Highly challenging balance and gait training for individuals with Parkinson’s disease improves pace, rhythm and variability domains of gait – A secondary analysis from a randomized controlled trial

Abstract

Objective: Evaluate immediate and long-term effects of highly challenging balance and gait training on pace-, rhythm-, variability-, asymmetry-, and postural control domains of gait for individuals with Parkinson’s disease (PD). Design: Randomized controlled trial - a secondary analysis. Setting: University hospital setting. Participants: One-hundred older adults with mild to moderate PD (Hoehn & Yahr 2 and 3). Intervention: Training group (n = 51): 10 weeks (3 times/week) of intensive balance and gait training, incorporating dual tasks. Control group (n = 49): care as usual. Main outcome measures: Spatiotemporal gait variables collected during normal and fast walking on a pressure-sensitive mat. A linear mixed model was used to evaluate training effects post intervention and at the 6 and 12 month follow-up. Results: Immediate training effects in the pace domain of gait were increased step velocity (normal speed: 8.2 cm/s, P = 0.04; fast: 10.8 cm/s, P < 0.01), increased step length (normal speed: 3 cm, P = 0.05; fast: 2.3 cm, P = 0.05) and reduced swing time variability (fast speed: –2.5 ms, P = 0.02). In the rhythm domain reduced step time (fast speed: –19.3 ms, P = 0.02), stance time (normal: –24.3 ms, P = 0.01; fast: –29.6 ms, P = 0.02) and swing time (fast speed: –8.7 ms, P = 0.04) was seen. Relative to the variability domain, the training decreased step time variability (fast: –2.8 ms, P = 0.02) and stance time variability (fast: –3.9 ms, P = 0.02). No training effects were retained at 6 months. Conclusions: Highly challenging balance and gait training improved pace, rhythm and variability aspects of PD gait in the short-term, but effects are not retained long-term. Trial registration number: NCT01417598.