Parkinson’s Disease and Balance

Why is balance important?

Having a sound level of balance is important to perform daily activities of living, such as going up and down the stairs, walking, even getting up to go to the bathroom at night requires having good balance, in order to reduce the risk of falling. As we age, our balance tends to become impaired, we often don’t know we have poor balance until it gets put to the test. Therefore, it is important we train our balance, in order to reduce the risk of falls and subsequent fractures.

How prevalent are falls in those living with Parkinson’s Disease (PD)?

Approximately 45-68% of those with Parkinson’s Disease (PD) fall each year, with around 50-86% experiencing multiple falls per year. Along with this, after the age of 40, the risk of falls and subsequent fractures steadily rise, much earlier than in those without PD. The impact of falls can be devastating, where the ability to perform daily activities of living can be impaired, fear of falling can increase and injuries can occur. Those with PD are 4 times more likely to fracture their hip when compared to age-matched individuals without PD.

Why is balance training important for those with PD? Does it improve outcomes?

A loss of balance can take place when moving suddenly or standing. There is a higher risk of falling for those living with PD. Two of the main causes of falls include poor balance (postural instability) and freezing of gait. Postural instability and gait tend to worsen with PD, as PD affects areas of the brain known as the basal ganglia and the brainstem. These parts of the brain help control walking and play a vital role in adjusting balance as one moves. This can lead to poor balancing ability, where the reflexes needed to adjust position and prevent falls, or maintain balance as we move is impaired. For example, those with PD can experience difficulties putting their arms out to balance when walking on uneven surfaces, or taking an extra small step to avoid falling when tripping.
 
Studies show that balance training improves not only balance, but also gait, for those living with PD. After a few weeks of consistent balance training, balance ability in PD patients can significantly improve and gait speed has been shown to increase. As a result, this has been shown to reduce the overall risk of falls. Additionally, through conducting questionnaires, it was noted that fear of falling had reduced, confidence to perform daily activities improved, and overall quality of life had increased. This highlights the significance and benefits of balance training for those with PD.

How can those with PD improve their balance?

Parkinson’s disease exercise guidelines recommend that balance training is conducted 2-3 days per week, however it is best to integrate daily. It is recommended that static and dynamic balance exercises on varied surfaces are practiced, as well as multi-directional movements, weight shifting, obstacle courses and multitasking, where activities requiring problem solving are included. Examples of these exercises include:
 
 
Static balance:
-       Double stance (feet together, hold for >30sec)
-       Tandem stance (heel to toe stance, hold for >30sec)
-       Single leg stance (balancing on one leg, hold for >30sec)


These exercises can be progressed by standing on foam surface or by having your eyes closed.
 
Dynamic balance:
-       Tandem walking (walking in a straight line from heel to toe)
-       Skater jumps (hopping from side to side)
-       Sit-To-Stands (sitting down and getting up from a chair repeatedly)
-       Completing an obstacle course
 
At KOPD, balance, mobility and gait classes are available weekly, where each class offers new and effective exercises that challenge your balance!
 
Ensure you seek advice and supervision from an exercise physiologist before conducting any exercise.

Written by Leonie Keiper

References


Balance Exercise. (2018). Retrieved 2 February 2022, from https://www.heart.org/en/healthy-living/fitness/fitness-basics/balance-exercise#:~:text=Having%20good%20balance%20is%20important,older%20adults%20and%20stroke%20patients.&text=A%20loss%20of%20balance%20can%20occur%20when%20standing%20or%20moving%20suddenly.


Debû, B., De Oliveira Godeiro, C., Lino, J., & Moro, E. (2018). Managing Gait, Balance, and Posture in Parkinson’s Disease. Current Neurology And Neuroscience Reports, 18(5). doi: 10.1007/s11910-018-0828-4


Falls. (2022). Retrieved 2 February 2022, from https://www.epda.eu.com/about-parkinsons/symptoms/motor-symptoms/falls/


Giardini, M., Nardone, A., Godi, M., Guglielmetti, S., Arcolin, I., Pisano, F., & Schieppati, M. (2018). Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease. Neural Plasticity, 2018, 1-17. doi: 10.1155/2018/5614242


Giardini, M., Nardone, A., Godi, M., Guglielmetti, S., Arcolin, I., Pisano, F., & Schieppati, M. (2018). Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease. Neural Plasticity, 2018, 1-17. doi: 10.1155/2018/5614242


Parkinson's Foundation. (2021). Exercise Guidelines [Ebook]. Retrieved from https://www.parkinson.org/sites/default/files/Exercise-Guidelines.pdf


Pelicioni, P., Menant, J., Latt, M., & Lord, S. (2019). Falls in Parkinson’s Disease Subtypes: Risk Factors, Locations and Circumstances. International Journal Of Environmental Research And Public Health, 16(12), 2216. doi: 10.3390/ijerph16122216