The Effects of Highly Challenging Balance Training in Elderly With Parkinson’s Disease

Abstract

Background. Highly challenging exercises have been suggested to induce neuroplasticity in individuals with Parkinson’s disease (PD); however, its effect on clinical outcomes remains largely unknown. Objective. To evaluate the short-term effects of the HiBalance program, a highly challenging balance-training regimen that incorporates both dual-tasking and PD-specific balance components, compared with usual care in elderly with mild to moderate PD. Methods. Participants with PD (n = 100) were randomized, either to the 10-week HiBalance program (n = 51) or to the control group (n = 49). Participants were evaluated before and after the intervention. The main outcomes were balance performance (Mini-BESTest), gait velocity (during normal and dual-task gait), and concerns about falling (Falls Efficacy Scale–International). Performance of a cognitive task while walking, physical activity level (average steps per day), and activities of daily living were secondary outcomes. Results. A total of 91 participants completed the study. After the intervention, the between group comparison showed significantly improved balance and gait performance in the training group. Moreover, although no significant between group difference was observed regarding gait performance during dual-tasking; the participants in the training group improved their performance of the cognitive task while walking, as compared with the control group. Regarding physical activity levels and activities of daily living, in comparison to the control group, favorable results were found for the training group. No group differences were found for concerns about falling. Conclusions. The HiBalance program significantly benefited balance and gait abilities when compared with usual care and showed promising transfer effects to everyday living. Long-term follow-up assessments will further explore these effects.

Implementation of the HiBalance training program for Parkinson’s disease in clinical settings: A feasibility study

“…The eligibility criteria were similar to that used in the RCT (Conradsson et al., 2015) however, the recruitment process revealed that younger patients (<60 years) are commonly referred to rehabilitation in primary healthcare settings. To promote access, the implementation trial will include persons of all ages.…”

“…Similar positive trends were found for secondary outcomes, that is, gait speed, concerns of falling, and exercise endurance. In fact, a similar (average) difference in gait speed was found following training in the Group 2x + HEP when compared to the efficacy trial (Conradsson et al., 2015). The fact that the findings of the two studies corroborate are an indication of the potential effectiveness of the adapted training dose in the current study.…”

“…To combat‐associated symptoms, the HiBalance training program has been designed, including highly challenging and progressive exercises targeting dysfunctions of subsystems of balance control among persons with mild‐to‐moderate PD (Conradsson, Lofgren, Stahle, Hagstromer, & Franzen, 2012). To date, the intervention has been found to be feasible (Conradsson, Lofgren, Stahle, & Franzen, 2014) and effective at improving balance and gait performance, activities of daily living, and physical activity levels in more controlled settings, that is, randomized controlled trials (Conradsson et al., 2015). In order to reach a larger proportion of people with PD, the next step involves testing the clinical applicability and implementation of the program.…”

Transcranial Magnetic Stimulation Versus Electrical Vestibular Stimulation on Balance in Geriatrics Parkinsonian Patients

“…They expressed imbalance in Parkinson's disease as occurs by combination of many disorders including loss of postural reflexes, insufficiency in postural adjustments, rigidity in the trunk and extremities and akinesia. Introducing balance training program to their PD patients provide great benefits to gait stability [21]. The optimum time for TMS intervention after PD remains unclear, so, we recruited patients 12-18 months after their ictus.…”

Pilates Exercise and Functional Balance in Parkinson's Disease

“…Considering the higher rate of imbalance and falls in old patients with PD rather than healthy ones, this type of exercises can therefore play a key role in improving motor functions and balance in these patients [14]. Conradsson et al (2015) reported significantly higher effects on neural adaptations in patients with PD for advanced balance exercises compared to conventional therapeutic methods [15]. Canning et al…”