Multi-dimensional balance training programme improves balance and gait performance in people with Parkinson's disease: A pragmatic randomized controlled trial with 12-month follow-up

Introduction: Previous studies have demonstrated that exercise interventions can improve balance and gait performance in people with Parkinson's disease (PD), but most training did not target all balance domains and was conducted mainly indoors. Objectives: To investigate the short- and long-term effects of a multi-dimensional indoor and outdoor exercise programme on balance, balance confidence and gait performance in people with PD. Methods: Eligible subjects with PD were randomly assigned to an eight-week indoor and outdoor balance training (EXP, N = 41) group or upper limb exercise (CON, N = 43) group. Outcome measures included BESTest total and subsection scores, gait speed, dual-task timed-up-and-go (dual-task TUG) time and Activities-specific Balance Confidence (ABC) score. All outcomes were assessed before training (Pre), immediately after intervention (Post) and at six-month (FU6m) and twelve-month (FU12m) follow-ups. Results: Immediately after training, EXP group showed more significant improvements than CON group in BESTest total and subsection scores, gait speed and dual-task TUG time (p < 0.05). At both FU6mand FU12m, EXP group showed significantly greater gains than CON group in BESTest total and subsection scores and dual-task TUG time (p < 0.05). EXP group also showed significantly greater increase in the gait speed than CON group at FU6m(p < 0.05). Conclusion: The positive findings of this study provide evidence that this multi-dimensional balance training programme can enhance balance and dual-task gait performance up to 12-month follow-up in people with PD.