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Improves balance and reduces falls (Parkinson’s evidence)

Evidence Summary
Activity programmes improve balance and reduces risk of falls in PwP
Evidence summary: A growing body of moderate quality data from non- randomised controlled trials and randomised controlled trials show that activity interventions have a positive effect on improving balance and reduce the fear of falling in PwP [1- 7]. A meta-analysis of 25 RCTs concluded that facility-based rather than home-based interventions were superior in terms of effect size [1]. A randomised control trial showed that an activity program targeting balance, leg strength and freezing of gait may reduce falls in people with milder disease but not that in more severe disease [6]. In a meta-analysis, balance- specific training programme and exercises with balance components showed a moderate effect on postural instability [8]. Four studies in this meta-analysis comparing balance training and interventions with other forms of exercise therapy showed a large significant effect on postural instability in favour of balance training [8].
Further research is required into the optimal FITT (frequency, intensity, time, type) of activity programme for improving balance and preventing falls in PwP. The type of exercises included in the studies included balance training, strengthening exercises prescribed by a physiotherapist, highly challenging balance training, aerobic and aquatic activities[1- 6]. During the focus group meeting, the general recommendation from experts was to maintain as much physical activity as possible

Quality of Evidence
B – This is based on three meta-analyses and a small number of RCTs. Study sizes tend be small but overall conclusion is in agreement.

Strength of Recommendation
1 – This is particularly in patients with mild to moderate disease.

Conclusion
Activity programmes in a controlled setting could be recommended to PwP (especially those with milder Parkinson’s) to improve balance and help prevent falls unless there are compelling reasons to do otherwise. Consider a referral to physiotherapist for individualised balance exercises.

References

[1] Shen X. Et al. Effects of Exercise on Falls, Balance, and Gait Ability in Parkinson’s Disease: a Meta-analysis. Neurorehabilitation and Neural repair. 2015, Oct. 30(6): 512-527

[2] Leavy B, et al. Outcome Evaluation of Highly Challenging Balance Training for People with Parkinson Disease: A Multicenter Effectiveness-Implementation Study. J Neurol Phys Ther. 2020;44(1):15–22.

[3] Silva AZ da, Israel VL. Effects of dual-task aquatic exercises on functional mobility, balance and gait of individuals with Parkinson’s disease: A randomized clinical trial with a 3-month follow-up. Complement Ther Med. 2019 Feb 1;42(1):119–24.

[4] Silva-Batista C et al. Balance and fear of falling in subjects with Parkinson’s disease is improved after exercises with motor complexity. Gait Posture. 2018 Mar 1;61(1):90–7

[5] Rowsell A et al. Participant expectations and experiences of a tailored physiotherapy intervention for people with Parkinson’s and a history of falls. Disabil Rehabil [Internet]. 2020;0(0):1–9.

[6] Canning CG et al. Exercise for falls prevention in Parkinson disease: A randomized controlled trial. Neurology. 2015;84(3):304–12.

[7] Shu et al. Aerobic exercise for Parkinson’s disease: a systematic review and meta-analysis of randomised controlled trials. PLOS ONE 2014

[8] Klamorth et al. Effects of Exercise Therapy on Postural Instability in Parkinson’s Disease, a meta-analysis. Journal of Neurologic Physical Therapy. 2016; 40(1): 3-14

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