULTS: A total of 26 reports were included in this review (n = 2863). Fear of falling, assessed by a single-question survey, was significantly associated with falls (relative risk = 1.44; 95% confidence interval (95% CI) = 1.22, 1.70; I2 = 0%) in people with acute stroke. Significant mean differences in fear of falling, based on the Falls Efficacy Scale (mean difference = 12.80; 95% CI = 1.81, 23.78; I² = 28%) and Activities-specific Balance Confidence Scale (mean difference = -9.99; 95% CI = -15.36, -4.62; I² = 57%), were also reported between fallers and non-fallers in people with chronic stroke. CONCLUSION: A small, but significant, association exists between falls and fear of falling in both acute and chronic stroke patients.

Modulating Cortical Hemodynamic Activity in Parkinson's Disease Using Focal Transcranial Direct Current Stimulation: A Pilot Functional Near-infrared Spectroscopy Study.

Reduced thalamocortical facilitation of the motor cortex in PD leads to characteristic motor deficits such as bradykinesia. Recent research has highlighted improved motor function following tDCS, but a lack of neurophysiological evidence limits the progress of tDCS as an adjunctive therapy. Here, we tested the hypothesis that tDCS may modulate M1 hemodynamic activity in PD and healthy using functional near-infrared spectroscopy (fNIRS). In this randomized crossover experiment, fourteen PD and twelve healthy control participants attended three laboratory sessions and performed a regulated (3 Hz) right index finger tapping task before and after receiving tDCS. On each visit, participants received either anodal, cathodal, or sham tDCS applied over M1. Hemodynamic activity of M1 was quantified using fNIRS. Significant task related activity was observed in M1 and the inferior parietal lobe in PD and healthy (p < 0.05). PD additionally recruited the dorsal premotor cortex. During tDCS, while at rest, anodal and cathodal tDCS significantly increased the oxygenated hemoglobin concentration of M1 compared to sham (t62 = 4.09 and t62 = 4.25, respectively). Task related hemodynamic activity was unchanged following any tDCS intervention (p > 0.05). Task related hemodynamic activity of M1 is not modulated by tDCS in PD or healthy. During tDCS, both anodal and cathodal stimulation cause a significant increase of M1 oxygenation, the clinical significance of which remains to be clarified.

Does Exercise Attenuate Disease Progression in People With Parkinson's Disease? A Systematic Review With Meta-Analyses.

INTRODUCTION: Exercise has many benefits for people with Parkinson's disease (PD) and has been suggested to modify PD progression, but robust evidence supporting this is lacking. OBJECTIVE: This systematic review (PROSPERO registration: CRD42020169999) investigated whether exercise may have neuroplastic effects indicative of attenuating PD progression. METHODS: Six databases were searched for randomized controlled trials (RCTs) that compared the effect of exercise to control (no or sham exercise) or to another form of exercise, on indicators of PD progression (eg, brain-derived neurotrophic factor [BDNF], brain activation, "off" Unified Parkinson's Disease Rating Scale [UPDRS] scores). Trial quality was assessed using the Physiotherapy Evidence Database Scale. Random-effects meta-analyses were performed where at least 3 comparable trials reported the same outcome; remaining results were synthesized narratively. RESULTS: Forty-nine exercise trials involving 2104 PD participants were included. Compared to control, exercise improved "off" UPDRS motor scores (Hedge's g -0.39, 95% CI: -0.65 to -0.13, P = .003) and BDNF concentration (Hedge's g 0.54, 95% CI: 0.10-0.98, P = .02), with low to very low certainty of evidence, respectively. Narrative synthesis for the remaining outcomes suggested that compared to control, exercise may have neuroplastic effects. The exercise versus exercise comparisons were too heterogenous to enable pooling of results. DISCUSSION: This review provides limited evidence that exercise may have an attenuating effect on potential markers of PD progression. Further large RCTs are warranted to explore differential effects by exercise type, dose and PD stage, and should report on a core set of outcomes indicative of PD progression.

Impaired Hand Function and Its Association With Self-Perceived Hand Functional Ability and Quality of Life in Parkinson Disease.

OBJECTIVE: Comprehensive hand function in people with Parkinson disease (PD) has been underevaluated. The objectives were to compare self-perceived and objective hand functions of PD and controls, compare outcomes between more and less affected hand subgroups, and evaluate relationship between self-perceived and objective outcomes in subgroups. DESIGN: A total of 165 PD and 82 healthy participants completed the Jebsen-Taylor Hand Function Test, Purdue Pegboard Test, grip strength test, and Manual Ability Measure-16 in a cross-sectional study. PD participants completed the Parkinson Disease Questionnaire-39. Associations between objective and self-perceived/quality of life outcomes in PD groups were analyzed, and nondominant and dominant more affected subgroups performance was compared. RESULTS: PD participants had significantly worse performance in most Jebsen-Taylor Hand Function Test and all Purdue Pegboard Test items, lower Manual Ability Measure-16 scores, and poorer handgrip strength. Weak associations were found between dexterity, but not grip strength, and self-perceived functional hand ability and Parkinson Disease Questionnaire-39 scores in PD subgroups. For nondominant more affected subgroup, poorer dexterity was associated with better Parkinson Disease Questionnaire-39 Activity of Daily Living domain scores. CONCLUSION: People with mild to moderate PD were shown to have poorer manual dexterity, reduced grip strength, and lower self-perceived functional hand ability than controls. Associations between dexterity and self-perceived outcomes highlight the importance of unimanual and bimanual training.

Single session transcranial direct current stimulation to the primary motor cortex fails to enhance early motor sequence learning in Parkinson's disease.

INTRODUCTION: Explicit motor sequence learning is impaired in Parkinson's disease (PD). Transcranial direct current stimulation (tDCS) applied over the motor cortex in healthy can improve explicit motor learning, but comparative effects in PD are unknown. This exploratory study aims to examine the effect of single session tDCS on explicit motor sequence learning in PD. METHODS: Thirty-three people with mild to moderate PD learnt a short and long finger tapping sequence with their right hand. Participants received either anodal, cathodal, or sham tDCS applied over the left primary motor cortex during task practice. Single- and dual-task finger tapping performance was assessed before and after task practice and functional near-infrared spectroscopy used to measure task related changes of oxygenated haemoglobin. RESULTS: Finger tapping performance of short and long sequences under single-task conditions significantly improved following practice (p = 0.010 and p < 0.001, respectively). A condition-by-time interaction trend was observed for the long finger tapping sequence (p = 0.069) driven by improved performance in the cathodal (p = 0.001) and sham (p < 0.001) tDCS conditions, but not anodal tDCS (p = 0.198). The primary and premotor cortex and supplementary motor area were active in all tasks. No interaction or main effects were observed for task related changes of oxygenated haemoglobin. CONCLUSIONS: PD patients retain the capacity to learn an explicit sequence of movements. Motor cortex tDCS does not improve explicit motor learning in PD and anodal tDCS may even suppress the rate of learning.

Intelligent wearable system with accurate detection of abnormal gait and timely cueing for mobility enhancement of people with Parkinson's disease.

Previously reported wearable systems for people with Parkinson's disease (PD) have been focused on the detection of abnormal gait. They suffered from limited accuracy, large latency, poor durability, comfort, and convenience for daily use. Herewith we report an intelligent wearable system (IWS) that can accurately detect abnormal gait in real-time and provide timely cueing for PD patients. The system features novel sensitive, comfortable and durable plantar pressure sensing insoles with a highly compressed data set, an accurate and fast gait algorithm, and wirelessly controlled timely sensory cueing devices. A total of 29 PD patients participated in the first phase without cueing for developing processes of the algorithm, which achieved an accuracy of over 97% for off-line detection of freezing of gait (FoG). In the second phase with cueing, the evaluation of the whole system was conducted with 16 PD subjects via trial and a questionnaire survey. This system demonstrated an accuracy of 94% for real-time detection of FoG and a mean latency of 0.37 s between the onset of FoG and cueing activation. In questionnaire survey, 88% of the PD participants confirmed that this wearable system could effectively enhance walking, 81% thought that the system was comfortable and convenient, and 70% overcame the FoG. Therefore, the IWS makes it an effective, powerful, and convenient tool for enhancing the mobility of people with PD.

Six-Month Community-Based Brisk Walking and Balance Exercise Alleviates Motor Symptoms and Promotes Functions in People with Parkinson's Disease: A Randomized Controlled Trial.

BACKGROUND: In Parkinson's disease (PD), sustained aerobic exercise is a promising therapy in delaying motor disability. Brisk walking is a moderate intensity aerobic training, which could be translated to community practice at low cost, but its effects on motor symptoms remains unclear. OBJECTIVE: To determine the effectiveness of a six-month brisk walking and balance program in alleviating motor symptoms, and promoting functional, gait, and balance performance in people with PD. METHODS: Seventy individuals with mild to moderate PD were randomly assigned to a brisk walking (BW) group or an active control (CON) group. BW group received ten 90-minute supervised brisk walking and balance exercise for six months (weeks 1-6: once/week, weeks 7-26: once/month). CON group received upper limb training. Both groups performed 2-3 self-practice sessions weekly. Primary outcome was Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor score. Secondary outcomes were fast gait speed (FGS), timed-up-and-go (TUG) time, six-minute walk distance (6MWD), and Mini-Balance Evaluation Systems Test (Mini-BEST) score. RESULTS: Sixty-four participants (33 BW/31 CON) completed training. BW group showed greater significant decreases from baseline than CON group in MDS-UPDRS motor score after six weeks (-5.5 vs -1.6, p < 0.001) and 6 months (-6.0 vs -1.4, p < 0.001) of training. BW group also showed greater significant improvement from the baseline than CON group for TUG time, FGS, 6MWD, and mini-BEST score (all p < 0.05). CONCLUSION: The six-month brisk walking and balance program alleviates motor symptoms, promotes functional and gait performance, walking capacity, and dynamic balance in people with mild to moderate PD.

Aerobic exercise in older people with subclinical sporadic cerebral small vessel disease: A randomized clinical trial.

INTRODUCTION: The benefit and risk of aerobic exercise among older people harboring advanced cerebral small vessel disease (CSVD) upon cognition, mood, and motor functions are unknown. METHODS: This rater-blind randomized trial examined effects of a 24-week aerobic exercise training (60 min/session, twice/week) upon clinical (cognition, mood, motor functions) and hemodynamic (pulse pressure [PP], blood pressure [BP], pulsatility index) measures in older people harboring moderate to severe CSVD, as evidenced by confluent white matter hyperintensity and/or ≥2 lacunes on magnetic resonance imaging. We further investigated interactions between treatment conditions and hemodynamics measures. RESULTS: Fifty-three and 54 subjects were randomized into the active and control group, respectively. There was no between-group difference in any of the clinical outcomes. The active group had a greater between-group reduction in systolic BP and PP than the control group. Within-group comparison showed that global cognition of the active group remained similar at end of the study compared to baseline, whereas it declined significantly in the control group. We observed "diverging" interaction effects in that greater reduction in systolic BP/PP was associated with greater improvement in memory functions and global cognition but worsening in processing speed in the active group. Side effects were comparable between the two groups. DISCUSSION: Future study should investigate the mechanisms of the diverging impacts of aerobic exercise upon different cognitive domains so that the benefit-risk ratio of aerobic exercise in older people harboring more advanced CSVD can be better defined.

Transcranial Magnetic Stimulation Promotes Gait Training in Parkinson Disease.

OBJECTIVE: To determine whether priming with 1 or 25Hz repetitive transcranial magnetic stimulation (rTMS) will enhance the benefits from treadmill training up to 3 months postintervention in people with Parkinson disease (PD), and to evaluate the underlying changes in cortical excitability. METHODS: This randomized double-blind, placebo-controlled trial was conducted between October 2016 and December 2018. Fifty-one participants with PD were randomized to receive 12 sessions of rTMS (25Hz, 1Hz, or sham) followed by treadmill training. All participants were assessed at baseline and 1 day, 1 month, and 3 months postintervention. Primary outcome was fastest walking speed, and secondary outcomes were timed up-and-go test (TUG), dual-task TUG (DT-TUG), motor section of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III), and electrophysiological evaluation of cortical excitability by TMS. RESULTS: The 1 and 25Hz rTMS groups produced a greater improvement in fastest walking speed at 1 day and 3 months postintervention than the sham group. Only the 1 and 25Hz rTMS groups sustained the improvements in TUG, and had a significant improvement in DT-TUG and MDS-UPDRS-III for up to 3 months. Behavioral improvements correlated with increased cortical silent period and short-interval intracortical inhibition in both groups receiving real rTMS. INTERPRETATION: Priming with 1 and 25Hz rTMS can augment the benefits of treadmill training and lead to long-term motor improvement up to 3 months postintervention. The motor improvement at follow-up was associated with a normalization of cortical excitability, which in turn suggests an alteration of the homeostatic plasticity range. Rebalancing cortical excitability by rTMS appears critical for plasticity induction. ANN NEUROL 2020;88:933-945.

The effect of transcranial direct current stimulation on upper limb motor performance in Parkinson's disease: a systematic review.

BACKGROUND AND PURPOSE: Parkinson's disease (PD) reduces independence and quality of life through deterioration of upper limb motor function. Transcranial direct current stimulation (tDCS) may offer an alternative, adjunctive therapy for PD. However, the efficacy of tDCS for upper limb motor rehabilitation in PD is unknown. In this systematic review, evidence is compiled regarding the effects of tDCS on upper limb motor function in PD. METHODS: Studies of tDCS applied to PD patients that assessed upper limb motor function, conducted between January 2000 and November 2018, were screened for inclusion via a systematic search of Medline, Cochrane, PsycINFO, EMBASE, CINAHL, and Web of Science. RESULTS: Ten out of 606 studies were included and their findings synthesized into five categories regarding the effects of tDCS on: (1) Unified Parkinson's Disease Rating Scale motor section (UPDRS III), (2) upper limb motor tasks, (3) manual dexterity, (4) reaction time, and (5) neurophysiology. CONCLUSIONS: When applied to the primary motor cortex, tDCS may improve UPDRS III and the speed and force of movement. Considerable variation was found in tDCS parameters and further study is needed to clarify the long-term effects of tDCS on both simple and complex motor tasks and to compile relevant neurophysiological evidence.

Exercise for Parkinson's disease.

Parkinson's disease is the second most common neurodegenerative disease with a prevalence rate of 1-2 per 1000 of the population worldwide. Pharmacological management is the mainstay of treatment. Despite optimal medication, motor impairment particularly balance and gait impairment persist leading to various degree of disability and reduced quality-of-life. The present review describes motor impairment including postural impairment, gait dysfunction, reduced muscle strength and aerobic capacity and falls. Physical therapy and complementary exercises have been proven to improve motor performance and functional mobility. Evidence on the efficacy of physical therapy and complementary exercises is presented in this review. These exercises include gait training with cues, gait training with treadmill, Nordic walking, brisk walking, balance training, virtual reality interventions, Tai Chi and dance. All these treatment interventions produce short-term beneficial effects and some interventions demonstrate long-term benefit. Gait training with treadmill enhance walking performance and the effects sustain for 3-6 months. Balance training improves balance, function and reduces fall rate, and these effects carry over to at least 12 months after training ended. Sustained Tai Chi for 6 months, dance therapy for 12 months, progressive resistive training for 24 months alleviates the PD motor symptoms, suggesting that they could slow down PD progression. Based on this evidence, individuals with PD are encouraged to sustain their training in order to improve/maintain their physical ability and to combat the progression of PD.

Multisystem Balance Training Reduces Injurious Fall Risk in Parkinson Disease: A Randomized Trial.

Previous studies have shown that balance training could reduce falls in people with Parkinson disease. However, it remains unclear whether exercise can reduce injurious falls. The objective of present study was to determine whether multisystem balance training could reduce injurious falls and modify targeted fall risk factors in Parkinson disease nonfallers and single fallers. Participants were randomly assigned to an 8-wk balance group (experimental, n = 41) or an upper limbs group (control, n = 43). Outcomes examined at posttraining and 12-mo follow-up were: (1) injurious fall risk (ratio of noninjurious fallers to injurious fallers); (2) two potential fall risk factors based on Balance Evaluation Systems Test scores and dual-task timed-up-and-go times. At posttraining, results indicated that there were no injurious falls, and fewer experimental participants were found in high fall risk cohorts based on Balance Evaluation Systems Test scores and dual-task timed-up-and-go times (P < 0.05). At 12-mo follow-up, the number of injurious fallers was lower in experimental group (P < 0.05). There was also a marginally lower percentage of experimental group in the high fall risk cohort based on Balance Evaluation Systems Test scores (P = 0.059). The findings conclude that multisystem balance training potentially reduces injurious fall risk up to 12-mo posttraining and lowers balance-related fall risks in people with Parkinson disease.

Long-term effects of exercise and physical therapy in people with Parkinson disease.

Parkinson disease (PD) is a progressive, neurodegenerative movement disorder with symptoms reflecting various impairments and functional limitations, such as postural instability, gait disturbance, immobility and falls. In addition to pharmacological and surgical management of PD, exercise and physical therapy interventions are also being actively researched. This Review provides an overview of the effects of PD on physical activity - including muscle weakness, reduced aerobic capacity, gait impairment, balance disorders and falls. Previously published reviews have discussed only the short-term benefits of exercises and physical therapy for people with PD. However, owing to the progressive nature of PD, the present Review focuses on the long-term effects of such interventions. We also discuss exercise-induced neuroplasticity, present data on the possible risks and adverse effects of exercise training, make recommendations for clinical practice, and describe new treatment approaches. Evidence suggests that a minimum of 4 weeks of gait training or 8 weeks of balance training can have positive effects that persist for 3-12 months after treatment completion. Sustained strength training, aerobic training, tai chi or dance therapy lasting at least 12 weeks can produce long-term beneficial effects. Further studies are needed to verify disease-modifying effects of these interventions.

Increased Cognitive Control During Execution of Finger Tap Movement in People with Parkinson's Disease.

BACKGROUND: Previous studies employed demanding and complex hand tasks to study the brain activation in people with Parkinson's Disease (PD). There is inconsistent finding about the cerebellar activity during movement execution of this patient population. OBJECTIVES: This study aimed to examine the brain activation patterns of PD individuals in the on-state and healthy control subjects in a simple finger tapping task. METHODS: Twenty-seven patients with PD and 22 age-matched healthy subjects were recruited for the study. Subjects were instructed to perform simple finger tapping tasks under self- and cue-initiated conditions in separate runs while their brain activations were captured using fMRI. RESULTS: Healthy subjects had higher brain activity in contralateral precentral gyrus during the self-initiated task, and higher brain activity in the ipsilateral middle occipital gyrus during the cue-initiated task. PD patients had higher brain activity in the cerebellum Crus I (bilateral) and lobules VI (ipsilateral) during the self-initiated task and higher brain activity in the contralateral middle frontal gyrus during the cue-initiated task. When compared with healthy controls, PD patients had lower brain activity in the contralateral inferior parietal lobule during the self-initiated task, and lower brain activity in the ipsilateral cerebellum lobule VIII, lobule VIIB and vermis VIII, and thalamus during the cue-initiated task. Conjunction analysis indicated that both groups had activation in bilateral cerebellum and SMA and ipsilateral precentral gyrus and postcentral gyrus during both self- and cue-initiated movement. Individuals with PD exhibited higher brain activity in the executive zone (cerebellum Crus I and II) during self-initiated movement, and lower brain activity in the sensorimotor zone (i.e. lobule VIIb and VIII of the cerebellum) during cue-initiated movement. DISCUSSIONS: The findings suggest that individuals with PD may use more executive control when performing simple movements.

The potential synergism by combining external counterpulsation with intermittent theta burst stimulation in post-stroke motor function recovery.

Upper limb weakness and incoordination is a common disability following ischemic stroke. Previous studies have showed that the single application of external counterpulsation (ECP) and intermittent theta burst stimulation (iTBS) can effectively enhance the cortical motor excitability and facilitate recovery. However, it remains uncertain if sequential application of these therapies would further augment the recovery. We hypothesize a synergistic effect of ECP followed by iTBS to upper limb function may happen through improvements in both cerebral perfusion and neuron excitability.

Effects of Exercise on Falls, Balance, and Gait Ability in Parkinson's Disease: A Meta-analysis.

Postural instability and falls are complex and disabling features of Parkinson's disease (PD) and respond poorly to anti-Parkinsonian medication. There is an imperative need to evaluate the effectiveness of exercise interventions in enhancing postural stability and decreasing falls in the PD population. The objectives of our study were to determine the effects of exercise training on the enhancement of balance and gait ability and reduction in falls for people with PD and to investigate potential factors contributing to the training effects on balance and gait ability of people with PD. We included 25 randomized control trials of a moderate methodological quality in our meta-analysis. The trials examined the effects of exercise training on balance and gait ability and falls against no intervention and placebo intervention. The results showed positive effects of exercise intervention on enhancing balance and gait performance (Hedges' g = 0.303 over the short-term in 24 studies and 0.419 over the long-term in 12 studies; P < .05) and reducing the fall rate (rate ratio = 0.485 over the short-term in 4 studies and 0.413 over the long-term in 5 studies; P < .05). The longest follow-up duration was 12 months. There was no evidence that training decreased the number of fallers over the short- or long-term (P > .05). The results of our metaregression and subgroup analysis showed that facility-based training produced greater training effects on improving PD participants' balance and gait ability (P < .05). The findings support the application of exercise training to improve balance and gait ability and prevent falls in people with PD.

Task- and Context-Specific Balance Training Program Enhances Dynamic Balance and Functional Performance in Parkinsonian Nonfallers: A Randomized Controlled Trial With Six-Month Follow-Up.

OBJECTIVES: To investigate the short- and long-term effects of a task- and context-specific balance training program on dynamic balance and functional performance, and to explore the effects on preventing total and injurious falls in parkinsonian nonfallers. DESIGN: A randomized controlled trial with group allocation single-blinded to the assessor. SETTING: Community centers, malls, and outdoor parks. PARTICIPANTS: Nonfallers with Parkinson disease (PD) (N=70; mean age ± SD, 61.2±8.8y) randomly assigned to either a balance (BAL) group (n=32) or a control (CON) group (n=38). INTERVENTIONS: The BAL group received 4 weeks of indoor and 4 weeks of outdoor balance training (with a 2-h session per week). The CON group received 8 weeks of upper limb training at the same dosage. Both groups were instructed to perform 3 hours of home exercise weekly posttraining. MAIN OUTCOME MEASURES: (1) Dynamic balance performance: Mini-Balance Evaluation Systems Test (Mini-BESTest); (2) Functional performance: functional reach (FR), 5 times sit-to-stand (FTSTS), 1-leg-stance (OLS), Timed Up and Go (TUG), and dual-task TUG tests; (3) Fall-related outcomes: ratios of total nonfallers to fallers and noninjurious fallers to injurious fallers, total and injurious fall rates, times to first falls and injurious falls. RESULTS: Sixty-eight participants completed training. A total of 7 patients (10%) withdrew before the 6-month follow-up, but not because of any adverse effects. At immediate and 6 months posttraining, the BAL group showed significantly greater improvements (from baseline) than the CON group in Mini-BESTest total scores, FR distances, and OLS times, together with greater time reductions in FTSTS, TUG, and dual-task TUG tests (all P<.05). The number of injurious fallers was significantly lower in the BAL group at 6-month follow-up. CONCLUSIONS: This task- and context-specific balance training program improved the dynamic balance and fall-prone functional performance of PD nonfallers for up to 6 months after training. The BAL group showed a reduction in injurious fallers.

Multi-dimensional balance training programme improves balance and gait performance in people with Parkinson's disease: A pragmatic randomized controlled trial with 12-month follow-up.

INTRODUCTION: Previous studies have demonstrated that exercise interventions can improve balance and gait performance in people with Parkinson's disease (PD), but most training did not target all balance domains and was conducted mainly indoors. OBJECTIVES: To investigate the short- and long-term effects of a multi-dimensional indoor and outdoor exercise programme on balance, balance confidence and gait performance in people with PD. METHODS: Eligible subjects with PD were randomly assigned to an eight-week indoor and outdoor balance training (EXP, N = 41) group or upper limb exercise (CON, N = 43) group. Outcome measures included BESTest total and subsection scores, gait speed, dual-task timed-up-and-go (dual-task TUG) time and Activities-specific Balance Confidence (ABC) score. All outcomes were assessed before training (Pre), immediately after intervention (Post) and at six-month (FU6m) and twelve-month (FU12m) follow-ups. RESULTS: Immediately after training, EXP group showed more significant improvements than CON group in BESTest total and subsection scores, gait speed and dual-task TUG time (p < 0.05). At both FU6m and FU12m, EXP group showed significantly greater gains than CON group in BESTest total and subsection scores and dual-task TUG time (p < 0.05). EXP group also showed significantly greater increase in the gait speed than CON group at FU6m (p < 0.05). CONCLUSION: The positive findings of this study provide evidence that this multi-dimensional balance training programme can enhance balance and dual-task gait performance up to 12-month follow-up in people with PD.