Abstract
BackgroundThere is increasing scientific knowledge about the interaction between physiological (musculoskeletal, neuromuscular, cognitive and sensory) systems and their influence on balance and walking impairments in Parkinson’s disease. We have developed a new conceptual framework for balance training, emphasising specific components of balance control related to Parkinson’s disease symptoms by using highly challenging, progressive and varying training conditions. The primary aim of this proposed randomised controlled trial will be to investigate the short-term and long-term effects of a 10-week balance training regime in elderly with Parkinson’s disease.Methods/DesignEighty participants with mild to moderate idiopathic Parkinson’s disease will be recruited and randomly allocated to an intervention group receiving balance training or a control group whose participants will continue to receive their usual care. The intervention will consist of a 10-week group training regime (1-hour training, three times per week), which will be led by two physiotherapists to ensure training progression and safety. The conceptual framework will be applied by addressing specific balance components (sensory integration, anticipatory postural adjustments, motor agility, stability limits) through varying training conditions and structured progression. Assessment will be conducted through a multi-dimensional battery of outcomes, prior to and immediately after the 10-week intervention, and at 9 and 15 months’ follow-up after entering the study. Primary outcome measures will be balance performance (assessed using the Mini Balance Evaluation Systems Test), change in gait velocity (m/s) between single and dual task walking, and fear of falling (evaluated using the Fall Efficacy Scale International).DiscussionThis study has the potential to provide new insight and knowledge of the effects of specific, varied and challenging balance training on a wide health spectrum in elderly with PD. If found to be effective, this pragmatic approach with translation of theory into practice, can be implemented in existing outpatient care.Trial registrationNCT01417598
Highlights
There is increasing scientific knowledge about the interaction between physiological systems and their influence on balance and walking impairments in Parkinson’s disease
The effects of balance training on balance and gait performance are promising for individuals with Parkinson’s disease (PD) [16,17,18], several questions remain unanswered, regarding dose, intensity and duration, as well as regarding specific exercises to improve balance control in the different stages of the disease [17,18,19,20,21]
For the interference effect of dual task performance, i.e. percent change in gait velocity (m/s) between single and dual task walking [74], a sample size of 27 subjects was Discussion In this study protocol, a conceptual framework based on current scientific knowledge from neuroscience constraints in PD is used to design a training intervention targeting balance and walking performance in PD
Summary
A conceptual framework based on current scientific knowledge from neuroscience constraints in PD is used to design a training intervention targeting balance and walking performance in PD. The proposed study will be one of the first trials to provide knowledge of potential effects of exercise intervention according to the whole spectra of ICF domains, including laboratory measurements, clinical tests, and free-living and selfperceived assessments (see Table 3). Long-term follow-up will provide knowledge of the maintenance of potential training effects This is important for PD given the progressive deterioration of the disease in which regular periods of supervised balance training may be required to sustain physical performance. Blinding of the test leaders will not be possible since they will serve as support for the physiotherapists conducting the intervention This proposed randomised controlled trial has the potential to provide new knowledge and a change in focus concerning balance interventions in PD. All authors critically reviewed the manuscript and approved the submitted version
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