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

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.