Long-term effects of highly challenging balance training in Parkinson’s disease—a randomized controlled trial

Wallén, Martin Benka; Hagströmer, María; Conradsson, David; Sorjonen, Kimmo; Franzén, Erika

doi:10.1177/0269215518784338

Cited by 33 publications

(83 citation statements)

References 31 publications

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“…on the PDQ-39. A 6-week intervention period may be too brief to observe noticeable changes in clinical or perceived measures (8,18,(45)(46)(47)(48)(49). In addition, as the ABC-C intervention was carried out as group exercise, including participants with different disease severity and cognitive abilities in the same group, the program may have been less challenging for people with milder disease severity.…”

Section: Discussionmentioning

confidence: 99%

Responsiveness of Objective vs. Clinical Balance Domain Outcomes for Exercise Intervention in Parkinson's Disease

et al. 2020

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Background: Balance deficits in people with Parkinson's disease (PD) are often not helped by pharmacological or surgical treatment. Although balance exercise intervention has been shown to improve clinical measures of balance, the efficacy of exercise on different, objective balance domains is still unknown. Objective: To compare the sensitivity to change in objective and clinical measures of several different domains of balance and gait following an Agility Boot Camp with Cognitive Challenges (ABC-C) intervention. Methods: In this cross-over, randomized design, 86 individuals with PD participated in 6-week (3×/week) ABC-C exercise classes and 6-week education classes, consisting of 3-6 individuals. Blinded examiners tested people in their practical off state. Objective outcome measures from wearable sensors quantified four domains of balance: sway in standing balance, anticipatory postural adjustments (APAs) during step initiation, postural responses to the push-and-release test, and a 2-min natural speed walk with and without a cognitive task. Clinical outcome measures included the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III, the Mini Balance Evaluation Systems Test (Mini-BESTest), the Activities of Balance Confidence (ABC), and the Parkinson's Disease Questionnaire (PDQ-39). The standardized response means (SRM) of the differences between before and after each intervention compared responsiveness of outcomes to intervention. A linear mixed model compared effects of exercise with the active control-education intervention. Results: The most responsive outcome measures to exercise intervention with an SRM > 0.5 were objective measures of gait and APAs, specifically arm range of motion, gait speed during a dual-task walk, trunk coronal range of motion, foot strike angle, and first-step length at step initiation. The most responsive clinical outcome measure was the patient-reported PDQ-39 activities daily living subscore, but all clinical measures had SRMs <0.5. Hasegawa et al. Objective vs. Clinical Balance Outcomes Conclusions: The objective measures were more sensitive to change after exercise intervention compared to the clinical measures. Spatiotemporal parameters of gait, including gait speed with a dual task, and APAs were the most sensitive objective measures, and perceived functional independence was the most sensitive clinical measure to change after the ABC-C exercise intervention. Future exercise intervention to improve gait and balance in PD should include objective outcome measures.

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Section: Discussionmentioning

confidence: 99%

Responsiveness of Objective vs. Clinical Balance Domain Outcomes for Exercise Intervention in Parkinson's Disease

et al. 2020

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“…All patients included in the RCTs were on a stable medication regimen. [18][19][20][21][22][23][24][25][26][27][28] With the exception of one study, all other studies involved assessments at the 'on' status of medications. 29 As shown in Table 1, the interventions in the experimental group involved two different types of tasks, whereas the control group either performed one type of approach or maintained regular activities.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

“…In addition to one study that applied the Balance Evaluation Systems Test to assess balance, 25,37 there were three studies that used the Mini-Balance Evaluation Systems Test. 24,26,29 Therefore, these studies were included in our meta-analysis. Results from the randomeffects model indicated that dual-task training had a significant improvement on balance function compared with that of the control groups (SMD, −0.44; 95% CI, −0.84 to −0.05; P = 0.03; I 2 , 56%; Figure 3), indicating large heterogeneity in terms of this parameter.…”

Section: Outcome Measures and Main Findings Of Included Studiesmentioning

confidence: 99%

Dual-task training on gait, motor symptoms, and balance in patients with Parkinson’s disease: a systematic review and meta-analysis

Liu

Jiang

et al. 2020

Clin Rehabil

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Objective: The aim of the present study was to systematically evaluate and quantify the effectiveness of dual-task training on gait parameters, motor symptoms and balance in individuals diagnosed with Parkinson’s disease. Data resources: A systematic review of published literature was conducted until May 2020, using PubMed, EMBASE, Cochrane Library, Web of Science, EBSCO and CNKI databases. Methods: We included randomized controlled trials (RCTs) and non-RCTs to evaluate the effects of dual-task training compared with those of non-intervention or other forms of training. The measurements included gait parameters, motor symptoms and balance parameters. Methodological quality was assessed using the PEDro scale. Outcomes were pooled by calculating between-group mean differences using fixed- or random-effects models based on study heterogeneity. Results: A total of 11 RCTs comprising 322 subjects were included in the present meta-analysis. Results showed that dual-task training significantly improved gait speed (standardized mean difference [SMD], −0.23; 95% confidence interval [CI], −0.38 to −0.08; P = 0.002), cadence (SMD, −0.25; 95% CI, −0.48 to −0.02; P = 0.03), motor symptoms (SMD, 0.56; 95% CI, 0.18 to 0.94; P = 0.004) and balance (SMD, −0.44; 95% CI, −0.84 to −0.05; P = 0.03). However, no significant changes were detected in step length or stride length. Conclusion: Dual-task training was effective in improving gait performance, motor symptoms and balance in patients with Parkinson’s disease relative to other forms of training or non-intervention.

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“…Because these axial symptoms only improve partially with dopaminergic medication [2,[5][6][7][8], non-pharmacological interventions such as physiotherapy are important to manage these problems [9][10][11][12]. There is growing evidence that physiotherapy interventions improve gait [13][14][15][16][17][18][19] and balance performance in PD [20][21][22][23][24][25][26][27][28]. Physiotherapy typically involves functional gait and balance exercises [9,10,24] that translate directly to daily life activities [29][30][31].…”

Section: Introductionmentioning

confidence: 99%

Multimodal Balance Training Supported by Rhythmical Auditory Stimuli in Parkinson’s Disease: A Randomized Clinical Trial

Capato

Vries²,

IntHout³

et al. 2020

JPD

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Background: Balance impairment in Parkinson's disease (PD) improves only partially with dopaminergic medication. Therefore, non-pharmacological interventions such as physiotherapy are important elements in clinical management. External cues are often applied to improve gait, but their effects on balance control are unclear. Objective/Methods: We performed a prospective, single-blind, randomized clinical trial to study the effectiveness of balance training with and without rhythmical auditory cues. We screened 201 volunteers by telephone; 154 were assigned randomly into three groups: (1) multimodal balance training supported by rhythmical auditory stimuli (n = 56) (RAS-supported multimodal balance training); (2) regular multimodal balance training without rhythmical auditory stimuli (n = 50); and (3) control intervention involving a general education program (n = 48). Training was performed for 5 weeks, two times/week. Linear mixed models were used for all outcomes. Primary outcome was the Mini-BESTest (MBEST) score immediately after the training period. Assessments were performed by a single, blinded assessor at baseline, immediately post intervention, and after one and 6-months follow-up. Results: Immediately post intervention, RAS-supported multimodal balance training was more effective than regular multimodal balance training on MBEST (difference 3.5 (95% Confidence Interval (CI) 2.2; 4.8)), p < 0.001). Patients allocated to both active interventions improved compared to controls (MBEST estimated mean difference versus controls 6.6 (CI 5.2; 8.0), p < 0.001 for RAS-supported multimodal balance training; and 3.0 (CI 2.7; 5.3), p < 0.001 for regular multimodal balance training). Improvements were retained at one-month follow-up for both active interventions, but only the RAS-supported multimodal balance training group maintained its improvement at 6 months. Conclusion: Both RAS-supported multimodal balance training and regular multimodal balance training improve balance, but RAS-supported multimodal balance training-adding rhythmical auditory cues to regular multimodal balance traininghas greater and more sustained effects.

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Long-term effects of highly challenging balance training in Parkinson’s disease—a randomized controlled trial

Abstract: These results suggest that training effects diminish within 6 months after balance training, implying that the program may need to be repeated regularly.

Cited by 33 publications

References 31 publications

Responsiveness of Objective vs. Clinical Balance Domain Outcomes for Exercise Intervention in Parkinson's Disease

Responsiveness of Objective vs. Clinical Balance Domain Outcomes for Exercise Intervention in Parkinson's Disease

Dual-task training on gait, motor symptoms, and balance in patients with Parkinson’s disease: a systematic review and meta-analysis

Multimodal Balance Training Supported by Rhythmical Auditory Stimuli in Parkinson’s Disease: A Randomized Clinical Trial

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