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Effectiveness of balance exercise and brisk walking on alleviating nonmotor and motor symptoms in people with mild-to-moderate Parkinson disease: a randomized clinical trial with 6-month follow-up
Mak MKY, Wong-Yu ISK, Cheung RTH, Ho S-L
Archives of Physical Medicine and Rehabilitation 2024 Oct;105(10):1890-1899
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To investigate the effects of balance exercise and brisk walking on nonmotor and motor symptoms, balance and gait functions, walking capacity, and balance confidence in Parkinson disease (PD) at posttraining and 6-month follow-up. DESIGN: Two-arm, assessor-blinded randomized controlled trial. SETTING: University research laboratory and the community. PARTICIPANTS: Ninety-nine eligible individuals with mild-to-moderate PD. INTERVENTIONS: Participants were randomized to balance and brisk walking group (B and B, n = 49) or active control group (n = 50). B and B received ten 90-minute sessions of balance exercises and brisk walking supervised by physical therapists for 6 months (week 1 to 6: weekly, week 7 to 26: monthly), whereas control practiced whole-body flexibility and upper limb strength exercise at same dosage (180 min/wk). Both groups performed unsupervised home exercises 2 to 3 times/wk during intervention and continued at follow-up. MAIN OUTCOME MEASURES: Primary outcomes were Movement Disorder Society Unified Parkinson Disease Rating Scale nonmotor (MDS-UPDRS-I) and motor (MDS-UPRDS-III) scores. Secondary outcomes were mini-Balance Evaluation Systems Test (mini-BEST) score, comfortable gait speed (CGS), 6-minute walk test (6MWT), dual-task timed-Up-and-Go (DTUG) time, and Activities-Specific Balance Confidence Scale score. RESULTS: Eighty three individuals completed the 6-month intervention with no severe adverse effects. The mean between-group (95% CI) difference for the MDS-UPDRS nonmotor score was 1.50 (0.19 to 2.81) at 6 months and 1.09 (-0.66 to 2.85) at 12 months. The mean between-group (95% CI) difference for the MDS-UPDRS motor score was 3.75 (0.69 to 6.80) at 6 months and 4.57 (1.05 to 8.01) at 12 months. At 6 and 12 months, there were significant between-group improvements of the B and B group in mini-BEST score, CGS, 6MWT, and DTUG time. CONCLUSIONS: This combined balance and brisk walking exercise program alleviates nonmotor and motor symptoms and improves walking capacity, balance, and gait functions posttraining, with positive carryover effects for all except nonmotor outcomes, at 6-month follow-up in mild-to-moderate PD.

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