Trunk Exercises May Improve Balance in Parkinson’s Disease, Study Finds

Exercise and fall prevention education can improve front-to-back trunk mobility in Parkinson’s patients with a history of falls, according to a Phase 2 clinical trial.

The study, “Trunk exercises improve gait symmetry in Parkinson disease: A blind phase II randomized-controlled trial” was published in the American Journal of Physical Medicine & Rehabilitation.

People with Parkinson’s disease are twice as likely to fall as those with other neurological disorders. Previous studies suggest that Parkinson’s patients underestimate the muscle work needed to produce a certain movement.  This lack of motor and perceptual ability leads them to adopt distinct postural strategies to keep their balance, both during static and dynamic movements.

Studies have associated falls to deficits in step-to-step symmetry and trunk muscle function.

Although antiparkinsonian medications can help control Parkinson’s motor symptoms as the disease progresses, patients typically need to gradually increase the treatment dose for maximum benefit. Even after increasing the dose, they might sometimes experience a reappearance or worsening of symptoms due to the diminishing effects of the therapy.

Therefore, there is a need for non-pharmacological therapies that alleviate patients’ motor symptoms and improve their quality of life.

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Australian Catholic University researchers set up to investigate whether an exercise program geared to improving the strength and endurance of the trunk muscles could improve standing and walking balance in those with Parkinson’s disease.

The Phase 2 study (ACTRN12613001175763), evaluated 22 Parkinson’s patients (15 men and seven women, mean age 65.4 years) with a history of falls who were randomly assigned to either 12-weeks of exercise and fall prevention education (11 participants) or fall prevention education alone (11 participants).

For the exercise intervention, patients had to attend a supervised 90-minute training session once a week for 12 weeks. Each session was conducted in groups of up to three subjects.

“In short, the exercise-based intervention comprised three parts; i) a warm-up focusing on trunk mobility exercises to improve range of motion; ii) an exercise routine focusing on the endurance and stability of the trunk muscles …; and iii) a cool-down involving stretching and walking in a real-world environment,” researchers stated.

The exercise group also received health advice (same as the education-only group), in the form of weekly educational brochures, aimed at preventing falls.

Participants in the education-only group were encouraged to continue their day-to-day lives, but received a weekly multidisciplinary health tip for 12 weeks that explained how exercise, nutrition and/or sleep quality could influence their fall risk and quality of life.

Initial assessment showed that there were no differences in cognition, vision, neurological function and mobility between study groups. Nonetheless, the exercise sample had a greater body mass index (measure of body fat based on height and weight) compared to the education-only group.

Twelve and 24 weeks after initial assessment, investigators examined patients’ symptom severity, balance confidence, mobility and quality of life.

All 22 patients were reassessed at 12 weeks, but four subjects (two in the exercise group and two in the education-only group) did not complete the 24-week follow-up.

At 12 weeks, the exercise sample had significant and clinically relevant improvements in front-to-back step-to-step symmetry of head and trunk movements, meaning these patients might be able to balance themselves more easily. The exercise group also had improved trunk muscle function.

The education-only group also had significant and clinically relevant improvements but in side-to-side and vertical step-to-step trunk symmetry, as measured by the harmonic ratio — a mathematical analysis of trunk acceleration used to measure walking smoothness, walking rhythmicity, or dynamic stability.

Step-to-step symmetry remained unchanged from the 12- to the 24-week evaluation in the exercise group. “The lack of significant changes in step-to-step symmetry between the 12- and 24-week assessments for the exercise group also suggests that the benefits of the weekly exercise program may be retained for up to 12 weeks following the cessation of the training regimen,” researchers said.

Regarding the education-only sample, their reduced step-to-step trunk symmetry at 12 weeks had almost been restored to initial assessment (baseline) values at 24 weeks.

These results indicate that torso-specific exercises may improve (or at the very least, maintain) trunk mobility in Parkinson’s patients and that measures of step-to-step symmetry, such as the harmonic ratio, could be used to assess subtle changes in postural control.

“Given the encouraging outcomes of this study, future research might seek to establish whether increasing the frequency of this exercise program offers greater improvements in step-to-step symmetry and/or has the potential to reduce the rate of falls in people with [Parkinson’s disease],” researchers said.