This study provides evidence of a specific therapeutic effect of treadmill training on Parkinsonian gait and balance. Walking on a treadmill may be used as an easy, effective and accessible way to improve the stride length and balance in PD patients.

We examined the adaptation and generalization effect of one familiarization treadmill walking session on gait in patients with Parkinson's disease (PD) with different degrees of disease severity. Eight moderate PD patients (Hoehn and Yahr stage 2-2.5), eight advanced PD patients (Hoehn and Yahr 3), and eight matched control subjects participated in this study. Subjects first walked overground on a 10-m walkway at a self-selected speed (pretreadmill). They then performed a 20-min treadmill training session, followed by three trials of overground walking (Post1, Post2, Post3). Cadence, step length, speed, and coefficient of variation of stride time (CV) were recorded. During the treadmill session the advanced PD patients significantly decreased their cadence (t = 3.9, P

Patients with Parkinson's disease (PD) improve gait after treadmill training and while they are walking over the treadmill. However, the mechanisms of these improvements have not been addressed. We designed a treadmill simulator without a belt that could move on a walkway in a constant speed, in order to explore the mechanism underlying treadmill walking improvements in PD. All subjects were tested in three different sessions (treadmill, simulator(assisted) and simulator(not assisted)). In each session, subjects first walked overground and then walked using the treadmill or simulator with the hands over the handrails (simulator(assisted)) or with the hands free (simulator(not assisted)). Step length, cadence, double support time, swing time, support time and the coefficient of variation (CV) of step time and double support time were recorded. Over the treadmill PD patients increased their step length and reduced significantly their cadence and CV of double support time in comparison with overground walking. In the simulator(assisted) condition PD patients reduced significantly the CV of double support time in comparison with overground walking. With the simulator(not assisted) both groups decreased their step length and increased their cadence and CV of double support time, compared with walking overground. These findings suggest that the step length improvement observed in PD patients, walking over a treadmill, is due to the proprioceptive information generated by the belt movement, since no improvement was reported when patients using a treadmill simulator.

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Parkinson's disease (PD) is clinically characterized by symptoms of akinesia, rigidity, and resting tremor, which are related to a dopaminergic deficiency of the nigrostriatal pathway. Disorders of gait are common symptoms of PD that affect the quality of life in these patients. One of the main focuses of physical rehabilitation in PD is to improve the gait deficits in the patients. In the last decade, a small number of studies have investigated the use of the treadmill for the rehabilitation of gait in PD patients. Although, the results of these studies are promising, the mechanisms underlying the therapeutic effect of the treadmill in PD are still largely unknown. This paper reviews 10 years of investigation of treadmill training in PD, focusing on the possible mechanisms involved in the therapeutic effect of the treadmill. Understanding these mechanisms may improve the prescription and design of physical therapy programs for PD patients.