Behavioural and neuroplastic effects of a double-blind randomised controlled balance exercise trial in people with Parkinson\u2019s disease

Malin Freidle,Alonso Abney,Franziska Albrecht,Hanna Johansson,William H Thompson,Urban Ekman,Alexander V Lebedev,Erika Franzén,Staffan Holmin,Per Svenningsson,Maria Hagströmer,Hanna Steurer,Martin Lövdén,Breiffni Leavy,Ellika Schalling

doi:10.1038/s41531-021-00269-5

Abstract

Balance dysfunction is a disabling symptom in people with Parkinson’s disease (PD). Evidence suggests that exercise can improve balance performance and induce neuroplastic effects. We hypothesised that a 10-week balance intervention (HiBalance) would improve balance, other motor and cognitive symptoms, and alter task-evoked brain activity in people with PD. We performed a double-blind randomised controlled trial (RCT) where 95 participants with PD were randomised to either HiBalance (n = 48) or a control group (n = 47). We found no significant group by time effect on balance performance (b = 0.4 95% CI [−1, 1.9], p = 0.57) or on our secondary outcomes, including the measures of task-evoked brain activity. The findings of this well-powered, double-blind RCT contrast previous studies of the HiBalance programme but are congruent with other double-blind RCTs of physical exercise in PD. The divergent results raise important questions on how to optimise physical exercise interventions for people with PD.Preregistration clinicaltrials.gov: NCT03213873.

Highlights

Worldwide over 6.1 million people live with Parkinson’s disease (PD), the fastest-growing neurological disorder to date[1]
Our research group has previously developed a framework of highly challenging balance exercises for people with PD: the HiBalance programme[12,13]
Neither did we find evidence that the HiBalance programme resulted in significant group differences for our secondary measures including gait variables, executive function and relations between the changes in the behavioural outcomes and the changes in functional magnetic resonance imaging (fMRI) and brainderived neurotrophic factor (BDNF)

Summary

Introduction

Worldwide over 6.1 million people live with Parkinson’s disease (PD), the fastest-growing neurological disorder to date[1]. Balance and gait impairments are some of the most debilitating symptoms in people with PD even after optimal medical management[10,11]. Our research group has previously developed a framework of highly challenging balance exercises for people with PD: the HiBalance programme[12,13]. The programme was developed based on the principles that physical exercise need to be performed near or at the limit of one’s capacity, specific to the impaired functions and performed in a progressive and varied manner[13,14,15]. We have previously evaluated the HiBalance programme both in research settings[12], and in realworld care settings[16] with encouraging effects on balance and gait ability

Objectives

Methods

Results

Conclusion