Multimodal Training Reduces Fall Frequency as Physical Activity Increases in Individuals With Parkinson’s Disease

Abstract

Background: Parkinson’s disease (PD) results in a global decrease in information processing, ultimately resulting in dysfunction executing motor-cognitive tasks. Motor-cognitive impairments contribute to postural instability, often leading to falls and decreased physical activity. The aim of this study was to determine the effects of a multimodal training (MMT) versus single-modal (SMT) training on motor symptoms, fall frequency, and physical activity in patients with PD classified as fallers. Methods: Individuals with PD were randomized into SMT (n = 11) or MMT (n = 10) and completed training 3 times per week for 8 weeks. The SMT completed gait and cognitive training separately, whereas MMT completed gait and cognitive training simultaneously during each 45-minute session. Physical activity, 30-day fall frequency, and PD motor symptoms were assessed at baseline, posttreatment, and during a 4-week follow-up. Results: Both groups exhibited significant (P < .05) improvements in clinical ratings of motor function, as symptoms improved by 8% and 15% for SMT and MMT, respectively. Physical activity significantly increased (P < .05) for both groups from baseline (mean steps 4942 [4415]) to posttreatment (mean steps 5914 [5425]). The MMT resulted in a significant 60% reduction in falls. Conclusions: Although SMT and MMT approaches are both effective in improving physical activity and motor symptoms of PD, only MMT reduced fall frequency after the intervention.

The Impact of Motor-Cognitive Dual-Task Training on Physical and Cognitive Functions in Parkinson’s Disease

“…Previous studies found that motor symptoms were improved after dual-task training [ 18 , 19 , 20 ]. Twenty patients were randomized into a 24-session single-modal training group (performing gait and cognitive training sequentially) or a dual-task training group (performing gait and cognitive training simultaneously).…”

“…Another study found that the shorter session of cognitive-cycling training (16 sessions) also showed benefits [ 20 ]. The Hoehn–Yahr stage of the included patients ranged from two to three, indicating that the dual-task training was suitable for mild to moderate PD [ 18 , 19 , 20 ]. Some studies assessed motor function outcomes using other scales.…”

“…An RCT with one hundred and twenty-one participants found that the 24-week frequency of falls did not decrease after dual-task training [ 25 ]. However, another RCT with a total of twenty-one patients found that 8 weeks of dual-task training decreased the 30-day frequency of the falls by 60% [ 19 ]. The dual-task training may decrease the risk of all groups for a short duration after training but the benefit is not persistent.…”

“…One primary study indicated that the dual-task group performed better in mediolateral balance with an eye closed but performed worse in anteroposterior balance compared to the single-motor-training group [ 11 ]. However, a previous study found that dual-task training was more effective in the improvement of motor symptoms and decreased the frequency of falls in a 30-day period compared to the separate motor and cognitive training [ 19 ].…”

Motor–Cognitive Treadmill Training With Virtual Reality in Parkinson’s Disease: The Effect of Training Duration

“…Following these observations, in recent years, great effort has been dedicated to developing rehabilitative strategies targeting motor–cognitive interactions to improve gait performance and reduce fall risk in PD ( Nieuwboer et al, 2007 ; Rochester et al, 2010 ; Mirelman et al, 2016 ; Strouwen et al, 2017 ; Silva-Batista et al, 2018 ; Penko et al, 2019 ; Pazzaglia et al, 2020 ; Imbimbo et al, 2021 ). Overall, results show that training based on motor–cognitive approaches is effective in reducing falls ( Mirelman et al, 2016 ; Penko et al, 2019 ) and fear of falling ( Nieuwboer et al, 2007 ; Silva-Batista et al, 2018 ) and leads to sustained improvements in usual and complex gait [e.g., dual task (DT)] ( Rochester et al, 2010 ; Mirelman et al, 2016 ; Strouwen et al, 2017 ; Pazzaglia et al, 2020 ; Imbimbo et al, 2021 ).…”